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

Mesenchymal chondrosarcoma of the thyroid - a rare tumour at an unusual site

We describe the light microscopic, immunohistochemical and ultrastructural features of the first case in the literature of a primary mesenchymal chondrosarcoma (MC) of the thyroid and discuss its differential diagnosis at unusual extraskeletal sites. A nodular lesion of the thyroid with no evidence of extrathyroid disease showed the bimorphic pattern and haemangiopericytoma-like areas typical of MC. In the undifferentiated areas, the cells were CD99 positive/CD117 negative, while the stroma showed focal positivity for alpha-inhibin. In spite of its rarity, it is important to diagnose primary mesenchymal chondrosarcoma in a parenchymatous organ such as the thyroid because its biological behaviour may be different from that of tumours of similar morphology and complete resection is the treatment of choice. The patient is free of disease nearly 66 months after its first presentation. Cytogenetic and immunohistological markers may play important roles in diagnosis of this lesion in future, especially with limited tissue samplings; however, for the present a thorough sampling of the tumour remains the best diagnostic strategy.

[Extraskeletal mesenchymal chondrosarcoma: a case report and review of the literature]

We report a new case of mesenchymal chondrosarcoma in a 25-Year-old woman who presented a tumefaction of the anteromedial aspect of the mid left leg which had developed over two Years. Computed tomography of the lower left limb demonstrated the presence of a soft tIssue tumor limited to the gastrocnemus medial. The 7.5 x 5 cm tumor was centered on a zone of calcification. Histological examination confirmed the diagnosis of malignant mesenchymatous proliferation with two components: a well differentiated cartilaginous component and a totally undifferentiated component. Surgical resection was performed but tumor recurrence was observed in the popliteal fossa as well as a pulmonary metastasis with a unique parenchymal nodule. Amputation of the left lower limb and metastasectomy were performed. At last follow-up, the patient presented permeation nodules on the scalp.

Mesenchymal chondrosarcoma: an immunohistochemical study of 10 cases examining prognostic significance of proliferative activity and cellular differentiation

AIMS

Mesenchymal chondrosarcoma is a rare malignant chondrogenic neoplasm that tends to affect young adults and teenagers. The prognosis is unpredictable, and the identification of prognostic markers that could aid in determining the behaviour of this tumour would be helpful. There are few studies in the literature that have attempted to address this issue.

METHODS AND RESULTS

In this study, we explored the prognostic significance of three different parameters: (1) tissue morphology of small cell areas, (2) the expression of tumour differentiation marker genes, and (3) the proliferation rate. Our results did not show a correlation of prognosis with the histological features of the neoplastic small cell areas or the expression of tumour differentiation genes. However, the proliferative activity of the tumour cells appeared to have some prognostic significance as related to patient survival.

CONCLUSION

Mesenchymal chondrosarcoma is a rare tumour with a wide clinical range of behaviour. Therefore, it is difficult to obtain reliable prognostic parameters. Nevertheless, our study suggests that proliferative activity may be a useful prognostic parameter for mesenchymal chondrosarcomas.

Congenital mesenchymal chondrosarcoma of the orbit

PURPOSE

To report the first case of congenital extraskeletal mesenchymal chondrosarcoma arising in the orbit.

DESIGN

Interventional case report and review of the literature.

METHODS

Ophthalmologic examination and computed tomography scan of the orbit were performed. Histologic and histochemical examination and immunohistochemistry of the biopsy specimen were evaluated.

MAIN OUTCOME MEASURES

Ocular and systemic disease control.

RESULTS

A 5-month-old girl was seen with a papillomatous lesion in the right lower tarsal conjunctiva present from birth. Histologic examination demonstrated an admixture of undifferentiated mesenchymal cells and islands of mature hyaline cartilage, and immunohistochemistry studies revealing positivity for vimentin and S-100 were consistent with the diagnosis of mesenchymal chondrosarcoma. The patient was treated with combined chemotherapy (ifosfamide, epirubicin, and cisplatin), radiotherapy, and surgery (exenteration). She is alive with no evidence of disease after 4 years of follow-up. Facial asymmetry and dental malformations have developed as late effects. Further reconstructive surgery is planned for the malformations.

