Giant skull base periosteal chondroma treated with endonasal endoscopic surgery: illustrative case

Kenta Nakase Departments of Neurosurgery, and

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Fumihiko Nishimura Departments of Neurosurgery, and

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Miho Kakutani Departments of Neurosurgery, and

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Yudai Morisaki Departments of Neurosurgery, and

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Shohei Yokoyama Departments of Neurosurgery, and

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Ryosuke Matsuda Departments of Neurosurgery, and

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Yasuhiro Takeshima Departments of Neurosurgery, and

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Shuichi Yamada Departments of Neurosurgery, and

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Maiko Takeda Diagnostic Pathology, Nara Medical University, Kashihara, Japan

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Ichiro Nakagawa Departments of Neurosurgery, and

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Yong-Soo Park Departments of Neurosurgery, and

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BACKGROUND

Intracranial chondroma is an extremely rare type of tumor composed of mature hyaline cartilaginous tissues. No previous cases of skull base periosteal chondroma have been presented.

OBSERVATIONS

A 31-year-old male had progressive memory loss and diminished motivation for the previous 1.5 years. Magnetic resonance imaging revealed a giant tumor with partial calcification arising from the upper clivus and extending to the prepontine cistern. Compression of the brainstem and hypothalamus was significant. Surgery was performed and intentionally limited to an intracapsular resection with endoscopic endonasal surgery (EES), and the brainstem and hypothalamus were successfully decompressed. Pathological examination findings showed a composition of hyaline cartilage with chondrocyte clusters. Genetic testing with next-generation sequencing indicated alternations in IDH1 R132C, KDR Q472H, IDH2 I142L, and TP53 P72R. On the basis of these findings, a diagnosis of periosteal chondroma was made. Postoperatively, complete relief from all symptoms was noted, and MRI one year later showed no evidence of tumor regrowth.

LESSONS

This is the first known report of skull base periosteal chondroma. Genetic testing was useful for confirming the diagnosis, and EES was effective for treatment. Should such a tumor show adhesion to an important structure, an intracapsular excision can be beneficial for avoiding complications.

ABBREVIATIONS

ADC = apparent diffusion coefficient; CT = computed tomography; EES = endoscopic endonasal surgery; IDH1 = isocitrate dehydrogenase 1; IDH2 = isocitrate dehydrogenase 2; MRI = magnetic resonance imaging

BACKGROUND

Intracranial chondroma is an extremely rare type of tumor composed of mature hyaline cartilaginous tissues. No previous cases of skull base periosteal chondroma have been presented.

OBSERVATIONS

A 31-year-old male had progressive memory loss and diminished motivation for the previous 1.5 years. Magnetic resonance imaging revealed a giant tumor with partial calcification arising from the upper clivus and extending to the prepontine cistern. Compression of the brainstem and hypothalamus was significant. Surgery was performed and intentionally limited to an intracapsular resection with endoscopic endonasal surgery (EES), and the brainstem and hypothalamus were successfully decompressed. Pathological examination findings showed a composition of hyaline cartilage with chondrocyte clusters. Genetic testing with next-generation sequencing indicated alternations in IDH1 R132C, KDR Q472H, IDH2 I142L, and TP53 P72R. On the basis of these findings, a diagnosis of periosteal chondroma was made. Postoperatively, complete relief from all symptoms was noted, and MRI one year later showed no evidence of tumor regrowth.

LESSONS

This is the first known report of skull base periosteal chondroma. Genetic testing was useful for confirming the diagnosis, and EES was effective for treatment. Should such a tumor show adhesion to an important structure, an intracapsular excision can be beneficial for avoiding complications.

