Giant chondrosarcoma of the falx in an adolescent: A case report

Abstract

Background: Intracranial chondrosarcomas are slowly growing malignant cartilaginous tumors that are especially rare in adolescents.

Case description: A 19-year-old woman with no medical history presented with symptoms of intermittent facial twitching and progressive generalized weakness for 6 months. The patient's physical examination was unremarkable. Imaging revealed a large bifrontal mass arising from the falx cerebri, with significant compression of both cerebral hemispheres and downward displacement of the corpus callosum. The patient underwent a bifrontal craniotomy for gross total resection of tumor. Neuropathologic examination revealed a bland cartilaginous lesion most consistent with low-grade chondrosarcoma. Her postoperative course was uneventful, and she was discharged to home on postoperative day 3.

Conclusion: This is an unusual case of an extra-axial, non-skull base, low-grade chondrosarcoma presenting as facial spasm in an adolescent patient.

Keywords: Adolescent; Chondrosarcoma; Falx cerebri; Intracranial; Pediatric.

Figure 1:

(a) Non-contrast axial CT section demonstrates a large, well-defined, partially calcified midline mass that displaces each cerebral hemisphere laterally and displaces lateral ventricles posteriorly. There is no evidence of cerebral edema. (b) Non-contrast axial T2-weighted MRI displays heterogeneous internal texture of the mass. Myelinated cerebral white matter shows normal signal intensity with no evidence of cerebral edema. Clear, cerebral spinal fluid-containing cleavage plane (arrows) between medial surface of the right hemisphere and central mass confirms that the mass is extra-axial. (c and d) Contrast-enhanced T1-weighted MRI in coronal (c) and sagittal (d) planes shows heterogeneous enhancement along the surface and within the interstices of the tumor. There is marked compression of corpus callosum and lateral ventricles and a central vector of mass that displaces the brain downward through tentorial incisura and displaces cerebellar tonsils downward through foramen magnum. The nearly linear contour of the left side of mass and of the medial border of the left cerebral hemisphere again suggests that the mass arises from midline falx.

Figure 2:

H&E at ×4 showing myxoid change and patchy necrosis.

Figure 3:

H&E at ×10 showing focal increased cellularity.

Figure 4:

H&E at ×40 showing a binucleate cell and mild atypia.