456 lines
35 KiB
Markdown
456 lines
35 KiB
Markdown
---
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title: "Skull Base Chondrosarcoma"
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docid: "d52746d2-9761-43a6-8f47-a2ccc01d612d"
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authors:
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- key: "94f835c8-fa13-4e8a-995b-53048e6b0605"
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value: "Philip R. Chapman, MD"
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breadcrumbs:
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-
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name: "Head and Neck"
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slug: "head-and-neck"
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treeNodeId: "ed24ed8c-5d57-4629-879b-447b82d2973d"
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-
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name: "Diagnosis"
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slug: "diagnosis"
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treeNodeId: "19b6b986-97d0-40e7-b317-00f0c5cd8fa2"
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-
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name: "Skull Base Lesions"
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slug: "skull-base-lesions"
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treeNodeId: "e2f573c9-3c74-435d-86f7-fe1d6c157f65"
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-
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name: "Diffuse or Multifocal Skull Base Disease"
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slug: "diffuse-or-multifocal-skull-base-d-"
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treeNodeId: "b7ce2ad6-77dc-4c50-a083-5fd04739fa1e"
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-
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name: "Skull Base Chondrosarcoma"
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slug: "skull-base-chondrosarcoma"
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treeNodeId: null
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category: "Head and Neck"
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cmeTopicId: "2e3b4196-d650-4dad-9cfb-638a0a54444e"
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documentVersionId: "b1cf1027-9e19-466e-976d-ea1d55114892"
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imageCount: 16
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lastUpdated: "08/10/21"
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pageDescription: "Skull Base Chondrosarcoma"
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pageKeywords: "Head and Neck, Diagnosis, Skull Base Lesions, Diffuse or Multifocal Skull Base Disease, Skull Base Chondrosarcoma"
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pageTitle: "Skull Base Chondrosarcoma | STATdx"
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enhancedTitle: "Skull Base Chondrosarcoma"
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type: "DX"
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references: true
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breadcrumbs:
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- "Head and Neck"
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- "Diagnosis"
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- "Skull Base Lesions"
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- "Diffuse or Multifocal Skull Base Disease"
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- "Skull Base Chondrosarcoma"
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---
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# KEY FACTS
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- ## Terminology
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- Skull base chondrosarcoma (CSa-SB): Chondroid malignancy of skull base
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- ## Imaging
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- Typical location **off-midline**, centered on**petrooccipital fissure**
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- CT
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- Characteristic **chondroid tumor matrix calcification** **in** **50%**
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- Arc or ring-like calcifications
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- Sharp, narrow, nonsclerotic transition zone to adjacent normal bone
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- MR
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- High T2 signal with scattered hypointense foci (calcifications)
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- Heterogeneously enhancing
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- Whorls of enhancing lines within tumor matrix often seen
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- ## Top Differential Diagnoses
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- Chordoma
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- Skull base metastasis
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- Plasmacytoma
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- Nasopharyngeal carcinoma (invasive)
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- Meningioma
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- Benign petrous apex lesions
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- ## Clinical Issues
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- Typically, middle-aged patient with insidious onset of headache and cranial nerve palsies (especially CNVI)
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- ## Diagnostic Checklist
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- Is lesion **off-midline** (CSa) or in midline (chordoma)?
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- Do calcifications represent **arc-whorl intralesional calcifications** (CSa) or fragmented destroyed bone (chordoma)?
