Mesenchymal chondrosarcoma of bone and soft tissue. A review of 111 cases

Chondrosarcoma Variants

This article presents a review of chondrosarcoma variants, with a focus on the extraordinarily rare variants of chondrosarcoma in which hyaline cartilage is not the dominant feature. Discussed are the differential diagnoses for these neoplasms, radiologic studies, gross and microscopic features, and prognosis. Summaries are provided of the key features for the major variants.

Mesenchymal Chondrosarcoma: Clinicopathologic Study of 20 Cases

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, osteolytic lesions with extraosseous extension. Typical histologic features were identified consisting of small, round or spindled cells, interspersed with hyaline cartilage islands. Seventeen patients (85%) were treated surgically, and 8 patients (40%) received adjuvant treatment. Seven patients (35%) were living at last follow-up, 1.8 to 12.5 years after diagnosis, and 8 patients (40%) died between 1.2 and 21.8 years after diagnosis.

Conclusions.—Mesenchymal chondrosarcoma presents multiple challenges. Diagnostic pitfalls include inadequate biopsy samples, which may result in sample error. Sox9 has been proposed as a unique marker for mesenchymal chondrosarcoma which may improve diagnostic specificity. Treatment and prognosis vary considerably. Patients who receive surgery and chemotherapy seem to fare better. Multicenter studies with higher sample numbers may improve our understanding of this malignancy.

Cytomorphology of intraparenchymal mesenchymal chondrosarcoma in frontal lobe: report of a case

lntracranial mesenchymal chondrosarcomas (MC) and especially those that originate in brain parenchyma, are rare. A diagnosis of MC can be challenging to make on squash cytology. We describe cytomoprhology of solid cystic extraskeletal intraparenchymal MC in a 22-year-old male. The tumor was located in left frontal lobe. Cytology results demonstrated oval-to-spindled cells with high nuclear-to-cytoplasmic ratios. Cells showed perivascular arrangement. Small foci of basophilic extracellular matrix with scattered malignant chondroid component were also seen. Histologic examination of lesion demonstrated biphasic tumor, with prominent small cell population and focal atypical cartilage. Whole body survey of the patient was performed and no other extracrainal lesion was identified in the patient. The patient developed recurrence within 2 months. To the best of authors' knowledge this is the first case report describing cytomorphology of intraparenchymal MC. We discuss the differential diagnosis in light of relevant literature.

Imaging of primary malignant bone tumors (nonhematological)

Primary malignant bone tumors are uncommon and are diagnosed typically based on radiographic and microscopic findings combined with clinical and demographic features. CT and MR imaging scans are useful in further staging the tumors by determining intraosseous and extraosseous spread.

Mesenchymal chondrosarcoma of the cervical spine: A case report

Mesenchymal chondrosarcoma (MCS) is a rare tumour accounting for less than 1% of all chondrosarcomas. We report here, the case of a 30-year-old female who presented with neck pain, weakness and tingling and numbness starting on the right side and later involving all four limbs. MRI revealed an ill-defined neoplastic lesion showing specks of calcification and arising from the right half of C2 and C3 cervical vertebrae. Microscopy showed an admixture of well differentiated cartilage showing focal calcification and spindly cell areas having a hemangiopericytomatous pattern.

Pathobiology of selected tumors of the base of the skull

Skull base surgery is a new subspeciality, and, up to this point, most articles on this subject have focused on innovative operative-reconstructive approaches to tumors in this region. It is now important that we embark on a new era, the era of tumor biology, and concentrate on new ways of evaluating these neoplasms from a pathologic viewpoint. The hematoxylin-cosin section is no longer an end point, but just a beginning. This is the age of molecular biology. It is important that these tumors be evaluated, either prospectively or retrospectively, employing immunohistochemical staining, flow cytometry, oncogene expression, cytogenetics, or other techniques in order to identify important prognostic features. Data from these additional studies may then be used to develop new treatment strategies. Skull base societies should develop protocols for one or more of these tumors to ensure that they are indeed evaluated uniformly. In this article I emphasize the importance of accurate histologic classification or subclassification of these neoplasms and focus on contemporary parameters that may or may not impact on prognosis.

