Plain radiographs, MRI, and CT are commonly ordered for the workup of a possible chondrosarcoma. It was first reported as a clear cell variant of chondrosarcoma by Unni et al. (B) Plain radiographs showing destruction of the fibula. Bone island CCCS has a strong predilection for the epiphysis or metaphysis of long . This is known as an enchondroma protuberans, and may either be seen sporadically or as part of Ollier disease 2. Radiotherapy applied in high doses (65 Gy) [ 48] or proton beam radiation [ 49, 50] becomes mostly important when treating chondrosarcoma of the upper cervical spine, due to the technical difficulties that an effort for wide surgical excision in this peculiar anatomical location entails. pulmonary arteries; - long-term survival rate of patients w/ treated chondrosarcoma is between 50-75%. Enchondroma and intramedullary chondrosarcoma can be difficult to distinguish on imaging, although certain features, including the lesion size, degree of endosteal scalloping, a rim of surrounding edema, and pain referable to the lesion, favor the diagnosis of intramedullary chondrosarcoma [ 7 - 13 ]. It mostly affects adults above the age of 40 and the most common sites are the upper arm, pelvis and thigh bone. CHONDROSARCOMA DEFINITION A malignant cartilage-producing tumour - it generally has a better prognosis than an osteosarcoma (due to late metastases) Classification: Central (intramedullary) vs peripheral Primary vs secondary (e.g. Chondrosarcoma is a malignant tumor that produces cartilage matrix, and lesions that arise de novo are called primary. 1,5 pain, swelling or both may be the presenting complaint. Schubert, R. Chondrosarcoma of the tibia. Localization: Proximal femur, pelvis, proximal humerus, scapula, and proximal tibia. Given the difficulty of localizing pain in the pediatric population, initial radiology findings and short-interval follow-up, both imaging and clinical, are critical to accurately differentiate a chondrosarcoma from a benign chondroid lesion. Distinguishing an enchondroma from a low-grade central chondrosarcoma is one of the most difficult problems in bone pathology. Norman A, Sissons HA. Chondrosarcoma is the most common form of primary bone cancer affecting all age groups. 4. femur, tibia, humerus rare: (consider chondrosarcoma) pelvis ribs scapula sternum Rarely an enchondroma may extend through the cortex and demonstrate an exophytic growth pattern. There are calcified strands within the soft tissues. To our knowledge, no case in the literature discusses a chondrosarcoma possibly arising secondarily from an enchondroma in a pediatric patient. Osteochondroma represents the most common bone tumor and is a developmental lesion rather than a true neoplasm. Enchondromas. Incidence: The incidence is reported to be 0.03 per 100,000 persons in the United States. Read more Background Professor David Sartoris was an avid teacher and won many awards for so doing. It constitutes 20%-50% of all benign bone tumors and 10%-15% of all bone tumors. The most common treatment is surgery to remove cancerous tissue and bone. Diagnosis of chondrosarcoma can be made on imaging studies (Xray, CT scan, MRI) in combination with biopsy specimen ( Skeletal Radiol 2013;42:611 ) Radiology is essential, especially in low grade lesions Radiology description FD = Fibrous dysplasia. Periosteal. A chondrosarcoma was diagnosed at biopsy. T2-weighted axial MR image demonstrates high signal intensity of the tumor in the metacarpal bone with extension of a lobulated soft tissue mass. 2 the most common location is in the hands and feet, with the metaphyseal region of long bones, particularly The differentiation of enchondromas and grade 1 chondrosarcomas is particularly challenging in the long tubular bones such as the femur, tibia and humerus, where enchondromas are very commonly observed. The distinctive radiologic features of conventional osteosarcoma, as demonstrated by radiography, are medullary and cortical bone destruction, an aggressive periosteal reaction, a soft-tissue mass, and tumor bone either within the destructive lesion or at its periphery, as well as within the soft-tissue mass ( Fig. TL;DR: It is concluded that computed tomography-guided biopsies and fine needle aspirates of musculoskeletal lesions remain the logical and safe choice for diagnostic studies of patients with lesions of the musculOSkeletal system. Film Teaching Collection. 