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Jones HB, Murphree J, Suryavanshi JR, Osemwengie BO, Rosqvist S, Cox CT, MacKay BJ. Multifocal chondrosarcoma of the hand: Case report and review of the literature. Clin Case Rep 2021; 9:e04352. [PMID: 34136252 PMCID: PMC8190542 DOI: 10.1002/ccr3.4352] [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] [Received: 09/15/2020] [Revised: 02/10/2021] [Accepted: 04/28/2021] [Indexed: 11/12/2022] Open
Abstract
Few multifocal hand chondrosarcomas have been reported. To our knowledge, this report is the first to describe multifocal hand chondrosarcoma in a patient with no evidence of prior enchondroma, Ollier's disease, or Maffucci syndrome.
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Affiliation(s)
| | - Jacob Murphree
- Texas Tech University Health Sciences CenterLubbockTXUSA
| | | | | | | | - Cameron T. Cox
- Texas Tech University Health Sciences CenterLubbockTXUSA
| | - Brendan J. MacKay
- Texas Tech University Health Sciences CenterLubbockTXUSA
- University Medical CenterLubbockTXUSA
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The value of chest and skeletal staging studies in conventional chondrosarcoma. Skeletal Radiol 2021; 50:125-135. [PMID: 32666323 DOI: 10.1007/s00256-020-03539-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the value of chest and skeletal staging in patients presenting with conventional chondrosarcoma (CS). MATERIALS AND METHODS Retrospective review of patients with CS diagnosed between January 2007 and December 2019. Data collected included age, sex, skeletal location and results of chest CT and whole-body bone scintigraphy (WB-BSc) obtained at initial diagnosis. The histological tumour grade based on surgical resection or needle biopsy was classified as low-grade (LGCT), high-grade (HGCT) and dedifferentiated (DD-CS). Findings of chest CT and WB-BSc were correlated with tumour grade. RESULTS Four hundred twenty patients were included (234 males and 186 females with mean age 54.5 years, range 9-91 years). The major long bones were involved in 205 cases, the flat bones in 166 cases, the mobile spine in 14 cases and the small bones of the hands and feet in 35 cases. Three hundred fifty tumours were central in location, 39 peripheral and 31 on the surface of the bone. There were 151 LGCTs, 196 HGCTs and 73 DD-CSs. Of patients with LGCT, 41.7% underwent chest CT and 25.2% WB-BSc. Of patients with HGCT, 95.4% underwent chest CT and 76.5% WB-BSc. Of patients with DD-CS, 98.6% underwent chest CT and 86.3% WB-BSc. Metastases were diagnosed in 2 (3.3%) chest CT studies and 0 WB-BSc in LGCT, in 8 (4.3%) chest CT studies and 0 WB-BSc in HGCT and in 21 (30%) chest CT studies and 6 (21%) WB-BSc in DD-CS. DISCUSSION Staging chest CT and WB-BSc is of little or no value except in DD-CS.
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Samuel AM, Munger AM, Lee FY, Friedlaender GE, Ibe IK, Lindskog DM. Bone Scans Have Little Utility in the Evaluation of Well-Differentiated Cartilaginous Lesions of the Humerus. Orthopedics 2020; 43:e498-e502. [PMID: 32882054 DOI: 10.3928/01477447-20200827-05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 10/18/2019] [Indexed: 02/03/2023]
Abstract
In the humerus, pain is a poor guide for differentiating between benign enchondromas and malignant well-differentiated chondrosarcomas. Radionuclide bone scans often are used, and chondrosarcomas reliably show increased uptake. However, it remains to be seen whether enchondromas consistently have negative findings on bone scans, which would provide reliable differentiation from malignant lesions. Imaging and medical records were reviewed for patients who underwent radionuclide bone scans for enchondroma of the humerus at one academic medical center over a period of 7 years. Bivariate logistic regression was used to determine the association of bone scan results with the finding of endosteal scalloping on radiographs and magnetic resonance imaging (MRI) scans. During initial evaluation, 25 patients who had enchondroma of the humerus underwent radionuclide bone scans. No patients showed progression of lesions during an average follow-up of 69 weeks. On bone scan, 18 (72%) had significantly positive findings, 5 (20%) had mildly positive findings, and 2 (8%) had negative findings. Of the 22 patients who underwent MRI scans, 4 showed endosteal scalloping and none showed aggressive features. No statistically significant association was seen between significantly positive (P=.299) or mildly positive findings on bone scans (P=.810) and the finding of endosteal scalloping on radiographs or MRI scans. Enchondromas rarely showed negative findings on bone scans, and bone scan findings did not correlate with the findings on radiographs or MRI scans. The diagnosis of enchondroma can be made based on clinical and radiographic findings, and the added utility of bone scans does not justify their regular use. [Orthopedics. 2020;43(6):e498-e502.].