Diffusion-weighted magnetic resonance imaging for the evaluation of musculoskeletal tumors

Conventional MR imaging provides low specificity in the differential diagnosis of musculoskeletal (MSK) tumors and is unable to offer information about the extent of tumoral necrosis and the presence of viable cells, information crucial to assess treatment response and prognosis. Therefore, diffusion-weighted imaging (DWI) is now used with conventional MR imaging to improve diagnostic accuracy and treatment evaluation. This article discusses the technical aspects of DWI, particularly the quantitative and qualitative interpretation of images in MSK tumors. The clinical application of DWI for tumor detection, characterization, differentiation of tumor tissue from others, and assessment of treatment response are emphasized.

Chondrosarcoma: with updates on molecular genetics

Chondrosarcoma (CHS) is a malignant cartilage-forming tumor and usually occurs within the medullary canal of long bones and pelvic bones. Based on the morphologic feature alone, a correct diangosis of CHS may be difficult, Therefore, correlation of radiological and clinicopathological features is mandatory in the diagnosis of CHS. The prognosis of CHS is closely related to histologic grading, however, histologic grading may be subjective with high inter-observer variability. In this paper, we present histologic grading system and clinicopathological and radiological findings of conventional CHS. Subtypes of CHSs, such as dedifferentiated, mesenchymal, and clear cell CHSs are also presented. In addition, we introduce updated cytogenetic and molecular genetic findings to expand our understanding of CHS biology. New markers of cell differentiation, proliferation, and cell signaling might offer important therapeutic and prognostic information in near future.

Sacral mesenchymal chondrosarcoma in childhood: a case report and review of the literature

Mesenchymal chondrosarcomas are rare malignant tumors in pediatric age group. The authors present a case of mesenchymal chondrosarcoma located in the sacrum in a 10-year-old-girl that was successfully treated with chemotherapy and radiotherapy after surgical excision. According to the authors' literature search, the patient is the first reported case of pediatric sacral primary mesenchymal chondrosarcoma. Mesenchymal chondrosarcoma cases in pediatric age group published in English literature was reviewed.

Primary mesenchymal chondrosarcoma of the pancreas

Extraskeletal chondrosarcomas are rare and there is only one reported case of primary pancreatic chondrosarcoma. We report the case of a 34-year-old woman with a 6-month history of abdominal pain and distention. Radiological studies indicated a mass in the pancreas, and exploratory laparotomy revealed a tumour of the pancreas extending to the hepatic vessels and hepatoduodenal ligament. The mass was completely excised, and the histopathological diagnosis was primary mesenchymal pancreatic chondrosarcoma. Tumour recurred at follow-up 52 months postoperatively.

Mesenchymal chondrosarcoma of the orbit: a unique radiologic-pathologic correlation

PURPOSE

To report a unique radiologic-histopathologic correlation of mesenchymal chondrosarcoma of the orbit in a 24-year-old Asian woman.

METHODS

Clinicopathologic case review.

RESULTS

The patient was examined for left-sided proptosis of several months' duration. CT showed a left orbital mass depicting a central radiolucent, nonenhancing component, and a denser peripheral enhancing portion. Histopathologic examination of the orbital mass showed a biphasic pattern of a mesenchymal chondrosarcoma exhibiting features of a high-grade sarcoma with hemangiopericytoma pattern that corresponds to the radiopaque portion of the mass and areas of chondrosarcoma that correlated with the radiolucent component of the tumor. The patient underwent exenteration of the left orbit followed by radiotherapy and chemotherapy. The last follow-up (8 years, 1 month) disclosed no evidence of recurrence or metastatic disease.

