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Yonezawa H, Yamamoto N, Hayashi K, Takeuchi A, Miwa S, Igarashi K, Morinaga S, Asano Y, Saito S, Tome Y, Ikeda H, Nojima T, Tsuchiya H. Dedifferentiated chondrosarcoma of the middle finger arising from a solitary enchondroma: A case report. World J Clin Cases 2022; 10:3297-3305. [PMID: 35647122 PMCID: PMC9082702 DOI: 10.12998/wjcc.v10.i10.3297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/19/2022] [Accepted: 02/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Dedifferentiated chondrosarcoma (DDCS) accounts for 10% of all chondrosarcomas and has the poorest outcome, with a 5-year survival rate of 7%-25%. DDCS commonly occurs in the femur and pelvis, whereas DDCS of the finger is extremely rare. Furthermore, the histological findings of preexisting solitary enchondroma samples are important and valuable for diagnosing malignant transformations.
CASE SUMMARY We report our experience with DDCS in the proximal phalanx of the left middle finger of an 87-year-old woman. She had undergone surgery for enchondroma, with curettage and artificial bone grafting, 11 years ago, in the same location. Several years after the primary surgery, the left middle finger gradually started to enlarge, and the growth speed increased in the past year. Plain radiographs showed an expansive osteolytic lesion with calcifications and residual grafting material. Owing to the suspicion of malignancy, we performed ray amputation. Histological findings revealed an abrupt transition between the low-grade chondrosarcoma and dedifferentiated sarcoma components. The dedifferentiated components showed the features of a high-grade undifferentiated pleomorphic sarcoma. The patient was diagnosed with DDCS arising from a preexisting enchondroma. She had no local recurrence or distant metastasis and died of pneumonia 6 years and 10 months after the second surgery.
CONCLUSION The histological findings of a precursor lesion showed a typical enchondroma, suggesting that DDCS can arise from enchondroma.
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Affiliation(s)
- Hirotaka Yonezawa
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Ishikawa, Japan
| | - Norio Yamamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Ishikawa, Japan
| | - Katsuhiro Hayashi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Ishikawa, Japan
| | - Akihiko Takeuchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Ishikawa, Japan
| | - Shinji Miwa
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Ishikawa, Japan
| | - Kentaro Igarashi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Ishikawa, Japan
| | - Sei Morinaga
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Ishikawa, Japan
| | - Yohei Asano
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Ishikawa, Japan
| | - Shiro Saito
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Ishikawa, Japan
| | - Yasunori Tome
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Nishihara 903-0215, Okinawa, Japan
| | - Hiroko Ikeda
- Department of Diagnostic Pathology, Kanazawa University Hospital, Kanazawa 920-8641, Ishikawa, Japan
| | - Takayuki Nojima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Ishikawa, Japan
- Department of Diagnostic Pathology, Kanazawa University Hospital, Kanazawa 920-8641, Ishikawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Ishikawa, Japan
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Gong LH, Su YB, Zhang W, Liu WF, Dong RF, Sun XQ, Zhang M, Ding Y. Dedifferentiated Central Chondrosarcoma: A Clinical, Histopathological, and Immunohistochemical Analysis of 57 Cases. Front Med (Lausanne) 2021; 8:746909. [PMID: 34631758 PMCID: PMC8494968 DOI: 10.3389/fmed.2021.746909] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 08/31/2021] [Indexed: 11/24/2022] Open
Abstract
Dedifferentiated central chondrosarcoma (DCCS) is a rare cartilage tumor with invasive biological behavior and a poor prognosis. To better understand the morphological characteristics of this type of tumor and its internal mechanism of dedifferentiation, we retrospectively analyzed 57 cases of DCCS. A total of 29 female and 28 male patients were included, ranging in age from 20 to 76 years, with a median age of 54 years. Fifty-seven cases of DCCS occurred in the pelvis (n = 29), femur (n = 17), scapula (n = 4), tibia (n = 2), humerus (n = 2), metatarsals (n = 1), fibula (n = 1), and radius (n = 1). Radiologically, DCCS had two different appearances on imaging, with an area showing calcifications of the cartilage forming the tumor juxtaposed to a lytic area with a highly aggressive, non-cartilaginous component. Histopathologically, the distinctive morphological features consisted of two kinds of defined components: a well-differentiated cartilaginous tumor and non-cartilaginous sarcoma. The cartilaginous components included grade 1 (n = 38; 66.7%) and grade 2 (n = 19; 33.3%) cartilage. The sarcoma components included those of osteosarcoma (n = 29; 50.9%), undifferentiated pleomorphic sarcoma (n = 20; 35.1%), rhabdomyosarcoma (n = 3; 5.2%), fibrosarcoma (n = 2; 3.5%), spindle cell sarcoma (n = 2; 3.5%) and angiosarcoma (n = 1; 1.8%). Immunohistochemistry showed that the expression of p53 and RB in the sarcoma components was significantly higher than that in the cartilaginous components, suggesting that these factors play roles in the dedifferentiation process of chondrosarcoma. DCCS is a highly malignant tumor with a poor prognosis. Except for the patients who were lost to follow-up, most of our patients died.