CONCLUSIONS

Extraskeletal mesenchymal chondrosarcoma in the orbit is extremely rare. This study reports the first case of congenital extraskeletal mesenchymal chondrosarcoma arising in the orbit (also the youngest patient) both in skeletal and extraskeletal sites. Multimodality treatment (surgery, chemotherapy, and radiotherapy) may lead to long-term survival.

From the archives of the AFIP: imaging of primary chondrosarcoma: radiologic-pathologic correlation

Chondrosarcoma is a malignant tumor that produces cartilage matrix, and lesions that arise de novo are called primary. Primary chondrosarcoma is the third most common primary malignant tumor of bone, constituting 20%-27% of all primary malignant osseous neoplasms. There are numerous types of primary chondrosarcomas, including conventional intramedullary, clear cell, juxtacortical, myxoid, mesenchymal, extraskeletal, and dedifferentiated. The conventional intramedullary chondrosarcoma is the most frequent type, and it most commonly involves the long bones or pelvis in up to 65% of cases. Although the pathologic appearance varies with specific lesion type, chondrosarcomas grow with lobular type architecture, and these hyaline cartilage nodules demonstrate high water content and peripheral enchondral ossification. Imaging features directly reflect this pathologic appearance, and the various subtypes often show distinctive features. Radiographic findings often suggest the diagnosis of chondrosarcoma because of identification of typical "ring-and-arc" chondroid matrix mineralization (representing the enchondral ossification) and aggressive features of deep endosteal scalloping and soft-tissue extension. These latter features are usually best assessed, as is lesion staging, with computed tomography (CT) or magnetic resonance (MR) imaging. CT is optimal to detect the matrix mineralization, particularly when it is subtle or when the lesion is located in anatomically complex areas. Both CT and MR imaging depict the high water content of these lesions as low attenuation and very high signal intensity with T2-weighting, respectively. Understanding and recognizing the spectrum of appearances of the various types of primary chondrosarcoma allow improved patient assessment and are vital for optimal clinical management including diagnosis, biopsy, staging, treatment, and prognosis.

Cytopathology of mesenchymal chondrosarcomas: a report and comparison of four patients

BACKGROUND

Mesenchymal chondrosarcoma (MC) is an infrequent neoplasm, representing approximately 1% of all chondrosarcomas. Cytologic descriptions of MCs have been confined to rare case reports. In the current report, the authors describe their experience with the cytologic features of four MCs: two primary tumors and two metastatic lesions.

METHODS

Four patients were diagnosed with MC at the authors' institution from 1994 to 2002. Three of four patients underwent fine-needle aspiration (FNA) biopsy as part of their diagnosis; in the fourth patient, imprint cytology was performed. Each tumor also received histologic confirmation.

RESULTS

The patients studied included three females and one male. In three patients, the tumor presented initially as a soft tissue mass; whereas, in the remaining patient, the MC presented in the tibia. FNA results demonstrated small, oval-to-spindled cells with high nuclear-to-cytoplasmic ratios. Cells occurred singly and in clumps in a background of basophilic extracellular matrix. Histologic examination of each lesion demonstrated biphasic tumors, including focal areas of relatively mature cartilage formation as well as a small cell population.

CONCLUSIONS

MC is a rare soft tissue tumor that occurs frequently in extraskeletal locations. FNA of these tumors can be diagnostic if the tumor is sampled appropriately and of critical features, such as the background extracellular matrix, are recognized. Given the propensity of these tumors to metastasize and the poor prognosis of patients with MC, early identification by FNA biopsy may allow earlier, more aggressive interventions.

Mesenchymal chondrosarcoma of the sinonasal tract: a clinicopathological study of 13 cases with a review of the literature

OBJECTIVES/HYPOTHESIS

Mesenchymal chondrosarcoma of the sinonasal tract is a rare, malignant tumor of extraskeletal origin. Isolated cases have been reported in the English literature, with no large series evaluating the clinicopathological aspects of these tumors.

STUDY DESIGN

Retrospective review.

METHODS

Thirteen patients with sinonasal mesenchymal chondrosarcoma were retrieved from the Otorhinolaryngologic-Head and Neck Registry of the Armed Forces Institute of Pathology.