2. Toknow differentiation between these two clinically and radiologically as many times histological findings are inconclusive. CT is best for examining tumor matrix mineralization, while MRI is best for assessing marrow and soft tissue involvement. In the pelvis and at more advanced phases, large soft tissue mass is present. Making the correct diagnosis depends on interpreting the pathologic findings in the light of the clinical and radiologic features. multiple clinical and imaging parameters demonstrated statistically significant differences between enchondroma and chondrosarcoma, particularly pain related to the lesion, deep endosteal scalloping (greater than two-thirds of cortical thickness), cortical destruction and soft-tissue mass (at computed tomography or magnetic resonance imaging), 1,4,5,11 In addition, chondrosarcomas are even more rare in children, with a reported incidence of only 0.9% to 1.6% of chondrosarcomas occurring in patients . Typically, long bone lesions were located in the epimetaphysis (19/22) and were lucent with a well-defined sclerotic margin and no cortical destruction or . Periosteal osteosarcoma is primarily a chondroblastic tumor (composed mostly of cartilaginous tissue) that produces osteoid or bone. Primary chondrosarcoma is the third most common primary malignant tumor of bone, constituting 20%-27% of all primary malignant osseous neoplasms. Chondrosarcoma is a malignant bone tumor accounting for 20% of all malignant bone malignancies. They are characterized by tumor cells producing cartilaginous matrix. Differentiating a bone infarct from an enchondroma or low-grade chondrosarcoma on plain films can be difficult or even impossible. Enchondroma and chondrosarcoma are common bone tumors that typically occur central in the medullary cavity in any bone originating from enchondral ossification. Osteosarcoma (OS) is a common primary malignant tumor of bone that produces osteoid matrix. [ 5] Typically, it is centrally located, but it may be seen in a juxtacortical position, arising from the periosteum. Histologic type or grade of chondrosarcoma generally cannot be characterized on the basis of visual analysis of signal intensity noted on routine MR images. Chondrosarcoma is a type of sarcoma that affects the bones and joints. Chrondroid tumors are more frequently encountered than bone infarcts. Clear cell chondrosarcoma Low-grade malignancy. Cartilaginous tumors in particular chondrosarcoma may show endosteal scalloping, while a bone infarct does not. Other symptoms may include: This cancer can appear anywhere you have cartilage, but it typically forms in your pelvis, sternum, ribs, arms or legs. Periosteal chondrosarcoma is a rare primary low-grade surface tumor of bone that often has specific radiologic features. A patient is described with periosteal mesenchymal chondrosarcoma that arose at the surface of the right tibia with multifocal bone metastases and Radiographic, CT, MRI, and PET-CT features of this unusual tumor are presented. Radiographic features Enchondromas are benign chondrogenic tumors composed of hyaline cartilage that typically occur in medullary cavity of the diaphysis or metaphysis, most commonly in the hands. They are most commonly found in older patients within the long bones and can arise de novo or secondary from an existing benign cartilaginous neoplasm. S Afr Med J 1974;48(16):671-676. Complications were infrequent and minor and MSTS functional scores were excellent. Epidemiology Chondrosarcomas of the base of the skull make up only a small fraction of all chondrosarcomas Head and neck chondrosarcomas- only 7%. Multinucleated giant cells are usually apparent. Fifty-four enchondromas and thirty-nine low-grade chondrosarcomas were . 9. Secondary chondrosarcoma in . An imaging test in which radioactive-tagged glucose (sugar) is injected into the bloodstream. (accessed on 07 Oct 2022) https://doi.org/10.53347/rID-14253 Signs and symptoms The most common symptom of chondrosarcoma is bone pain. Local recurrence is site-specific, higher in flat bones and can happen in up to 18% usually in an interval ranging from 6 months to 8 years 1,2. Round cells with abundant clear cytoplasm Distinct cytoplasmic borders with a background of cartilaginous matrix. At his untimely departure he left a valuable collection of radiographic teaching cases at UCSD. Tissues that use the glucose more than normal tissues (such as tumors) can be detected by a scanning machine. LearningRadiology - Chondrosarcoma Tuesday August 9, 2022 Chondrosarcoma Most often occurs in 5th or 6th decades Pelvis most frequent bone involved Also femur, tibia, humerus Most often geographic bone lesion Sometimes permeative Destruction of bone occurs late in disease Large soft tissue mass is common e.g. Initial evaluation - plain radiograph CT or MRI - essential to characterize the lesion(s) and determine the full extent of . radiographically, a juxtacortical chondroma usually appears as a small, cortically based, radiolucent oval/oblong bony defect, longer than wide with little or no calcification. Introduction Chondrosarcoma of the skull base are rare tumors. We . CMF = Chondromyxoid fibroma. Osteochondromas are composed of cortical and medullary bone with an overlying hyaline cartilage cap . Most chondrosarcomas grow slowly and may not cause many signs and symptoms at first. Abstract: The study was undertaken to assess the diagnostic accuracy and clinical . Chondrosarcoma is a bone sarcoma, a primary cancer composed of cells derived from transformed cells that produce cartilage. There are many confusing issues concerning the imaging feature that can facilitate early diagnosis and the factors that might be related to outcomes. In 3 of the 10 cases, cytological evidence of malignancy could not be demonstrated, although the size of . Radiographic hallmarks of peripheral chondrosarcoma. In the UK there are around 190 new cases of chondrosarcoma diagnosed each year. UCSD Musculoskeletal Radiology. This series of low-grade chondrosarcoma, surgically treated with an intralesional procedures, with 10-year follow-up, demonstrates excellent local control (88.9%). Chondrosarcoma happens most often in the pelvis, hip and shoulder. Abbreviations used: ABC = Aneurysmal bone cyst. In most cases, the distinction can be made on clinical and radiographic features before . 