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Affiliation(s)
- Li-Hua Gong
- Department of Pathology, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, Beijing, China
| | - Yong-Bin Su
- Department of Radiology, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, Beijing, China
| | - Wen Zhang
- Department of Pathology, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, Beijing, China
| | - Wei-Feng Liu
- Department of Orthopedic Oncology Surgery, Beijing Jishuitan Hospital, Fourth Medical College of Peking University, Beijing, China
| | - Rong-Fang Dong
- Department of Pathology, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, Beijing, China
| | - Xiao-Qi Sun
- Department of Pathology, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, Beijing, China
| | - Ming Zhang
- Department of Pathology, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, Beijing, China
| | - Yi Ding
- Department of Pathology, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, Beijing, China
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Hatai H, Tokorozaki K, Haraguchi Y, Matsui T, Ozawa M. Chondrosarcoma with undifferentiated neoplastic cell proliferation around the distal tibiotarsus bone in a wild Hooded Crane (Grus monacha). J Vet Med Sci 2020; 82:1093-1096. [PMID: 32507786 PMCID: PMC7468071 DOI: 10.1292/jvms.20-0241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
An adult male Hooded Crane was found dead on the Izumi plane. At autopsy, subcutaneous
nodules were found around the medial and lateral sides of the left distal tibiotarsus
bone. The largest cross-section of the masses revealed a multilobular pattern, with small
amounts of viscous mucus. Histopathologically, the nodules were composed of three types of
neoplastic cells: chondrocytic cells with abundant lightly basophilic cartilaginous
matrices, mesenchymal cells and a small portion of the neoplastic tissue consisted of
undifferentiated neoplastic cells exhibiting a high mitotic count and frequent
multinucleation. This is the first case of a chondrosarcoma including undifferentiated
neoplastic cell proliferation in a wild Hooded Crane.
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Affiliation(s)
- Hitoshi Hatai
- Department of Pathogenetic and Preventive Veterinary Science, Joint Faculty of Veterinary Medicine, Kagoshima University, 1-21-24 Korimoto, Kagoshima 890-0065, Japan
| | - Kaori Tokorozaki
- Kagoshima Crane Conservation Committee, 1000 Bunkacho, Izumi, Kagoshima 899-0208, Japan
| | - Yuko Haraguchi
- Kagoshima Crane Conservation Committee, 1000 Bunkacho, Izumi, Kagoshima 899-0208, Japan
| | - Tsutomu Matsui
- Kagoshima Crane Conservation Committee, 1000 Bunkacho, Izumi, Kagoshima 899-0208, Japan
| | - Makoto Ozawa
- Department of Pathogenetic and Preventive Veterinary Science, Joint Faculty of Veterinary Medicine, Kagoshima University, 1-21-24 Korimoto, Kagoshima 890-0065, Japan.,Kagoshima Crane Conservation Committee, 1000 Bunkacho, Izumi, Kagoshima 899-0208, Japan
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Chen L, Yu Z, Jiang R, Dong P, Shen B, Li Y. A case of dedifferentiated chondrosarcoma arising in the cricoid cartilage that mimicked an aneurysmal bone cyst. Postgrad Med 2017; 130:274-277. [PMID: 29160138 DOI: 10.1080/00325481.2018.1408382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Dedifferentiated chondrosarcoma of the larynx is a rare and highly malignant tumor. We present the report of a 59-year-old man with dedifferentiated laryngeal chondrosarcoma, which was difficult to diagnose even under microscopic examination. The original diagnosis was an aneurysmal bone cyst, and the final diagnosis was established only after careful consideration of the imaging, surgical, and microscopic findings. In clinical practice, there are many similarities between dedifferentiated chondrosarcoma and aneurysmal bone cysts. Furthermore, it is difficult to identify dedifferentiated laryngeal chondrosarcoma with a giant-cell malignant mesenchymal component. This report describes our experience and discusses this phenomenon.
