Chondromyxoid fibroma of the skull base: Differential diagnosis and radiotherapy. Two case reports and a review of the literature

Figures & data

Table I.  Summary of published cases of skull chondromyxoid fibromas.

Cases	Authors	Site	Age/Gender	Treatment	RT yes/no	Follow-up-Outcome	Details
1	Everke et al. 1966 [26]	Petrosphenoidal junction	26y/M	Excision	no	NA
2	Rahimi et al. 1972 [1]	Occipital bone	NA	NA	NA	NA
3	Okubo et al. 1973 [27]	Petrous pyramidal	NA	NA	NA	NA
4	Chalapati et al. 1976 [28]	Right frontal bone	30y/F	NA	NA	NA
5	Inoue et al. 1978 [20]	Intrasellar tumor	30y/ F	Subtotal excision	no	Recurrence 6 years and 7 years after first surgery (removed each time). NED 9 years after first treatment.
6	Szmeja et al. 1981 [29]	Ethmoid labyrinth	NA	NA	NA	NA
7	Miyamoto et al. 1981 [30]	Frontal bone	15y/F	Excision with a rim	no	NED 10 months
8	Frank et al. 1987 [31]	Petrous-sphenoid junction	26/M	Gross tumour resection	no	NA	Extension into the posterior clinoid process, sella, cavernous sinus
9	Viswanathan et al. 1987 [32]	Parasellar tumour	33y/M	Intracapsular removal	no	NA	Ipsilateral total internal carotid artery occlusion
10	Morikawa et al. 1987 [33]	Skull base extending from middle fossa to posterior fossa	57y/F	Excision	no	NA	Stenosis of cavernous portion of internal carotid artery.
11	Kitamura et al. 1989 [34]	Mastoid bone	48y/M	Excision	no	Recurrence 1 year and re-excision. NED 1 year after last surgery	Tumour extending into the occipital bone, invading the foramen magnum and jugular foramen
12	Morimura et al. 1992 [35]	Frontal bone	41y/M	Excision	no	NA
13	Dumas et al. 1994 [36]	Occipital bone	43y/F	Surgery	no	NA	Extension into the petrous ridge of the temporal bone, the jugular foramen, the carotid canal. Thrombosis of the sigmoid sinus and the internal jugular vein
14	Maruyama et al. 1994 [37]	Petrous temporal bone	67y/M	NA	NA	NA	Extension into the jugular foramen Intracranial chondromyxoid fibroma in an elderly person is rare
15	Koay et al. 1995 [18]	Nasal bone	57y/F	Excision	no	NED 6 months	Extension into the frontal and ethmoidal sinuses.
16	Nazeer et al. 1996 [11]	Sphenoid sinus	66y/F	Curettage	no	Recurrence 1 year and re-curettage. NED 6 months	Extension into the nasopharynx
17		Left ethmoid sinus	20day/M	Excision	no	NED 1 year	Congenital chondromyxoid fibroma
18	Keel et al. 1997 [8]	Clivus	34y/F	Curettage+ 68 Gy	yes	NED 11 months
19		Clivus	65y/ F	Excision	no	NED 26 months
20		Sphenoid sinus	66y/ F	Excision	no	Recurrence 6 months: excision, 61 Gy. NED 20 months	Extended into ethmoid sinus, cavum
21		Clivus	42y/M	NA	NA	NA
22		Sphenoid, ethmoid sinus	51y/F	NA	NA	NA
23	Wolf et al. 1997 [4]	Left inferolateral frontal bone	35y/F	Gross total remove	no	NA
24	LeMay et al. 1997 [4]	Left temporal bone	22y/M	Excision	no		Tumour arising from the superior and medial portion of the left mastoid
25	Mendoza et al. 1998 [38]	Ethmoid	NA	NA	NA		Congenital chondromyxoid fibroma
26	Hashimoto et al. 1998 [39]	Ethmoid sinus	32y/M	Excision	no	NED 2 years
27	Patino-Cordoba et al. 1998 [40]	Clivus	41y/F	Biopsy	yes	Recurrence 6 years after first surgery: excision
28		Mastoid bone	20y/M	Excision	no	NA
29	Wu et al. 1998 [2]	Frontal Bone	NA	Excision or curettage	no	NA
30		Frontal Bone	NA	Excision or curettage	no	NA
31		Frontal Bone	NA	Excision or curettage	no	NA
32		Sphenoid bone	NA	Excision or curettage	no	NA
33		Sphenoid bone	NA	Excision or curettage	no	NA
34		Sphenoid bone	NA	Excision or curettage	no	NA
35		Occipital bone	NA	Excision or curettage	no	NA
36		Occipital bone	NA	Excision or curettage	no	NA
37		Ethmoid	NA	Excision or curettage	no	NA
38	Suzuki et al. 1999[41]	Left temporal bone	49y/M	Excision	no	NA
39	Skek et al. 1999 [17]	Nasal cavities	6y/F	Excision	no	Recurrence 4 years after first surgery (debulking tumor). Last surgery, 10 years after first surgery. Irradiation 50 Gy after the third surgery.	The recurrence involved the sphenoid body, superior nasal cavity and posterior ethmoid sinuses.
40	Tarhan et al. 2000 [42]	Left temporal bone (tympanic portion)	44y/F	Total excision	no	NA
41	Wang et al. 2000 [43]	Nasal septum	60y/F	Total excision	no	NED 6 months
42	Baujat et al. 2001 [7]	Nasal bone with extension into the frontal and ethmoidal sinuses	50y/F	Macroscopic completely resection	no	NED 18 months
43	Azorin et al. 2003 [44]	Right frontal sinus	46y/M	En bloc resection	no	NED 22 months
44	Bloom et al. 2004 [45]	Clivus and right occipital condyle	NA	Resection	no	NA
45	Our study	Right sphenoid bone	28y/F	Partial resection + 59CGE	yes	Recurrence: 11 months: 61 Gy NED 48 months after radiotherapy
46	Our study	Left cavernous sinus	19y/M	Biopsy + 59 CGE	yes	NED 1 year

RT: radiotherapy; NED: No evidence of disease; NA: Not available; Gy: Gray; CGE: Cobalt Gray Equivalent

Figure 1. Case 1- Axial CT of the head in bone window showed calcified matrix and a thin peripheral calcified rim in petro-sphenoidal junction. Gadolinium-enhanced MRI, T1-weighted image shows mixed signal intensity in the tumour at the diagnosis.

Figure 2. Case 2- MRI, coronal T1-weighted images of chondromyxoid fibroma in right sphenoid bone before radiotherapy (left) and 4 years later (right).

Figure 3. Flow diagram- role of radiotherapy for skull chondromyxoid fibromas.

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