3. Extraskeletal chondrosarcoma was visualized as a lobulated soft-tissue mass. Enchondromas are thought to originate as cartilage rests derived from the physeal plate. Ten peripheral chondrosarcomas, nine arising in the cap of an osteochondroma and one developing as a primary periosteal tumor, are reported. Chondrosarcomas can grow from cancerous tissue on your bone or from benign bone tumors that have become cancerous. Periosteal osteosarcomas are intermediate grade tumors as compared to conventional (most common type) osteosarcomas that are high grade. - von Hippel-Lindau tumor suppressor gene (VHL), located in chromosome 3p25 may be involved in chondrosarcoma. There are numerous types of primary chondrosarcomas, including conventional intramedullary, clear cell, juxtacortical, myxoid . Dedifferentiated chondrosarcoma is a rare, highly malignant tumor with a poor survival. formation; - primary form occurs most often in men between 50-60 yrs of age (where as osteosarcoma occurs between 20-30 yrs of age); Patients typically present after the age of 40, with a progressively painful mass. Chondroma is a benign tumor composed of mature hyaline cartilage. It has a predilection for the diaphysis of long bones particularly the tibia. Secondary Chondrosarcoma from an Osteochondroma of the Proximal Tibia Involving the Fibula . Chondrosarcoma is a bone sarcoma that develops in the cartilage cells. On radiographs, chondroblastomas tend to be well-defined lucent lesions with a thin rim of sclerosis; calcifications can be seen in approximately 50% of cases. Central Chondrosarcoma. 1 Chondrosarcoma typically affects adults between the age of 20 and 60 years old, and it is more common in men. Pediatric Orthopaedic Society of North America (POSNA) 9400 West Higgins Road, Suite 500 Rosemont, IL 60018-4976 p: (847) 698-1692 f: (847) 268-9694 e: posna@aaos.org In all cases, MR imaging accurately depicted intraosseous and soft-tissue extent of tumor noted at surgery and pathologic examination. Methods Case study, Radiopaedia.org. Here a 44-year old male with a mixed lytic and sclerotic mass arising from the fifth metacarpal bone. The patient underwent a primary resection of a chondrosarcoma of . Similarly, the long tubular bones are the most common location for chondrosarcomas, accounting for approximately 45% of all cases [ 7 ]. Imaging plays a crucial role in the . It is a rare cancer that accounts for about 20% of bone tumors and is diagnosed in approximately 600 patients each year in the United States. HPT = Hyperparathyroidism with Brown tumor. Toacquire basic and advance clinical and radiological knowldge of both the chondroid tumours Enchondroma and Chondrosarcoma. Chondrosarcoma is a malignant cartilaginous group of tumors with highly diverse features and behavior patterns that characteristically produce cartilage matrix from neoplastic tissue devoid of osteoid in which ossification, calcification, and myxoid changes can occur. We are presenting a case of a lower extremity recurrence of chondrosarcoma that encapsulated the anterior tibial artery and the fibular artery in a 35-year-old Caucasian male patient. This can be a problem when deciding treatment because E only requires regular followup but LGC needs surgical treatment. The radiographs of ninety-three histologically-confirmed cartilaginous tumors of the fibula were retrospectively reviewed along with demographic information as to patient age and gender. Chondrosarcoma can affect people of all ages but is mostly found in adults between the ages of 30 and 60 years. View larger version (109K) Increasingly severe grades of chondrosarcoma demonstrate greater degrees of hypercellularity and cellular atypia. 06 Mar 2002 - Skeletal Radiology. 