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Mesenchymal chondrosarcoma is a rare malignant neoplasm of bone and soft tissues. An unique case is described of an 8-year-old child with a midline cerebellar lesion. Pertinent clinical and radiologic findings along with histopathologic features are described. To our knowledge, this is the first case of mesenchymal chondrosarcoma arising in the cerebellar parenchyma of a child.
In chondrosarcomas, angiography may be helpful in confirming malignancy, delineating the anatomic extent and detecting recurrence. The angiographic findings in three chondrosarcomas are demonstrated including a vertebral one, abrupt narrowing of tumor vessels, neovascularlity and accumulation of contrast medium during the capillary phase. Changing calibre of arteries and neovascularity are better seen on selective angiograms and after subtraction technique.
Chondrosarcomas located in the anterior cranial fossa are rare. They usually invade the ethmoid sinus and may involve the orbit. We observed two such cases in the last five years, during which approximately 10.000 patients with histologically verified brain tumors were admitted to our Institution. CT and MRI represented the chief diagnostic tests. A combined staged procedure using an initial subfrontal approach, followed by a lateral rhynotomy at a later stage, was performed in the patients described herein. Total tumor removal was possible in both cases. Radiotherapy was not administered to the second patient, in whom surgery allowed gross total removal of the mass. Experience with the present cases of anterior fossa chondrosarcoma, though limited, is encouraging. The pertinent literature is reviewed, and guide-lines for the management of these rare tumors are outlined.
We have immunohistochemically examined the localization of matrix metalloproteinases (MMPs) and tissue inhibitors of matrix metalloproteinases (TIMPs) in human chondrosarcomas (CHS) (23 cases) and benign chondroid lesions (BCL) (16 cases of osteochondromas and 11 cases of enchondromas). In CHS, all the MMPs and TIMPs examined were positive. Among them, MMP-1 was immunolocalized in more than 90% of both CHS and BCL, but positive score of MMP-1 was significantly higher in CHS than that in BCL (p < 0.01). Compared with BCL, CHS expressed MMP-3 at a low level, and more often positive in MMP-9. It is possible that chondrosarcoma might have a tendency to lose the ability to secrete MMP-3, which is a metalloproteinase that can degrade cartilage proteoglycans and is related to normal cartilage turnover. MMP-2, TIMP-1 and TIMP-2 were immunolocalized in more than 70% of the cases of both BCL and CHS, but the positive scores of these were not statistically different between the two groups. Interestingly, in several cases of CHS, both MMP-1 and MMP-9 immunostains were observed preferentially within the cells at the marginal areas of cartilaginous lobules. These findings suggest that increased expression of MMP-1 and MMP-9 and decrease in MMP-3 expression are associated with the malignant phenotype of the cartilaginour tumors.
Mesenchymal chondrosarcoma is a rare small-cell neoplasm of bone and soft tissue. After reviewing the literature, we believe that the patient in this report is the youngest in whom mesenchymal chondrosarcoma originating in a cervical vertebra has been diagnosed.
The case of a twenty-year-old male with orbital chondrosarcoma is reported. He visited National Defense Medical College Hospital because of reduced vision in the right eye since two months previously. His corrected visual acuity was 8/20 in the right eye and 20/20 in the left eye. Fifteen degrees lateral displacement of the right globe and limitation of right ocular movement were recognized. Right fundus examination revealed optic disc edema and protuberant nasal fundus. Orbital computed tomography (CT) demonstrated a high density area between the inner part of the right orbit and the ethmoid sinus. Magnetic resonance imaging (MRI) showed a smoothly outlined and low intensity (T1) space occupying lesion. This lesion was irregularly enhanced by gadolinium-diethylene triamine pentaacetic acid (Gd-DTPA). This orbital tumor was removed by an anterior approach. Histopathological examination revealed well-differentiated chondrosarcoma (grade 1) as determined by small prominent chondromatous cell projection into the collagen fibrous stroma, and existence of binucleate cells in the hypercellular region. After the operation the disc edema disappeared and his corrected right visual acuity improved to 20/20.
Malignant transformation of synovial chondromatosis into chondrosarcoma is unusual. Thirteen cases and one series have been reported; only four of them developed in the hip. The overall survival is about 50%, possibly because of the difficulty of arriving at a correct early diagnosis (radiographically and histologically) and subsequent adequate surgical therapy. We report two patients (ages 30 and 50 years) in whom synovial chondrosarcoma developed in previously excised synovial chondromatosis of the hip. The diagnosis was made with modern imaging techniques (computed tomography and magnetic resonance imaging) and verified by open biopsy. The early recognition allowed a wide limb-saving resection; both patients are disease free 3 and 2 years after surgery.
The authors present diagnostic-therapeutic record concerning chondrosarcoma-tumor in 41-year-old women operated on ovary-tumor. They point out the rareness of chondrosarcoma within pelvis, the diagnostic and therapeutic difficulties and relapses into illness after radical remove of tumour without pelvis bones resection.
