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Karele EN, Paze AN. Chordoma: To know means to recognize. Biochim Biophys Acta Rev Cancer 2022; 1877:188796. [PMID: 36089204 DOI: 10.1016/j.bbcan.2022.188796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/13/2022] [Accepted: 09/03/2022] [Indexed: 10/14/2022]
Abstract
Chordoma is a rare type of bone cancer characterized by its locally aggressive and destructive behavior. Chordoma is located in one of the three primary regions: skull base/clivus, sacrum or mobile spine. Chordoma grows slowly, therefore its insidious onset leads to delayed diagnosis, accounting for the low survival rates. Treatment centers around successful en bloc resection with negative margins, though, considering the anatomically constrained site of growth, it frequently requires adjuvant radiotherapy. This article analyzes the existing literature with the aim to provide a better insight in the current state of research in chordoma classification, characteristics, and management.
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Affiliation(s)
- Emija Nikola Karele
- Faculty of Medicine, Riga Stradins University, 16 Dzirciema Street, Riga LV-1007, Latvia.
| | - Anda Nikola Paze
- Faculty of Medicine, Riga Stradins University, 16 Dzirciema Street, Riga LV-1007, Latvia.
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Clear Cell Chondrosarcoma: Clinical Characteristics and Outcomes in 15 Patients. Sarcoma 2020. [DOI: 10.1155/2020/2386191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background. Clear cell chondrosarcoma (CCC) represents less than 6% of all chondrosarcomas, and thus, our understanding of this rare entity is limited. Analyzing clinical characteristics and treatment patterns, thus increasing our knowledge, may improve treatment strategy. We review our institutional experience with 15 patients, including one case with dedifferentiation. Methods. A retrospective review was conducted in CCC patients treated at our institution from 1996 to 2015, with at least 2-year follow-up. Descriptive statistics and Kaplan–Meier survival analyses were performed. Results. Of 19 patients identified, 15 patients had at least 2-year follow-up and were included. The median age at diagnosis was 43 years. 80% were male. The most common presenting signs were pain (12 patients; 80%) and fracture (2 patients; 13.3%). The most common site was proximal femur (8 patients; 53%). All patients had MSTS Stage I disease. Primary treatment included wide resection in 10 patients (67%) and intralesional or marginal resection in 5 patients (33%). Three patients died of disease during the study period, 1 with dedifferentiation of recurrent CCC. The median time to death from disease was 15.3 years (95% CI: (14.2; NA)). The median time to either recurrence or death was 7.73 years for patients who had intralesional/marginal resection and 16.44 years for patients with wide resection (HR (wide vs. intralesional/marginal) = 0.21, 95% CI: (0.04; 1.18),
). The median time to recurrence or death was significantly shorter for patients not initially treated at a sarcoma center (
). Conclusions. CCC is a rare entity, and our understanding of it is still evolving. We observed a higher recurrence rate for intralesional or marginal resection, and wide resection alone remains the mainstay of treatment. Better outcomes were observed in patients initially treated by trained musculoskeletal oncologists. Due to the propensity of CCC to recur decades after initial resection, lifelong surveillance is recommended.
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Zhang Y, Alagic Z, Tani E, Skorpil M, Tsagkozis P, Haglund F. Clear-cell chondrosarcomas: Fine-needle aspiration cytology, radiological findings, and patient demographics of a rare entity. Diagn Cytopathol 2020; 49:46-53. [PMID: 32786062 PMCID: PMC7754112 DOI: 10.1002/dc.24582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/10/2020] [Accepted: 07/30/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Clear-cell chondrosarcomas (CCCSs) constitute a very rare subtype of chondrosarcoma. CCCS may radiologically mimic chondroblastoma, and given the difference in surgical approach, it is important to distinguish these two entities preoperatively. DESIGN Using the institutional digital records, we identified histologically verified CCCS between 1996 and 2013, where preoperative fine-needle aspiration (FNA) cytology was available. Clinical characteristics were categorized and described, and FNAs were reviewed by a panel of senior cytopathologists. In addition, corresponding radiological imaging was reviewed by senior radiologists, and a literature review on CCCS and chondroblastoma was conducted. RESULTS A total of seven CCCS FNAs were identified from six patients. The cytomorphology showed low to intermediate cellular smears of clusters and single round or oval tumor cells. Tumor cells had rounded (sometimes binucleated) nuclei with limited pleomorphism and rich vacuolated cytoplasm. Chondroid background matrix was always found. While CCCS patients had a significantly higher age at diagnosis compared to chondroblastoma, no age cut-off would distinctly separate the two. CONCLUSIONS CCCS has distinguished cytomorphological features on FNA smears. CCCS should be considered as a possible differential diagnosis in adults (>25 years) with a radiological suspicion of chondroblastoma. Since radiology and patient age cannot conclusively distinguish CCCS from chondroblastoma, FNA may prove an important tool for correct preoperative diagnosis of CCCS.
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Affiliation(s)
- Yifan Zhang
- Department of Clinical Pathology and Cytology, Karolinska University Hospital, Solna, Stockholm, Sweden.,Department of Oncology-Pathology, Karolinska Institutet, Solna, Sweden
| | - Zlatan Alagic
- Functional Unit for Musculoskeletal Radiology Function Imaging and Physiology, Karolinska University Hospital, Solna, Stockholm, Sweden.,Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Solna, Sweden
| | - Edneia Tani
- Department of Clinical Pathology and Cytology, Karolinska University Hospital, Solna, Stockholm, Sweden.,Department of Oncology-Pathology, Karolinska Institutet, Solna, Sweden
| | - Mikael Skorpil
- Department of Neuroradiology, Karolinska University Hospital, Solna, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Sweden
| | - Panagiotis Tsagkozis
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Sweden.,Section of Orthopaedics, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Felix Haglund
- Department of Clinical Pathology and Cytology, Karolinska University Hospital, Solna, Stockholm, Sweden.,Department of Oncology-Pathology, Karolinska Institutet, Solna, Sweden
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Updates in Primary Bone Tumors: Current Challenges and New Opportunities in Cytopathology. Surg Pathol Clin 2018; 11:657-668. [PMID: 30190146 DOI: 10.1016/j.path.2018.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The review summarizes the current diagnostic challenges in fine-needle aspiration of primary bone tumors, with focus on the application of new molecular and immunohistochemical techniques in the diagnosis of giant cell-rich neoplasms, chondrosarcomas, and notochordal tumors.
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