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Solitary nonchordomatous lesions of the clival bone: differential diagnosis and current therapeutic strategies

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Abstract

A nonchordomatous solitary lesion of the clival bone is an exceptionally rare pathological entity, which represents a diagnostic and a therapeutic challenge. Many diseases with extremely different biological behavior, and requiring a dedicated treatment strategy, may result in similar clinical patterns. The approach to a correct differential diagnosis has to consider the specific epidemiological, radiological, and histopathological characteristics of each pathology to minimize the diagnostic bias and to allow the planning of the best treatment strategy. Because of the rarity of these diseases, a systematical review of nonchordomatous lesions of the clival bone still lack in the literature. The purposes of this study are to provide an overview of the epidemiological, clinical, radiological, and histopathological characteristics of nonchordomatous clival lesions, with particular emphasis on diagnostic and therapeutic strategies and related clinical outcome.

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Authors and Affiliations

  1. Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy

    Filippo Gagliardi, Nicola Boari & Pietro Mortini

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  1. Filippo Gagliardi
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  2. Nicola Boari
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  3. Pietro Mortini
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Correspondence to Filippo Gagliardi.

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Comments

Kiyoshi Saito, Fukushima, Japan

This is an interesting review paper on nonchordomatous clival lesions. The 14 lesions in this paper are not common as a solitary tumor in the clivus, although some of them are familiar in other cranial base regions.

These lesions can be classified into tumors of bone and soft tissue, tumors of hematopoietic and lymphoid tissues, metastasis, and ectopic tumors. As tumors of bone and soft tissue, chondrosarcoma and fibrous dysplasia are relatively common. Giant cell tumor and aneurysmal bone cyst are familiar for skull base surgeons. Hemangioma is familiar but rare in the clivus. Osteosarcoma, benign osteoblastoma, and osteochondroma in the clivus are extremely rare. Besides these tumors, I experienced fibroma and ossifying fiboma in the clivus. Tumors of hematopoietic and lymphoid tissues and metastasis can be seen in any bony region. Ectopic adenoma and neuroenteric cyst are rare.

To consider a surgical exposure, it is important to differentiate tumors requiring radical resection from tumors requiring biopsy for histological identification. Most tumors of bone and soft tissue are better to be radically resected if possible. Since most fibrous dysplasias are widely extended and stop growth after adolescence, partial resection can be accepted. Lymphoma should be treated using chemotherapy and radiation after biopsy. Plasmacytoma, eosinophilic granuloma, and metastasis require surgical resection followed by radiation and/or chemotherapy. Ectopic adenoma and neuroenteric cyst require surgical resection.

This paper contributes to understand the characteristics of these rare lesions.

Deanna Sasaki-Adams, Saint Louis, USA

Drs. Gagliardi et al. have performed an extensive literature review and provided a summative description of solitary nonchordomatous lesions of the clival bone. They provide descriptions outlining the epidemiology, symptomatology, imaging characteristics, histopathology, and treatment strategies for chondrosarcomas, osteosarcomas, ectopic pituitary tumors, primary bone tumors, and metastatic lesions involving the clivus. As lesions in this location from entities other than chordoma are relatively rare, it is a useful adjunct to the literature to be able to peruse this manuscript and obtain key information regarding the differential diagnoses and steps in accurate evaluation of these lesions. The authors also suggest that many of the lesions are treated via surgical resection through a transphenoidal approach. In future studies, it may be worth exploring whether these tumors are treated primarily through an open approach or endoscopic approach, and what the common pitfalls in surgical treatment are with respect to the differing disease presentations.

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Gagliardi, F., Boari, N. & Mortini, P. Solitary nonchordomatous lesions of the clival bone: differential diagnosis and current therapeutic strategies. Neurosurg Rev 36, 513–522 (2013). https://doi.org/10.1007/s10143-013-0463-0

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  • DOI: https://doi.org/10.1007/s10143-013-0463-0

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