Rare presentation of intra-spinal extradural grade 1 chondrosarcoma: A case report

Abstract

Introduction: Lumbar Spine Chondrosarcomas are rare entities that accounts for less than 10% of all spinal Chondrosarcomas, patients can present with symptoms of nerve root irritation secondary to direct compression caused by the tumor mass effect. Radiologically these tumors are destructive in nature with soft tissues classifications, and the treatment of choice for it is complete surgical excision, however in some scenarios they are difficult to access and complete resection becomes not feasible.

Presentation of case: A 37 years old male, presented to our spine clinic with chief complaint of chronic low back pain with radicular symptoms, normal power in both lower limbs, while his radiological evaluation showed intra-spinal extra-dural Chondrosarcoma arising from the posterior cortex of the 5th vertebral body, for which he underwent surgical decompression of the lumbar canal with resection of the lesion and unilateral stabilization of the spinal segment.

Conclusions: Unlike Chondrosarcomas of the appendicular skeleton, lesions arising in the spinal element may be difficult to detect on plain radiographs and further imaging is crucial for better evaluation, as this will help in surgical planning for excision of the tumor. In difficult cases with inaccessible locations, marginal excision of spinal Chondrosarcomas can be achieved utilizing a minimally invasive technique with preservation of some spine motion with acceptable clinical outcomes.

Keywords: Back pain; Calcification; Case report; Chondrosarcoma; Lumbar spine; Spinal tumors.

Fig. 1

Standing lateral flexion and extensions Plain radiographs showing Heterogenous ill-defined calcific shadow superimposing the spinal canal at L5.

Fig. 2

Axial cuts CT scan of the L5-S1, showing the intra-spinal extradural calcified soft tissue lesion, located para-centrally, originating from the posterior cortex of L5 vertebral body, and occupying the spinal canal, as well as the left neural foramen.

Fig. 3

T2 weighted sagittal & Axial cuts MRI of the lumbar spine demonstrating large para-central heterogeneous intra-spinal extradural calcified soft tissue lesion, occupying the left lateral recess at L5-S1 level compressing the left L5 exiting nerve, compressing the spinal canal, and significantly displacing the thecal sac to the right side, as well as extending/filling through the left neural foramen.

Fig. 4

histology revealed bone with a fibrocartilaginous cap in continuity with trabecular bone and bone marrow that is replaced by fat. Occasional bi-nucleated chondrocytes is noted with focal proliferation, hypercellularity, nuclear enlargement with hyperchromatasia and mild pleomorphism, favoring a malignant transformation of osteochondroma into grade 1 Chondrosarcoma.

Fig. 5

T2 weighted sagittal & Axial cuts MRI of the lumbar spine post decompression and lumbar spine stabilization 3 years follow up showing the residual mass with no increase of its size.