title: Endoscopic endonasal resection of clival xanthoma: case report and literature review.
abstract: Bone xanthoma is an extremely rare and benign tumor in terms of its nature and growth over time. We describe the first case coexisting with ventriculomegaly secondary to aqueduct stenosis (non-tumoral hydrocephalus), the second xanthoma of the clivus described to date. The patient was a 51-year-old woman with headaches and absence seizures. Axial T1-weighted MRI showed a well-demarcated, hypointense, osteolytic, 25 × 18 × 15 mm lesion with cortical erosion located at the right margin of the clivus. Sagittal T2-weighted MRI demonstrated a hypointense mass without associated edema. Sagittal gadolinium-enhanced T1-weighted MRI showed contrast uptake with a partially hypointense rim. The increased ventricular size without periventricular edema was associated with aqueduct stenosis, and there was no contiguity with the tumor. A neuronavigation image-guided transsphenoidal approach was chosen to perform a macroscopically complete resection. Intraoperative histopathological study showed a chordoma of the clivus. Exhaustive postsurgical study revealed the benign nature of a bone xanthoma. Given the finding of a clival lesion, the differential diagnosis is essentially with other malignant entities with a rapidly fatal outcome, such as metastases, or with a possible invasive evolution, such as clivus chordomas. This report describes the clinical, radiological, and pathological keys for such differentiation in order to avoid unnecessarily aggressive treatment with ablative surgery and radiotherapy.
authors.affiliation: Department of Neurosurgery, Carlos Haya University Hospital, Malaga, Spain, gonzalezgarcialaura@hotmail.com.
authors.forename: Laura
authors.initials: L
authors.lastname: González-García
authors.forename: Beatriz
authors.initials: B
authors.lastname: Asenjo-García
authors.forename: María Dolores
authors.initials: MD
authors.lastname: Bautista-Ojeda
authors.forename: Miguel
authors.initials: M
authors.lastname: Domínguez-Páez
authors.forename: Lorena
authors.initials: L
authors.lastname: Romero-Moreno
authors.forename: Álvaro
authors.initials: Á
authors.lastname: Martín-Gallego
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Arráez-Sánchez
mesh_terms: D002552:Cerebral Ventricles / Q000473:pathology; D002817:Chordoma / Q000601:surgery; D003388:Cranial Fossa, Posterior / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology; D015192:Infratentorial Neoplasms / Q000175:diagnosis / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009296:Nasal Cavity / Q000601:surgery*; D038361:Neuronavigation / Q000379:methods; D019635:Neurosurgical Procedures / Q000379:methods*; D013100:Sphenoid Bone / Q000601:surgery; D014973:Xanthomatosis / Q000175:diagnosis / Q000601:surgery*
references.citation: Iowa Orthop J. 2008;28:58-64
references.pmid: 19223950
references.citation: Head Neck. 2014 Jun;36(6):892-906
references.pmid: 23804541
references.citation: Rinsho Hoshasen. 1990 Sep;35(9):1057-60
references.pmid: 2232280
references.citation: Neurosurgery. 2012 Sep;71(3):614-24; discussion 624-5
references.pmid: 22592328
references.citation: Radiat Med. 2004 Mar-Apr;22(2):116-9
references.pmid: 15176607
references.citation: Acta Paediatr Taiwan. 2000 May-Jun;41(3):158-60
references.pmid: 10920551
references.citation: Am J Otol. 1987 Mar;8(2):111-5
references.pmid: 3591917
references.citation: J Laryngol Otol. 1982 May;96(5):451-7
references.pmid: 7077138
references.citation: Surg Neurol. 1977 Jun;7(6):371-5
references.pmid: 882912
references.citation: Turk Neurosurg. 2010 Oct;20(4):533-5
references.pmid: 20963706
references.citation: Otolaryngol Head Neck Surg. 1983 Feb;91(1):100-4
references.pmid: 6405340
references.citation: Neurosurgery. 2000 Apr;46(4):996-8
references.pmid: 10764278
references.citation: Brain Tumor Pathol. 2012 Apr;29(2):123-8
references.pmid: 22215107
references.citation: N Engl J Med. 1956 Aug 23;255(8):387-8
references.pmid: 13348875
references.citation: AJNR Am J Neuroradiol. 1992 Nov-Dec;13(6):1627-36
references.pmid: 1442442
references.citation: Curr Opin Otolaryngol Head Neck Surg. 2003 Oct;11(5):324-7
references.pmid: 14502061
references.citation: Ear Nose Throat J. 2000 Jun;79(6):433-6
references.pmid: 10893833
references.citation: J Craniofac Surg. 2005 May;16(3):391-4
references.pmid: 15915102
references.citation: J Neurosurg. 2008 Feb;108(2):361-4
references.pmid: 18240935