CONCLUSIONS

In this case, a unique CT-histopathologic correlation of the mass was established. The authors believe that recognizing the different radiologic features of the orbital tumor can help clinicians in establishing the correct preoperative diagnosis of this potentially lethal neoplasm. To the best of the authors' knowledge, this diagnostic correlation has not been previously reported.

Mesenchymal chondrosarcoma of the orbit: an unusual site for a rare tumour

Mesenchymal chondrosarcoma is a rare tumour with orbital involvement being an exceptional occurrence. We present a case of a 22-year old man with such disease, together with details of his management. A brief literature review of this uncommon tumour was also enclosed.

The role of the plain radiograph in the characterisation of soft tissue tumours

A radiograph is often the first investigation to be requested when a patient presents with limb pain or a mass. Whilst we do not advocate that this is the only investigation to be employed in the evaluation of such patients, a working knowledge of the variety of abnormal findings that can present in the soft tissues on radiographs remains useful. We reviewed the radiographic findings of soft tissue masses from a prospectively compiled database of all such lesions presenting to a specialist orthopaedic oncology service over the past 8 years. Of the cohort of 1,058 individuals with a proven soft tissue tumour, 454 had had a radiograph taken of the affected area. Of these, 281 (62%) patients had a positive radiographic finding. The most common findings were a visible soft tissue mass (n = 141), the presence of calcification (n = 76), fat (n = 32) and evidence of bone involvement (n = 62). More than one finding was sometimes present in the same patient. These findings were present in both benign and malignant tumours. This review article describes the incidence and diagnostic relevance of these plain film findings for suspected soft tissue tumours.

Efficacy of weekly docetaxel and bevacizumab in mesenchymal chondrosarcoma: a new theranostic method combining xenografted biopsies with a mathematical model

The paucity of clinical treatment data on rare tumors, such as mesenchymal chondrosarcoma (MCS), emphasizes the need in theranostic tools for these diseases. We put forward and validated a new theranostic method, combining tumor xenografts and mathematical models, and used it to suggest an improved treatment schedule for a particular MCS patient. Growth curves and gene expression analysis of xenografts, derived from a patient's lung metastasis, served for creating a mathematical model of MCS progression and adapting it to the xenograft setting. The pharmacokinetics and pharmacodynamics of six drugs were modeled, with model variables being adjusted by patient-specific chemosensitivity tests. The xenografted animals were treated by various monotherapy and combination schedules, and the MCS xenograft model was computer simulated under the same treatment scenario. The mathematical model for xenograft growth was then up-scaled to retrieve the MCS patient's tumor progression under different treatment schedules. An average accuracy of 87.1% was obtained when comparing model predictions with the observed tumor growth inhibition in the xenografted animals. Simulation results suggested that a regimen containing bevacizumab applied i.v. in combination with once-weekly docetaxel would be more efficacious in the MCS patient than all other simulated schedules. Weekly docetaxel in the patient resulted in stable metastatic disease and relief of pancytopenia due to tumor infiltration. We suggest that the advantage of weekly docetaxel on the triweekly regimen is directly related to the angiogenesis rate of the tumor. Further validation of this conclusion, and the theranostic method we provide, may facilitate personalization of solid cancer pharmacotherapy.

Mesenchymal chondrosarcoma of soft tissues and bone in children, adolescents, and young adults: experiences of the CWS and COSS study groups

BACKGROUND

Mesenchymal chondrosarcoma (MCS) is a rare tumor with a strong tendency toward late recurrences leading to reported 10-year survival rates below 50%. The recommended treatment is resection with wide margins; the effectiveness of chemo- and radiotherapy remain poorly defined. As reports about MCS in young patients are scarce, treatment and outcomes of children/adolescents/young adults in the CWS and COSS studies were investigated.

METHODS

Since 1977, 15 of >7000 CWS and COSS patients <or=25 years had a confirmed diagnosis of MCS.

