Pediatric case of the day. Mesenchymal chondrosarcoma

Archives of Pathology & Laboratory Medicine, 2012

Context.—Mesenchymal chondrosarcoma is a rare, high-grade malignancy of bone or soft tissue with a unique, biphasic histology and poor prognosis. Because of its rarity and variable length of disease-free survival, the natural history of the disease remains poorly understood. Objective.—To present clinical, radiographic, and histopathologic features of mesenchymal chondrosarcoma from one of the largest case series collected by a single, senior-level bone pathologist. Design.—Twenty cases were reviewed in consultations spanning 45 years. Results.—Eighteen tumors (90%) originated in bone, and 2 tumors (10%) were of extraskeletal origin. Of the skeletal tumors, locations included craniofacial bones (n = 9; 50%), ribs and chest wall (n = 4; 22%), sacrum and spinal elements (n = 3; 17%), and lower extremities (n = 2; 11%), whereas soft tissue tumors were located about the scapula (n = 1; 50%) and lower extremity (n = 1; 50%). Plain radiographs demonstrated calcified, osteolyti...

Cancer, 1983

Mesenchymal chondrosarcoma of bone and soft tissues treated at the Istituto Ortopedico Rizzoli are reviewed. The skeletal locations were prominent in five cases. Only two cases were in the soft tissues. Radiographic picture in the bone shows an aggressive osteolysis, with soft tissues invasion. Histologic picture is the same in bone and soft tissues, and is highly distinctive: islands of well-differentiated chondrosarcoma embedded in undifferentiated mesenchymal cells with high malignancy characteristics. The cases showed a poor prognosis, and no patient survived more than four years.

Journal of Oral and Maxillofacial Surgery, 1987

Cancer, 1973

2020

A 15-year-old boy reported a 2-month history of severe left thigh pain Physical examination revealed left thigh swelling measuring 6x5 cm. X-ray of the region showed mixed lytic and sclerotic lesion involving the femoral head and neck. A Computed Tomography scan showed mixed lytic and sclerotic lesion involving the femoral head and neck with cortical irregularity and mild periosteal reaction with associated soft tissue in the anterior aspect. Magnetic resonance imaging demonstrated heterogeneous signal intensity lesion with areas of sclerosis involving the femoral head and neck. The large associated soft tissue in the anterior aspect appears predominantly hyperintense on T2W images. On post-contrast axial and sagittal images, heterogeneous enhancement with areas of necrosis involving soft tissue was seen. A presumptive radiological differential diagnosis of Ewing Sarcoma and Osteosarcoma was made. However, on histopathology, it was a case of mesenchymal chondrosarcoma.

Current Problems in Diagnostic Radiology, 2020

Although rare in everyday practice, malignancies that classically arise from bone or cartilage have been reported to arise de novo in various soft tissues in the body, resulting in a diagnostic challenge for the clinician, radiologist, and pathologist. Differential diagnoses of bone tumors often depend on anatomic location of the lesion. For example, the classic location of osteosarcoma is in the metaphysis of long bones about the knee. Histologically osteosarcoma is characterized by tumor cells that directly produce osteoid, bone, or cartilaginous matrix. In extraskeletal osteosarcoma, the clinical and radiologic picture is very different from a conventional osteosarcoma. They occur in older patients, present as a soft tissue mass often coincidentally following trauma and have a worse prognosis. The imaging characteristics are often nonspecific with mineralized elements in a welldefined soft tissue mass. The mineralized elements may or may not be visible. Magnetic Resonance sequences demonstrate a well circumscribed soft tissue mass with hemorrhagic and enhancing solid components. The pathologic features of extraskeletal osteosarcoma on a microscopic scale are identical to that of skeletal lesions. Likewise, conventional chondrosarcomas present in older patients with a growing, painful soft tissue prominence most commonly involving the long tubular bones. In extraskeletal chondrosarcoma however, the presentation is in somewhat younger patients with a painful soft tissue prominence typically in the head (meninges), neck, or upper leg. The pathologic features are most often that of a myxoid chondrosarcoma which is characterized by strands of small cells over a myxoid matrix. Imaging features include chondroid matrix, heterogenous contrast enhancement, and amorphous internal calcification on Computed Tomography. On Magnetic Resonance sequences the matrix has a low signal on all sequences, and variable inhomogeneity depending on grade of the lesion. Other extraskeletal bone tumors include Ewing's sarcoma and osteoid osteoma amongst other lesions. Although these malignancies may be rare clinical entities, they often exhibit characteristic clinical, imaging, and histopathological findings although differing in treatment and prognosis. Knowledge of these and other common mimicking lesions will help guide the clinician and radiologist to make an accurate diagnosis.

Skeletal Radiology, 2006

Journal of the Chinese Medical Association, 2009

Background: To identify the different and identical features of 2 tumors with similar pathologic findings, chondroblastic osteosarcoma (OGS) and chondrosarcoma (CSA), with highlights on radiography and magnetic resonance imaging (MRI). Methods: Ten patients with chondroblastic OGS and 10 patients with CSA were enrolled. After recording the tumor location, tumor morphology was evaluated for patterns of bony destruction, visible tumor matrix, and aggressive periosteal reactions, endosteal scalloping, cortical expansion, cortical breakthrough and pathologic fracture by radiographic analysis. Signal intensity changes, enhancement pattern, and tumor extensions were evaluated by MRI. Results: The mean patient ages were 24.7 and 56.7 years in patients with chondroblastic OGS and CSA, respectively (p = 0.001). Tumor occurrence was detected in the appendicular bones in 8 chondroblastic OGS and 3 CSA. Three chondroblastic OGS occurred around the knee (p = 0.003). In addition, there were 6 tumors arising from the metaphysis and 2 arising from the diaphysis in chondroblastic OGS patients. In CSA patients, 1 tumor arose in the metaphysis, 1 in the diaphysis, and 1 in the epiphysis (p = 0.039). On radiographs, visible bone-forming tumor matrix was present in 8 chondroblastic OGS, and coexistence of bone-and cartilage-forming patterns were detected in 2. Visible cartilage-forming tumor matrix was present in 7 CSA, and atypical radiodensity patterns were detected in 2 (p < 0.001). Aggressive periosteal reaction was present in 7 chondroblastic OGS, and non-aggressive periosteal reaction was found in 1 CSA (p = 0.008). MRI revealed the presence of a lobular structure of high signal intensity on T2-weighted images, and peripheral rim and septal enhancement pattern was noted in 2 chondroblastic OGS and 10 CSA patients. Inhomogeneous and marginal enhancement patterns were noted in 6 and 2 chondroblastic OGS, respectively (p = 0.001). Conclusion: Metaphysis origin, bone-forming tumor matrix, aggressive periosteal reaction, and young patient age favored chondroblastic OGS. Some chondroblastic OGS showed radiologic and MRI appearances that were typical of CSA. [J Chin Med Assoc 2009;72(2):76-82]

Medical Journal of Indonesia, 2001

Skeletal Radiology, 2002