Giant Chondroma of the Saddle Area: Case Report and Literature Review

Abstract

A 63-year-old man presented with sexual dysfunction of 6-year duration, 5-year history of bilateral vision loss, and left nasal obstruction for 3 years. Brain computed tomography and magnetic resonance imaging showed a large mass lesion in the saddle area and extending upward to the dorsum sellae, bilateral cavernous sinus, and suprasellar region, and down into the sphenoid sinus and nasal cavity; the optic nerves and optic chiasm were elevated upward and compressed. Endocrine tests indicated that all serum level of anterior pituitary hormones decreased. The preoperative diagnosis included invasive pituitary adenoma, chordoma, osteosarcoma, chondrosarcoma, and craniopharyngioma. The tumour was subtotally removed through transsphenoidal approach. Histopathology examination revealed a chondroma. Postoperatively, the patient was stable and his visual acuity and visual field defect improved and his pituitary function return to normal except for hypothyroidism.

Keywords: Computed tomography (CT); histology; magnetic resonance (MR); sellar chondroma; transsphenoidal approach.

FIGURE 1

The analysis of visual fields shows that both eyes had bilateral superior altitudinal visual field defect. (A) visual fields of left eye, preoperative; (B) visual fields of left eye, postoperative; (C) visual fields of right eye, preoperative; (D) visual fields of right eye, postoperative.

FIGURE 2

Preoperative CT scan showing a large mass with scattered calcification at the sellar region and upper clivus. Bone-window images disclosed skull base bone destruction (A, B). Preoperative MRI showing a huge lesion with scattered cystic core in the saddle area and was slightly enhanced and showing heterogeneous signal intensities. The lesion occupied the entire hypophyseal fossa, dorsum sellae, bilateral cavernous sinus, and suprasellar region, and down into the sphenoid sinus and nasal cavity. The optic chiasm were elevated upward and compressed, the pituitary gland was not identified, and the boundary of lesion could be basically separated from the adjacent structures and there was peri-tumoural oedema (C, D).

FIGURE 3

Endoscopic view preoperative (A) shows a tumour analogue in the posterior segment of the left nasal cavity, the surface of which is pale red, smooth, and the choanal has been completely blocked. Postoperative endoscopy (5 months) (B, C) reveals that the anterior wall of the sphenoid sinus and posterior section of nasal septum have been partially resected, the nasal cavity is now unobstructed. Postoperative endoscopic examination (9 months) (D) shows that the anterior wall of the sphenoid sinus has recovered. N = nasal septum; S = sphenoid sinus; T = tumour.

FIGURE 4

Histology and immunohistochemistry (IHC) of chondroma. General HE stain (A, B, C) showing the tumour consisted of hyaline cartilage; (IHC a) positive IHC to anti-S-100 (×200); (IHC b) positive IHC to anti-vimentin (×100); (IHC c–f) negative IHC to anti-ck, anti-ema, anti-gfap, anti-ki67 (×100), respectively.

FIGURE 5

Postoperative (1.5 months) (A) plain axial T1-weighted and (C) sagittal T1-weighted with contrast MRI showing subtotal removal of the tumour, the residual lesion situated in the suprasellar area and outside of the cavernous sinus. Postoperative (9.5 months) (B) axial T1-weighted and (D) sagittal T1-weighted with contrast MRI showing no recurrence of the lesion.