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- Consider MR angiography or CTA for preoperative characterization of vessel involvement
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# TERMINOLOGY
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- ## Abbreviations
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- Skull base chondrosarcoma (CSa-SB)
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- ## Definitions
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- CSa-SB: Chondroid malignancy of skull base
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# IMAGING
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- ## General Features
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- ### Best diagnostic clue
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- Solitary enhancing osteolytic soft tissue mass, centered at petrooccipital fissure (POF) ± chondroid matrix
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- ### Location
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- Off-midline at **POF** (2/3)
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- Anterior basisphenoid (1/3)
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- Rarely multiple
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- ### Size
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- Variable, usually > 3 cm at time of diagnosis
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- ### Morphology
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- Well-circumscribed, lobulated margins
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- Lobulated growth in 3 dimensions results in cauliflower shape
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- ## CT Findings
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- ### NECT
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- Soft tissue component is relatively dense
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- ### CECT
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- Variable, heterogeneous enhancement
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- ### Bone CT
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- Expansile mass at POF producing erosive or destructive bone changes in clivus and petrous apex
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- ~ 50% will have radiographically classic chondroid matrix with **"rings and arcs" calcification**
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- Sharp, narrow, nonsclerotic transition zone to adjacent normal bone
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- ## MR Findings
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- ### T1WI
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- Low to intermediate signal intensity relative to gray matter
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- ↓ signal foci within tumor may suggest underlying coarse matrix mineralization or fibrocartilaginous elements
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- ### T2WI
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- Variable, usually **high signal**
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- CSa-SB may be homogeneously hyperintense or simply contain localized zones of hyperintensity
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- Degree of T2 hyperintensity is inversely related to degree of calcified matrix
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- Steady-state free precession T2 images may be low signal (even if bright on T2 spin echo)
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- Hypointense foci (calcifications) less conspicuous than on CT
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- ### PD/intermediate
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- High signal
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- ### T1WI C+
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- Heterogeneous enhancement
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- Usually has nodular or focal enhancement within tumor
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- Whorls of enhancing lines within tumor matrix often seen
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- ## Angiographic Findings
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- Avascular or hypovascular mass
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- Internal carotid artery displacement ± encasement
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- ## Imaging Recommendations
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- ### Best imaging tool
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- Combination of multiplanar, gadolinium-enhanced MR and high-resolution bone CT
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- ### Protocol advice
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- High-resolution axial bone CT for evaluation of chondroid matrix and pattern of bone destruction
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- MR of skull base to include T2WI and multiplanar T1WI, followed by T1WI C+ FS in same planes for direct comparison
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- MRA and MRV, or CTA helpful to assess vascular involvement preoperatively
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- Carotid injury risk higher for endoscopic resection of CSa-SB
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- Preoperative angiography with test occlusion if vessel sacrifice necessary
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# DIFFERENTIAL DIAGNOSIS
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- [Chordoma](/document/chordoma/84148164-fa26-479a-b615-6e932a4a280e)
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- Destructive clival lesion; bone fragments within matrix
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- Midline > lateral location
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- Low T1 and markedly high T2 MR signal; enhancing mass
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- Chondroid chordomas more aggressive and worse prognosis
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- May be impossible to distinguish chordoma from chondrosarcoma on routine imaging
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- [Skull Base Metastasis](/document/skull-base-metastasis/54838a9e-d712-4a48-8928-a1ca925d6aea)
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- Bone CT: Destructive mass that can be anywhere in skull base
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- MR: Often multiple enhancing, invasive lesions
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- Typically low to intermediate T2 signal
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- Known primary tumor
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- [Plasmacytoma & Multiple Myeloma](/document/skull-base-multiple-myeloma/f6984d5f-5d95-4f22-b91b-ea6b5d0a3a23)
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- Usually more midline, within clivus
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- **T2 signal is low** to intermediate
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- > 50% have concurrent multiple myeloma
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- Multiple lesions of skull base or calvarium generally excludes CSa-SB
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- [Nasopharyngeal Carcinoma](/document/nasopharyngeal-carcinoma/1e193b95-6d8b-4605-b83e-3de8d22982b4)
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- Primary mass in nasopharyngeal mucosal space
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- Tumor invades superiorly to clivus, foramen lacerum, and POF
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- [Meningioma](/document/skull-base-meningioma/e264a03f-f5c1-42f3-8725-155c648c3e45)
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- Calcification in meningioma can mimic chondroid matrix
