Giant Chondromyxoid Fibroma Associated With Epileptic Seizures: A Case Report

Abstract

This case report presents an exceedingly rare instance of skull base chondromyxoid fibroma (CMF) managed surgically. Chondromyxoid fibromas are very rare tumors (<1% of benign bone tumors), the occurrence in the skull area being even more rare. The location of tumors at the skull base makes their surgical resection extremely challenging, usually resulting in subtotal resection (STR). One aspect that makes this case stand out is its unique clinical presentation, particularly the presence of epileptic seizures. Patients suffering from skull base CMFs must receive regular follow-up exams in order to track disease progress, maintain quality of life, and prevent further complications.

Keywords: chondromyxoid fibroma; epileptic seizures; neurosurgery; skull base; subtotal resection.

Figure 1. Sagittal section of the MRI examination

The MRI shows a voluminous, expansive, multilobulated process in the right temporal lobe with an infratentorial component that engulfs both the middle cerebral artery and the apex of the basilar artery.

Figure 2. Transverse section of the MRI

An infiltrative component is observed in the right half of the clivus, the right half of the sella turcica, and the cavernous sinus.

Figure 3. (A) Lobules have stellate cells in a myxoid background and reside in lacunae in chondroid areas (H&E 10X); (B) Lobules have stellate cells in a myxoid background and reside in lacunae in chondroid areas (H&E 40x); (C) Myxoid to chondroid stroma, representing various stages of cartilaginous development (H&E 20x); (D) Paucicellular chondroid proliferation consisting of relatively monomorphic chondrocytic type cells mixed with fibroblastic type cells with a stellate or spindle shape appearance (H&E 40x); (E) Slightly lobular chondroid tumor formation showing on the periphery a fragment of sclerotic bone tissue and skeletal muscle fibers (H&E 4x); (F) Come chondroid areas are sequestered in compact bone tissue with areas of osteosclerosis (H&E 4x)

Figure 4. Surgical resection of the tumor

Sub-total resection of the tumoral mass

Figure 5. MRI with contrast showed a minimal area of tumor recurrence in the right basal frontotemporal region, without mass effect or indication for surgery.

Figure 6. A cranial CT scan, both native and with contrast, demonstrated minimal area of tumor recurrence in the right basal frontotemporal region, without mass effect or surgical indication.