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CORR Insights®: Is Skeletal Imaging Essential in the Staging Workup for Conventional Chondrosarcoma? Clin Orthop Relat Res 2020; 478:2485-2486. [PMID: 32740478 PMCID: PMC7594928 DOI: 10.1097/corr.0000000000001423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Gulia A, Kurisunkal V, Puri A, Purandare N, Gupta S, Rangarajan Drm V. Is Skeletal Imaging Essential in the Staging Workup for Conventional Chondrosarcoma? Clin Orthop Relat Res 2020; 478:2480-2484. [PMID: 32567825 PMCID: PMC7594919 DOI: 10.1097/corr.0000000000001357] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 05/21/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Staging of a bone sarcoma before initiating treatment helps orthopaedic oncologists determine the intent of treatment and predicting the prognosis. As per National Comprehensive Cancer Network (NCCN) and European Society for Medical Oncology (ESMO) guidelines, there are no exclusive recommendations for chondrosarcoma staging. They are staged similar to other bone sarcomas even though skeletal metastases are extremely rare in chondrosarcomas. QUESTIONS/PURPOSES We asked: (1) What proportion of patients with a chondrosarcoma present with detectable only skeletal metastasis? (2) What proportion of patients with chondrosarcoma present with skeletal metastasis with or without concurrent pulmonary metastases? METHODS Between January 2006 to December 2017, 480 patients with histology-proven chondrosarcomas of the extremity, including clavicle, scapula, spine, and pelvis, presented to our institute. Fifty-three patients were excluded due to incomplete details about their staging. The remaining 427 were retrospectively analyzed and included in this study. Their clinical, radiological, and histopathological details were retrieved from patient files and electronic medical records. Of the 427 patients included, 53 had Grade 1 chondrosarcoma, 330 had Grade 2 chondrosarcoma, and 41 had Grade 3 chondrosarcoma. Grade was not available in three patients. All patients were staged with a thoracic CT scan and bone scan or a whole body fluorodeoxyglucose positron-emission tomography/CT (FDG PET/CT). Patients with a suspected or documented metastasis were reviewed again by an experienced radiologist and a nuclear medicine expert for the purpose of this study. A total of 8% (35 of 427) of patients with chondrosarcoma had isolated lung metastases at the time of initial staging. These included 9% (31 of 330) of patients with Grade 2 chondrosarcomas and 10% (4 of 41) of patients with Grade 3 chondrosarcomas. No patient with a Grade 1 chondrosarcoma had detectable lung metastases. The primary study endpoint was the number of patients who had a diagnosis of skeletal or skeletal and lung metastases as identified by the staging modalities. RESULTS Three patients with Grade 2 chondrosarcoma had only skeletal metastasis. No patients with Grade 1 or Grade 3 chondrosarcoma had detectable bone metastases. Combined lung and bone metastases were seen in only two patients with Grade 2 chondrosarcoma. CONCLUSIONS Our study found that the incidence of bony metastasis in conventional chondrosarcomas is extremely low. Considering the present results, we believe skeletal scanning may be overused in current staging algorithms. We do not have survival outcomes to know if detecting these few patients with skeletal lesions at initial presentation would be important in the absence of symptoms, but our data suggest that omitting skeletal imaging from the staging work-up of conventional chondrosarcomas should be considered. It may be reserved for patients with documented pulmonary metastases. LEVEL OF EVIDENCE Level IV, diagnostic study.