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- Hyperostosis possible; not typically destructive in absence of invasion
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- Low to intermediate T2 MR signal; enhancing with dural tails
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- Skull base meningioma occurring just above POF with bone invasion could closely resemble chondrosarcoma
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- ## Non-Hodgkin Lymphoma
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- Lymphoproliferative neoplasm with focal or multifocal, osseous &/or extraosseous involvement of skull base
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- Low to intermediate T2 MR signal, may restrict on DWI
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- ## Nonneoplastic Lesion of Petrous Apex
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- Includes benign, expansile lesions: Cholesteatoma, mucocele, cholesterol granuloma
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- Should be nonenhancing, smoothly marginated without calcified matrix
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- High signal from asymmetric petrous apex marrow can mimic enhancing tumor
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- Petrous apicitis could demonstrate inflammatory enhancement of petrous apex with permeative bone changes
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- Expect acute clinical syndrome with fever, leukocytosis, Gradenigo syndrome
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- ## Chondromyxoid Fibroma
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- Rare, expansile, noninfiltrating skull base mass
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- Areas of ground-glass density may be seen
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- Appearance may overlap with CSa-SB
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# PATHOLOGY
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- ## General Features
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- ### Etiology
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- Arises from remnants of embryonal cartilage, endochondral bone, or from primitive mesenchymal cells in meninges
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- May arise from metaplasia of meningeal fibroblasts
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- ### Genetics
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- May complicate Ollier disease and Maffucci syndrome
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- ## Staging, Grading, & Classification
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- Classification
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- Conventional CSa: Hyaline (7%), myxoid (30%), or mixed (63%)
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- Clear cell
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- Mesenchymal
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- Dedifferentiated
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- Grading from low to high grade
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- Based on degree of cellularity, pleomorphism, mitoses, and multinucleated cells
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- ## Gross Pathologic & Surgical Features
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- Smooth, lobulated mass "welling up" from POF
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- Cut surface shows gray-white, glistening parenchyma
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- ## Microscopic Features
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- Hypercellular tumor composed of chondrocytes with hyperchromatic, pleomorphic nuclei and prominent nucleoli
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- Binucleate or multinucleate cells are rule
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- Hyaline matrix may calcify in "ringlets"
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- Intercellular matrix is solid in hyaline type compared to mucinous/gelatinous matrix in myxoid or mixed types
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- Histology may overlap with or be confused with that of chordoma
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- Histology particularly confusing in chondroid chordoma, myxoid CSa
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- Differentiation facilitated by immunohistochemical staining
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# CLINICAL ISSUES
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- ## Presentation
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- ### Most common signs/symptoms
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- **Abducens (CNVI) palsy** due to proximity of Dorello canal
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- **Headache**
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- Mean duration of symptoms at diagnosis = 27 months
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- ### Other signs/symptoms
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- Other cranial nerve palsies (CNIII, V, VII, VIII)
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- ### Clinical profile
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- Middle-aged patient with insidious onset of headaches and cranial nerve palsies
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- ## Demographics
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- ### Age
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- Range: 10-80 years
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- Mean: 40 years
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- ### Epidemiology
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- 6% of all skull base tumors
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- 75% of all cranial CSa occur in skull base
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- ## Natural History & Prognosis
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- Prognosis depends on extent at diagnosis, histologic grade, and completeness of surgical resection
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- Disease-specific 10-year survival rates of 99% recently reported
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- Most central CSa-SBs are well to moderately differentiated
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- High-grade CSa metastasizes to bones and lung more frequently
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- Conventional CSa: Indolent growth pattern
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- Most are slow growing, locally invasive, but rarely metastasize
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- Mesenchymal and dedifferentiated forms: Aggressive behavior; poor prognosis
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- ## Treatment
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- Aggressive resection associated with significant morbidity and low likelihood of complete resection
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- Basal subfrontal approach used for tumor that invades clivus and extends anteriorly into sphenoid and ethmoid sinuses
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- Subtemporal and preauricular infratemporal approach used when CSa extends laterally beyond petrous internal carotid artery
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- Combined radical resection and postoperative, high-dose, fractionated precision conformal radiation therapy most often utilized
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- Charged particle radiation therapy (protons or carbon ions) alone or combined with subtotal resection
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# DIAGNOSTIC CHECKLIST
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- ## Consider
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- Is lesion in off-midline (CSa) vs. midline (chordoma)?