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Affiliation(s)
- Lixiao Chen
- a Department of Otolaryngology , Head and Neck Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine , P.R. China
| | - Ziwei Yu
- a Department of Otolaryngology , Head and Neck Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine , P.R. China
| | - Rui Jiang
- b Department of Otolaryngology , Kun Shan Hospital of Traditional Chinese Medicine , Jiangsu Province , P.R. China
| | - Pin Dong
- a Department of Otolaryngology , Head and Neck Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine , P.R. China
| | - Bin Shen
- a Department of Otolaryngology , Head and Neck Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine , P.R. China
| | - Yu Li
- a Department of Otolaryngology , Head and Neck Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine , P.R. China
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Stemm M, Beck C, Mannem R, Neilson J, Klein MJ. Dedifferentiated chondrosarcoma of bone with prominent rhabdoid component. Ann Diagn Pathol 2017. [DOI: 10.1016/j.anndiagpath.2016.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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H3F3 mutation status of giant cell tumors of the bone, chondroblastomas and their mimics: a combined high resolution melting and pyrosequencing approach. Mod Pathol 2017; 30:393-406. [PMID: 28059095 DOI: 10.1038/modpathol.2016.212] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 10/24/2016] [Accepted: 10/25/2016] [Indexed: 12/25/2022]
Abstract
Behjati et al recently described recurrent mutations of H3F3 genes in giant cell tumors of the bone and chondroblastomas. Both these entities belong to the spectrum of giant cell-rich bone lesions, often presenting a diagnostic challenge for the pathologist. Our aim was to investigate the value of searching for H3F3 mutations in the diagnosis of giant cell tumors of the bone and giant cell-rich chondroblastomas. Two hundred eighty-one bone lesion samples, including 170 giant cell tumors of the bone, 26 chondroblastomas and 85 other giant cell-rich and/or epiphyseal tumors, were analyzed. Mutation status was determined using first high resolution melting screening and then mutation profiling pyrosequencing. Mutational status was compared with clinical data and, for giant cell tumors of the bone, with p63 immunostaining status. As histone methylation changes have been reported in association with H3F3 mutations, the methylation status of lysine 37 was investigated. H3F3A and H3F3B were found in 85% of giant cell tumors of the bone and 88% of chondroblastomas. In addition to the major G35W mutation, we found two rare H3F3A mutations: one G35R and one G35V. Among the other tumors studied, we only found H3F3A gene mutations in two cases of 'dedifferentiated chondrosarcoma mimicking giant cell tumor of the bone'. A H3F3B mutation was also observed in one case of dedifferentiated chondroblastoma. P63 expression in giant cell tumors of the bone seems to be associated with H3F3 gene mutations (P=0.004). H3F3 mutations did not correlate with clinical data, outcome or methylation changes in Lysin 37. In conclusion, H3F3 mutations are sensitive and specific markers of giant cell tumors of the bone and chondroblastomas. High resolution melting and pyrosequencing procedures are high-performance tools in this context. Determination of H3F3 mutation will allow reclassification of some entities belonging to the spectrum of giant cell-rich lesions.
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Knösel T, Werner M, Jung A, Kirchner T, Dürr HR. Dedifferentiated chondrosarcoma mimicking a giant cell tumor. Is this low grade dedifferentiated chondrosarcoma? Pathol Res Pract 2014; 210:194-7. [DOI: 10.1016/j.prp.2013.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 09/16/2013] [Accepted: 12/03/2013] [Indexed: 11/16/2022]
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Huang J, Jiang Z, Yang Q, Zhang H. Benign Looking Giant Cell Component in Dedifferentiated Chondrosarcoma. Int J Surg Pathol 2012; 21:48-53. [PMID: 22736299 DOI: 10.1177/1066896912451322] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Dedifferentiated chondrosarcomas (DDCS) account for approximately 10% of all chondrosarcoma cases and its 5-year survival is only 10%. The dedifferentiated components of DDCS could be osteosarcoma, malignant fibrous histiocytoma, and fibrosarcoma. In this article, the authors report a rare case of DDCS in a 19-year-old female, in which the dedifferentiated component showed a close histological resemblance to a giant cell tumor of bone. Radiological diagnosis revealed an expansive osteolytic lesion in the epiphysis of right proximal humerus, which also extended to the diaphysis with irregular calcification and focal cortical breakthrough. The biopsy tissue contained the features of a giant cell tumor of bone and well-differentiated cartilage. Pathological examination revealed a biphasic tumor comprising of low-grade chondrosarcoma and nonchondroid giant cell–rich lesion similar to conventional giant cell tumor of bone, and there is an abrupt transition between the 2 components.
