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Journal of Craniovertebral Junction and Spine
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CASE REPORT
Year : 2014  |  Volume : 5  |  Issue : 3  |  Page : 131-133  

Extradural chondroma presenting as lumbar mass with compressive neuropathy


1 Department of Neurosurgery, Case Western Reserve University, Cleveland, OH, USA
2 Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
3 Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA

Date of Web Publication7-Oct-2014

Correspondence Address:
Andrew M Lozen
Department of Neurosurgery, 9200 West Wisconsin Ave., Milwaukee, WI 53226
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-8237.142308

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   Abstract 

The identification of a soft tissue chondroma within the spine represents a rarity and is typically not included within the differential diagnosis for patients with sensory complaints of the leg. The authors describe 46-year-old female presenting with 3-week history of decreased sensation and paresthesias of the left leg. Magnetic resonance imaging of the lumbar spine demonstrated an L3 extradural soft tissue mass. She underwent an uncomplicated excision through an L3 laminectomy and exhibited complete resolution of symptoms. Pathologic examination revealed benign cartilaginous tissue; however, the authors recommend long-term follow-up for such lesions as the potential for malignant transformation is unknown.

Keywords: Dural-based chondroma, lumbar mass, radiculopathy, spinal chondroma


How to cite this article:
Pace J, Lozen AM, Wang MC, Cochran EJ. Extradural chondroma presenting as lumbar mass with compressive neuropathy . J Craniovert Jun Spine 2014;5:131-3

How to cite this URL:
Pace J, Lozen AM, Wang MC, Cochran EJ. Extradural chondroma presenting as lumbar mass with compressive neuropathy . J Craniovert Jun Spine [serial online] 2014 [cited 2020 Feb 23];5:131-3. Available from: http://www.jcvjs.com/text.asp?2014/5/3/131/142308


   Introduction Top


Patients presenting with recent onset of low back pain and dermatomal sensory loss are often evaluated for common entities including disc herniation, degenerative lateral recess stenosis, nerve sheath tumor, and meningioma. Described herein is a patient presenting with such symptoms who was found to have an extradural soft tissue chondroma in the lumbar spine, which was successfully treated with surgical excision.

When found in an intraosseous location, chondromas are called endochondromas. If associated with the cortical surface, they are termed periosteal chondromas, and when located at a site distant from the bone, they are referred to as soft tissue chondromas. True soft tissue chondromas are uncommon, and the identification of this tumor within the spinal canal represents an extreme rarity. [1],[2]


   Case report Top


A 46-year-old female presented with a 3-week history of lower back pain with decreased sensation and paresthesias of the left lower extremity. She denied prior oncological history or new motor weakness. Plain X-ray films of the lumbar spine were noted to be unremarkable with no boney erosion or reactive bone growth visualized [Figure 1]. The magnetic resonance imaging of the lumbar spine with and without contrast demonstrated an extradural soft tissue mass within the spinal canal at the L3 level with extension into the left L3/4 neural foramen [Figure 2].
Figure 1: (a) Anteroposterior and (b) lateral X-ray films of the lumbar spine with attention to the L3/4 intervertebral space show no signs of boney erosion or reactive bone growth to suggest invasive tumor

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Figure 2: Axial noncontrast T1 (a) and postgadolinium T1 with fat saturation (b) magnetic resonance imaging of the lumbar spine show a homogeneously enhancing soft tissue mass within the left L3 lateral recess extending into L3/4 neural foramen

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The patient initially refused surgery and noted moderate improvement of symptoms following administration of dexamethasone. As symptoms did not completely resolve, she agreed to proceed with an L3 laminectomy with wide left L3/4 foraminotomy for excision of the lesion. Intraoperative electromyography was utilized for the monitoring of motor potentials during tumor removal. During the operation, the thecal sac was noted to have a normal appearance, with moderate amounts of abnormal grey tissue, found both ventrally and dorsally to the ligamentum flavum. At the site of the nerve root axilla, excess soft tissue was encountered which was firm in consistency and noted to be compressing the nerve. While the tissue was resected clear of the dura, transient self-resolving irritation was noted on electromyogram. A gross total resection was performed. Postoperatively the patient did well and had exhibited complete resolution of symptoms at 5-month follow-up.

Pathologic examination revealed benign cartilaginous tissue organized in a lobulated pattern of loose clusters of chondrocytes surrounded by abundant chondroid stroma. Neoplastic cells were relatively uniform in morphology with small dark oval nuclei. No calcification was present. Findings suggestive of aggressive chondrosarcoma such as mitotic figures, double-nucleated chondrocytes, and a significant spindle cell component were notably absent [Figure 3].
Figure 3: Hematoxylin and eosin stain at ×10 magnification (a) shows benign cartilaginous tissue organized in a lobulated pattern. At ×40 magnification (b) chondrocytes surrounded by abundant chondroid stroma without mitosis are present

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   Discussion Top


Chondromas of the spinal column comprise <5% of primary spinal tumors. [3],[4],[5],[6],[7],[8],[9] It is rare for these tumors to arise in an extradural location but when such tumors have been encountered they are frequently located within the cranium. These cranial chondromas typically represent the periosteal variant which is common at the spheno-petrosal, spheno-occipital, or petro-occipital synchondroses. [2],[4] Definitive treatment of these tumors is usually accomplished with complete resection. [5]

The soft tissue variant of chondroma such as described above is rare and is thought to arise from cartilaginous cell rests of mesenchymal origin that are thought to be displaced during development. These ectopic masses are typically asymptomatic and often noted as incidental findings on radiographic evaluation. This variant of chondroma is a rarity at any location particularly along the central nervous system and exceptionally rare in the lumbar spine.

