Chondromyxoid fibroma of the temporal bone: A rare entity
A 12-year-old, right-handed, female patient was admitted with complaints of gradual-onset headache of 1 month duration. Initially, her headache was generalized, but later on, it was localized in left temporal region. It was mild to moderate in intensity, not associated with vomiting and no other aggravating and relieving factors. It was associated with pain in the left ear of 1 month duration, the pain was continuous, dull-aching in nature, and not associated with fever, ear discharge, or diminished hearing in the left ear.\nThe patient also gave a history of painful swelling over the left preauricular region of 15 days’ duration. Swelling was initially about the size of a lemon which had gradually increased over a period of 15 days to the present size of an apple. There was no redness or discharge from the swelling. There was no history of trauma at the site of swelling. There was no difficulty in chewing from left side of the jaw.\nOn examination, higher mental functions were normal. Cranial nerve examination was normal. Power was 5/5 in both the lower limbs. The sensations were intact. Reflexes were normal in both lower limbs and plantars were down-going bilaterally. On local examination, there was a 4 cm × 3 cm-sized swelling over the left temporal and zygoma in the left preauricular region. The swelling was hard, lobular, and tender on palpation. The swelling was non-pulsatile and there were no scars, sinuses, or dilated veins over the swelling. There was no difficulty in chewing or jaw movements on the left side.\nX-ray of the skull [] was suggestive of a multilobulated radiolucent lesion with well-defined margins in the left temporal region.\nComputerized tomography (CT) scan [] revealed an expansile mass about 4.1 cm × 3.2 cm in size, arising from the left temporal region in the floor of the middle cranial fossa. It showed isodense, soft tissue within and also showed small calcific foci suggestive of chondroid neoplasm.\nMagnetic resonance imaging (MRI) scan [] showed 4 cm × 3.7 cm × 4.4 cm-sized lobulated expansile mass in the squamous part of left temporal bone. Cortex was well maintained with no intracranial extension. The lesion was hypointense on T1-weighted images, isointense on T2 FLAIR, and heterogeneously hyperintense on T2-weighted images with strong heterogeneous post-contrast enhancement with non-enhancing areas within.\nThe patient was operated by left temporal curvilinear incision with complete excision of the lesion along with a 5 mm-margin of surrounding normal bone. The tumor was well circumscribed along with thinning of the adjacent temporal and zygomatic bone. The tumor was firm in consistency and grayish white in color.\nOn histopathological examination [], tumor cells could be seen arranged in a lobular pattern. Individual lobules show central hypocellular and peripheral hypercellular areas comprised of sheets of chondrocytes and stellate cells interspersed within a chondromyxoid background. There was no evidence of mitosis. The periphery of the lesion showed capillary proliferation with numerous, dilated, cystic spaces. Focal areas of dense calcification were also seen suggestive, of CMF.\nPost-operatively, the patient was relieved from her headache, left-ear pain, and swelling with no new neurological deficit. Post-operative CT scan [] showed complete excision of the tumor.\nThere has been no recurrence till the recent follow-up.