Parafalcine chondrosarcoma: an unusual localization for a classical variant. Case report and review of the literature

Abstract

Background: Intracranial chondroid tumors are infrequently seen in neurosurgical practice. These tumors usually arise from cartilaginous synchondroses at the base of the skull, but occasionally from the pluripotential mesenchymal cells of the meninges. We present here a case of classic low-grade giant chondrosarcoma of the falx cerebri. This is only the second case of this variant reported in this location, and we summarize the diagnostic criteria with a brief review of literature.

Case report: A 56-year-old female patient was admitted to the hospital with a history of progressive right-sided weakness occurring in the last 8 months and a recent grand mal seizure. Radiological evaluation demonstrated a large extra-axial mass in the left parafalcine area, suggesting a possible meningioma. An anterior interhemispheric approach enabled gross total removal of the tumor and a histologic diagnosis of a low-grade classic chondrosarcoma was made. The patient is currently stable and has shown no evidence of recurrence in more than 3 years without any adjuvant treatment.

Conclusions: Intracranial cartilaginous tumors include classical, mesenchymal and myxoid chondrosarcomas in addition to benign chondromas. Parafalcine localization should be considered for all these variants as well as for meningiomas, hemangiopericytomas, solitary fibrous tumors, and meningeal metastatic carcinomas. Detailed radiological evaluation, light microscopic and ultrastructural analyses, and immunocytochemistry are essential for correct diagnosis. In contrast to mesenchymal and myxoid types, the prognosis of classic variants is usually good and does not require adjuvant treatment modalities if a radical resection of the tumor can be obtained. Increased documentation of clinical, radiological, and histologic findings as well as response to treatment modalities will provide a better understanding of the pathophysiology of these rare tumors, and highlight the optimum treatment strategies