Chondrosarcoma

Case contributed by A.Prof Frank Gaillard

Presentation

4 weeks of facial numbness.

Patient Data

Age: 25 years
Gender: Female
Modality: MRI

There is a large extra-axial mass with mass effect on the temporal lobe and brainstem. It appears to be arising from the either the posterior aspect of the right cavernous sinus or the right posterior clinoid process and clivus. On the sagittal sequences it has a broad dural attachment and protrudes superiorly and posteriorly. The lesion demonstrates variable signal intensity on T1 and T2 imaging and variable contrast enhancement. Extensive punctate loss of signal on T2 and extensive susceptibility on gradient echo imaging suggests blood products and/or calcium, with the former favoured due to high signal on phase imaging. There is no restricted diffusion. The mass appears separate from the internal carotid artery and the sella. On image 8 of the axial T2 sequence, the mass appears separate from Meckel's cave which is displaced laterally and the lower margin of the cisternal trigeminal nerve. The lateral margin of the lesion effaces the right medial temporal lobe. The posterior margin displaces the upper pons, midbrain and cerebral peduncle posteriorly and medially. There is however no temporal lobe or brainstem oedema. No other mass lesion. The remainder of the brain is normal. No evidence of demyelination.

Conclusion:

The differential for this mass is relatively broad, including chondrosarcoma, chordoma or dural masses (less likely). Further assessment with CT is recommended. 

Modality: CT

The 30 x 40 mm mass located above the right petrous apex, involving Meckel's cave, is inseparable from the postero-lateral margin of the clivus, and has coarse central calcifications. There is local destruction of cortex. Note that the right supraclinoid internal carotid artery has a close relationship to the mass, and that the right posterior cerebral artery is almost entirely fetal origin, the branch displaced by and covered by the mass. Extracranial vessels are normal. No significant stenosis. No intracranial aneurysm or vascular malformation.

Conclusion:

The additional information from the CT study effectively excludes neurofibroma or meningioma. Either chondrosarcoma or less likely chordoma. 

Case Discussion

The patient went on to have surgery.

Histology

MICROSCOPIC DESCRIPTION: Sections show a hypocellular cartilaginous tumour composed of sheets and lobules of chondroid matrix containing small chondrocytes. Occasional binucleate forms are present. Foci of necrotic cartilage are present. No cellular atypia or mitoses are seen. Cartilage is closely associated with mature bony trabeculae, however no permeation or destructive bone invasion is seen.

Multiple fragments of bone partly replaced by a chondroid proliferation with hilar matrix and paucicellular and bland appearing chondrocytes. However in areas the chondroid proliferation extends between pre-existing bony trabeculae and the occasional large irregular nucleus is noted.

FINAL DIAGNOSIS: Low grade chondroid tumour with features of low grade chondrosarcoma.

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Case Information

rID: 41937
Case created: 29th Dec 2015
Last edited: 28th Apr 2016
Inclusion in quiz mode: Included

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