ABBREVIATIONS

ADC = apparent diffusion coefficient; CT = computed tomography; EES = endoscopic endonasal surgery; IDH1 = isocitrate dehydrogenase 1; IDH2 = isocitrate dehydrogenase 2; MRI = magnetic resonance imaging

An intracranial chondroma is a rare type of primary cerebral tumor seen in 0.2% to 0.3% of affected cases.1 It is benign, composed of mature hyaline cartilaginous tissues, and generally nonmalignant.2,3 However, because of intrachondral ossification during the embryonic stage, chondrocytes can form as a chondroma at the skull base. Additionally, there may be residual chondrocytes at the cartilaginous junction of skull base sutures.4 Such body tumors are categorized according to origin, with a periosteal chondroma known to arise from the surface of the periosteum, with an occurrence in the long tubular bones in the hands and feet often noted. To the best of our knowledge, there are no previous reports regarding a periosteal chondroma occurring in the skull base. Here, we present the details of a case of skull base periosteal chondroma treated using an extended endoscopic endonasal transsphenoidal surgical procedure.

Illustrative Case

History and Examination

A 31-year-old male presented with progressive memory loss and decreased motivation that had developed over the past 1.5 years. He rinary incontinence beginning 9 months prior, leading to a visit to our hospitalso complained of a light headache and urinary incontinence beginning 9 months prior, leading to a visit to our hospital. Computed tomography (CT) findings revealed intracranial mass lesions with partial calcification arising from the upper clivus (Fig. 1). Furthermore, magnetic resonance imaging (MRI) depicted a mass enlarged in the prepontine cistern, which exhibited hypointensity on T1-weighted images and hyperintensity on T2-weighted images, as well as apparent diffusion coefficient (ADC) map findings, with heterogeneous enhancement revealed following gadolinium administration (Fig. 2A–E). Significant compression of important structures such as the brainstem and hypothalamus was also noted, along with attachment to a thalamoperforating artery (Fig. 2F). The initial diagnosis was chordoma or chondroid tumor. Gross-total resection without complications was likely to be very difficult; thus, surgery to decompress as much as possible was planned, along with consideration of a second surgical procedure depending on the pathology and clinical course.

FIG. 1
FIG. 1

Preoperative axial (A) and sagittal (B) CT scans of a giant mass with scattered calcification in the prepontine cistern. Bone window CT scan (C) shows thinning of the upper clivus.

FIG. 2
FIG. 2

A giant tumor was found arising from the upper clivus and extending to the prepontine cistern. MRI showed a solitary mass, with hypointensity on axial T1-weighted sequences (A) and hyperintensity on axial T2-weighted sequences (B). Hyperintensity on an ADC map (C). Contrast-enhanced T1-weighted images (D and E) showing heterogeneous enhancement. Coronal heavy T2-weighted image (F) showing attachment of the tumor to thalamoperforating artery (white arrow).

A transsphenoidal extended endoscopic endonasal surgery (EES) using neuronavigation and neuromonitoring of the transcranial motor evoked potentials and visual evoked potentials was performed (Video 1). After performing an extensive dural opening, we split the pituitary gland on the lateral third to create a corridor. After drilling out the upper clivus, fibrous bone tissue related to the tumor was encountered, which was also drilled under observation with a 30°-angle endoscope (Fig. 3A). Following resection of the fibrous bone tissue, cartilaginous tissue was found (Fig. 3B), which was very soft; thus, debulking by suction was performed. Subtotal removal of the tumor was performed, during which a small dural defect formed on the lower surface of the tumor, which was closed using fat and cellulose. The skull base defect was repaired using inlay fascia, onlay fascia, native bone, and fibrin glue.

VIDEO 1. Clip showing an extended EES. After performing an extensive dural opening, the pituitary gland on the lateral third was split to create a corridor. After drilling out the upper clivus, fibrous bone tissue related to the tumor was encountered, which was also drilled under observation with a 30°-angle endoscope. After resection of the fibrous bone tissue, cartilaginous tissue was found, which was very soft; thus, debulking by suction was performed. Subtotal removal of the tumor was performed, during which a small dural defect formed on the lower surface of the tumor, which was closed using a multilayer method. Click here to view.

