Neurol India Home 
 

LETTER TO EDITOR
Year : 2015  |  Volume : 63  |  Issue : 1  |  Page : 114--116

Primary spinal extraosseous cervical chondroma in an adult

Amol Raheja1, Sachin A Borkar1, Aasma Nalwa2, Vaishali Suri2,  
1 Department of Neurosurgery and Gamma Knife, All India Institute of Medical Sciences, New Delhi, India
2 Department of Pathology, All India Institute of Medical Sciences, New Delhi, India

Correspondence Address:
Sachin A Borkar
Department of Neurosurgery and Gamma Knife, All India Institute of Medical Sciences, New Delhi
India




How to cite this article:
Raheja A, Borkar SA, Nalwa A, Suri V. Primary spinal extraosseous cervical chondroma in an adult.Neurol India 2015;63:114-116


How to cite this URL:
Raheja A, Borkar SA, Nalwa A, Suri V. Primary spinal extraosseous cervical chondroma in an adult. Neurol India [serial online] 2015 [cited 2021 May 17 ];63:114-116
Available from: https://www.neurologyindia.com/text.asp?2015/63/1/114/152682


Full Text

Sir,

A 25-year-old male patient presented with ascending spastic quadriparesis and graded sensory loss below the C4 dermatome for 10 months without any history of sphincteric involvement. His imaging revealed a cervical, intradural extramedullary lesion [Figure 1]a-c. During surgery, a fibrous, moderately vascular, greyish tumor in close proximity to the left ventrolateral dura was seen compressing the cord toward the right side. Histopathology revealed a cartilaginous tumor arranged in lobules with mild pleomorphism but without any evidence of mitosis. Immunopositivity for S100 confirmed a diagnosis of a chondroma [Figure 2]. At a 1-year follow-up, the patient was clinically stable. The follow-up scan showed a small, residual nodular enhancement [Figure 1]d-f. The patient has been kept on a regular follow-up. {Figure 1}{Figure 2}

Chondromas accounts for 4% of all primary spinal tumors, have a male predilection (2:1) and a peak incidence in the 2 nd and 3 rd decade. [1] They are further classified based on the site of origin into enchondromas (arising from the medullary cavity) and periosteal chondromas (arising from the surface of periosteum). [1] They arise from any part of the vertebrae with the neural arch being the commonest site of origin. [2] The patients may present with nerve root or spinal cord compression, local pain, palpable mass, and/or pathological fracture; or, may be diagnosed incidentally if asymptomatic. [2] Till date, only 12 cases of a cervical chondroma have been reported in literature, [1],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13] all having an osseous origin and an extradural compression (if at all present). Thus, they may be categorized into either an enchondroma or a periosteal chondroma. We report the first case of an intraspinal, extraosseous, intradural primary cervical chondroma in an adult.

The natural history of an osseous extradural spinal chondroma is usually benign with a late presentation of neurological symptoms and a recurrence rate of <10% after complete resection. [14] In contrast, spinal extraosseous intradural, extramedullary chondromas are more aggressive clinically with an early presentation and a higher chance of recurrence. This is due to the difficulties encountered in their complete resection. Based on the prevelant hypotheses for origin of dural-based chondromas in the intracranial compartment, [15] we postulate that the intradural variant of spinal chondromas arise from either heterotopic chondrocytes; secondary to metaplasia from meningeal fibroblasts or perivascular mesenchymal tissue; or, from meningeal connective tissue secondary to cartilaginous activation of fibroblasts by trauma or inflammation. Chondromas can undergo a sarcomatous change (especially in the setting of Ollier's or Maffucci's syndrome) [16],[17] or a metaplasia to a fibrochondroma or myxochondroma. [6] Tumor size <7 cm and cortical destruction with a soft tissue component are the radiological hallmarks of malignant degeneration in an osseous chondroma. [12],[18]

Although not pathognomonic, well-circumscribed solitary lesions with stippled calcification, a characteristic pattern of ring-like mild peripheral enhancement with central nonenhancing area; heterogeneously hyperintense appearance on T2-weighted imaging; absence of dural tail, hemorrhage, or cystic areas; and lack of tumor blush on angiography should suggest the radiological diagnosis of a chondroma. [1],[19] The differential diagnosis includes a mesenchymal chondrosarcoma, meningioma, schwannoma, hemangiopericytoma, solitary fibrous tumor, Ewing's sarcoma, and metastatic tumor. [20] Histologically, the chondroma has a well-differentiated cartilaginous tissue surrounded by a delicate fibrous connective tissue capsule. Bland chondrocytes with no evidence of multinucleation, mitotic activity, or pleomorphism are evident among copious chondroid matrices. [15] Immunostaining reveals S100 positivity and absence of epithelial markers. Cellular atypia is an indicator of possible malignant transformation. [15] The primary microscopic differential diagnosis is a well-differentiated chondrosarcoma. The treatment of choice is radical excision of the tumor (if feasible) with preservation of vital neurovascular structures, and maintenance of spinal stability. [1] Preoperative computed tomography (CT)-guided biopsy may be relevant for appropriate surgical planning. [1] Subtotal excision, curettage, and chemical cauterization of the tumor cavity are other viable options. [12] Despite a few isolated cases of intracranial chondroma showing tumor control by proton or photon beam radiotherapy, [21] the role of the latter modalities is limited because of the radioresistant nature of these lesions, adverse effect on adjacent neural tissue, and a higher propensity to having a subsequent malignant degeneration.