RESULTS

Nine women and 4 men (age range, 11 to 83 y; mean age, 38.8 y) presented with nasal obstruction (n = 8), epistaxis (n = 7), or mass effect (n = 4), or a combination of these. No patients reported prior head and neck irradiation. The maxillary sinus was the most common site of involvement (n = 9), followed by the ethmoid sinuses (n = 7) and the nasal cavity (n = 5). Tumors had an overall mean size of 5.1 cm. Microscopically, the tumors displayed a small, blue, round cell morphology appearance arranged in a hemangiopericytoma-like pattern with foci of cartilaginous matrix. All cases were managed by surgery with adjuvant radiation therapy (n = 4) and/or chemotherapy (n = 3). The overall mean survival was 12.1 years, although five of six patients who developed local recurrences died of disease (mean survival, 6.5 y). Six patients were alive and disease free (mean survival, 17.3 y), and two patients were lost to follow-up.

CONCLUSIONS

Mesenchymal chondrosarcoma of the sinonasal tract is an aggressive tumor with a predilection for young women. The pattern of growth and scarcity of cartilaginous matrix result in frequent misdiagnosis. Recurrence develops in approximately one-third of patients and seems to predict a poor prognosis. Aggressive, exenterative surgery combined with adjuvant therapy appears to yield the best clinical outcome.

Extraskeletal mesenchymal chondrosarcoma: case report

This is a case report of an extraskeletal mesenchymal chondrosarcoma (ESMC) that originally occurred in the retroperitoneum of a 24-year-old female and later metastasized to the left proximal humerus. Mesenchymal chondrosarcomas are very rare in comparison to conventional chondrosarcomas and even more so when arising from an extraskeletal location. In this report, we discuss the major characteristics of ESMC and offer a review of the current knowledge regarding this rare disease entity.

Pathologic and molecular aspects of soft tissue sarcomas

This article retains the conventional approach to the classification of soft tissue sarcomas, dividing them into several major histogenetic categories based on their overall microscopic appearance, tissue differentiation pattern, and biologic potential. The author advocates a multimodal approach, in which four distinctive data sets--clinical, radiographic, microscopic, and, in some cases, molecular--are considered to establish the diagnosis and treatment plan. Such step-wise analysis is more likely to lead to consistency and accuracy as compared with an intuitive approach based on fragmentary data. The author describes individual lesions of soft tissue as clinicopathologic entities and believes that they can be more accurately diagnosed and appropriately treated with the help of data generated by a multidisciplinary team. In addition, this article emphasizes the need to use emerging molecular techniques that can provide important clues for both diagnosis and prognosis.

Sox9, a master regulator of chondrogenesis, distinguishes mesenchymal chondrosarcoma from other small blue round cell tumors

Over the last decade, a number of "master regulator" genes that control distinct pathways of mesenchymal differentiation have been discovered. These genes are expressed early during embryogenesis and initiate a cascade of gene expression responsible for specific cell lineage commitment. Thus, identification of their products may allow the classification of seemingly primitive, morphologically uncommitted tumors such as small blue round cell tumors. The transcription factor Sox9 has been demonstrated to be a master regulator of the differentiation of mesenchymal cells into chondrocytes. For this reason, we examined the utility of Sox9 in distinguishing mesenchymal chondrosarcoma (a small cell malignancy thought to be derived from primitive chondroprogenitor cells) from other primitive small cell malignancies. Representative sections from 90 cases of small blue round cell tumors (22 mesenchymal chodrosarcoma, 10 neuroblastomas, 11 rhabdomyosarcomas, 9 Ewing's sarcomas/primitive neuroectodermal tumors, 5 desmoplastic small round cell tumors, 7 small cell carcinomas, 6 Merkel cell carcinomas, 6 small cell osteosarcomas, 7 diffuse large B-cell lymphomas, 7 lymphoblastic leukemias/lymphomas, and 5 extraskeletal myxoid chondrosarcomas) were immunohistochemically stained with antibodies to Sox9 protein. All but 1 mesenchymal chondrosarcoma showed positive nuclear staining in both primitive mesenchymal and cartilaginous components of the tumor. All other types of small blue round cell tumors, as well as the lymphomas and leukemias, were negative for Sox9 protein. These findings confirm that mesenchymal chondrosarcoma has phenotypic features corresponding to the early condensational phase of cartilaginous differentiation. More important, Sox9 may serve as a useful tool in the differentiation of small cell malignancies.