RESULTS

The median age was 16.6 (range, 1-25) and median follow-up 9.6 years (range, 1-22). Four MCS were osseous and 11 extraosseous. All but 1 patient had nonmetastatic disease. Tumor sites were head/neck (n = 6), paravertebral (n = 3), pelvis (n = 3), limbs (n = 2), and kidney (n = 1). All tumors were resected, but only 8 completely. Thirteen individuals received chemotherapy, 6 were irradiated. Actuarial 10-year event-free and overall survival rates were 53% and 67%, respectively. Four recurrences occurred, all within 4 years from diagnosis (3 local, 1 combined; 2 of these in irradiated patients). One of these patients survived after surgery and radiation for local recurrence. Seven of 8 patients whose tumors were completely resected during primary treatment, but only 4 of 7 patients with incomplete surgery survived disease-free.

CONCLUSIONS

This series of 15 MCS differs from others: the median age was young, most tumors were extraosseous, most patients received chemotherapy, and the outcome was better than published. Despite long-term follow-up, characteristic late metastatic recurrences were not observed. Treating MCS according to standard multimodal soft tissue/bone sarcoma regimens is proposed.

Congenital intracranial mesenchymal chondrosarcoma: case report and review of the literature in pediatric patients

In this paper we report the 1st case of a congenital intracranial mesenchymal chondrosarcoma in a 2-month-old infant, apparently present at birth. A magnetic resonance image showed a large left parietal solid mass, while microscopy revealed a mixture of undifferentiated small cells and mature hyaline cartilage islands, positive for vimentin, S-100, and CD99. A surgical excision was performed but the patient died after a few weeks as a result of a rapid relapse of the tumor. We also review the pediatric cases (in patients less than 20 years old) of extraskeletal (intracranial) mesenchymal chondrosarcomas of the literature, with a focus on the most recent cytogenetic and immunohistochemical studies.

Mesenchymal chondrosarcoma of the orbit: a report of two cases and review of the literature

Mesenchymal chondrosarcoma, an uncommon lesion in bone and extraskeletal tissue, is extremely rare in the orbit. Two cases of orbital mesenchymal chondrosarcoma in young adults presenting with proptosis and diminution of vision are reported. The diagnosis was established by histopathological examination in both cases, which showed undifferentiated mesenchymal cells with islands of cartilage. Both patients underwent exenteration followed by chemotherapy and radiation therapy and are alive with healthy orbits after two years of follow-up.

Primary extraskeletal mesenchymal chondrosarcoma arising from the pancreas

We report here on a case of primary extraskeletal mesenchymal chondrosarcoma that arose from the pancreas. A 41-year-old man was evaluated by CT to find the cause of his abdominal pain. The CT scans showed a heterogeneously enhancing necrotic mass with numerous areas of coarse calcification, and this was located in the left side of the retroperitoneal space and involved the body and tail of the pancreas. Portal venography via the celiac axis also showed invasion of the splenic vein. Following excision of the mass, it was pathologically confirmed to be primary extraskeletal mesenchymal chondrosarcoma that arose from the pancreas.

Primary orbital mesenchymal chondrosarcoma: a case report and literature review

BACKGROUND

Mesenchymal chondrosarcoma (MC) is a subtype of chondrosarcoma, with an incidence varying from 1 to 8% of all chondrosarcomas. It is an aggressive neoplasm with a high tendency for late recurrence and occasional delayed distant metastasis. Orbital MC is very rare, and only approximately 30 cases have been described in the literature. We describe here one case of primary orbital MC.

CASE REPORT

A 14-year-old boy without a past medical history presented with a 1-month history of progressive proptosis on the right eye. Computed tomography (CT) scans of the orbit revealed a right intraconic lesion, with areas of calcification. The lesion was excised. Histopathological analysis revealed that the tumor had a biphasic pattern, showing a combination of small cell malignancy and well-differentiated cartilage. Immunohistochemistry examination revealed a diffuse membrane expression of CD99 on the small cell malignancy; S-100 was positive only within the cartilage component. The patient received chemotherapy, and no metastatic disease was found at the 2-month follow-up.

