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We report the case of a man, aged 48 years, with a primary chondrosarcoma of the sternum which was treated by radical resection and reconstruction with an iliac allograft and musculocutaneous flaps. No complications were seen at follow up after two years.
The association of an ovarian tumour with Ollier's disease or the Maffucci Syndrome is rare. We report what we believe to be the first patient with Ollier's disease associated with an ovarian tumour who later developed a secondary chondrosarcoma.
A case of grade 1 chondrosarcoma of the phalanx of a finger complicating MHE is presented. Although the cytological features did not include anaplasia, other histological features, the presence of MHE, and recurrence of the tumor after local excision aided in making the correct diagnosis. This case emphasizes the importance of correlating the histological features with the radiological and clinical findings of all bone tumors, and especially cartilaginous lesions.
A case of prolonged history of synovial chondromatosis of the knee joint that transformed into low-grade chondrosarcoma was reported. The pathological differentiation of this rare entity from synovial chondromatosis has been discussed, as have the radiographic appearance and differential diagnosis.
We report two unusual cases of clear cell chondrosarcoma. Both emphasize the slow-growing nature of the lesion and the need for long-term follow-up. Additionally, the clinical, radiologic and histologic characteristics of this neoplasm are discussed.
We have presented a case of mesenchymal chondrosarcoma of the sacrum in a 20-year-old woman. We have emphasized that CT and MR are the best imaging modalities for the assessment of the neoplasm and the surgical decision-making process. Histologic study is mandatory for diagnosis of the tumor, with its characteristic dual pattern of chondroid tissue and undifferentiated mesenchymal cells. The rarity of the neoplasm, its deep pelvic location and nonspecific symptomatology led to a late diagnosis and an unfortunate but necessary sacral amputation resulting in bladder and bowel functional sequelae.
Enchondroma protuberans has been defined as an exophytic enchondroma of a long bone. We contrast a case of enchondroma protuberans with two cases of coincident enchondroma and osteochondroma. Our cases and the previously published ones lead us to believe that enchondroma protuberans is probably an enchondroma variant and that its unusual growth pattern may be related to the oblique orientation of the proximal humeral epiphysis. Unlike osteochondroma, which may be treated surgically by removing the cartilage cap and, in some cases, the stalk, enchondroma protuberans requires intralesional curettage. Enchondroma protuberans must be distinguished radiographically from chondrosarcoma.
A case is presented in which the conventional radiograph was suggestive of avascular necrosis. This impression remained unchanged inspite of an MRI examination that was more suggestive or replacement of marrow. The diagnosis of ischemic necrosis was strongly supported by the patient having previously established avascular necrosis in the opposite hip. The gross pathologic specimen showed only necrotic tumor, which mimicked avascular necrosis on the plain film. The importance of placing proper confidence in the MRI findings is thus emphasized. A classification and brief description of the various types of chondrosarcoma are included in the Discussion.
Two children presented with acute spinal cord compression by primary and metastatic intraspinal mesenchymal chondrosarcoma, a rare pediatric malignancy. Patients with the primary intraspinal tumor usually present early and often respond well to combined surgery, irradiation and chemotherapy. Patients with intraspinal metastases present late in the course of their disease and their prognoses are poor.
We evaluated the radiologic studies of 30 medullary chondrosarcomas with respect to their accuracy in diagnosis and surgical staging. There were 30 sets of plain radiographs, 14 conventional tomograms, 26 radionuclide bone scans, 19 arteriograms, and 15 computed tomograms (CT). Plain radiographs provided most of the diagnostic information although many tumours looked benign. CT provided the most complete anatomic staging, including intra- and extraosseous tumor, and neurovascular involvement. However, it was difficult to be sure about subtle soft tissue invasion. Arteriography remained useful for evaluating major vessel involvement or cortical penetration when CT and conventional tomography were equivocal. Scintigrams disclosed increased uptake, usually corresponding to the true tumor extent; "extended uptake" beyond the tumor was uncommon. Conventional tomography has been largely replaced by CT, but was occasionally useful when the tumor was near the end of a bone.
Secondary chondrosarcoma of the bone of the hand arising from a solitary enchondroma is a rare entity, with only 16 published cases in the literature. We report the clinicopathologic findings of a new case arising from a preexisting solitary enchondroma. A review of the literature is discussed.
An unusual case of a chondrosarcoma developed in the proximal phalanx of the thumb is described. Although the diagnosis of the malignancy was made preoperatively and the finger was amputated without any delay, the tumor metastasized widely and killed the patient 6 years later.
Report of a case of clear-cell chondrosarcoma at the upper end of the left femur of a 32-year-old woman. She had two pathologic fractures during a period of 4 years. After the first fracture an excochleation and after the second fracture a resection were done. Two years after resection she had no local recurrence and was free from metastasis.
A bone tumor was detected in the distal right femur of a 15-year-old girl. The age of the patient, the localization, and the X-ray picture were in favor of an osteosarcoma. However, histology was consistent with a "highly differentiated chondrosarcoma with dedifferentiation and focal osteosarcomatous metaplasia". The tumor was resected with preservation of the limb. One year later the tumor recurred, and the leg was exarticulated. Histology was again of the same type, as was the case in a single lung metastasis taken out another half year later. Two series of chemotherapy according to an osteosarcoma protocol had no recognizable effect. An unambiguous diagnosis cannot yet be made.
Daily oral treatment with retinoic acid (100 mg/kg bodyweight) induced regression of a transplantable rat chondrosarcoma. In a previous biochemical investigation we have shown that the tissue breakdown is preceded by the loss of proteoglycan. The present study describes the histological changes induced by retinoic acid. A decrease in the intensity of metachromatic staining with toluidine blue was noted already after 1 day and the discoloration was almost complete after 4 days correlating with the loss of proteoglycan. Especially in the perichondrium there was a rapid proliferation of fibroblasts and monocytes. Osteoclast-like cells were missing, but tumor nodules were eroded and split up by penetrating perichondrium. After 4 days of treatment larger necrotic areas were found, initially in the center of tumor nodules only. In other areas the majority of tumorous chondroblasts survived. Tumor nodules appeared partly mesenchyma-like with some fibroblast-like cells suggesting a dedifferentiation of chondroblasts by retinoic acid. we believe that tumor regression induced by retinoic acid involved proteoglycan degradation by chondroblasts themselves and chondroclast-like activity of monocytes and fibroblasts.
A case of cervical chondrosarcoma that recurred after incomplete excision is presented. The mass was removed in three stages and the involved vertebrae were fused. Excision of the huge mass with only minor complications was only possible by staging the procedure. Due to the location of the lesion, only marginal excision could be performed and the patient was given adjuvant radiotherapy. No signs of recurrence have been detected at 1-year follow-up and surgical measures to improve the function of the neurologically involved extremity are being undertaken.
A rare case of cervical chondrosarcoma is presented and its clinical behavior and treatment modalities are discussed.
In summary, extraskeletal chondrosarcoma is a rare soft tissue tumor. There may or may not be calcification, and in uncalcified tumors the diagnosis may not even be considered by the radiologist. The body of information as to clinical outcome is limited. Both of the patients whose tumors have been illustrated here are alive 2 years following surgery.