Mesenchymal chondrosarcoma originating from the femoral vein

Mesenchymal chondrosarcoma is a rare variant of chondrosarcomas characterized by a bimorphic pattern with areas of the undifferentiated malignant small cells and well differentiated cartilaginous islands.(1) It occurs most commonly in the bone but can also occur in the extraskeletal soft tissues, the brain, and the meninges. This type of tumor has also been described in the eyelids, parapharyngeal space, mediastinum, and the kidney.(1-5) An origin from the large vessels has not been reported in the medical literature. The authors report a case of mesenchymal chondrosarcoma originating from the femoral vein in a 28-year-old female patient, treated by the wide-margin resection.

Retroperitoneal extraskeletal mesenchymal chondrosarcoma in a dog

A young adult female Mastiff dog developed a large retroperitoneal mass, pleural effusion, and multiple pulmonary and pleural nodules. All masses were diagnosed as mesenchymal subtype chondrosarcomas, using histological and immunohistochemical criteria. Reports of canine extraskeletal mesenchymal chondrosarcomas (EMCs) are rare but involved animals less than 3 years of age in 60% of the cases. This is the first description of this type of tumor developing distant metastases. Evidence from this case and previous reports suggests that EMCs are associated with a poor prognosis.

Mesenchymal chondrosarcoma of the temporal bone

A 64-year-old patient with mesenchymal chondrosarcoma of the temporal bone is described. CT and MRI showed an extensive mass with calcification involving the temporal bone and extending into the middle cranial fossa and nasopharynx. The tumor was ill-defined from surrounding normal bone, and a subtotal petrosectomy was carried out. The nasopharyngeal extension was removed secondarily using an endoscope. The clinical and diagnostic aspects and management of this rare lesion are discussed.

Primary mesenchymal chondrosarcoma of the lung

Mesenchymal chondrosarcoma has been well documented in the somatic soft tissue and bone. It is a rare subtype of chondrosarcoma characterized by the presence of islands of chondroid or by less osteoid tissue enmeshed within dense sheets of primitive small blue mesenchymal cells with hemangiopericytoma-like vessels, or by both. The vast majority of previously published pulmonary mesenchymal chondrosarcoma was metastatic. To the best of our knowledge, only one case of primary pulmonary mesenchymal chondrosarcoma has been described in the literature. Herein, we report the second case of primary mesenchymal chondrosarcoma of the lung and emphasize that biopsy may yield only nonspecific small blue cells, whereas a detailed evaluation of the resected specimen allows definite diagnosis of this rare lung tumor.

Translocation der(13;21)(q10;q10) in skeletal and extraskeletal mesenchymal chondrosarcoma

Cytogenetic studies of mesenchymal chondrosarcoma are few and to date, no specific or recurrent aberrations have been found. In this investigation, the cytogenetic and molecular cytogenetic (spectral karyotypic and fluorescence in situ hybridization) findings for two mesenchymal chondrosarcomas, one arising skeletally and the other extraskeletally, are reported. An identical Robertsonian translocation involving chromosomes 13 and 21 [der(13;21)(q10;q10)] was detected in both cases, possibly representing a characteristic rearrangement for this histopathologic entity. Both cases also exhibited loss of all or a portion of chromosomes 8 and 20 and gain of all or a portion of chromosome 12. The observation of similar chromosomal abnormalities in both skeletal and extraskeletal mesenchymal chondrosarcoma supports a genetic as well as histopathologic relationship between these anatomically distinct neoplasms.

Cartilaginous lesions of bone

Cartilaginous lesions of the skeleton are very unusual. It is extremely important to correlate the roentgenographic features, the clinical features, and the histological features to arrive at a definite diagnosis. Most cartilaginous lesions are benign or of low-grade malignancy. However, there are some subtypes of chondrosarcoma that behave in a highly aggressive fashion.

