Chondrosarcoma




CLINICAL SUMMARY


Chondrosarcoma is the second most common primary bone sarcoma, after osteosarcoma. It has a broad spectrum of presentation largely dependent on the grade of the tumor. Treatment is almost exclusively surgical, as chemotherapy and radiotherapy are largely ineffective. Excision of large chondrosarcomas in the pelvis may result in significant morbidity.




DIAGNOSTIC FEATURES





















History


  • Average age: 40 to 45 years



  • Rare in young adults



  • Several months of gradually worsening deep bone pain

Location


  • Depends on subtype but more commonly metaphyseal and central



  • Distribution: femur (25%), pelvis (30%), shoulder (15%), ribs/sternum (10%), vertebrae (7%), scapula (5%)

Margins


  • Depends on grade



  • Low-grade lesions may be predominantly sclerotic but with deep endosteal scalloping



  • Higher-grade tumors demonstrate nongeographic margins, cortical destruction, and soft tissue mass

Matrix Chondroid mineralization, consisting of stipples and arcs





IMAGING

















































  • Low-grade chondrosarcoma in the proximal humerus ( left ) with mixed lytic and sclerotic features. Blue arrows demonstrate the typical ring and arc chondroid mineralization. The black arrow shows the focus of deep cortical scalloping.



  • Bone scan demonstrating heterogeneous radiotracer uptake, greater than that in the anterior iliac crest.










  • Matched coronal T2 MRI ( left ) and gross specimen ( right ) demonstrate focal extraosseous extension laterally ( small arrows ), corresponding to the focus of deep endosteal scalloping seen on radiograph (previous image) and expansile remodeling of bone. Note typical lobular growth pattern of cartilage on imaging and gross examination ( large arrows ).










  • Low-grade lesion in the distal femur is seen on radiograph ( left ) and T1 MRI ( right ) with typical chondroid mineralization and region of extraosseous extension anteriorly.










  • Intermediate-grade chondrosarcoma in the tibia ( left ) with focal, less prominent mineralization ( large arrow ). Note also the deep cortical scalloping ( small arrows ) and periosteal reaction ( arrowheads ).



  • Bone scan showing extensive medullary replacement and increased uptake relative to the anterior iliac crest ( right ).










  • Paired CT scan and contrast-enhanced MRI shows a focal region of mineralization ( C ), deep scalloping, extraosseous mass ( M ), and peripheral enhancement ( black arrows ), reflecting the hypovascularity of hyaline cartilage neoplasms ( left ).



  • Matched sagittal T2 MRI and gross specimen ( right ) demonstrate high water content and extraosseous mass ( M ).










  • Chondrosarcoma arising from costal cartilage ( arrows ) with typical arc and ring mineralization pattern seen on radiograph ( left ) and CT ( right ).



  • Gross specimen ( bottom right ) showing tumor ( arrows ) arising from costal cartilage (R), with typical lobular growth ( C ) of hyaline cartilage neoplasms.










  • High-grade pelvic chondrosarcoma appears as a destructive supracetabular lesion without definite mineralization ( left ).



  • CT better demonstrates the extent of bone destruction, as well as a large soft tissue mass and mineralization in the bone and soft tissue components of the lesion ( right ).





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