In our experience, the lesions that affect the skull base, and the clivus in particular, may be easily overlooked and can be difficult to differentiate given their cellular and embryologic diversity. This is further confounded by overlapping findings, benign variants, and pseudolesions.
As a result of its diverse histologic makeup, primary clival lesions that emanate from the skull base can be derived from residual notochord (eg, chordoma, ecchordosis physaliphora), cartilaginous tissue (eg, chondrosarcoma, enchondroma), or hematopoietic cells (eg, plasmacytoma, lymphoma).
Other real or pseudolesions can complicate the differential diagnosis and include arrested pneumatization, marrow variants, arachnoid granulations, meningocele, fibrous dysplasia, and Paget disease. Due to its central location in the skull base, secondary tumors that infiltrate the clivus
can originate from a cephalad origin (eg, invasive pituitary macroadenoma, meningioma, craniopharyngioma) or a caudal origin (eg, nasopharyngeal carcinoma, rhabdomyosarcoma). Osseous metastases are also frequently a consideration. The aim of this review article is to elucidate the embryologic
origins of these clival findings as well as their anatomic predispositions to better delineate between malignant tumors and benign lesions. We hope to achieve this through the exposition of cases from our local institution cross-referenced with information gleaned from reference articles.
Objective: Understand predictable embryologic changes and anatomic predispositions to accurately characterize clival lesions and pseudolesions.
NPC = nasopharyngeal carcinoma
Document Type: Research Article
August 1, 2019
This article was made available online on July 23, 2019 as a Fast Track article with title: "Quite a Slippery Slope: Pictorial Review of the Radiographic Appearance of Mass Lesions and Pseudolesions of the Clivus".