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- Do calcifications represent arc-whorl intralesional calcifications (CSa) or fragmented destroyed bone (chordoma)?
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- Does patient have known primary neoplasm (metastasis), myeloma (plasmacytoma), or nasopharyngeal mass (nasopharyngeal carcinoma)?
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- ## Image Interpretation Pearls
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- Classic appearance: Heterogeneously enhancing tumor located at **POF** with hyperintense signal on T2 MR
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- CT shows chondroid mineralization and bone destruction
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- When no tumor matrix found, difficult to tell from CSa plasmacytoma, focal metastasis, or chondromyxoid fibroma
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c47564a6-1df8-40c1-97cb-e02a5fd09f92
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## References
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# Selected References
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1. [Edem I et al: Advances in the management of primary bone sarcomas of the skull base. J Neurooncol. 150(3):393-403, 2020](http://www.ncbi.nlm.nih.gov/pubmed/?term=32306199%5Bpmid%5D)
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1. [Kano H et al: Radiosurgery for chordoma and chondrosarcoma. Prog Neurol Surg. 34:207-14, 2019](http://www.ncbi.nlm.nih.gov/pubmed/?term=31096236%5Bpmid%5D)
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1. [Purgina B et al: Distinctive head and neck bone and soft tissue neoplasms. Surg Pathol Clin. 10(1):223-79, 2017](http://www.ncbi.nlm.nih.gov/pubmed/?term=28153134%5Bpmid%5D)
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1. [Awad M et al: Skull base chondrosarcoma. J Clin Neurosci. 24:1-5, 2016](http://www.ncbi.nlm.nih.gov/pubmed/?term=26724847%5Bpmid%5D)
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1. [Van Gompel JJ et al: Chordoma and chondrosarcoma. Otolaryngol Clin North Am. 48(3):501-14, 2015](http://www.ncbi.nlm.nih.gov/pubmed/?term=25863568%5Bpmid%5D)
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1. [Bag AK et al: Neuroimaging: intrinsic lesions of the central skull base region. Semin Ultrasound CT MR. 34(5):412-35, 2013](http://www.ncbi.nlm.nih.gov/pubmed/?term=24216451%5Bpmid%5D)
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1. [Bloch O et al: Skull base chondrosarcoma: evidence-based treatment paradigms. Neurosurg Clin N Am. 24(1):89-96, 2013](http://www.ncbi.nlm.nih.gov/pubmed/?term=23174360%5Bpmid%5D)
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1. [Gardner PA et al: Carotid artery injury during endoscopic endonasal skull base surgery: incidence and outcomes. Neurosurgery. 73(2 Suppl Operative):ons261-9; discussion ons269-70, 2013](http://www.ncbi.nlm.nih.gov/pubmed/?term=23695646%5Bpmid%5D)
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1. [Sbaihat A et al: Skull base chondrosarcomas: surgical treatment and results. Ann Otol Rhinol Laryngol. 122(12):763-70, 2013](http://www.ncbi.nlm.nih.gov/pubmed/?term=24592579%5Bpmid%5D)
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1. [Amichetti M et al: A systematic review of proton therapy in the treatment of chondrosarcoma of the skull base. Neurosurg Rev. 33(2):155-65, 2010](http://www.ncbi.nlm.nih.gov/pubmed/?term=19921291%5Bpmid%5D)
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1. [Bloch OG et al: Cranial chondrosarcoma and recurrence. Skull Base. 20(3):149-56, 2010](http://www.ncbi.nlm.nih.gov/pubmed/?term=21318031%5Bpmid%5D)
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1. [Ares C et al: Effectiveness and safety of spot scanning proton radiation therapy for chordomas and chondrosarcomas of the skull base: first long-term report. Int J Radiat Oncol Biol Phys. 75(4):1111-8, 2009](http://www.ncbi.nlm.nih.gov/pubmed/?term=19386442%5Bpmid%5D)