Distinctive soft tissue tumors of the head and neck

Among soft tissue tumors as a whole, those in the head and neck region are relatively uncommon, and the proportion of all soft tissue sarcomas that arise in this region is <or=5-10% (although this figure is higher in children). With the exceptions of nasopharyngeal angiofibroma and sinonasal hemangiopericytoma, most mesenchymal lesions are not truly distinctive to this site. This overview focuses on tumors that show a relative predilection for this region, including principally benign fibroblastic/myofibroblastic lesions, nerve sheath tumors, vascular tumors (both benign and malignant), and small round cell sarcomas, especially rhabdomyosarcoma in young patients. Important generalizations to bear in mind include the facts that (1) among spindle cell malignancies in the head and neck of adults, spindle cell carcinoma and melanoma are by far more common than sarcomas; (2) because of anatomic constraints and dramatic clinical presentation, the index of clinical suspicion for malignancy is often high; (3) certain subsets of benign mesenchymal lesions in this anatomic region frequently show pseudosarcomatous morphology; and (4) the ability to define or obtain an adequate surgical resection margin in this region is often very limited, hence issues of local control may supercede the importance of overall biologic/metastatic potential in some cases.

Parafalcine chondrosarcoma: an unusual localization for a classical variant. Case report and review of the literature

BACKGROUND

Intracranial chondroid tumors are infrequently seen in neurosurgical practice. These tumors usually arise from cartilaginous synchondroses at the base of the skull, but occasionally from the pluripotential mesenchymal cells of the meninges. We present here a case of classic low-grade giant chondrosarcoma of the falx cerebri. This is only the second case of this variant reported in this location, and we summarize the diagnostic criteria with a brief review of literature.

CASE REPORT

A 56-year-old female patient was admitted to the hospital with a history of progressive right-sided weakness occurring in the last 8 months and a recent grand mal seizure. Radiological evaluation demonstrated a large extra-axial mass in the left parafalcine area, suggesting a possible meningioma. An anterior interhemispheric approach enabled gross total removal of the tumor and a histologic diagnosis of a low-grade classic chondrosarcoma was made. The patient is currently stable and has shown no evidence of recurrence in more than 3 years without any adjuvant treatment.

CONCLUSIONS

Intracranial cartilaginous tumors include classical, mesenchymal and myxoid chondrosarcomas in addition to benign chondromas. Parafalcine localization should be considered for all these variants as well as for meningiomas, hemangiopericytomas, solitary fibrous tumors, and meningeal metastatic carcinomas. Detailed radiological evaluation, light microscopic and ultrastructural analyses, and immunocytochemistry are essential for correct diagnosis. In contrast to mesenchymal and myxoid types, the prognosis of classic variants is usually good and does not require adjuvant treatment modalities if a radical resection of the tumor can be obtained. Increased documentation of clinical, radiological, and histologic findings as well as response to treatment modalities will provide a better understanding of the pathophysiology of these rare tumors, and highlight the optimum treatment strategies

Mesenchymal Chondrosarcoma: A Small Cell Neoplasm with Polyphenotypic Differentiation

We analyzed the clinicoradiographic, microscopic, and immunophenotypic features of 21 tumors from 13 patients with mesenchymal chondrosarcoma (11 primary and 10 metastatic) and addressed the issue of their potential polyphenotypic differentiation. The immunophenotypic profile of the tumors was analyzed by studying the expressions of the MIC2 gene protein (p30/32(MIC2)), S-100 protein, desmin, myoD1, myogenin, myoglobin, smooth-muscle actin, cytokeratin, neuron-specific enolase, and HMB-45. The expression of p30/32(MIC2) was typically restricted to the small cell component of the mesenchymal chondrosarcoma and could be documented in 17 tumors. The cartilaginous areas were positive for S-100 protein in 20 tumors. Scattered positivity of small cells for desmin was seen in 8 cases. In 2 primary tumors from different patients (1 intraosseous and 1 extraskeletal) a diffuse expression of desmin with focal coexpression of myoD1 was present within the small cell component of the tumor. The positivity for smooth-muscle actin was documented in 2 cases. Either the small cell or cartilaginous components were at least focally positive for neuron-specific enolase in 11 tumors. All tumors were negative for myogenin, myoglobin, cytokeratins (AE1/AE3, CAM5.2) and HMB-45. This study showed that, in addition to cartilaginous differentiation, mesenchymal chondrosarcomas may exhibit focal expression of desmin. In rare cases more diffuse rhabdomyoblastic differentiation can be seen within the small cell component of the tumor. Thus, mesenchymal chondrosarcoma is another primitive neoplasm with polyphenotypic differentiation and features that overlap those of other small cell malignances of bone and soft tissue. Int J Surg Pathol 8(4):291-301, 2000

