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Chondromas of the nasal septum are rare. A case of chondroma originating in the left side of the nasal septum is reported. The patient, a 61-year-old female, presented bilateral nasal obstruction, headache, and nasal bleeding. The tumor was removed surgically through the transpalatal approach under general anesthesia. No recurrence was noticed after 6 months follow-up.
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A clinicopathologic study of 46 patients with periosteal chondroma and 14 patients with periosteal chondrosarcoma revealed that periosteal chondroma tended to affect younger patients and that the lesion was usually smaller. Radiographically, the typical periosteal chondroma was a small, well-marginated tumor on the outer surface of a long bone. Erosion of the cortical surface and marginal buttresses were usually present. Periosteal chondrosarcoma had a more aggressive appearance and was seen as a large mass located superficially on the cortex; the margins of the mass were more irregular than those of chondroma. Histologically, periosteal chondroma frequently showed hypercellularity, plump nuclei, and binucleation. Thus, the differentiation of chondroma from chondrosarcoma is difficult and is based mainly on evidence of invasion. The prognosis in periosteal chondroma is good: only one patient had a local recurrence, none of the tumors underwent malignant change, and excision seems to be curative. However, the prognosis in periosteal chondrosarcoma is not as good: two patients died of metastasis to the lungs after local excision and two patients had recurrences after local resection. Periosteal chondrosarcoma should be treated more aggressively than periosteal chondroma.
Soft tissue and skeletal chondromas are rare entities, and only 21 cases with abnormal karyotypes have been reported. A survey of these, and 10 new cases reported herein, showed that the 12q13-15 segment is nonrandomly involved in structural rearrangements in chondromas. The HMGA2 (HMGI-C) locus in 12q15 is frequently rearranged in other benign mesenchymal tumors, and this study aimed at characterizing the expression of HMGA2 in chondromatous tumors. The material consisted of 8 soft tissue and 6 skeletal chondromas, as well as of 14 skeletal chondrosarcomas. All cases had been cytogenetically analyzed. Expression of HMGA2 could be assessed by RT-PCR in 8 chondromas and 13 chondrosarcomas. HMGA2 was expressed in 4 of six soft tissue chondromas, all displaying 12q-rearrangements at cytogenetic analysis. A truncated transcript (exons 1-3), but not a full-length (exons 1-5) transcript, was detected in three of them, suggesting activation through an intragenic rearrangement. One soft tissue chondroma had a t(3;12)(q27;q15), and the RT-PCR analysis revealed an HMGA2-LPP fusion transcript, composed of HMGA2 exons 1-3 and LPP exons 9-11. An identical fusion transcript previously has been identified in lipoma and pulmonary chondroid hamartoma. In the fourth soft tissue chondroma, a full-length transcript was detected, indicating expression of at least one intact allele. Both skeletal chondromas expressed HMGA2. In one of them, a full-length transcript was detected, even though 12q was cytogenetically unaffected. A truncated or full-length transcript was found in 8 of 13 chondrosarcomas, 4 of which displayed 12q rearrangements. Possibly, cryptic rearrangements were present among the many complex marker chromosomes in the remaining 4 cases.
Differential diagnosis of chordoma and chondroma in the skull base is sometimes difficult. We retrospectively reviewed the MR images of 14 patients with skull base tumors (nine chordomas, four chondromas and one chondrosarcoma). MR imaging was performed with a 0.5 Tesla system (Picker International). Inversion recovery (IR) (2500-2100/600-500/40), T1-weighted spin echo (SE) (800-600/40), and T2-weighted SE (2500-1800/120) images were obtained. On IR images, seven of eight chordomas showed heterogeneous low signal intensity, and one chordoma and all chondromas showed markedly low signal intensity similar to that of CSF. Calcified or ossified portions of the chondromas were demonstrated as areas of moderately low intensity on IR images. Chondrosarcoma showed moderately low intensity similar to that of chordoma. T1-weighted SE images of chordoma and chondroma showed no difference in signal intensity. On T2-weighed SE images, six of nine chordomas and all chondromas showed markedly high signal intensity. Three chordomas and one chondrosarcoma showed moderately high signal intensity. In the diagnosis of skull base tumors, the IR sequence seems to be useful for differentiating chondroma from chordoma.