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1. [Borges A: Imaging of the central skull base. Neuroimaging Clin N Am. 19(4):669-96, 2009](http://www.ncbi.nlm.nih.gov/pubmed/?term=19959012%5Bpmid%5D)
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1. [Gallia GL et al: Skull base chondrosarcoma presenting with hemorrhage. Can J Neurol Sci. 36(6):774-5, 2009](http://www.ncbi.nlm.nih.gov/pubmed/?term=19960759%5Bpmid%5D)
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1. [Güneş M et al: Intracranial chondrosarcoma: a case report and review of the literature. Minim Invasive Neurosurg. 52(5-6):238-41, 2009](http://www.ncbi.nlm.nih.gov/pubmed/?term=20077365%5Bpmid%5D)
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1. [Hong P et al: Chondrosarcoma of the head and neck: report of 11 cases and literature review. J Otolaryngol Head Neck Surg. 38(2):279-85, 2009](http://www.ncbi.nlm.nih.gov/pubmed/?term=19442379%5Bpmid%5D)
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1. [Samii A et al: Surgical treatment of skull base chondrosarcomas. Neurosurg Rev. 32(1):67-75; discussion 75, 2009](http://www.ncbi.nlm.nih.gov/pubmed/?term=18818961%5Bpmid%5D)
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1. [Abdelmalek M et al: Recurrent chondrosarcoma of the right skull base in a patient with Maffucci syndrome. Am J Clin Dermatol. 9(1):61-5, 2008](http://www.ncbi.nlm.nih.gov/pubmed/?term=18092846%5Bpmid%5D)
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1. [Cho YH et al: Chordomas and chondrosarcomas of the skull base: comparative analysis of clinical results in 30 patients. Neurosurg Rev. 31(1):35-43; discussion 43, 2008](http://www.ncbi.nlm.nih.gov/pubmed/?term=17922295%5Bpmid%5D)
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1. [Ferrer Pérez AI et al: Skull base chondrosarcoma: a case treated by the CyberKnife system. Clin Transl Oncol. 10(10):670-2, 2008](http://www.ncbi.nlm.nih.gov/pubmed/?term=18940749%5Bpmid%5D)
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1. [Gelderblom H et al: The clinical approach towards chondrosarcoma. Oncologist. 2008 Mar;13(3):320-9. Review. Erratum in: Oncologist. 13(5):618, 2008](http://www.ncbi.nlm.nih.gov/pubmed/?term=18378543%5Bpmid%5D)
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1. [Nguyen QN et al: Emerging role of proton beam radiation therapy for chordoma and chondrosarcoma of the skull base. Curr Oncol Rep. 10(4):338-43, 2008](http://www.ncbi.nlm.nih.gov/pubmed/?term=18778560%5Bpmid%5D)
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1. [Sanna M et al: Chondrosarcomas of the jugular foramen. Laryngoscope. 118(10):1719-28, 2008](http://www.ncbi.nlm.nih.gov/pubmed/?term=18622309%5Bpmid%5D)
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1. [Seizeur R et al: Chondrosarcoma of the skull base in Maffucci's syndrome. Br J Neurosurg. 22(6):778-80, 2008](http://www.ncbi.nlm.nih.gov/pubmed/?term=19085363%5Bpmid%5D)
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1. [Zhang Q et al: Endoscopic endonasal surgery for clival chordoma and chondrosarcoma. ORL J Otorhinolaryngol Relat Spec. 70(2):124-9, 2008](http://www.ncbi.nlm.nih.gov/pubmed/?term=18408411%5Bpmid%5D)
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1. [Almefty K et al: Chordoma and chondrosarcoma: similar, but quite different, skull base tumors. Cancer. 110(11):2457-67, 2007](http://www.ncbi.nlm.nih.gov/pubmed/?term=17894390%5Bpmid%5D)
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1. [Dini LI et al: Maffucci's syndrome complicated by intracranial chondrosarcoma: two new illustrative cases. Arq Neuropsiquiatr. 65(3B):816-21, 2007](http://www.ncbi.nlm.nih.gov/pubmed/?term=17952287%5Bpmid%5D)
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1. [Lustig LR et al: Chondrosarcomas of the skull base and temporal bone. J Laryngol Otol. 121(8):725-35, 2007](http://www.ncbi.nlm.nih.gov/pubmed/?term=17319989%5Bpmid%5D)
