Neurology India Medknow Publications on behalf of the Neurological Society of India ISSN: 0028-3886 EISSN: 1998-4022 Vol. 59, Num. 2, 2011, pp. 310-313

Neurology India, Vol. 59, No. 2, March-April, 2011, pp. 310-313

Letter to Editor

An intracranial chondroma with intratumoral and subarachnoidal hemorrhage

Mu Linsen¹, Wang Junmei², Zhang Liwei¹, Dai Jianping³, Chen Xuzhu³

¹ Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
² Department of Neuropathology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
³ Department of Neuroimaging, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

Correspondence Address: Zhang Liwei, Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China, zhangliweidoctor@hotmail.com

Date of Submission: 28-Dec-2010
Date of Decision: 28-Dec-2010
Date of Acceptance: 29-Dec-2010

Code Number: ni11091

PMID: 21483150

DOI: 10.4103/0028-3886.79170

Sir,

Intracranial chondroma with hemorrhage is rare. ^[1],[2] To the best of our knowledge, tumor showing intratumoral bleeds and subarachnoid hemorrhage (SAH) simultaneously has not been reported to date. We present such a case.

A 34-year-old male patient attended the outpatient on November 23, 2009 with the complaint of decreased left visual acuity of 6 months duration and water-bucking of 1 month duration. He denied any history of headache, dizziness, polydipsia, and polyuria. His medical history was uneventful. Neurologic examination showed left visual acuity of 0.5 (1.5/1.5) and no other deficits. Magnetic resonance imaging (MRI) scan of brain done on November 24 showed a space-occupying lesion located in the left petrous apex and clivus. The signal intensity was heterogenous [Figure - 1] and [Figure - 2]. On post-contrast imaging, it demonstrated non-homogenous enhancement [Figure - 3]. Computed tomography (CT) scan done on November 26 showed multiple dot-like and patchy calcifications of tumor [Figure - 4]. He was admitted to the neurosurgical ward for possible operation. While waiting in the wards for possible operation, on December 7, he complained of sudden headache, nausea and vomiting. An emergency CT scan demonstrated intratumoral hemorrhage and SAH [Figure - 5] and [Figure - 6]. He was taken up for an emergency operation. Intraoperatively, the tumor was located in the floor of the left middle cranial fossa and clivus. It was dark red in color and partly soft in texture with rich blood supply. Inside it, there were massive calcifications with hard texture. There was old hemorrhage in the posterior part of the tumor. The tumor was subtotally resected with a size about 4.5 Χ 4 Χ 4 cm ³. Histopathological examination confirmed the diagnosis of chondroma [Figure - 7], [Figure - 8], [Figure - 9] and [Figure - 10]. The patient died of serious pulmonary infection 7 days after operation.

Intracranial chondroma is a rare benign neoplasm, accounting for 0.2-0.3% of all intracranial tumors. ^[3] The peak age is in the third decade with no gender predominance. ^[4] The most common location is in the skull base, especially in the sellar and parasellar regions. Although several hypotheses have been proposed, the exact pathogenesis of the tumor is still uncertain. Most of the tumors arise from the cartilage found in the basilar synchondroses. Calcification is common with an incidence as high as 60%. ^[5] Thus, the attenuation of the tumor is not homogenous on CT studies and the signal intensity is heterogenous on MRI images. Usually, chondromas are avascular lesions. ^[6] However, our patient had rich blood supply as documented during operation. Possible reason for the intratumoral hemorrhage, showing as patchy high attenuation in the posterior part of the lesion on CT studies, in our patient is the rich blood supply of the tumor as documented during operation. We suppose that significant intratumoral hemorrhage might have ruptured the tumor membrane, resulting in SAH.

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