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| LETTER TO EDITOR |
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| Year : 2011 | Volume
: 59
| Issue : 2 | Page : 310-313 |
An intracranial chondroma with intratumoral and subarachnoidal hemorrhage
Mu Linsen1, Wang Junmei2, Zhang Liwei1, Dai Jianping3, Chen Xuzhu3
1 Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
2 Department of Neuropathology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
3 Department of Neuroimaging, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| Date of Submission | 28-Dec-2010 |
| Date of Decision | 28-Dec-2010 |
| Date of Acceptance | 29-Dec-2010 |
| Date of Web Publication | 7-Apr-2011 |
Correspondence Address:
Zhang Liwei
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing
China
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0028-3886.79170
How to cite this article:
Linsen M, Junmei W, Liwei Z, Jianping D, Xuzhu C. An intracranial chondroma with intratumoral and subarachnoidal hemorrhage. Neurol India 2011;59:310-3 |
Sir,
Intracranial chondroma with hemorrhage is rare. [1],[2] To the best of our knowledge, tumor showing intratumoral bleeds and subarachnoid hemorrhage (SAH) simultaneously has not been reported to date. We present such a case.
A 34-year-old male patient attended the outpatient on November 23, 2009 with the complaint of decreased left visual acuity of 6 months duration and water-bucking of 1 month duration. He denied any history of headache, dizziness, polydipsia, and polyuria. His medical history was uneventful. Neurologic examination showed left visual acuity of 0.5 (1.5/1.5) and no other deficits. Magnetic resonance imaging (MRI) scan of brain done on November 24 showed a space-occupying lesion located in the left petrous apex and clivus. The signal intensity was heterogenous [Figure 1] and [Figure 2]. On post-contrast imaging, it demonstrated non-homogenous enhancement [Figure 3]. Computed tomography (CT) scan done on November 26 showed multiple dot-like and patchy calcifications of tumor [Figure 4]. He was admitted to the neurosurgical ward for possible operation. While waiting in the wards for possible operation, on December 7, he complained of sudden headache, nausea and vomiting. An emergency CT scan demonstrated intratumoral hemorrhage and SAH [Figure 5] and [Figure 6]. He was taken up for an emergency operation. Intraoperatively, the tumor was located in the floor of the left middle cranial fossa and clivus. It was dark red in color and partly soft in texture with rich blood supply. Inside it, there were massive calcifications with hard texture. There was old hemorrhage in the posterior part of the tumor. The tumor was subtotally resected with a size about 4.5 Χ 4 Χ 4 cm 3. Histopathological examination confirmed the diagnosis of chondroma [Figure 7], [Figure 8], [Figure 9] and [Figure 10]. The patient died of serious pulmonary infection 7 days after operation. | Figure 1: Axial T1-weighted image (T1WI) demonstrating a large lesion in the posterior and left sellar region. It is heterogenously of low signal with small area of high signal
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 | Figure 2: Axial T2-weighted image (T2WI) showing a patchy low signal area in the tumor
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 | Figure 3: Post-contrast coronal MRI revealing non-homogenous enhancement of the tumor
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 | Figure 4: Axial CT scan indicating massive calcification in the left and anterior part of the lesion. The right and posterior part is of low attenuation compared with the parenchyma
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 | Figure 5: Axial CT scan showing patchy hemorrhage in the posterior area of the lesion. Note the obvious subarachnoid hemorrhage
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 | Figure 6: Axial CT scan revealing massive hemorrhage in the posterior area of the lesion
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 | Figure 7: In the myxoid degenerative cartilaginous substrate, there are small amount of cells which are uniformly distributed. The cells are bipolarity or starry (H and E ×200)
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 | Figure 8: Immunohistochemistry stain indicating positive reaction for vimentin (×200)
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 | Figure 9: Immunohistochemistry stain indicating positive reaction for S-100 (×200)
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 | Figure 10: Immunohistochemistry stain indicating negative reaction for cell keratin (×200)
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Intracranial chondroma is a rare benign neoplasm, accounting for 0.2-0.3% of all intracranial tumors. [3] The peak age is in the third decade with no gender predominance. [4] The most common location is in the skull base, especially in the sellar and parasellar regions. Although several hypotheses have been proposed, the exact pathogenesis of the tumor is still uncertain. Most of the tumors arise from the cartilage found in the basilar synchondroses. Calcification is common with an incidence as high as 60%. [5] Thus, the attenuation of the tumor is not homogenous on CT studies and the signal intensity is heterogenous on MRI images. Usually, chondromas are avascular lesions. [6] However, our patient had rich blood supply as documented during operation. Possible reason for the intratumoral hemorrhage, showing as patchy high attenuation in the posterior part of the lesion on CT studies, in our patient is the rich blood supply of the tumor as documented during operation. We suppose that significant intratumoral hemorrhage might have ruptured the tumor membrane, resulting in SAH.
| » References | |  |
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| 2. | Albert FK. Tumor hemorrhage in intracranial tumors. Neurochirurgia (Stuttg) 1986;29:67-74.
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| 3. | Delgado-López PD, Martín-Velasco V, Galacho-Harriero AM, Castilla-Díez JM, Rodríguez-Salazar A, Echevarría-Iturbe C. Large chondroma of the dural convexity in a patient with Noonan's syndrome. Case report and review of the literature. Neurocirugia (Astur) 2007;18:241-6.
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| 4. | Nakayama M, Nagayama T, Hirano H, Oyoshi T, Kuratsu J. Giant chondroma arising from the dura mater of the convexity. Case report and review of the literature. J Neurosurg 2001;94:331-4.
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| 5. | Tanohata K, Maehara T, Aida N, Unimo S, Matsui K, Mochimatsu Y, et al. Computed tomography of intracranial chondroma with emphasis on delayed contrast enhancement. J Comput Assist Tomogr 1987;11:820-3.
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| 6. | Sarwar M, Swischuk LE, Schecter MM. Intracranial chondromas. AJR Am J Roentgenol 1976;127:973-7.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10]
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