CONCLUSION

Although rare, MC should be considered in the differential diagnosis of a well-circumscribed orbital lesion in young adults, especially when CT scans reveal areas of calcification within the tumor.

Primary retroperitoneal extraskeletal mesenchymal chondrosarcoma: a computed tomography diagnosis

Mesenchymal chondrosarcomas, although very rare compared with conventional chondrosarcomas, are one of the few primary malignant tumours of bone that sometimes also arise in the soft tissues. Here we present a rare case of retroperitoneal extraskeletal mesenchymal chondrosarcoma (ESMC) in a 50-year-old female that showed characteristic extensive calcification. In this report, we discuss CT features of ESMC with pathological correlation.

Retroperitoneal mesenchymal chondrosarcoma mimicking a large retroperitoneal sacral schwannoma

We report a case of retroperitoneal chondrosarcoma in which preoperative radiological study induced to a possible diagnosis of sacral schwannoma. A 25-year-old woman was admitted to our neurosurgical institute for a progressive sciatic pain with gait difficulties with a sudden radicular deficit with right positive Lasegue's sign at 30 degrees, loss of Achilles reflex, sensory deficit on right S1 dermatome, and complete motor deficit of right plantar flexion. We performed an en bloc removal of the lesion via an anterior retroperitoneal approach. We believe that the treatment of choice is radical surgical excision of the tumor with complete en-bloc removal of the lesion; postoperative radiotherapy and chemotherapy should be valuated case by case.

Extraskeletal mesenchymal chondrosarcoma of the cervical meninx

We report a case of recurrent mesenchymal chondrosarcoma in the cervical paravertebral region that was diagnosed preoperatively by imaging studies. The tumor showed findings of a well-differentiated cartilaginous tumor with a characteristic pattern of calcifications on computed tomography (CT). However, it appeared as a soft tissue sarcoma of lower intensity than common cartilaginous tumors on T2-weighted magnetic resonance imaging (MRI). This discrepancy between CT and MRI was well correlated with pathological findings of mesenchymal chondrosarcoma and suggested this entity.

Mesenchymal chondrosarcoma of the head and neck

Mesenchymal chondrosarcoma of the head and neck is an uncommon tumor with a potential for exhibiting highly aggressive behavior. When these tumors arise in the head and neck region, they appear to have a predilection for the maxillofacial skeleton; less often, they may involve other soft tissue sites in the head and neck. The diagnosis is challenging and may be assisted by molecular pathologic techniques when only limited tissue is available for analysis. Management is primarily surgical. Although adjuvant radiation appears to convey some benefit by reducing tumor bulk when these lesions have extended beyond bony confines, there is no evidence to suggest that this is associated with improved outcome. Chemotherapy does not appear to be effective in the limited experience documented thus far. Patients with complete local control following resection should be followed closely for development of distant metastasis, which signifies a worse clinical outcome. Future effective therapy may be found in the identification of molecular targets responsive to adjuvant chemotherapy or biologic modifiers.

Extraskeletal mesenchymal chondrosarcoma of the forearm: a case report

Mesenchymal chondrosarcomas represent less than 10% of all chondrosarcomas. The majority of these tumors arise from the skeleton; only 22% have an extraosseous origin. Of the extraskeletal locations, the meninges, brain, and thigh are the most common. Involvement of the forearm is a rare occurrence. This case report describes an extraskeletal mesenchymal chondrosarcoma involving the forearm.

[Spheno-orbital mesenchymal chondrosarcoma. A case report]

Mesenchymal chondrosarcoma is a highly malignant and extremely rare tumor of the orbit: only 18 cases have been reported to date. We report a case of spheno-orbital mesenchymal chondrosarcoma in a 36-year-old woman presented with a 4-month history of progressive left exophthalmia and temporal mass. A CT-scan of the orbit and MRI showed a spheno-orbital mass, with temporal fossa extension, fed by the internal maxillary artery visible on cerebral angiography. Surgery via a transcranial, left frontotemporozygomatic approach after selective embolization enabled subtotal removal. Definitive histologic examination revealed mesenchymal chondrosarcoma. Postoperatively, exophthalmia spectacularly regressed. We report our clinical findings and present a review of the literature.