FIG. 3
FIG. 3

Intraoperative findings. A: Fibrous bone tissue can be seen behind the upper clivus (white arrow). B: After resection of the fibrous bone tissue, cartilaginous tissue was found.

Pathological Findings

Histopathological analysis revealed that the tumor was composed of hyaline cartilage with chondrocyte clusters. The tumor border was clear, and the clivus bony structure was preserved (Fig. 4A), with no atypical cells, mitoses, myxoid foci, or vascular lesions noted (Fig. 4B). Furthermore, there were no characteristic pathological findings indicating chordoma, such as a scheme-like arrangement of vacuolar cells and physaliphorous cells. Immunohistochemistry findings for cytokeratin AE1/AE3 were also negative, thus contraindicating chordoma including chondroid chordoma. Genetic testing using next-generation sequencing showed alternations in IDH1 R132C, KDR Q472H, IDH2 I142L, and TP53 P72R. The findings were consistent with a diagnosis of periosteal chondroma that arose from the periosteum of the clivus surface.

FIG. 4
FIG. 4

A: Histopathological analysis revealed that the tumor was comprised of hyaline cartilage with chondrocyte clusters. The tumor border was clear, and the clivus bony structure was preserved. B: No atypical cells, mitosis, myxoid foci, or vascular lesions were seen. Hematoxylin and eosin (A and B), original magnification ×100 (A) and ×200 (B).

Postoperative Course

Although central hypothyroidism and central adrenal insufficiency were transiently observed following surgery, they showed subsequent improvement. After surgery, the patient had complete relief from memory loss and returned to a routine schedule. One year later, MRI indicated significant cytoreduction, and there was no evidence of tumor regrowth at the site of removal (Fig. 5).

FIG. 5
FIG. 5

Postoperative MRI (A and B) indicating significant cytoreduction and no evidence of regrowth at site of removal.

Patient Informed Consent

The necessary patient informed consent was obtained in this study.

Discussion

Periosteal chondroma, first reported by Lichtenstein and Hall5 in 1952, is a gradually proliferating, benign, and cartilaginous neoplasm that originates beneath the periosteal membrane. Its occurrence is predominantly noted in children and young adults, with the highest frequency in the second decade of life.6 A previous study reported only 46 periosteal chondromas among more than 7,000 cases of primary bone tumors.7 The long tubular bones in the hands and feet are thought to be the most frequent sites of origin for these lesions, and to the best of our knowledge, this is the first report of a periosteal chondroma with a clivus location.

Correct identification of a periosteal chondroma is possible based on typical findings obtained in CT and MRI examinations. With CT imaging, a lobulated soft tissue mass is shown to generate pressure erosion at the cortical surface and has a thin cortical shell or sclerotic rim, with the medullary cavity often unaffected.8 Elevated signal intensity observed in the tumor matrix on T2-weighted and short tau inversion recovery images has been ascribed to a modulation in the abundant aqueous content of hyaline cartilage, relative to the mucopolysaccharide constituent.9,10 After the intravenous injection of gadolinium, MRI reveals inhomogeneous enhancement. Chondromas grow slowly; therefore, MRI does not show findings indicating peritumoral edema. A previous study noted that ADC values were lower in chordomas than in chondromas and suggested that such variations are related to differences in tumoral microstructure, such as cartilaginous stroma with different levels of cellularity in a chondroma and a myxoid stroma organized through sheets of physaliferous cells in a chordoma.11 Regarding the present case, ADC map findings showed a hyperintense lesion, leading to a suspicion that the tumor was a chondroma/chondrosarcoma rather than a chordoma.

