Abstract
Intracranial chondromas are uncommon benign lesions usually attached to dura and located over the convexity of the skull. Osteochondromas are even rarer and additionally contain a benign bony component. Both lesions are reportedly difficult to distinguish from meningiomas on pre-operative neuroimaging studies, although few detailed pathologic-neuroimaging correlation studies have appeared in the literature, particularly for intracranial osteochondromas. A 33-year-old woman with a 4-year history of headaches presented with recent onset of left-sided muscle spasms and weakness. Two days prior to admission to our hospital, neuroimaging studies had shown a large right convexity mass with unusual multifocal bright signal intensities throughout an otherwise isointense mass. The bright signals were interpreted as showing multifocal hemorrhage and the mass was felt to be a convexity meningioma. However, subsequent catheter angiography characterized the lesion as being avascular. The mass was resected en bloc. Extensive histological sectioning revealed a benign osteochondroma predominantly composed of lobules of hypocellular cartilage. Microdissection of the different components revealed that the multifocal, spicule-like bright foci interpreted as hemorrhage on neuroimaging studies were instead foci of benign bone containing metaplastic bone marrow with trilineage hematopoietic cell populations and adipose tissue. Centrally, the hilum of the lesion contained avascular loose connective tissue. No recent or remote hemorrhage was identified anywhere in the lesion. Rare convexity osteochondromas may be mistaken for high-grade meningiomas on neuroimaging studies; their avascular nature, coupled with their complex signal pattern can serve as clues to the correct pre-operative diagnosis.
References
Berkmen YM, Blatt ES (1968) Cranial and intracranial cartilaginous tumours. Clin Radiol 19(3):327–333
Haddad GF, Haddad FS, Zaatari G (1998) Dural osteochondroma: case report, review of the literature and proposal of a new classification. Br J Neurosurg 12(4):380–384
Omalu BI, Wiley CA, Hamilton RL (2003) February 2003: a 53-year-old male with new onset seizures. Brain Pathol 13(3):419–420, 423
Delgado-López PD, Martín-Velasco V, Galacho-Harriero AM et al (2007) Large chondroma of the dural convexity in a patient with Noonan’s syndrome. Case report and review of the literature. Neurocirugia (Astur) 18(3):241–246
Colpan E, Attar A, Erekul S et al (2003) Convexity dural chondroma: a case report and review of the literature. J Clin Neurosci 10(1):106–108
Erdogan S, Zorludemir S, Erman T et al (2006) Chondromas of the falx cerebri and dural convexity: report of two cases and review of the literature. J Neurooncol 80(1):21–25
Nakazawa T, Inoue T, Suzuki F et al (1993) Solitary intracranial chondroma of the convexity dura: case report. Surg Neurol 40(6):495–498
Nagai S, Yamamoto N, Wakabayashi K et al (1998) Osteochondroma arising from the convexity dura mater. Case illustration. J Neurosurg 88(3):610
Loewinger RJ, Lichtenstein JR, Dodson WE et al (1977) Maffucci’s syndrome: a mesenchymal dysplasia and multiple tumour syndrome. Br J Dermatol 96(3):317–322
Ghogawala Z, Moore M, Strand R et al (1991–1992) Clival chondroma in a child with Ollier’s disease. Case report. Pediatr Neurosurg 17(1):53–56
Tibbs RE, Bowles AP, Raila FA (1997) Maffucci’s syndrome and intracranial chondrosarcoma. Skull Base Surg 7(1):49–55
Beck DW, Dyste GN (1989) Intracranial osteochondroma: MR and CT appearance. AJNR Am J Neuroradiol 10(5 Suppl):S7–S8
Cybulski GR, Russell EJ, D’Angelo CM et al (1985) Falcine chondrosarcoma: case report and literature review. Neurosurgery 16(3):412–415
Kathiravel Y, Finnis ND (2008) Primary falcine chondrosarcoma. J Clin Neurosci 15(12):1406–1409
Matz S, Israeli Y, Shalit MN, Cohen ML (1981) Computed tomography in intracranial supratentorial osteochondroma. J Comput Assist Tomogr 5(1):109–115
Nakayama M, Nagayama T, Hirano H et al (2001) Giant chondroma arising from the dura mater of the convexity. Case report and review of the literature. J Neurosurg 94(2):331–334
Laghmari M, Metellus P, Fuentes S et al (2007) Cranial vault chondroma: a case report and literature review. Neurochirurgie 53(6):491–494
Wu W, Hu X, Lei D (2007) Giant osteochondroma derived from pterygoid process of sphenoid. Int J Oral Maxillofac Surg 36(10):959–962
Acknowledgments
The authors thank Ms. Lisa Litzenberger for photographic expertise.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Somerset, H.L., Kleinschmidt-DeMasters, B.K., Rubinstein, D. et al. Osteochondroma of the convexity: pathologic-neuroimaging correlates of a lesion that mimics high-grade meningioma. J Neurooncol 98, 421–426 (2010). https://doi.org/10.1007/s11060-009-0089-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11060-009-0089-9