Cho et al. described a case of lumbar extradural chondroma in a patient with ipsilateral lower extremity paresthesias. In their report, Cho et al., describe a complete excision through a unilateral hemilaminotomy without reported recurrence. [2] Cetinkal et al. have reported a single case of extradural chondroma at the L2 level. This patient presented with femoral numbness and L2 hypesthesia and was treated with complete excision through a partial hemilaminectomy. It is of note that in this rare case, the intradural compartment was explored, and no gross infiltration of tumor was observed. [3] Additional authors have described the more common periosteal variant presenting within the vertebrae. Recently, Ogata et al. described a periosteal chondroma in the lumbar region presenting with lower extremity weakness and radiculopathy. [9] These periosteal chondromas are distinct in their origination from within the periosteal tissue plane and are frequently nestled partly within the underlying cortical bone. [10] It is of note that the present case was characterized by localization outside of the periosteal tissues and contained partially by the epidural fat pad.

While the majority of chondromas of the lumbar spine are likely to remain asymptomatic or present merely as a palpable paravertebral mass, many may mimic disc herniation or nerve sheath tumors. [7],[8] For this patient, our differential diagnosis upon presentation included nerve sheath tumor, meningioma, or possibly lymphoma. While the majority of vertebral chondromas represent benign tumors, long-term follow-up is recommended for lesions of unusual pathology, such as the presented case as the potential for malignant transformation is unknown. [3]

Histologically, chondromas typically appear as well differentiated lobules of chondrocytes in hyaline cartilage. Cells may reside in small nests referred to as isogenous groups and occupy lucent spaces within their myxoid matrix called lacunae. Varying degrees of calcification are found in approximately one-third of cases. Immunohistochemical staining will typically be positive for S-100 protein, and negative for epithelial markers such as AE1/AE3 and epithelial membrane antigen. [3] Additional research will be helpful in further characterizing the genetic makeup of similar ectopic lesions as this may provide insight into their formation.

 
   References Top

1.Abeloos L, Maris C, Salmon I, Balériaux D, Sadeghi N, Lefranc F. Chondroma of the dural convexity: A case report and literature review. Neuropathology 2012;32:306-10.  Back to cited text no. 1
    
2.Cho HJ, Shim J, Kim HK, Suh JH, Lee GJ, Kim YH, et al. A soft tissue chondroma originating from the dura mater of the lumbar spinal canal and it mimicked a nerve sheath tumor: A case report with the MR imaging. J Korean Soc Radiol 2009;60:221-5.  Back to cited text no. 2
    
3.Cetinkal A, Güven G, Topuz AK, Colak A, Demircan MN, Haholu A. Lumbar spinal chondroma presenting with radiculopathy: Case report. Turk Neurosurg 2008;18:397-9.  Back to cited text no. 3
    
4.Yücetürk G, Sabah D, Keçeci B, Kara AD, Yalçinkaya S. Prevalence of bone and soft tissue tumors. Acta Orthop Traumatol Turc 2011;45:135-43.  Back to cited text no. 4
    
5.Fahim 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.  Back to cited text no. 5
    
6.Abdelwahab IF, Contractor D, Bianchi S, Hermann G, Hoch B. Synovial chondromatosis of the lumbar spine with compressive myelopathy: A case report with review of the literature. Skeletal Radiol 2008;37:863-7.  Back to cited text no. 6
    
7.Erten SF, Koçak A, Mizrak B, Kutlu R, Colak A. An end-plate chondroma mimicking calcified lumbar disc herniation. A case report and review of the literature. Neurosurg Rev 1999;22:145-8.  Back to cited text no. 7
    
8.Gaetani P, Tancioni F, Merlo P, Villani L, Spanu G, Baena RR. Spinal chondroma of the lumbar tract: Case report. Surg Neurol 1996;46:534-9.  Back to cited text no. 8
    
9.Ogata T, Miyazaki T, Morino T, Nose M, Yamamoto H. A periosteal chondroma in the lumbar spinal canal. Case report. J Neurosurg Spine 2007;7:454-8.  Back to cited text no. 9
    
10.Lichtenstein L, Hall JE. Periosteal chondroma; A distinctive benign cartilage tumor. J Bone Joint Surg Am 1952;24-A-3:691-7.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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