Dural-based Intracranial Chondroma Enigmatically Presenting with Intra-lesional Bleed

A 35 year-old-female presented with a slowly progressive headache for the last 3 months. Her neurological examination did not reveal any localizing signs. Her CT [Figure 1] and MRI brain [Figure 2] revealed a right dural-based parietal lesion measuring 5 × 4 cm2. The contrast images were not possible owing to the contrast allergy in the patient. Excision of a dural-based armored tumor with intra-lesional bleed was undertaken [Figure 3]. Histopathology revealed benign proliferation of chondrocytes [Figure 4], with IHC being positive to S100, negative for GFAP and EMA, and a Ki-67 proliferation index of < 1%. The final diagnosis of dural-based chondroma with intra-lesional bleeding was affirmed.Figure 1: Plain CT image revealing dural-based parietal lesion with peripheral hyperdensity and stippled calcificationsFigure 2: Radio imaging of the lesion in T1 and T2 MR sequencesFigure 3: Intraoperative image of a dural-based armored tumor with intra-lesional bleedFigure 4: Histopathology revealing a benign proliferation of chondrocytesIntracranial dural-based chondroma is a very rare entity.[1] Intra-lesional bleed within a chondroma is even a rarer and enigmatic epiphenomenon.[2] In most cases, such lesions are heterogeneous in T1 and T2 with characteristic "punica granatum seeds" sign in contrast MRI sequences.[3] Bone destruction and irregular calcifications are also common. Our lesion was predominantly hyper-intense with hypointense peripheral rim in both the T1 and T2 MR sequences. It was hypodense with peripheral hyperdensity and stippled calcifications in plain CT images. This probably was the result of the intra-lesional bleed. The differential diagnosis includes meningiomas, metastases, and calcified extra-axial hematomas.[4] This lesion is benign and amenable to complete surgical excision. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.