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1. [Schulz-Ertner D et al: Carbon ion radiotherapy of skull base chondrosarcomas. Int J Radiat Oncol Biol Phys. 67(1):171-7, 2007](http://www.ncbi.nlm.nih.gov/pubmed/?term=17056193%5Bpmid%5D)
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1. [Baehring JM et al: Chondrosarcoma of the skull base. J Neurooncol. 76(1):49, 2006](http://www.ncbi.nlm.nih.gov/pubmed/?term=16402277%5Bpmid%5D)
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1. [Brackmann DE et al: Chondrosarcoma of the skull base: long-term follow-up. Otol Neurotol. 27(7):981-91, 2006](http://www.ncbi.nlm.nih.gov/pubmed/?term=17006349%5Bpmid%5D)
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1. [Frank G et al: The endoscopic transnasal transsphenoidal approach for the treatment of cranial base chordomas and chondrosarcomas. Neurosurgery. 59(1 Suppl 1):ONS50-7; discussion ONS50-7, 2006](http://www.ncbi.nlm.nih.gov/pubmed/?term=16888551%5Bpmid%5D)
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1. [Harada K et al: Chondrosarcoma of the clivus presenting with intratumoral hemorrhage: case report. J Neurooncol. 77(2):221-3, 2006](http://www.ncbi.nlm.nih.gov/pubmed/?term=16333684%5Bpmid%5D)
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1. [Tzortzidis F et al: Patient outcome at long-term follow-up after aggressive microsurgical resection of cranial base chondrosarcomas. Neurosurgery. 58(6):1090-8; discussion 1090-8, 2006](http://www.ncbi.nlm.nih.gov/pubmed/?term=16723888%5Bpmid%5D)
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1. [Krishnan S et al: Radiosurgery for cranial base chordomas and chondrosarcomas. Neurosurgery. 56(4):777-84; discussion 777-84, 2005](http://www.ncbi.nlm.nih.gov/pubmed/?term=15792516%5Bpmid%5D)
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1. [Oghalai JS et al: Skull base chondrosarcoma originating from the petroclival junction. Otol Neurotol. 26(5):1052-60, 2005](http://www.ncbi.nlm.nih.gov/pubmed/?term=16151358%5Bpmid%5D)
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1. [Noël G et al: Chondrosarcomas of the base of the skull in Ollier's disease or Maffucci's syndrome--three case reports and review of the literature. Acta Oncol. 43(8):705-10, 2004](http://www.ncbi.nlm.nih.gov/pubmed/?term=15764214%5Bpmid%5D)
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1. [Raghu M et al: Chondrosarcomas of the temporal bone: presentation and management. J Laryngol Otol. 118(7):551-5, 2004](http://www.ncbi.nlm.nih.gov/pubmed/?term=15318964%5Bpmid%5D)
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1. [Neff B et al: Chondrosarcoma of the skull base. Laryngoscope. 112(1):134-9, 2002](http://www.ncbi.nlm.nih.gov/pubmed/?term=11802051%5Bpmid%5D)
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1. [Schmidinger A et al: Natural history of chondroid skull base lesions--case report and review. Neuroradiology. 44(3):268-71, 2002](http://www.ncbi.nlm.nih.gov/pubmed/?term=11942386%5Bpmid%5D)
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1. [Richardson MS: Pathology of skull base tumors. Otolaryngol Clin North Am. 34(6):1025-42, vii, 2001](http://www.ncbi.nlm.nih.gov/pubmed/?term=11728930%5Bpmid%5D)
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1. [Hug EB et al: Proton radiation therapy for chordomas and chondrosarcomas of the skull base. J Neurosurg. 91(3):432-9, 1999](http://www.ncbi.nlm.nih.gov/pubmed/?term=10470818%5Bpmid%5D)
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1. [Rosenberg AE et al: Chondrosarcoma of the base of the skull: a clinicopathologic study of 200 cases with emphasis on its distinction from chordoma. Am J Surg Pathol. 23(11):1370-8, 1999](http://www.ncbi.nlm.nih.gov/pubmed/?term=10555005%5Bpmid%5D)