Nuchal fibrocartilaginous pseudotumor in a 10-year-old girl

We report a case of a 10-year-old girl who, 4 years after a trauma to the neck, developed a soft tissue mass in the midline at the C5-6 level. The lesion was not attached to the bone and was composed of fibrocartilaginous tissue, similar to the nuchal fibrocartilaginous pseudotumor, a rare, recently reported condition that has been described in the medical literature in only 4 cases, all of them adults.

A comparison of staging systems for localized extremity soft tissue sarcoma

BACKGROUND

Staging systems for soft tissue sarcoma (STS) are important to identify patients with similar systemic risk who might benefit from specific treatments. This study compared four commonly used staging systems for predicting systemic outcomes of patients with localized extremity STS, as proposed by the fourth and fifth editions of the American Joint Committee on Cancer/International Union Against Cancer (AJCC/UICC) staging system, the Memorial Sloan-Kettering Cancer Center (MSK) system, and the Surgical Staging System (SSS) of the Musculoskeletal Tumor Society.

METHODS

Three hundred consecutive adult patients with newly diagnosed nonmetastatic STS of the lower extremity were treated at Memorial Sloan-Kettering Cancer Center between 1982 and 1989. Metastasis free survival was the end point of the study. The prognostic value of the four staging systems and their components were examined in univariate and multivariate analyses. The Akaike information criterion (AIC) was used to identify the system that best predicted the risk of systemic recurrence.

RESULTS

Compartment status, depth, grade, and size were all independent predictors of outcome within their respective staging systems. However, when compared with one another, only depth, grade, and size retained their prognostic significance. Of the four models, the AIC predicted that the MSK was the best predictor of systemic relapse, followed by the fifth edition of the AJCC/UICC staging system.

CONCLUSIONS

Staging systems such as the MSK system or the fifth edition of the AJCC/UICC system, which include tumor depth, grade, and size as prognostic factors, are the most predictive of systemic relapse in patients presenting with localized extremity STS. Both of these systems identify the same group of patients at the highest risk who would be the most suitable for adjuvant chemotherapy trials.

Cell differentiation and matrix gene expression in mesenchymal chondrosarcomas

Mesenchymal chondrosarcomas are small-cell malignancies named as chondrosarcomas due to the focal appearance of cartilage islands. In this study, the use of in situ detection techniques on a large series of mesenchymal chondrosarcoma specimens allowed the identification of tumor-cell differentiation pathways in these neoplasms. We were able to trace all steps of chondrogenesis within mesenchymal chondrosarcoma by using characteristic marker genes of chondrocytic development. Starting from undifferentiated cells, which were negative for vimentin and any other mesenchymal marker, a substantial portion of the cellular (undifferentiated) tumor areas showed a chondroprogenitor phenotype with an onset of expression of vimentin and collagen type IIA. Cells in the chondroid areas showed the full expression panel of mature chondrocytes including type X collagen indicating focal hypertrophic differentiation of the neoplastic chondrocytes. Finally, evidence was found for transdifferentiation of the neoplastic chondrocytes to osteoblast-like cells in areas of neoplastic bone formation. These results establish mesenchymal chondrosarcoma as the very neoplasm of differentiating premesenchymal chondroprogenitor cells. The potential of neoplastic bone formation in mesenchymal chondrosarcoma introduces a new concept of neoplastic (chondrocytic) osteogenesis in musculoskeletal malignant neoplasms, which qualifies the old dogma that neoplastic bone/osteoid formation automatically implies the diagnosis of osteosarcoma.