Four cases of costal chondrosarcoma were observed in the Thoracic Surgery Department of Nostra Señora de Aránzazu Hospital in San Sebastián. This tumour rarely occurs in the ribs and no papers concerning more than one personal case, over such a brief interval, have been reported. The diagnosis was established on the basis of clinical and radiological data in three cases and after biopsy in the fourth case. Large surgical resection allowed complete histological examination, which confirmed the diagnosis of chondrosarcoma. The tumours were classified into grade I and II according to the degree of differentiation of the tumour cells. All 4 patients were treated exclusively by surgical resection. Marlex mesh was necessary to repair the chest wall defect in 3 cases. The functional result was satisfactory. One of these patients was lost to follow-up and no signs of recurrence have been observed in the other 3 patients, although the follow-up remains relatively short (9, 8 and 7 months, respectively).
Unlike osteosarcoma and Ewing's sarcoma chondrosarcomas are primarily surgically managed as they are resistant to chemo- and radio-therapy. A female patient, aged 36 years, was operated in 1992 for pelvic chondroma; a year later she was reoperated due to local recurrence, and diagnosis of chondrosarcoma was established. Because of tumour regrowth she was referred to our institution for hemipelvectomy. The operative team consisted of and orthopaedic surgeon, an urologist, and a general surgeon. A (large) tumour was completely removed. The patient's recovery was rapid, and she is now able of controlling urination and defecation. This kind of operation is extensive and traumatic, but it is useful in appropriately selected cases.
Cytogenetic analysis of an extraskeletal myxoid chondrosarcoma revealed a der(16)t(1;16)(q21;q13) in addition to the t(9;22)(q22;12) described as characteristic for this chondrosarcoma clinicohistopathologic subtype. An identical der(16) has been identified as the most common secondary structural aberration in Ewing's sarcoma and alveolar rhabdomyosarcoma.
Rapid growth of a painful and often recurrent bone tumor of the hand, is suspicious of low malignant chondrosarcoma, even despite previous histological identification as an enchondroma. The difficulty of differential diagnosis of enchondroma and chondrosarcoma is demonstrated in two cases and discussed in a review of the literature.
A 22-year-old woman presented with a 3-year history of progressive frontal headache. Computerized tomography (CT) and magnetic resonance imaging (MRI) revealed a tumor in the left trigone of the lateral ventricle and which enhanced homogeneously. The tumor was attached to the cerebellar tentorium and was compressing the brain stem. On the angiography, no tumor staining was seen. On November 26, 1996, total removal of the tumor was performed using the left subtemporal approach. The tumor was attached to the cerebellar tentorium. The pathological diagnosis was mesenchymal chondrosarcoma. After surgery, gamma-knife radiosurgery was carried out on the tentorium at the place where the tumor had been attached. There has been no recurrence for 6 months. Mesenchymal chondrosarcoma in the brain is very rare and therapy for this tumor is difficult. We report this rare tumor and the therapy is discussed.
Chondrosarcoma is a primary malignant bone tumour which only exceptionally metastasises to the heart. We report a case of chondrosarcoma with left intracavitary cardiac metastasis discovered following abnormal cardiac auscultation. To our knowledge, only 21 cases have been described in the literature. A lesion of the right atrium is the most frequent event. The major risk of these tumours is their emboligenic properties: pulmonary embolism for metastases of the right heart, systemic embolism for metastases of the left heart. Echocardiography establishes the diagnosis by specifying the site and extent of the tumour. CT scan allows local assessment of the lesions. The course is fatal, although surgery has been able to increase survival of patients with isolated cardiac mestastases.
A 22-year-old male presented with proptosis of his right eye of one month's duration. No abnormalities were present regarding visual acuity, ocular motility, or fundus findings. Systemic examinations gave negative results. An orbital tumor, 25 mm in size, was detected by computed tomography and magnetic resonance imaging in the affected side. The tumor was located nasal-posterior to the eyeball and appeared to be in apposition with the orbital floor. The tumor was removed through a maxillary sinus approach. Histopathological studies led to the diagnosis of extraskeletal mesenchymal chondrosarcoma. To the best of our knowledge, this is only the fifth case reported in Japan of mesenchymal chondrosarcoma. Originating in the orbit.
A case of chondrosarcoma of the nasal septum is presented with the result of treatment. The patient was admitted for a growth in the nose of four years' duration. Fine needle aspiration for cytological examination was suggestive of squamous cell carcinoma. She was treated with lateral rhinotomy and wide excision followed by septorhinoplasty. Histological examination showed that the lesion was chondrosarcoma. The patient remained free of disease 26 months after surgery.
OBJECTIVE: To discuss the clinical radiographic findings in a 70-yr-old woman suffering from chondrosarcoma. CLINICAL FEATURES: The patient experienced right SI pain present initially only at night. She later developed morning numbness. An X-ray examination revealed a flocculent calcification in the right buttock region. Computed tomographic scans confirmed the diagnosis. INTERVENTION AND OUTCOME: Initial palliative care continued until surgery was performed to resect the area. CONCLUSION: Chondrosarcoma is a severe disease that must be differentiated from myositis ossificans.
We describe a 43-year-old woman with grade 1 chondrosarcoma of the cervical spine who developed neuropathic arthropathy. Plain radiography, computed tomography, and magnetic resonance imaging of the cervical spine revealed a so-called dumbbell tumor. We suggest that this tumor was responsible for the development of neuropathic arthropathy in bilateral hip joints, the left shoulder joint, and the left first metacarpophalangeal joint. This is the first reported case of neuropathic arthropathy secondary to chondrosarcoma of the cervical spine.