Histopathological findings indicate that periosteal chondromas have a lobulated structure of hyaline cartilage covered by periosteum.12 Most cases are hypocellular, although on rare occasions the tumor may exhibit enhanced cellularity with nuclear pleomorphism, binucleation, and multinucleation.13 Because of hypercellularity and nuclear atypia characteristics, a periosteal chondroma can occasionally be incorrectly identified as a chondrosarcoma. The present case lacked nuclear atypia, and destruction of the clivus itself was so weak that ossification of the lesion margins was considered to be stimulating growth, thus making it more likely to be a periosteal chondroma than a chondrosarcoma. Moreover, periosteal chondromas are characterized by somatic mutations in isocitrate dehydrogenase 1 (IDH1) and isocitrate dehydrogenase 2 (IDH2),14 and the expression of brachyury and an IDH1/IDH2 mutation is mutually exclusive in these tumors.15 Therefore, the determination of such a mutation is useful for distinguishing a chordoma from other chondromas such as osteochondroma.

Standard treatment for chondroma is complete surgical removal. However, gross-total removal can be challenging in some cases because of the adhesion of vital structures, such as the hypothalamus, brainstem, nerves, and arteries. To avoid serious postoperative complications, a subtotal or partial resection can be performed to alleviate clinical symptoms.16 The tumor in the present case showed attachments to the brainstem, hypothalamus, and premammillary artery. It was decided to limit the procedure to subtotal or partial excision and then to consider a second-stage surgery if the findings showed high malignancy.

Data on the efficiency and safety of an EES for chondroma have been reported.17 Furthermore, other studies have reported that gross-total resection for a craniotomy was performed in 22.7% to 36.7% of affected cases, whereas EES was used in 58.8%.18,19 This procedure has a few advantages. First, a chondroma is usually located in the epidural space, where it can be easily reached and removed without causing injury to surrounding structures such as arteries and nerves. Furthermore, with the use of an endoscope, the tumor can be seen in a broad surgical field and removed. Finally, this approach is less invasive than a transcranial approach. Nevertheless, it is difficult to entirely remove a tumor that has infiltrated the subdural area and compressed and encircled arteries and nerves. Moreover, a possible major complication of EES is cerebrospinal fluid leakage; thus, care must be taken when performing a closing repair.

The distinctive characteristics setting periosteal chondroma apart from other chondromas include the absence of systemic diseases such as Ollier disease, Maffucci syndrome, and hereditary multiple exostoses, as well as the lack of malignant transformation in periosteal chondroma, a contrast to some other chondromas that may manifest these features.20–23 Consequently, the decision was made to pursue observation instead of opting for an aggressive second surgery. However, Lewis et al.13 noted that six of 165 affected cases were affected by local recurrence, a rate of incidence of 3.6%. Therefore, careful long-term follow-up for detecting a recurrence is necessary.

Observations

Skull base periosteal chondromas have not been reported to date. The unique features that distinguish periosteal chondroma from other chondromas encompass the absence of systemic diseases and the lack of malignant transformation, which sets it apart from some other chondromas that may exhibit these characteristics. Consequently, the diagnosis of periosteal chondroma may change management.

Lessons

This is the first known report of a skull base periosteal chondroma, for which genetic testing was found useful for diagnosis. Surgical therapy related to the pathological diagnosis is advised for lesions in symptomatic cases, with EES considered effective because it provides direct access to the lesion and allows resection of the area of origin. Should the tumor show adhesion to an important structure, intracapsular resection can be beneficial for avoiding complications.

Acknowledgments

We wish to thank Professor Eiichi Konishi, Department of Pathology, Kyoto Prefectural University of Medicine, for his valuable advice.

Author Contributions

Conception and design: Nishimura, Nakase, Yokoyama. Acquisition of data: Nishimura, Nakase, Kakutani, Yokoyama. Analysis and interpretation of data: Nishimura, Nakase, Takeshima. Drafting the article: Nishimura, Nakase. Critically revising the article: Nishimura, Nakase, Takeshima, Nakagawa, Park. Reviewed submitted version of manuscript: Nishimura, Nakase, Matsuda, Takeshima, Nakagawa, Park. Approved the final version of the manuscript on behalf of all authors: Nishimura. Administrative/technical/material support: Nishimura, Morisaki, Yokoyama, Nakagawa. Study supervision: Nishimura, Yamada, Nakagawa, Park. Pathological diagnosis: Takeda.