Mesenchymal chondrosarcoma in a young German shepherd dog

An 18-month-old, entire male German shepherd dog was presented with signs indicative of a caudal abdominal space-occupying mass. A needle-core biopsy of this mass failed to establish a definitive diagnosis, but identified a prominent round-cell component. The dog's condition worsened and euthanasia was performed on humane grounds. Histopathology of the mass revealed a mesenchymal chondrosarcoma.

A case of soft tissue mesenchymal chondrosarcoma metastatic to skin, clinically mimicking keratoacanthoma

We report the first case of metastatic involvement of the skin by a soft tissue mesenchymal chondrosarcoma (MS). A 64-year-old man presented 15 months after resection of a 7.0 cm MS from his left forearm with a rapidly growing, erythematous nodule on the left side of the upper lip. The lesion was clinically interpreted as a keratoacanthoma. The histologic appearance was identical to that of the soft tissue MS; an immunohistochemical stain for CD99 was positive. Lung and bone metastases were subsequently documented. Our case expands the differential diagnosis of malignancies with cartilaginous differentiation that can involve the skin.

Inhibitory effects of transforming growth factor-beta1 pretreatment on experimental pulmonary metastasis of MCS-1 Chinese hamster mesenchymal chondrosarcoma cells

Recent studies have suggested that transforming growth factor(TGF)-beta1 acts as a multifunctional regulator of cell growth, and also modifies tumor progression and metastasis. In the present study, we investigated the effects of TGF-beta1 on the proliferation and experimental pulmonary metastasis of MCS-1. MCS-1 are undifferentiated type cloned tumor cells established from a mesenchymal chondrosarcoma which spontaneously occurred in the soft tissue of a female Chinese hamster. MCS-1 cells were pretreated with TGF-beta1 (0, 0.05, 0.5, 2, 10 ng/ml) for 72 hours in a medium containing 1% fetal bovine serum, then tested for in vitro growth by the MTT method, in vivo growth by subcutaneous inoculation into athymic nude mice (1 x 10(6) cells/mouse) and experimental pulmonary metastasis by injection into the lateral tail vein of athymic nude mice (5 x 10(4) cells/mouse). TGF-beta1 significantly inhibited in vitro growth of MCS-1, depending on its concentrations, and also experimental metastasis with maximal inhibition at 0.5 or 2 ng/ml treatment compared to untreated controls. TGF-beta1, however, was ineffective for in vivo subcutaneous growth of MCS-1. These results indicated that TGF-beta1 might be an inhibitor of metastasis of mesenchymal chondrosarcomas including other types of non-epitherial cartilage or bone formation tumors.

Histologic prognostication in soft tissue sarcomas: grading versus subtyping or both? A comprehensive review of the literature with proposed practical guidelines

Despite the validation of many histologic grading systems for soft tissue sarcomas, none have been universally accepted. Because of the overall rarity of specific histologic sarcoma subtypes, evaluation of grading systems and their prognostic significance have tended to base the results on sarcomas as a general group, diminishing the value and significance of histologic subtyping. A representative review of the literature regarding histologic grading of soft tissue sarcomas and its relationship to histologic subtype, stage, and prognosis is analyzed and discussed. Histologic grading of many soft tissue sarcomas appears to be a valuable predictor of patient survival, as confirmed by the literature. However, accurate histologic subtyping is essential for accurate histologic grading. Histologic grading in some sarcoma subtypes is probably not applicable and may underestimate biologic behavior. Clinicians and pathologists should be aware of the limitations, prognostic significances, and relationships of histologic subtyping and histologic grading in the therapeutic management and prognostication of soft tissue sarcomas.

Mesenchymal chondrosarcoma and simulating lesions of the orbit

Although an extremely rare neoplasm, orbital mesenchymal chondrosarcoma has a characteristic radiologic appearance. Suspicion of this lesion preoperatively can be of great value to the ophthalmologist because it tends to produce profuse bleeding at biopsy. This article reviews the clinical presentation, pathologic features, and radiologic findings of patients with orbital mesenchymal chondrosarcoma.

