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Table of Contents    
LETTER TO EDITOR
Year : 2012  |  Volume : 60  |  Issue : 3  |  Page : 364-366

Giant chondroma of the falx


1 Department of Radiology, King Edward Memorial Hospital, Mumbai, India
2 Department of Neurosurgery, King Edward Memorial Hospital, Mumbai, India
3 Department of Neuropathology, King Edward Memorial Hospital, Mumbai, India

Date of Submission15-May-2012
Date of Decision15-May-2012
Date of Acceptance04-Jun-2012
Date of Web Publication14-Jul-2012

Correspondence Address:
Amit Mahore
Department of Neurosurgery, King Edward Memorial Hospital, Mumbai
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.98548

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How to cite this article:
Pauranik A, Mahore A, Kataria NG. Giant chondroma of the falx. Neurol India 2012;60:364-6

How to cite this URL:
Pauranik A, Mahore A, Kataria NG. Giant chondroma of the falx. Neurol India [serial online] 2012 [cited 2020 Oct 22];60:364-6. Available from: https://www.neurologyindia.com/text.asp?2012/60/3/364/98548


Sir,

A 24-year-old male presented with frontal headache and right-sided weakness with urinary incontinence of 1 month duration. Neurological examination revealed grade 4/5 power in right upper and lower limbs and no other deficits. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a large (12.2 × 8 × 4 cm) multilobulated mass with calcification in the right frontal region, extending posteriorly along the falx cerebri toward the left [Figure 1]a. It showed minimal contrast enhancement [Figure 1]b. Axial T2-weighted MR image showed a huge well-circumscribed heterogeneous lesion in right frontal region, extending posteriorly along the falx into the cingulate gyrus [Figure 1]c and d. There was no contrast enhancement [Figure 1]e. Hyperpneumatization of frontal and sphenoid sinuses and empty sella were additional findings seen on MRI [Figure 1]f. The tumor was approached using a right parasagittal frontoparietal craniotomy. A large well-circumscribed grayish-white hard tumor with bosselated surface was found originating from the falx [Figure 2]a. On cutting, it revealed pieces of cartilage [Figure 2]b. Histopathology showed large lobules of hyaline cartilage. Chondrocytes had small nuclei with few bi- and tri-nucleate cells. No mitotic activity was seen. These features were suggestive of a chondroma [Figure 2]c. At 12-month follow-up, the patient was in good clinical health. MRI revealed no residual or recurrent tumor [Figure 2]d.
Figure 1: (a) Plain CT scan shows a hyperdense right frontal lesion crossing the midline with multiple areas of calcification. (b) Contrast-enhanced axial CT scan shows minimal enhancement. (c and d) Axial T2W MR image shows a huge well-circumscribed heterogeneous lesion in right frontal region, extending posteriorly along the falx into the cingulate gyrus. (e) Post-contrast axial T1W image shows an isointense mass without any enhancement. (f) Sagittal post-contrast image shows hyperpneumatization of frontal and sphenoid sinuses and empty sella in addition to the midline location of mass

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Figure 2: (a) Gross section shows grayish-white hard tumor with glistening surface. (b) Cut sections reveal large lobules of cartilage. (c) H and E photomicrograph (400 ×) shows dura (black arrow) with underlying hyaline cartilage containing chondrocytes with bland nuclei. Foci of endochondral ossification are seen. (d) Postoperative postcontrast coronal T1W MRI shows complete excision of the tumor

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Intracranial chondromas are rare, slow-growing tumors usually arising from the base of skull, with an incidence of 0.5% of all intracranial tumors. [1],[2] Those arising from the falx are even rarer. [3],[4] Cartilaginous rests along the basilar synchondroses give rise to the skull base chondromas. [2] However, the origin of chondromas arising from other locations is unclear and they are generally considered to be due to heterotopical embryonal cartilaginous rests, metaplasia of meningeal fibroblasts, metaplasia of perivascular mesenchymal cells, or displacement and migration caused by trauma or an inflammatory process. [4] Falx chondromas are speculated to originate from such heterotopic embryonal cartilaginous remnants.

Clinical features depend on the site of origin. However, seizures, focal deficits, raised intracranial pressure, or hydrocephalus can occur due to the mass effect of these tumors. [3],[4] On CT scan, tumors usually appear as well-demarcated, isodense masses, with calcifications in 60-90% of the cases and hyperostosis or scalloping of the adjacent calvarium in 50-60% of the cases. [1] The lesion is well circumscribed on MRI and exhibits heterogeneous signal with intermediate to low intensity on T1-weighted images and mixed intensity on T2-weighted images. Edema does not manifest due to extremely slow growth. Minimal enhancement with gadolinium is usually seen. [3],[4] The clinical and imaging features may resemble meningioma. [1] However, patients with chondromas tend to be of younger age with no sex predilection, usually show lack of contrast enhancement and "dural tail" sign, and are avascular. [1]

Complete surgical removal with meticulous resection of all dural attachments is the treatment of choice. Chondromas are always well demarcated, which facilitates easy dissection of the tumor from the adjacent brain parenchyma in the majority of cases. [1] Piece-meal resection is advocated for very large tumors in order to avoid excessive brain retraction. [3],[4] With complete resection, the outcome is excellent. [1] Long-term imaging follow-up is warranted in cases with subtotal resection of the chondroma as rare malignant transformation into chondrosarcoma has been reported. [3],[4] Local invasion or recurrence may suggest malignant degeneration. [3],[4]

 
  References Top

1.Fountas KN, Stamatiou S, Barbanis S, Kourtopoulos H. Intracranial falx chondroma: Literature review and a case report. Clin Neurol Neurosurg 2008;110:8-13.  Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2.Dening TR, Berrios GE, Walshe JM. Intradural chondroma: A case report and review of literature. Neurosurgery 1983;12:111-4.  Back to cited text no. 2
    
3.Colpan E, Attar A, Erekul S, Arasil E. Convexity dural chondroma: A case report and review of the literature. J Clin Neurosci 2003;10:106-8.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Nakayama M, Nagayama T, Hirano H, Oyoshi T, Kuratsu J. Giant chondroma arising from the dura mater of the convexity. J Neurosurg 2001;94:331-4.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  


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