Keywords: chondroma; intracranial; dural; clinical; CT scan; MRI; anatomopathology

Citation: Yehouenou Tessi RT, Dokponou YCH, El Kacemi I, Miloudi G. Radio clinico histological presentation of intracranial dural chondroma. J Clin Images Med Case Rep. 2022; 3(1): 1615.

Description

We report a challenging diagnosis and the successful management of a rare case of intracranial dural chondroma in a 19-year-old student. He was admitted for secondary epilepsy with behavioral and mood disorder without neurological deficit. His past medical history was unremarkable. The patient was initially taken, by his parents, to the psychiatry department, where medical treatment was prescribed. The cerebral MRI was done, and based on the extra-axial, left fronto-parietal lesion found. Plus, the nonspecific aspect of the clinical findings, the radiological investigations did not help for a straight forward diagnosis orientation. The patient underwent surgery and promptly recovered after the gross total resection of the tumor.

Intracranial chondroma of dural origin is a rare (incidence less than 0,5% of all intracranial tumors) and even exceptional type of chondromas. The first case reported by Hirschfeld in 1851. Chondromas are benign tumors composed of mature hyaline cartilage. The clinical symptoms are variable and due to mass effect depending on the size and location of the lesion (Headache 52.5%, Diplopia 11.9%). It has been reported more frequently at the skull base, less regularly at the falxcerebri, and exceptionally of the dura, when it happened to be intracranial [1,2]. CT scan shows a cerebral tumor with calcifcation and bone erosion due to the tumoral infiltration. Moreover on MRI, the tumor parenchyma appeared heterogeneously hyposignal on T1WI and hypersignal or mixed hypersignal and hyposignal on T2WI, inhomogeneous enhancement on postcontrast (Figure 1). The differential diagnosis with other dural origin tumors like meningioma may not be certain before surgery. The diagnosis confirmation requires a histopathological finding (Figure 1D).

Figure 1: Different aspects of intracranial duralchondroma: A: Cerebral CT on axial slice shows an extra axial heterogenous frontoparietal lesion with calcification, bone infiltration. It’s associated with deviation of median line and commitment under falcoriel. B: Cerebral MRI enhanced on Coronal slice shows an extra axial fronto-parietal intradural lesion, with heterogenous enhancement, bone infiltration and commitment under falcoriel. C: Post-operative mass showing insertion into the dura matter, round, hard, calcified, and irregular in sharp with its extension to the adjacent parietal bone. D: Histopathogical confirmation of chondroma on post-operative mass.

References

1. Sullivan JC, Goldsmith J, Rojas R, Varma H, Kasper EM. Intracranial dural parafalcine chondroma: Case report and systematic review of the literature. World neurosurgery. 2019; 122: 1-7.
2. Reinshagen C, Redjal N, Sajed DP, Nahed BV, Walcott BP, et al. Intracranial dural based chondroma. Journal of Clinical Neuroscience. 2016; 25: 161-163.