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Affiliation(s)
- Ashish Gulia
- A. Gulia, V. Kurisunkal, A. Puri, N. Purandare, S. Gupta, V. Rangarajan, Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Vineet Kurisunkal
- A. Gulia, V. Kurisunkal, A. Puri, N. Purandare, S. Gupta, V. Rangarajan, Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Ajay Puri
- A. Gulia, V. Kurisunkal, A. Puri, N. Purandare, S. Gupta, V. Rangarajan, Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Nilendu Purandare
- A. Gulia, V. Kurisunkal, A. Puri, N. Purandare, S. Gupta, V. Rangarajan, Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Srinath Gupta
- A. Gulia, V. Kurisunkal, A. Puri, N. Purandare, S. Gupta, V. Rangarajan, Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Venkatesh Rangarajan Drm
- A. Gulia, V. Kurisunkal, A. Puri, N. Purandare, S. Gupta, V. Rangarajan, Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
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Importance of Skeletal Staging in Chondrosarcoma of Bone: Results of Survey on Current Practices Among Musculoskeletal Oncologists. Indian J Orthop 2020; 55:234-240. [PMID: 34113428 PMCID: PMC8149512 DOI: 10.1007/s43465-020-00125-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 04/15/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE There are no clear guidelines for staging of conventional chondrosarcoma. We conducted an online survey to determine the current practices for skeletal staging for conventional chondrosarcoma among practicing oncologists and to assess any discrepancy in practices and with the published literature. METHODOLOGY A simple ten-question online survey (e-mails and WhatsApp) was conducted among practicing oncologists over a period of 3 weeks using online portal (surveymonkey.com). It was followed by analysis based on each question to find current practices. RESULTS 139 members participated in the survey (84% surgeons, 9% radiologists, 3% medical and 3% radiation oncologists and 1% nuclear medicine). 65% have been treating chondrosarcoma for more than 5 years. 88% opined that biopsy is mandatory even if the radiology is suggestive of a chondrosarcoma. 66% said that solitary skeletal metastasis is seen in less than 2% of the cases but 84% of participants were in favour of performing an investigation (bone scan/PET scan) for skeletal survey. While 43% opined skeletal metastasis is more common in recurrent chondrosarcoma, 26% said that performing a bone scan was likely to impact management, 28% said it will not impact management and 46% were unsure. Of the group who thought that a bone scan would impact management or were unsure, the majority (56%) opined that this was relevant only in grade 2 and grade 3 chondrosarcoma. CONCLUSION There was lack of consensus regarding staging for chondrosarcoma. Only 26% of respondents were convinced that performing a bone scan was likely to impact management of chondrosarcoma. There is a need to analyze large data sets (retrospective/prospective) to arrive at an evidence-based staging algorithm for chondrosarcoma.
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Abstract
Chondrosarcomas in children and adolescents are uncommon and constitute < 5% of all chondrosarcomas. There are very few studies discussing extremity chondrosarcomas in young patients. The pelvis is the most common site, followed by the proximal femur. As cartilaginous tumours can be quite challenging to diagnose, it is best for these lesions to be discussed in a multidisciplinary meeting which includes a radiologist and a pathologist specializing in bone tumours. Treatment principles are similar to those in adults, with adequate surgical excision respecting oncologic principles being the mainstay of treatment. Select extremity Grade I chondrosarcomas may be managed with extended intralesional curettage without increasing the risk for local recurrence or metastatic disease, but case selection is critical and should be based on clinical, imaging and histological characteristics. Chondrosarcomas are resistant to chemotherapy and relatively radioresistant. For mesenchymal chondrosarcomas, there may be a role for chemotherapy, though data on this is limited. Prognosis and rate of recurrence correlate directly to the adequacy of the surgical resection. Chondrosarcomas in younger patients behave in a similar fashion to those in adults, and outcomes in the young are no different from those in adults.
