Chondrosarcoma - sphenoid wing

Case contributed by A.Prof Frank Gaillard
CT

An extra-axial lesion arising from just lateral to the clivus and cavernous sinus is noted. It is of mixed density with regions of calcifications.

The location and appearance are suggestive of a chondrosarcoma. The off-midline location and ring-like calcification make a chordoma much less likely. A meningioma or trigeminal schwannoma are less likely possibilities. 

MRI

Selected MRI images confirm the presence of an extra-axial lesion arising from just lateral to the clivus and cavernous sinus. It is heterogeneous in signal with the more medial component demonstrated high T2 signal and variegated contrast enhancement, without restricted diffusion.

Features are consistent with a chondrosarcoma (histologically proven). The off-midline location and ring-like calcification make a chordoma much less likely.

Case Discussion

The patient went on to have a resection. 

HIstology: 

Sections show a moderately cellular cartilage-forming neoplasm with large areas of tumor necrosis. The tumor cells are round to polygonal with hyperchromatic nuclei and are embedded in a hyaline chondromatous matrix. There are foci, however, in which the tumor cells are stellate to spindle in shape, have slightly vacuolated cytoplasm and are embedded in a myxoid stroma. The tumor cells are diffusely and strongly positive for S-100 protein and negative for EMA and cytokeratin.

Final Diagnosis: chondrosarcoma (grade 2 of 3).

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Case information

rID: 5421
Published: 20th Jan 2009
Last edited: 29th Aug 2019
Inclusion in quiz mode: Included

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