Supplemental Information

Videos

Video 1. https://vimeo.com/896591480.

References

  • 1

    Nakayama M, Nagayama T, Hirano H, Oyoshi T, Kuratsu J Giant chondroma arising from the dura mater of the convexity. Case report and review of the literature. J Neurosurg. 2001;94(2):331334.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Robinson P, White LM, Sundaram M, et al. Periosteal chondroid tumors: radiologic evaluation with pathologic correlation. AJR Am J Roentgenol. 2001;177(5):11831188.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Inoue T, Ohara Y, Niiro T, Endo T, Tominaga T, Mizuno J-I Cervical periosteal chondroma causing spinal cord or nerve compression: 2 case reports and literature review. World Neurosurg. 2018;114:99105.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Sichel JY, Monteil JP, Elidan J Skull base chondroma of extracranial origin. Head Neck. 1994;16(6):578581.

  • 5

    Lichtenstein L, Hall JE Periosteal chondroma; a distinctive benign cartilage tumor. J Bone Joint Surg Am. 1952;24 A(3):691697.

  • 6

    Samaddar A, Mishra AK, Katti M, Gangopadhayay A Successful surgical management of periosteal chondroma of the left second rib: a case report. Indian J Thorac Cardiovasc Surg. 2019;35(1):101103.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Nojima T, Unni KK, McLeod RA, Pritchard DJ Periosteal chondroma and periosteal chondrosarcoma. Am J Surg Pathol. 1985;9(9):666677.

  • 8

    Inoue S, Fujino S, Kontani K, Sawai S, Tezuka N, Hanaoka J Periosteal chondroma of the rib: report of two cases. Surg Today. 2001;31(12):10741078.

  • 9

    Kransdorf MJMJ, Meis JM From the archives of the AFIP. Extraskeletal osseous and cartilaginous tumors of the extremities. Radiographics. 1993;13(4):853884.

  • 10

    Ikeda R, Tateda M, Okoshi A, Morita S, Hashimoto S Extraosseous chondroma of anterior neck in pediatric patient. Int J Pediatr Otorhinolaryngol. 2015;79(8):13741376.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Ota Y, Liao E, Capizzano AA, et al. Differentiation of skull base chondrosarcomas, chordomas, and metastases: utility of DWI and dynamic contrast-enhanced perfusion MR imaging. AJNR Am J Neuroradiol. 2022;43(9):13251332.

    • PubMed
    • Search Google Scholar
    • Export Citation
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    Lorente Moltó F, Bonete Lluch DJ, Martí Perales V Childhood periosteal chondroma. Arch Orthop Trauma Surg. 2000;120(10):605608.

  • 13

    Lewis MM, Kenan S, Yabut SM, Norman A, Steiner G Periosteal chondroma. A report of ten cases and review of the literature. Clin Orthop Relat Res. 1990;(256):185192.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Amary MF, Bacsi K, Maggiani F, et al. IDH1 and IDH2 mutations are frequent events in central chondrosarcoma and central and periosteal chondromas but not in other mesenchymal tumours. J Pathol. 2011;224(3):334343.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Vujovic S, Henderson S, Presneau N, et al. Brachyury, a crucial regulator of notochordal development, is a novel biomarker for chordomas. J Pathol. 2006;209(2):157165.

    • PubMed
    • Search Google Scholar
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    Qiu L, Zhu Y, Wang H, Wang Y, Wu Q, Yang J Giant chondroma of the saddle area: case report and literature review. Neuroophthalmology. 2013;37(6):231238.

  • 17

    Ogawa Y, Niizuma K, Tominaga T Transsphenoidal removal of retroclival chondroma with pituitary transposition manifesting as repeated subarachnoid hemorrhage: a case report. J Neurol Surg A Cent Eur Neurosurg. 2019;80(3):228232.