Cite this article: EFORT Open Rev 2020;5:90-95. DOI: 10.1302/2058-5241.5.190052
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Affiliation(s)
- Ajay Puri
- Department of Surgery, Tata Memorial Hospital, HBNI, Mumbai
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McLoughlin E, Davies AM, Iqbal A, James SL, Botchu R. The diagnostic significance of pulmonary nodules on CT thorax in chondrosarcoma of bone. Clin Radiol 2019; 75:395.e7-395.e16. [PMID: 31898960 DOI: 10.1016/j.crad.2019.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/13/2019] [Indexed: 10/25/2022]
Abstract
AIM To provide a diagnostic approach to pulmonary nodules in patients with chondrosarcoma. MATERIALS AND METHODS A search of the oncology database at a specialist orthopaedic oncology referral centre was performed to identify all patients who were treated surgically for chondrosarcoma between January 2007 and December 2018. Reports from the computed tomography (CT) examinations of the thorax of these patients were reviewed. In patients who had pulmonary nodules/metastases identified on CT, data on the primary chondrosarcoma and pulmonary nodule characteristics were collected. RESULTS Twenty point two percent of patients had a pulmonary nodule identified on either initial or follow-up staging CT of the thorax, of which 8.1% were pulmonary metastases. Patients with grade 3 and dedifferentiated chondrosarcoma were more likely to have pulmonary metastases than patients with grade 1/2 chondrosarcoma. The time interval to developing metastases was shorter in patients with grade 2/3 and dedifferentiated chondrosarcoma versus patients with grade 1 chondrosarcoma. A low proportion of patients with grade 1 chondrosarcoma developed metastases (12.5%), all of which were identified at the time of a local recurrence. Nodules ≥10mm, nodules with lobulate margins, nodules containing irregular or subtle calcification, and nodules seen bilaterally or both centrally and peripherally were more likely to represent pulmonary metastases than benign nodules. CONCLUSION The diagnostic significance of pulmonary nodules (i.e., whether they represent pulmonary metastases or not) can be predicted by taking into account a number of factors, in particular, the histological grade of the patient's chondrosarcoma, the size and margins of the nodules, and the presence of subtle/irregular calcification.
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Affiliation(s)
- E McLoughlin
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - A M Davies
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - A Iqbal
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - S L James
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK.
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Patel A, Davies A, Botchu R, James S. A pragmatic approach to the imaging and follow-up of solitary central cartilage tumours of the proximal humerus and knee. Clin Radiol 2019; 74:517-526. [DOI: 10.1016/j.crad.2019.01.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 01/30/2019] [Indexed: 02/08/2023]
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Gulia A, Puri A, Byregowda S. Staging investigations in chondrosarcoma: Is evaluation for skeletal metastases justified? Analysis from an epidemiological study at a tertiary cancer care center and review of literature. South Asian J Cancer 2016; 5:3-4. [PMID: 27169107 PMCID: PMC4845606 DOI: 10.4103/2278-330x.179690] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ashish Gulia
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Ajay Puri
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Suman Byregowda
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Brown MT, Gikas PD, Bhamra JS, Skinner JA, Aston WJS, Pollock RC, Saifuddin A, Briggs TWR. How safe is curettage of low-grade cartilaginous neoplasms diagnosed by imaging with or without pre-operative needle biopsy? Bone Joint J 2014; 96-B:1098-105. [PMID: 25086127 DOI: 10.1302/0301-620x.96b8.32056] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The pre-operative differentiation between enchondroma, low-grade chondrosarcoma and high-grade chondrosarcoma remains a diagnostic challenge. We reviewed the accuracy and safety of the radiological grading of cartilaginous tumours through the assessment of, first, pre-operative radiological and post-operative histological agreement, and second the rate of recurrence in lesions confirmed as high-grade on histology. We