BACKGROUND: Cartilage-forming tumors are benign cartilaginous tumors that rarely affect the spinal canal: they account for 2% of all spinal tumors and 2.6% of all benign bone tumors. Pathologically, they may be classified as chondromas, osteochondromas, chondroblastomas, and chondromyxoid fibromas. This oncotype may remain asymptomatic (it is confined within the vertebral structure) or may present as a hard paravertebral swelling (it invades the paravertebral structures) or more rarely, with a slowly-developing neurologic syndrome (it extends into the vertebral canal). METHODS: Thirty-one cases have been reported (including our case) of benign cartilage-forming tumors localized in the lumbar column. Only three cases of chondroma of the lumbar spine presented with lumbar radicular pain. We report a fourth case and review clinical and radiologic characteristics of these lesions. RESULTS: Eleven out of the 31 cases were diagnosed as chondromas, 17 as osteochondromas, while in three cases the histopathologic diagnosis was not reported. Seventeen cases originated from the neural arch, seven from the vertebral body, two from the spinous process, and in five cases the exact localization was not reported. This tumor is more frequent in males (21 cases out of 31), than in females (five cases); in five cases the sex was not reported. Mean duration of symptoms was 23 +/- 5.1 months (range: 1-96); chondromas have a short clinical history before diagnosis (13.8 +/- 3.4 months) compared to osteochondromas (28.6 +/- 7.6). Clinical presentation with local swelling is reported in 10 cases, in 10 cases local pain without radicular irradiation, in six cases lumbar pain with sciatica, in two cases signs and symptoms of cord compression, one case of cauda syndrome, while in four cases no clinical details are reported. Among the six cases presenting with sciatica, four were chondromas (in all cases the L4 level was involved), and one osteochondroma, while in one case the histopathologic diagnosis was not reported. CONCLUSION: Computed tomography is important and indispensable for preoperative diagnosis, giving a precise indication of tumor extent and location and its relationship to the adjacent structures; while MRI is helpful in detecting patterns related to histologic malignancy. It is important to examine the whole tumor histologically because it is known that there may be small areas that show signs of malignancy; thus is more likely in chondromas than osteochondromas.
Histologically benign soft-tissue chondromas have been reported at many anatomical sites but are an uncommon cause of soft tissue mass lesions in childhood, accounting for less than 1% of cases. The most frequent sites for extraosseous soft-tissue chondromas are the hands and feet. For the extremely rare visceral chondromas, the site can be lung, where they may represent a component of Carney's syndrome of extra-adrenal paraganglioma, pulmonary chondroma, and epithelioid leiomyosarcoma of the gastrointestinal tract. Primary cardiac chondromas are exceptionally rare in patients of any age although cardiac chondrosarcoma, both primary and metastatic, is well reported. We present a case of a teenage boy with a fatal cardiac chondroma
1. Extraskeletal chondromas occur in three variants: (a) as multiple nodules of synovial chondromatosis within a joint, (b) as a solitary lesion in association with articulations, within or adjacent to them, and (c) as an isolated cartilagenous lesion in the soft tissues, mostly of the hands and feet. 2. There are no histological characteristics which could differentiate articular, para-articular and soft tissue chondromas among themselves. 3. The latter two groups of extraskeletal chondromas are rare and frequently exhibit areas of immature cartilage with worrisome histologic features which could mislead the pathologist to an overdiagnosis of chondrosarcoma. 4. As a general rule, no matter how worrisome the histologic appearance of an extraskeletal, well delimited cartilagenous tumor may be, metastasis have not been recorded. Local recurrences are not infrequent after inadequate surgical removal; however, the tumor can always be controlled by adequate wide re-exision or resection. 5. Two cases of extraskeletal chondromas, one para-articular in the knee and the other in the soft tissue of the arm, have been presented with an exhaustive review of the literature on the subject. 6. It is of interest to note that our para-articular chondroma represents the first case reported in the literature where computerized tomography was utilized in the diagnosis. 7. The location of a soft tissue chondroma in the upper arm is extremely rare and only one previous case has been reported in said location.