Small Round Cell Tumors of Bone

Context.—Primary small round cell tumors of the bone are a heterogeneous group of malignant neoplasms presenting predominantly in children and adolescents. They include Ewing sarcoma/peripheral neuroectodermal tumor or Ewing family tumors, lymphoma, mesenchymal chondrosarcoma, and small cell osteosarcoma. Even though they share many morphological similarities, their unique biological and genetic characteristics have provided substantial insights into the pathology of these diverse neoplasms.

Objective.—To provide an overview of the clinical, radiologic, pathologic, and genetic characteristics of these tumors along with a pertinent review of the literature.

Data Sources.—A literature search using PubMed and Ovid MEDLINE was performed, and data were obtained from various articles pertaining to clinicopathologic, biological, and genetic findings in these tumors. Additionally, findings from rare cases have been included from author's subspecialty experience.

Conclusion.—The diagnosis of small round cell tumors can be made accurately by applying clinicopathologic criteria, as well as a panel of immunohistochemical and genetic studies in appropriate cases. Molecular genetic studies may provide further insight into the biology, histogenesis, and prognosis of these tumors.

Mesenchymal chondrosarcoma of the orbit

PURPOSE

To describe a patient with mesenchymal chondrosarcoma of the orbit, review clinical and imaging findings, and refine the differential diagnosis from other tumors of the orbit.

METHODS

Interventional case report and literature review.

RESULTS

A 21-year-old woman with a 6-month history of progressive proptosis presented with left-sided visual loss of recent onset. CT revealed a clearly outlined heterogeneous mass with calcified foci, whereas MRI showed an isointense signal to gray matter on T1- and T2-weighted images. The patient was diagnosed with mesenchymal chondrosarcoma of the orbit only after orbitotomy and subsequent histopathologic study. After surgery, she received adjuvant therapy with irradiation of the orbit.

CONCLUSIONS

Mesenchymal chondrosarcoma is a rare malignant tumor of the orbit capable of mimicking several other lesions. Early diagnosis requires a high level of suspicion, particularly with regard to internally calcified lesions. The treatment of choice is complete surgical resection, or, when the tumor is not resectable or residual mass is present after surgery, chemotherapy and radiotherapy. Prognosis for patients with orbital mesenchymal chondrosarcoma is tentative at best, in part because of the rarity of the lesion.

[Cartilage tumours of the bone. Diagnosis and therapy]

Primary malignant bone tumours are rare. The annual incidence of these tumours is 10 per 1 million. Nearly 30% of the primary malignant bone tumours are malignant cartilage tumours. The frequency of benign cartilage tumours cannot be definitely estimated because these tumours are normally clinically inapparent and therefore often diagnosed as an incidental finding. The cartilage tumours appear as benign lesions (e.g. chondroma), as borderline tumours (proliferative chondroma vs grade I chondrosarcoma) or as highly malignant chondrosarcoma (e.g. dedifferentiated chondrosarcoma). Commensurate with the different clinical and oncological manifestations of the cartilage tumours, there are wide differences in the treatment and clinical course of the individual tumour. This article discusses the problems in the diagnosis and treatment of cartilage tumours from an orthopaedic point of view.

Extraskeletal mesenchymal chondrosarcoma of the kidney

A 61-year-old woman was referred for evaluation of an incidental mass found on the right kidney. Abdominal ultrasonography and computed tomography showed a 3-cm tumor with calcification and peripheral enhancement. Under the diagnosis of renal cell carcinoma, a transabdominal right radical nephrectomy was performed. The pathological diagnosis was extraskeletal mesenchymal chondrosarcoma of the kidney. No recurrence or metastasis occurred during a 6-year follow up. Primary renal chondrosarcoma is extremely rare, this being only the fifth case reported in the English literature, and the patient's extended survival is attributed to the small size of the tumor, as well as early diagnosis and treatment.