performed a retrospective review of major long bone cartilaginous tumours managed by curettage as low grade between 2001 and 2012. A total of 53 patients with a mean age of 47.6 years (8 to 71) were included. There were 23 men and 30 women. The tumours involved the femur (n = 20), humerus (n = 18), tibia (n = 9), fibula (n = 3), radius (n = 2) and ulna (n = 1). Pre-operative diagnoses resulted from multidisciplinary consensus following radiological review alone for 35 tumours, or with the addition of pre-operative image guided needle biopsy for 18. The histologically confirmed diagnosis was enchondroma for two (3.7%), low-grade chondrosarcoma for 49 (92.6%) and high-grade chondrosarcoma for two (3.7%). Three patients with a low-grade tumour developed a local recurrence at a mean of 15 months (12 to 17) post-operatively. A single high-grade recurrence (grade II) was treated with tibial diaphyseal replacement. The overall recurrence rate was 7.5% at a mean follow-up of 4.7 years (1.2 to 12.3). Cartilaginous tumours identified as low-grade on pre-operative imaging with or without additional image-guided needle biopsy can safely be managed as low-grade without pre-operative histological diagnosis. A few tumours may demonstrate high-grade features histologically, but the rates of recurrence are not affected.
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Affiliation(s)
- M T Brown
- Royal National Orthopaedic Hospital, London Bone and Soft Tissue Sarcoma Service, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - P D Gikas
- Royal National Orthopaedic Hospital, London Bone and Soft Tissue Sarcoma Service, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - J S Bhamra
- Royal National Orthopaedic Hospital, London Bone and Soft Tissue Sarcoma Service, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - J A Skinner
- Royal National Orthopaedic Hospital, London Bone and Soft Tissue Sarcoma Service, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - W J S Aston
- Royal National Orthopaedic Hospital, London Bone and Soft Tissue Sarcoma Service, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - R C Pollock
- Royal National Orthopaedic Hospital, London Bone and Soft Tissue Sarcoma Service, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - A Saifuddin
- Royal National Orthopaedic Hospital, London Bone and Soft Tissue Sarcoma Service, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - T W R Briggs
- Royal National Orthopaedic Hospital, London Bone and Soft Tissue Sarcoma Service, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
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Douis H, Saifuddin A. The imaging of cartilaginous bone tumours. II. Chondrosarcoma. Skeletal Radiol 2013; 42:611-26. [PMID: 23053201 DOI: 10.1007/s00256-012-1521-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Revised: 08/27/2012] [Accepted: 08/30/2012] [Indexed: 02/07/2023]
Abstract
Chondrosarcoma is the third most common primary malignant bone tumour. There are various histological subtypes of chondrosarcomas, of which conventional intramedullary chondrosarcoma is by far the most common. Rarer sub-types include clear cell chondrosarcoma, myxoid chondrosarcoma, mesenchymal chondrosarcoma and dedifferentiated chondrosarcoma. Chondrosarcoma is also classified into central, peripheral and periosteal, dependent upon the lesion site, and into primary chondrosarcoma if the lesion arises de novo and secondary chondrosarcoma if the tumour arises in a pre-existing lesion. The various subtypes of chondrosarcoma have characteristic imaging features that may aid diagnosis and may guide biopsy, therefore potentially preventing misdiagnosis. The aim of this article is to provide an overview of the pertinent clinical and imaging findings of the different forms of chondrosarcoma.
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Affiliation(s)
- H Douis
- Department of Radiology, The Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
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Campbell R. Highlights of the scientific meeting of the 18th Annual Congress of the European Society of Skeletal Radiology (ESSR) 2011. Skeletal Radiol 2012; 41:121-4. [PMID: 22080361 DOI: 10.1007/s00256-011-1312-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Rob Campbell
- Department of Radiology, Royal Liverpool University Hospital, Liverpool, L7 8XP, UK.
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