    • PubMed
    • Search Google Scholar
    • Export Citation
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    Xin Y, Hao S, Zhang J, et al. Microsurgical treatment of intracranial chondroma. J Clin Neurosci. 2011;18(8):10641071.

  • 19

    Liu H, Cai Q, Li J, et al. Surgical strategies and outcomes for intracranial chondromas: a retrospective study of 17 cases and systematic review. Front Oncol. 2022;12(May):865865.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Morinaga Y, Akutsu H, Kino H, et al. Endoscopic endonasal extreme far-medial approach for a lower clivus osteochondroma in a patient with hereditary multiple exostoses: illustrative case. J Neurosurg Case Lessons. 2021;1(20):CASE2153.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Oushy S, Peris-Celda M, Van Gompel JJ. Skull Base Enchondroma and Chondrosarcoma in Ollier Disease and Maffucci Syndrome. World Neurosurg. 2019;130:e356e361.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Müller PE, Dürr HR, Nerlich A, Pellengahr C, Maier M, Jansson V Malignant transformation of a benign enchondroma of the hand to secondary chondrosarcoma with isolated pulmonary metastasis. Acta Chir Belg. 2004;104(3):341344.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Vaidya PR, Weber PJ, Farrar JD, Jarrett RW Jr, Ramey NA Sino-orbital osteochondroma with malignant transformation to osteosarcoma. Am J Ophthalmol Case Rep. 2022;26:101481.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • Collapse
  • Expand
  • FIG. 1

    Preoperative axial (A) and sagittal (B) CT scans of a giant mass with scattered calcification in the prepontine cistern. Bone window CT scan (C) shows thinning of the upper clivus.

  • FIG. 2

    A giant tumor was found arising from the upper clivus and extending to the prepontine cistern. MRI showed a solitary mass, with hypointensity on axial T1-weighted sequences (A) and hyperintensity on axial T2-weighted sequences (B). Hyperintensity on an ADC map (C). Contrast-enhanced T1-weighted images (D and E) showing heterogeneous enhancement. Coronal heavy T2-weighted image (F) showing attachment of the tumor to thalamoperforating artery (white arrow).

  • FIG. 3

    Intraoperative findings. A: Fibrous bone tissue can be seen behind the upper clivus (white arrow). B: After resection of the fibrous bone tissue, cartilaginous tissue was found.

  • FIG. 4

    A: Histopathological analysis revealed that the tumor was comprised of hyaline cartilage with chondrocyte clusters. The tumor border was clear, and the clivus bony structure was preserved. B: No atypical cells, mitosis, myxoid foci, or vascular lesions were seen. Hematoxylin and eosin (A and B), original magnification ×100 (A) and ×200 (B).

  • FIG. 5

    Postoperative MRI (A and B) indicating significant cytoreduction and no evidence of regrowth at site of removal.

  • 1

    Nakayama M, Nagayama T, Hirano H, Oyoshi T, Kuratsu J Giant chondroma arising from the dura mater of the convexity. Case report and review of the literature. J Neurosurg. 2001;94(2):331334.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Robinson P, White LM, Sundaram M, et al. Periosteal chondroid tumors: radiologic evaluation with pathologic correlation. AJR Am J Roentgenol. 2001;177(5):11831188.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Inoue T, Ohara Y, Niiro T, Endo T, Tominaga T, Mizuno J-I Cervical periosteal chondroma causing spinal cord or nerve compression: 2 case reports and literature review. World Neurosurg. 2018;114:99105.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Sichel JY, Monteil JP, Elidan J Skull base chondroma of extracranial origin. Head Neck. 1994;16(6):578581.

  • 5

    Lichtenstein L, Hall JE Periosteal chondroma; a distinctive benign cartilage tumor. J Bone Joint Surg Am. 1952;24 A(3):691697.

