Primary Spinal Intradural Mesenchymal Chondrosarcoma with Several Local Regrowths Treated with Osteoplastic Laminotomies: A Case Report

Abstract

Mesenchymal chondrosarcomas (MCSs) are rare malignant tumors of the bone and soft tissues. Only a few cases of such tumors originating from the spinal canal meninges have been described in the literature. The authors report on a case of a 22-year-old woman with MCS of the arachnoid at the T12-L1 level with a 14-year-long observation. The tumor was totally resected using osteoplastic laminotomy with reconstruction of laminar roof. This small spindle cell tumor was initially microscopically suspected of synovial sarcoma, but correctly verified with widened immunophenotyping and molecular studies as MCS. At its first recurrence, the neoplasm showed microscopically a typical bimorphic pattern of small round cell component with foci of hyaline cartilage. The patient experienced three local recurrences: 4, 6, and 10 years after the initial resection, respectively. The techniques of laminotomy and relaminotomy were also used during three following operations. The repeated surgical removal, radiotherapy, and chemotherapy were the methods of complex oncological treatment. The patient remains now in complete remission, fully self-dependent with slight motor disturbance, and mild sensory deficits. Current views on the clinicopathological characteristics and treatment modalities of the chondrosarcomas of the spinal canal are discussed.

Keywords: adjuvant treatment; intradural tumor; mesenchymal chondrosarcoma; neurosurgery; spinal tumor.

Fig. 1

First manifestations of the tumor in 2002 in MR imaging (the arrow points to the tumor). ( A ) Preoperative sagittal T2. ( B ) Preoperative sagittal T1 + C. ( C ) Preoperative coronal T1 + C. ( D ) Preoperative axial T1 + C. MR, magnetic resonance.

Fig. 2

Postoperative control MR imaging performed 6 months after operation showed no evidence of the tumor. ( A ) Sagittal T1 + C. ( B ) Axial T1 + C. MR, magnetic resonance.

Fig. 3

First recurrence of the tumor in 2006 in MR imaging. ( A ) Preoperative sagittal T1 + C (the arrow points to the tumor). ( B ) Postoperative control MR imaging performed 6 months after operation—sagittal T1 + C—showed no evidence of the tumor. MR, magnetic resonance.

Fig. 4

Histopathological features of tumor. ( A ) The main component of tumor made of monotonous small round blue cells (HE ×50). ( B ) Small, malignant cells with low nuclear pleomorphism and atypia (HE ×100). ( C ) The second component of tumor—well-differentiated cartilage areas (HE ×100). ( D ) Diffuse and strong Bcl-2 immunostaining (bcl-2, ×100). ( E ) Scattered cells positive for desmin (desmin, ×100). ( F ) Diffuse membranous CD99 immunoreactivity (CD99, ×100). HE, hematoxylin and eosin.

Fig. 5

Second recurrence of the tumor in 2008 in MR imaging. ( A ) Preoperative sagittal T1 + C (the arrow points to the tumor). ( B ) Postoperative control MR imaging performed 6 months after operation—sagittal T1 + C—showed no evidence of the tumor. MR, magnetic resonance.

Fig. 6

Third recurrence of the tumor in 2014 in MR imaging. ( A ) Preoperative sagittal T1 + C (the arrow points to the tumor). ( B ) Postoperative control MR imaging performed 32 months after operation—sagittal T1 + C—showed no evidence of the tumor. MR, magnetic resonance.