Mesenchymal chondrosarcoma of the jaws. Report of four cases

Mesenchymal chondrosarcoma (MCS), described in 1959 by Lichtenstein & Bernstein, is a very rare malignant tumour. Only 46 cases have been previously reported in the jaws. Over a period of 30 years, four chondrosarcomas of mesenchymal type (of which one has already been published in 1987 with a three-month follow up) were treated in our department. Two patients have been followed for more than 17 years, of whom one has died of an intracranial extension and the other is still alive after surgical treatment of numerous recurrences and metastases. The two others are tumour-free with a follow up of 18 months and 11 years respectively. Histological, epidemiological and clinical features and treatment of MCS are discussed relevant to the data published in the literature.

[Chondrosarcoma in Ollier's disease. Apropos of 2 cases and review of the literature]

Ollier's disease is a rate affliction (not more than approximately 100 cases have been reported over a 30-year period) characterized by bone dysplasia in which evolution to degenerative neoplasia has been described. Diagnosis of chondrosarcoma is delicate in these cases. It is a kind of slowly evolving low grade malignant tumor. Surgery is the primary treatment course, and can lead to remission. Prognosis, depending on the number and dimension of the lesions, their localization and metastasis prevention, is usually good, but relapses are relatively frequent: 25 to 50%. In case of relapse, radiotherapy and chemotherapy were tested but their efficacy is limited. We report here two clinical cases and discuss literature data.

Mesenchymal chondrosarcoma of the jaw bones: clinicopathologic study of 19 cases

BACKGROUND

Patients with mesenchymal chondrosarcomas in general have a 5-year survival rate ranging from 42-54.6% and a 10-year survival rate of 28%. Nineteen cases of mesenchymal chondrosarcoma of the jaw bones were reviewed to study their clinicopathologic features and to compare their clinical behavior with that of mesenchymal chondrosarcomas of other locations.

METHODS

The patients were 10 males and 9 females (age range, 2-51 years). Sixteen patients were age < 30 years, and the average age at presentation was 19 years. Eleven tumors involved the mandible and eight involved the maxilla.

RESULTS

Histologically, the classic picture of a bimorphic tumor, composed of islands of well differentiated hyaline cartilage juxtaposed to a small cell undifferentiated malignancy, was present in every case. Resection, including hemimandibulectomy and hemimaxillectomy, was the main treatment in 16 patients. Seven patients had local recurrence, and five patients developed distant metastases. Six patients died of disease, and the 5-year and 10-year survival rates were 82% and 56%, respectively.

CONCLUSIONS

Mesenchymal chondrosarcoma of the jaw bones appears to have a more indolent course than mesenchymal chondrosarcoma of other anatomic

Nuchal fibrocartilaginous pseudotumor: a distinctive soft-tissue lesion associated with prior neck injury

Soft-tissue tumors with a predilection to involve the head and neck region include spindle cell lipoma, pleomorphic lipoma, and nuchal fibroma. We have recently studied three patients with distinctive soft-tissue fibrocartilaginous masses in the posterior aspect of the base of the neck, at the junction of the nuchal ligament and the deep cervical fascia. Two of the patients were women (ages 37 and 40) and one a man (age 53). All three had sustained neck injuries in automobile accidents in the past (27 years, 20 years, and 2 months before surgery, respectively). Each patient presented with a soft-tissue nodule overlying the spinous process of one of the lower cervical vertebrae. Two were painful. Computed tomography and magnetic resonance imaging performed in two patients showed focal thickening of the ligamentum nuchae at the C4-5 and C5-6 levels. All three masses were completely excised. They ranged in size from 1.0 to 1.5 cm. The three lesions were histologically identical, and each consisted of a poorly defined, moderately cellular fibrocartilage nodule located within the nuchal ligament at its junction with the deep cervical fascia. Atypia or mitotic activity was not present. The ligamentous tissue adjacent to the mass was irregular and degenerated. None of the masses have recurred in follow-up periods of 3 to 6 months, and all patients are currently asymptomatic. The lesion we describe is a distinctive soft-tissue pseudotumor that occurs in the mid-line of the lower cervical spine within the nuchal ligament. It is likely non-neoplastic and probably develops as a reaction to soft-tissue injury, in an analogous manner to fibrocartilage metaplasia seen in degenerated tendoligamentous structures. We propose the term "nuchal fibrocartilaginous pseudotumor" for these lesions.