Femoral mesenchymal chondrosarcoma with secondary aneurysmal bone cysts mimicking a small-cell osteosarcoma

Mesenchymal chondrosarcoma is a rare but aggressive, high-grade malignancy of primitive cartilage-forming mesenchyme that arises most commonly from skeletal sites. Although there are radiological findings suggestive of the diagnosis, imaging features often overlap with those of other skeletal sarcomas. The definitive diagnosis relies on the histological finding of a typical bimorphic appearance, consisting of nests of small, round, poorly differentiated cells and more mature cartilaginous tissue. To highlight this, we present the case of a 21-year-old man who was referred to our institution with a history of right knee pain. Initial imaging and histological evaluation of a core biopsy of the lesion suggested osteosarcoma of the distal right femur; after review, however, the correct diagnosis of mesenchymal chondrosarcoma was made. Adequate tissue sampling and thorough histological evaluation of biopsy specimens is vital for the accurate diagnosis of primary bone malignancies, especially those of chondroid origin.

Primary intradural myxoid chondrosarcoma: a case report and review in the literature

OBJECTIVE AND IMPORTANCE

Chondrosarcomas are extremely rare cartilaginous tumours that typically usually are associated with bone. Therapeutic experience with primary spinal mesenchymal chondrosarcomas is also extremely limited. The exact origin of rare intradural spinal chondrosarcomas remains obscure. We report the first case in the literature of a primary intradural myxoid chondrosarcoma.

CLINICAL PRESENTATION

This 40-year-old man experienced a 3 month history with back pain. The results of his neurological examination were normal. Magnetic resonance imaging (MRI)demonstrated at the T12 level intradural tumour. We could not identify this lesion as chondrosarcoma in preoperative period.

INTERVENTION

At surgery, a mass found attached solely to pia mater, with a normal arachnoid and dura mater overlying was seen. The mass was excised completely and microscopic examination identified a myxomatous chondrosarcoma. The postoperative course was unremarkable. But a histological examination revealed primary myxoid chondrosarcoma. Experience with primary spinal mesenchymal chondrosarcomas is also extremely limited. We especially discussed to the histological examination.

CONCLUSION

The differential diagnosis considered in the present case included meningioma, plasmacytoma, and non-neoplastic intradural spinal cord lesion. We emphasize the benefit of surgical resection without radiotherapy and/or chemotherapy. This case presents the first case in the literature of an primary spinal intradural myxoid chondrosarcoma.

Extraskeletal mesenchymal chondrosarcoma: an imaging review of ten new patients

OBJECTIVE

Extraskeletal mesenchymal chondrosarcoma (EMC) is a rare soft-tissue tumor that most arises in young adults. Because of its rarity, few imaging studies have been reported to date. The purpose of this study was to elucidate the imaging features of this tumor.

DESIGN

We conducted a multi-institutional study in cooperation with five referral cancer centers in Japan. Imaging findings of ten new EMC cases, including conventional radiography, computed tomography (CT), and magnetic resonance imaging (MRI), performed at each institute, were reviewed along with clinical features.

PATIENTS

Ten patients with EMC, who had been treated at each hospital from 1990 to 2001, participated in this study.

RESULTS AND CONCLUSIONS

Soft-tissue masses with well-demarcated, dense and granular calcification were most frequently observed on plain radiographs and CT scans. T2-weighted MR images most clearly depicted a two-component structure composed of calcified and uncalcified areas, and enhanced MRI showed inhomogeneous enhancement in both areas. Although the sensitivity and specificity of these findings are unknown, they might be characteristic and have diagnostic value for this rare tumor.