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1. [Korten AG et al: Intracranial chondrosarcoma: review of the literature and report of 15 cases. J Neurol Neurosurg Psychiatry. 65(1):88-92, 1998](http://www.ncbi.nlm.nih.gov/pubmed/?term=9667567%5Bpmid%5D)
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1. [Keel SB et al: Chondromyxoid fibroma of the skull base: a tumor which may be confused with chordoma and chondrosarcoma. A report of three cases and review of the literature. Am J Surg Pathol. 21(5):577-82, 1997](http://www.ncbi.nlm.nih.gov/pubmed/?term=9158683%5Bpmid%5D)
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1. [Rapidis AD et al: Chondrosarcomas of the skull base: review of the literature and report of two cases. J Craniomaxillofac Surg. 25(6):322-7, 1997](http://www.ncbi.nlm.nih.gov/pubmed/?term=9504309%5Bpmid%5D)
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1. [Geirnaerdt MJ et al: Calcified meningioma of the skull base simulating chondrosarcoma. Eur J Radiol. 21(2):148-51, 1995](http://www.ncbi.nlm.nih.gov/pubmed/?term=8850513%5Bpmid%5D)
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1. [Brown E et al: Chondrosarcoma of the skull base. Neuroimaging Clin N Am. 4(3):529-41, 1994](http://www.ncbi.nlm.nih.gov/pubmed/?term=7952954%5Bpmid%5D)
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1. [Kveton JF et al: Chondrosarcoma of the skull base. Otolaryngol Head Neck Surg. 94(1):23-32, 1986](http://www.ncbi.nlm.nih.gov/pubmed/?term=3081852%5Bpmid%5D)
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## Images
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### Selected Images
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*Axial graphic depicts the classic location of a chondrosarcoma of the skull base centered in the left petrooccipital fissure <img src='img/arrows/WC.png'/>. Note the normal right petrooccipital fissure <img src='img/arrows/WS.png'/>. Chondroid calcifications, depicted in yellow, are present within the lesion <img src='img/arrows/BS.png'/>.*
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*Axial graphic depicts the classic location of a chondrosarcoma of the skull base centered in the left petrooccipital fissure <img src='img/arrows/WC.png'/>. Note the normal right petrooccipital fissure <img src='img/arrows/WS.png'/>. Chondroid calcifications, depicted in yellow, are present within the lesion <img src='img/arrows/BS.png'/>.*
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*Axial T2 MR reveals a large, high-signal chondrosarcoma of the left petrooccipital fissure. Note that the vertical segment of the petrous internal carotid artery is compressed <img src='img/arrows/WS.png'/>. Note the normal right petrooccipital fissure <img src='img/arrows/WO.png'/>.*
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*Axial T1 C+ MR shows mottled enhancement <img src='img/arrows/WO.png'/> within a chondrosarcoma centered at the left petrooccipital fissure. Calcified matrix is seen as a focal low signal intensity area <img src='img/arrows/WS.png'/> within the otherwise enhancing tumor. The left internal carotid artery is patent <img src='img/arrows/WC.png'/>.*
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*Axial bone CT demonstrates typical chondroid calcification <img src='img/arrows/WS.png'/> in a left petrooccipital fissure chondrosarcoma. In this case, no significant destruction of the adjacent petrous apex <img src='img/arrows/WC.png'/> is appreciated.*
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*Axial bone CT shows rounded <img src='img/arrows/WO.png'/> and arc-like <img src='img/arrows/BS.png'/> calcified foci in this large chondrosarcoma centered at the petrooccipital fissure. Up to 50% of chondrosarcomas demonstrate matrix calcification. Note slight narrowing of the left vidian canal <img src='img/arrows/WS.png'/>.*