  • 6

    Samaddar A, Mishra AK, Katti M, Gangopadhayay A Successful surgical management of periosteal chondroma of the left second rib: a case report. Indian J Thorac Cardiovasc Surg. 2019;35(1):101103.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Nojima T, Unni KK, McLeod RA, Pritchard DJ Periosteal chondroma and periosteal chondrosarcoma. Am J Surg Pathol. 1985;9(9):666677.

  • 8

    Inoue S, Fujino S, Kontani K, Sawai S, Tezuka N, Hanaoka J Periosteal chondroma of the rib: report of two cases. Surg Today. 2001;31(12):10741078.

  • 9

    Kransdorf MJMJ, Meis JM From the archives of the AFIP. Extraskeletal osseous and cartilaginous tumors of the extremities. Radiographics. 1993;13(4):853884.

  • 10

    Ikeda R, Tateda M, Okoshi A, Morita S, Hashimoto S Extraosseous chondroma of anterior neck in pediatric patient. Int J Pediatr Otorhinolaryngol. 2015;79(8):13741376.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Ota Y, Liao E, Capizzano AA, et al. Differentiation of skull base chondrosarcomas, chordomas, and metastases: utility of DWI and dynamic contrast-enhanced perfusion MR imaging. AJNR Am J Neuroradiol. 2022;43(9):13251332.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Lorente Moltó F, Bonete Lluch DJ, Martí Perales V Childhood periosteal chondroma. Arch Orthop Trauma Surg. 2000;120(10):605608.

  • 13

    Lewis MM, Kenan S, Yabut SM, Norman A, Steiner G Periosteal chondroma. A report of ten cases and review of the literature. Clin Orthop Relat Res. 1990;(256):185192.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Amary MF, Bacsi K, Maggiani F, et al. IDH1 and IDH2 mutations are frequent events in central chondrosarcoma and central and periosteal chondromas but not in other mesenchymal tumours. J Pathol. 2011;224(3):334343.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Vujovic S, Henderson S, Presneau N, et al. Brachyury, a crucial regulator of notochordal development, is a novel biomarker for chordomas. J Pathol. 2006;209(2):157165.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Qiu L, Zhu Y, Wang H, Wang Y, Wu Q, Yang J Giant chondroma of the saddle area: case report and literature review. Neuroophthalmology. 2013;37(6):231238.

  • 17

    Ogawa Y, Niizuma K, Tominaga T Transsphenoidal removal of retroclival chondroma with pituitary transposition manifesting as repeated subarachnoid hemorrhage: a case report. J Neurol Surg A Cent Eur Neurosurg. 2019;80(3):228232.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Xin Y, Hao S, Zhang J, et al. Microsurgical treatment of intracranial chondroma. J Clin Neurosci. 2011;18(8):10641071.

  • 19

    Liu H, Cai Q, Li J, et al. Surgical strategies and outcomes for intracranial chondromas: a retrospective study of 17 cases and systematic review. Front Oncol. 2022;12(May):865865.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Morinaga Y, Akutsu H, Kino H, et al. Endoscopic endonasal extreme far-medial approach for a lower clivus osteochondroma in a patient with hereditary multiple exostoses: illustrative case. J Neurosurg Case Lessons. 2021;1(20):CASE2153.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Oushy S, Peris-Celda M, Van Gompel JJ. Skull Base Enchondroma and Chondrosarcoma in Ollier Disease and Maffucci Syndrome. World Neurosurg. 2019;130:e356e361.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Müller PE, Dürr HR, Nerlich A, Pellengahr C, Maier M, Jansson V Malignant transformation of a benign enchondroma of the hand to secondary chondrosarcoma with isolated pulmonary metastasis. Acta Chir Belg. 2004;104(3):341344.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Vaidya PR, Weber PJ, Farrar JD, Jarrett RW Jr, Ramey NA Sino-orbital osteochondroma with malignant transformation to osteosarcoma. Am J Ophthalmol Case Rep. 2022;26:101481.

    • PubMed
    • Search Google Scholar
    • Export Citation

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