Knorpelbildende Tumoren

Primary cartilage-forming tumors of the bone are a large group among the rare bone tumors. The clinical and radiographic findings of the different entities show similar findings. Bone biopsy is still the most relevant examination in the final diagnosis of the lesion. The requirements for a correct biopsy and the main features of the macroscopic and histologic findings of cartilage tumors are presented from the viewpoint of the pathologist. Differentiation between benign enchondroma and grade I chondrosarcoma requires close interdisciplinary cooperation to avoid over-treatment and relapse. Rare low-grade malignant cartilage tumors such as clear-cell chondrosarcoma need to be diagnosed in specialized centres to arrive at the correct therapy. The morphologic features of mesenchymal chondrosarcoma, clear-cell chondrosarcoma and secondary chondrosarcoma in osteochondroma are demonstrated. The aim is to correlate the morphologic and radiographic features. The same applies to benign entities such as osteochondroma, chondroblastoma and chondromyxoid fibroma.

Type II collagen as specific marker for mesenchymal chondrosarcomas compared to other small cell sarcomas of the skeleton

Mesenchymal chondrosarcoma is a rare, usually highly malignant chondrogenic neoplasm. The diagnosis of mesenchymal chondrosarcoma can be challenging, it nonetheless has important therapeutic and diagnostic implications. Thus, biopsies of mesenchymal chondrosarcomas without conspicuous cartilaginous differentiation cannot be safely distinguished from other small cell mesenchymal neoplasms such as Ewing's sarcoma and peripheral neuroendrocrine tumors, synovial sarcomas and hemangiopericytomas, because all of these neoplasms might show overlapping histological features, and so far, there have been no safe immunohistochemical markers available in order to differentiate these neoplasms. In our study on a large series of mesenchymal chondrosarcomas (n=30) and other small cell sarcomas (Ewing's sarcomas (n=12), synovial sarcomas (n=6), hemangiopericytomas (n=5), small cell osteosarcomas (n=3), and desmoplastic small round cell tumors (n=1)), we could establish the presence of type II collagen in the extracellular tumor matrix of the small cell areas of mesenchymal chondrosarcomas as a specific and sensitive marker to identify mesenchymal chondrosarcomas and to exclude other small cell neoplasms (except chondroblastic areas in small cell osteosarcomas). In contrast, the S-100 protein was less sensitive and vimentin and total collagen content unspecific for discriminating these neoplasms. Thus, the presence of type II collagen in the extracellular tumor matrix significantly facilitates the diagnosis of mesenchymal chondrosarcomas in the absence of histologically visible chondroid matrix formation.

Cutaneous extraskeletal mesenchymal chondrosarcoma in a cat

A 4-year-old, male cat was presented with a fixed, subcutaneous mass in the lumbosacral region. A histopathological examination revealed a well-defined but nonencapsulated neoplasm characterized by a proliferation of predominantly spindle cells, with high mitotic activity. Interspersed between these cells were single cellular elements with chondroid differentiation. Large areas of cartilaginous tissue with foci of endochondral ossification, necrosis and myxoid tissue were also observed within the neoplastic parenchyma. A diagnosis of extraskeletal mesenchymal chondrosarcoma was made based on the histological pattern - characterized by the coexistence of cartilaginous islands and undifferentiated mesenchymal cells, results of Alcian blue staining at various pH, immunohistochemical reactivity against vimentin and S-100, and the absence of skeletal involvement or other primary tumour sites. Clinical history of the cat excluded traumas, vaccinations or other types of subcutaneous inoculation. Six months on from surgical treatment, neither recurrence nor metastases have been detected.

Trisomy 8 as the sole cytogenetic abnormality in a case of extraskeletal mesenchymal chondrosarcoma

Mesenchymal chondrosarcoma is a rare malignant tumor that comprises about 3-10% of all sarcomas. Reports of cytogenetic studies of mesenchymal chondrosarcoma are limited and no consistent cytogenetic abnormality has surfaced. Some mesenchymal chondrosarcomas have a t(11;22) translocation suggesting a relationship with the PNET/Ewing tumor family. We report what to our knowledge is the first case of trisomy 8 as the sole cytogenetic abnormality in a mesenchymal chondrosarcoma.