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*Axial bone window CT shows subtle bone destruction <img src='img/arrows/WS.png'/> with cortical erosion <img src='img/arrows/WO.png'/> in this small left petrous apex chondrosarcoma. No calcified matrix is seen. MR showed a corresponding T2-hyperintense and enhancing mass in this location.*
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*Axial T2 MR shows a hyperintense chondrosarcoma involving the right petrous apex <img src='img/arrows/WC.png'/> and extending into the right cerebellopontine angle cistern (CPA) <img src='img/arrows/WO.png'/>. The petrous carotid artery is displaced anteriorly <img src='img/arrows/WS.png'/>.*
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*Axial T1 C+ FS MR demonstrates avid enhancement in this chondrosarcoma. Note petrous apex <img src='img/arrows/WC.png'/> and CPA cistern <img src='img/arrows/WO.png'/> involvement. Most skull base chondrosarcomas emanate from the petrooccipital fissure. However, when they become large, it may be hard to see the point of origin.*
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*Axial T2 MR shows a hyperintense right parasellar chondrosarcoma <img src='img/arrows/WS.png'/> that extends into the prepontine cistern <img src='img/arrows/WO.png'/> and sphenoid sinus <img src='img/arrows/WC.png'/>. Note internal carotid <img src='img/arrows/CS.png'/> and basilar <img src='img/arrows/CO.png'/> arterial displacement by the mass.*
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*Axial T1 C+ FS MR shows moderate enhancement within a right parasellar chondrosarcoma <img src='img/arrows/WS.png'/>. The patient presented with intractable headache, epistaxis, and diplopia. Tumor invades prepontine cistern <img src='img/arrows/WO.png'/> and sphenoid sinus <img src='img/arrows/WC.png'/>, partly encases the right ICA <img src='img/arrows/CS.png'/>, and displaces the basilar artery <img src='img/arrows/CO.png'/>.*
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### Additional Images
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*Axial bone CT of the skull base shows a chondrosarcoma <img src='img/arrows/WS.png'/> centered over the left petrooccipital fissure. Notice the absence of chondroid calcifications within the tumor matrix in this case.*
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*Axial bone CT in a patient with a petro-occipital chondrosarcoma shows coarse chondroid calcifications within the tumor matrix <img src='img/arrows/WS.png'/>.*
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*Axial T2 FS MR shows intermediate, heterogeneous signal in the cephalad margin of a petrooccipital fissure chondrosarcoma <img src='img/arrows/WS.png'/>. Curvilinear and punctate hypointensities in the lesion are due to chondroid calcifications.*
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*Axial T2 MR shows a hyperintense small early left petrous apex chondrosarcoma <img src='img/arrows/WS.png'/>. Although one might consider trapped fluid in a pneumatized petrous apex based on the T2 image, associated enhancement and bone destruction on CT suggested a more aggressive process. The cisternal 6th cranial nerves <img src='img/arrows/WC.png'/> are faintly seen, and their proximity to the petrous temporal bone illustrates why chondrosarcomas here frequently present with 6th nerve involvement.*
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*Axial CECT demonstrates a left cavernous sinus/paracavernous myxoid chondrosarcoma <img src='img/arrows/WS.png'/>. Orbital apex involvement is present <img src='img/arrows/WO.png'/>. Note absence of chondroid calcifications.*
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*Axial T2 FS MR in the same patient reveals a homogeneously hyperintense left cavernous and paracavernous myxoid chondrosarcoma <img src='img/arrows/WS.png'/>. Notice that the cavernous internal carotid artery <img src='img/arrows/WO.png'/> is nearly surrounded by tumor.*
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