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Affiliation(s)
- Jin Huang
- Shanghai Sixth People’s Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Zhiming Jiang
- Shanghai Sixth People’s Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Qingcheng Yang
- Shanghai Sixth People’s Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Huizhen Zhang
- Shanghai Sixth People’s Hospital, Shanghai Jiaotong University, Shanghai, China
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Cardona DM, Knapik JA, Reith JD. Dedifferentiated parosteal osteosarcoma with giant cell tumor component. Skeletal Radiol 2008; 37:367-71. [PMID: 18256826 DOI: 10.1007/s00256-007-0440-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2007] [Revised: 10/30/2007] [Accepted: 12/09/2007] [Indexed: 02/02/2023]
Abstract
Dedifferentiated parosteal osteosarcoma is characterized histologically by the admixture of low-grade fibroblastic osteosarcoma and a high-grade component typically resembling conventional osteosarcoma or malignant fibrous histiocytoma. We report an unusual distal femoral dedifferentiated parosteal osteosarcoma in which the dedifferentiated component resembled a giant cell tumor of bone. This phenotype is rarely described in the dedifferentiated component of a dedifferentiated parosteal osteosarcoma. The clinical, radiographic, and pathologic features of this unusual tumor are described to further expand the histologic spectrum of dedifferentiated parosteal osteosarcoma.
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Affiliation(s)
- Diana M Cardona
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, College of Medicine, P.O. Box 100275, Gainesville, FL 32601-0275, USA
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Ishida T, Kuwada Y, Motoi N, Oka T, Machinami R. Dedifferentiated chondrosarcoma of the rib with a malignant mesenchymomatous component: an autopsy case report. Pathol Int 1997; 47:397-403. [PMID: 9211528 DOI: 10.1111/j.1440-1827.1997.tb04514.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A rare variant of dedifferentiated chondrosarcoma with malignant mesenchymomatous component in a 57-year-old male is reported. The patient presented with a posterior mediastinal mass arising from the left eighth and ninth ribs showing well differentiated, low-grade chondrosarcoma. Five years later, local recurrence occurred and an excised specimen also showed the same histological features as the primary tumor. Another 6 years later, the tumor recurred and metastasized to the multiple organs, the patient dying 4 months later. Autopsy revealed that the recurrent and metastatic tumors showed malignant mesenchymomatous 'dedifferentiation' of chondrosarcoma composed of rhabdomyosarcoma, angiosarcoma, chondrosarcoma, osteosarcoma, and leiomyosarcoma, in addition to fibrosarcomatous areas. Although the less differentiated component of dedifferentiated chondrosarcoma usually shows the histological features of malignant fibrous histiocytoma and fibrosarcoma, multilineage differentiation can occur in that component. The phenomenon of 'dedifferentiation' in chondrosarcoma and the relationship to and distinction from malignant mesenchymoma of soft tissue and bone are discussed.
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Affiliation(s)
- T Ishida
- Department of Pathology, Faculty of Medicine, University of Tokyo, Japan
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Reith JD, Bauer TW, Fischler DF, Joyce MJ, Marks KE. Dedifferentiated chondrosarcoma with rhabdomyosarcomatous differentiation. Am J Surg Pathol 1996; 20:293-8. [PMID: 8772782 DOI: 10.1097/00000478-199603000-00005] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Dedifferentiated chondrosarcomas are primary bone tumors characterized by the presence of both low-grade cartilaginous and high-grade sarcomatous components. The high-grade component usually shows histologic features of either malignant fibrous histiocytoma or fibrosarcoma. We are aware of only 10 published cases in which the high-grade component showed rhabdomyosarcomatous differentiation. To further clarify the clinical, radiographic, and pathologic features of this unusual variant, we report three additional cases of dedifferentiated chondrosarcoma with rhabdomyosarcomatous differentiation. The patients included two men and one woman; their mean age was 63 years. Tumors originated in the pelvis (ilium), scapula, and tibia. Two patients presented with radiographic findings typical of dedifferentiated chondrosarcoma, including a geographic, lytic lesion with areas of mineralization suggestive of cartilage in close association with a permeative component. The third patient presented with a primarily lytic, destructive lesion of the right iliac wing. Histologically, the tumors contained lobules of well-differentiated chondrosarcoma associated with a high-grade sarcoma with prominent rhabdomyoblasts. Immunohistochemical stains for actin and desmin were positive in all three tumors, and electron microscopy revealed evidence of skeletal muscle differentiation. All three patients died with metastatic disease, 1, 6, and 12 months postoperatively. This histologic variant of dedifferentiated chondrosarcoma is rare, but it shows radiographic and clinical features similar to "conventional" dedifferentiated chondrosarcoma, including a very poor prognosis.
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Affiliation(s)
- J D Reith
- Department of Anatomic Pathology, Cleveland Clinic Foundation, OH 44195, USA
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