References

1Fahim DK, Johnson KK, Whitehead WE, Curry DJ, Luerssen TG, Jea A. Periosteal chondroma of the pediatric cervical spine. J Neurosurg Pediatr 2009;3:151-6.
2Kim DH, Nam KH, Choi BK, Han I. Lumbar spinal chondroma presenting with acute sciatica. Korean J Spine 2013;10:252-4.
3Antic B, Roganovic Z, Tadic R, Ilic S. Chondroma of the cervical spinal canal. Case report. J Neurosurg Sci 1992;36:239-41.
4Baber WW, Numaguchi Y, Kenning JA, Harkin JC. Periosteal chondroma of the cervical spine: One more cause of neural foramen enlargement. Surg Neurol 1988;29:149-52.
5Calderone A, Naimark A, Schiller AL. Case report 196: Juxtacortical chondroma of C2. Skeletal Radiol 1982;8:160-3.
6Lozes G, Fawaz A, Perper H, Devos P, Benoit P, Krivosic I, et al. Chondroma of the cervical spine. Case report. J Neurosurg 1987;66:128-30.
7Maiuri F, Corriero G, De Chiara A, Giamundo A, Benvenuti D, Gangemi M. Chondroma of the cervical spine: A case report. Acta Neurol (Napoli) 1980;2:204-8.
8Palaoglu S, Akkas O, Sav A. Chondroma of the cervical spine. Clin Neurol Neurosurg 1988;90:253-5.
9Shurland AT, Flynn JM, Heller GD, Golden JA. Tumor of the cervical spine in an 11-year-old girl [clinical]. Clin Orthop Relat Res 1999:287-90, 293-5.
10Slowik T, Bittner-Manioka M, Grochowski W. Case reports and technical notes. Chondroma of the cervical spine. Case report. J Neurosurg 1968;29:276-9.
11Willis BK, Heilbrun MP. Enchondroma of the cervical spine. Neurosurgery 1986;19:437-40.
12Wani AA, Zargar JI, Ramzan AU, Malik NK, Lone I, Wani M. Isolated enchondroma of atlas. Turk Neurosurg 2011;21:226-9.
13Russo V, Platania N, Graziano F, Albanese V. Cervical spine chondroma arising from C5 right hemilamina: A rare cause of spinal cord compression. Case report and review of the literature. J Neurosurg Sci 2010;54:113-7.
14Morard M, De Tribolet N, Janzer RC. Chondromas of the spine: Report of two cases and review of the literature. Br J Neurosurg 1993;7:551-6.
15Abeloos L, Maris C, Salmon I, Baleriaux D, Sadeghi N, Lefranc F. Chondroma of the dural convexity: A case report and literature review. Neuropathology 2012;32:306-10.
16Ghogawala Z, Moore M, Strand R, Kupsky WJ, Scott RM. Clival chondroma in a child with Ollier's disease. Case report. Pediatr Neurosurg 1991;17:53-6.
17Traflet RF, Babaria AR, Barolat G, Doan HT, Gonzalez C, Mishkin MM. Intracranial chondroma in a patient with Ollier's disease. Case report. J Neurosurg 1989;70:274-6.
18Staals EL, Bacchini P, Mercuri M, Bertoni F. Dedifferentiated chondrosarcomas arising in preexisting osteochondromas. J Bone Joint Surg Am 2007;89:987-93.
19Choi BB, Jee WH, Sunwoo HJ, Cho JH, Kim JY, Chun KA, et al. MR differentiation of low-grade chondrosarcoma from enchondroma. Clin Imaging 2013;37:542-7.
20Turel MK, Rajshekhar V. Primary spinal extra-osseous intradural mesenchymal chondrosarcoma in a young boy. J Pediatr Neurosci 2013;8:111-2.
21Habrand JL, Schneider R, Alapetite C, Feuvret L, Petras S, Datchary J, et al. Proton therapy in pediatric skull base and cervical canal low-grade bone malignancies. Int J Radiat Oncol Biol Phys 2008;71:672-5.