265 cases of solitary chondroma, multiple chondromas and chondromatosis were analysed. Two hundred cases had a long term follow up of 1-50 years (average ten years). Recurrence after surgical removal is rare. It is exceptional for malignancy to develop in chondromas of the hand. Malignant degeneration (chondrosarcoma, fibrosarcoma, etc.) was found in 12 per cent of the solitary chondromas and in 32 per cent of the multiple chondromas and chondromatosis involving the bones elsewhere than in the hand. The first of these figures is probably excessive, since many of the solitary chondromas elsewhere than in the hand remain asymptomatic and unrecognised; but the second figure is probably too low, since the risk of sarcomatous degeneration remains present throughout the patient's life.
Chondroma of the laryngeal cartilage is a rare, benign neoplasm which can manifest as a neck mass or, if situated within the airway, as slowly progressive obstruction, hoarseness or dyspnea. The most common location for chondroma is the posterior lamina of the cricoid cartilage; the next most common locations are the thyroid, arytenoid and epiglottic cartilages. Chondroma and low-grade chondrosarcoma are difficult to distinguish from one another histologically. Although chondrosarcoma reportedly recurs, local surgical excision without radical margins and with long-term clinical follow-up is recommended. We report one case of thyroid cartilage chondroma and include a review of radiologic studies and histopathologic analysis results. We also report a second case with severe airway obstruction caused by a large cricoid chondroma. A review of the English language biomedical literature on laryngeal chondroma is included.
Chondroma is a benign cartilaginous tumor and fairly rare in the spine. A case of chondroma in the lumbar spine is presented. A male at age 66 was suffered from progressive low back pain associated with hypesthesia in his right leg. Radiographic examination showed an extradural mass in the dorsal part of spinal canal at L 5 level. No osteolytic change was noted by CT scan. MRI showed iso-intensity with marginal enhancement on T 1-weighted images and heterogeneous intensity on T 2-weighted image. The mass was totally removed by laminectomy and pathohistologically diagnosed as chondroma. Postoperative course was uneventful and the symptoms disappeared completely. One of the origin of chondroma is thought to be metaplasia of the connective tissue in contact with spine. This is why no pathological change was found in bone adjacent to the tumor. Careful preoperative diagnosis and total removal of the tumor is important since malignant transformation may happen in chondroma.
Summary Chondromas of the skull base are extremely rare cartilaginous tumors. Etiology of chondromas remains unknown. The clinical presentation and radiological findings are not unique and cannot reliably distinguish from other similar lesions in this area. The low frequency of patients with chondromas of the skull base makes it impossible to draw definitive treatment conclusions. Chondromas are benign tumors and have good clinical outcomes. However, follow-up depends on localization of the tumor and neighboring vital structures within a small area. The authors present a case of 16-year-old patient with chondroma of the skull base, followed by a diagnostic evaluation and surgical management. Clinical characteristics of the neoplasm was presented on the basis of literature.
We report two cases of thoracic spine chondroma in two girls aged 14 and 12 years. The lesion was revealed by signs of spinal cord compression and affected T1 and T7 respectively. Chondroma is a benign bone tumour, fairly frequent in the extremities but very rare in the spine. It accounts for 2.8% of benign bone tumours and 12% of all bone tumors. 3.6% to 4% of chondroma are located in the spine. Out of 51 cases reported in the literature 21 had been revealed by spinal cord compression, with an age range of 5 to 76 years. In all cases of spinal cord compression magnetic resonance imaging (MRI) is necessary as first-line examination, but CT scans are still useful in the diagnosis and post-operative follow-up of spinal chondroma because of the osteo-cartilaginous nature of these tumors. The purpose of this study was to report two new cases of spinal cord compression by thoracic spine chondroma and to review the literature.
METHODS: Two cases of chondroma at the skull base, most probably of extracranial origin, are presented: one at the apex of the petrous pyramid and the other in the infratemporal fossa. RESULTS: In the second case, the surgical findings suggested that the tumor originated in the cartilagineous part of the eustachian tube. The world literature was reviewed and only three cases of extracranial chondromas at the skull base, and ten cases of chondromas of the nasopharynx have been described so far. CONCLUSIONS: The potential origins of chondromas at the skull base are discussed: Cartilagineous remnants at the basisphenoid and basiocciput or the cartilagineous part of the eustachian tube seem to be the most probable origin.