10. Because prognosis and survival are excellent after adequate local surgery, this lesion must be recognized and differentiated from other surface tumors. Chondrosarcoma is distinguished from enchondroma by the infiltration and entrapment of normal trabecular bone. To evaluate demographic and radiographic features that may differentiate between enchondroma and low-grade chondrosarcoma of the fibula. A chondrosarcoma is a member of a category of tumors of bone and soft tissue known as sarcomas.About 30% of bone sarcomas are chondrosarcomas. Similarly, its malignant counterpart, chondrosarcoma, is the second most common malignant primary bone tumor.The 2013 World Health Organization (WHO) updated this group of tumors, and grade 1 chondrosarcoma was renamed "atypical cartilage tumor" and classified as an intermediate type of tumor, not a malignancy, which better describes its clinical behavior.In this article we summarize changes . Chondrosarcomas make up 37% of all bone sarcoma diagnoses. Treatment for chondrosarcoma Specific treatment for chondrosarcoma will be determined by your healthcare provider based on: More rarely, it can happen in the bones of the spine. An extremely rare case of CCCS that involved the middle shaft of the tibia that has a strong predilection for the epiphysis or metaphysis of long bones. Its radiologic features are often pathognomonic and identically reflect its pathologic appearance. Among cartilage tumors, two entities can be misleading for the pathologist when trying to reach a correct diagnosis: enchondroma (E), a benign tumor, and low grade chondrosarcoma (LGC), which is a low-aggressivity malignancy. David J. Sartoris. Conventional chondrosarcoma is the . Mesenchymal chondrosarcoma of bone is a rare high-grade variant of chondrosarcoma, which typically has central intramedullary location. Chondrosarcoma is a disease often associated with middle-aged and older patients. Patients typically present between the ages of 20-50 with an asymptomatic lesion, discovered incidentally on radiographs. Histological subtypes Clear cell chondrosarcoma Mesenchymal chondrosarcoma Dedifferentiated chondrosarcoma 18. tumor that can behave clinically as a benign or low-grade malignant bone tumor. This collection was given to me by his wife Cyd, and we believe he would want his collection . Clinical: Deep, discontinuous, mild pain with small swelling. In long bones, it starts metaphyseal extending as far as half or more of the entire bone. 1,10 It is extremely rare in young patients, with < 7% of all chondrosarcomas occurring in patients younger than 21 years of age at the time of diagnosis. Radiofrequency ablation may be used 1,8,11. 23-year-old man was diagnosed with secondary chondrosarcoma in the proximal tibia. Wide resection of LGCS was associated with lower MSTS Twenty-two lesions were in long bones (15, proximal femur; 1, distal femur; 1, proximal tibia; 5, proximal humerus) and 11 were in flat bones (5, vertebra; 4, rib; 1, scapula; 1, innominate). One lesion occurred in the tarsal navicular bone. Chondrosarcomas are malignant cartilaginous tumors that account for ~25% of all primary malignant bone tumors. Chondrosarcoma is a rare type of cancer that usually begins in the bones, but can sometimes occur in the soft tissue near bones. Solomon L. Chondrosarcoma in hereditary multiple exostosis. Radiographic features Useful features include: size lesion size over 5-6 cm favors chondrosarcomas cortical breach seen in 88% of long bone chondrosarcomas seen in only 8% of enchondromas deep endosteal scalloping involving > 2/3 of cortical thickness seen in 90% of chondrosarcomas seen in only 10% of enchondromas (C) T2-weighted axial magnetic resonance imaging showing a thick cartilage cap with high signal . However, MR imaging is . Treatment typically consists of curettage and packing of the resulting cavity and with or without adjuvant therapy 1-3,11-13. GCT = Giant cell tumour. 21.3 ). The differential diagnosis mostly depends on the review of the conventional radiographs and the age of the patient. To apply statistically significant criteria in further management. Radiology 1984;151(3):589-596. in 1976. Periosteal reaction can occasionally be seen quite a distance away from the primary lesion. chondrosarcoma conventional variant uncommon variants peripheral periosteal clear cell myxoid mesenchymal central 7. According to the World Health Organization, OS of bone is classified into eight subtypes with distinct biologic behaviors and clinical outcomes: conventional, telangiectatic, small cell, low-grade central, secondary, parosteal, periosteal, and high-grade surface. (A) Plain radiographs taken 3 years before the surgery showing a benign osteochondroma in the proximal tibia. CLINICAL PRESENTATION AND DIAGNOSTIC EVALUATION Localised pain in the affected bone with or without associated soft tissue swelling or palpable mass. Chondrosarcomas are malignant primary bone tumors composed of chondrocytes with variable degrees of malignancy that are most commonly found in the pelvis and proximal femur. 80% of cases are in people aged 40 years or older. Some rare . arising in a pre-existing bone lesion such as a central enchondroma or a peripheral osteochondroma) It is resistant to chemotherapy and radiotherapy.Unlike other primary bone sarcomas that mainly affect children and adolescents . Chondroblastomas are benign tumors. In addition, CT C/A/P may be indicated to evaluate for metastatic Dz, particularly for high-grade histologies. Ahmed AR, Tan TS, Unni KK, Collins MS, Wenger DE, Sim FH. The radiological and histological features of these tumors are compared with those of 203 benign osteochondromas and two soft-tissue chondrosarcomas. EG = Eosinophilic Granuloma.
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