Mesenchymal chondrosarcoma of the orbit: CT and MRI findings

Evaluation of orbital lesions with DCE-MRI: a literature review

PURPOSE

To provide a major review on the applications of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in evaluating orbital lesions. This review also outlines selected scenarios where DCE-MRI may be helpful.

METHODS

A comprehensive retrospective literature review of all English language publications on PubMed, EMBASE, and Google Scholar between 1994 and 2022. This literature review examined the specific applications and clinical scenarios surrounding the utility of DCE-MRI in orbital lesions and various findings that have been presented in the current literature.

RESULTS

DCE-MRI provides information on tissue physiology and permeability, beyond the anatomical features displayed on static imaging. Various measured parameters (qualitative, semi-quantitative, and quantitative) obtained by DCE-MRI have been used to differentiate between benign and malignant lesions, specific orbital lymphoproliferative diseases (OLPD), lacrimal gland lesions, and various rare orbital tumours. DCE-MRI has a limited role as an initial diagnostic imaging modality. However, DCE-MRI may prove to have benefit in predicting and monitoring treatment response in orbital lymphoma as a critical imaging study, but literature specific to orbital malignancies remains limited.

CONCLUSION

The value of DCE-MRI may be in situations of diagnostic uncertainty, where it may be an additional imaging aid following conventional imaging techniques. It may also act as a critical imaging modality for monitoring of orbital tumour treatment response, but the literature remains limited. Standardisation of imaging protocol, measured parameters, and statistical analysis remain limitations of this imaging technique.

Mesenchymal chondrosarcoma of the orbit masquerading as a hemophilic pseudotumor

An 11-year-old boy presented with a lesion of the right orbit that was thought to be a hemophilic pseudotumor. Excisional biopsy revealed an unexpected diagnosis of mesenchymal chondrosarcoma. Both mesenchymal chondrosarcoma and hemophilic pseudotumor of the orbit are exceedingly rare. To the best of our knowledge, this is the first reported case of orbital mesenchymal chondrosarcoma masquerading as hemophilic pseudotumor.

Primary mesenchymal chondrosarcoma of the orbit in a young female: imaging and histopathological features

Mesenchymal chondrosarcoma (MCS) is a rare high-grade sarcoma of bone and soft tissue with highly aggressive behavior and a peak incidence in the second and third decades. We report a case of primary orbital MCS in a 30 year-old female, with radiological and clinicopathological features. Orbital MCS is an entity that should be considered in the differential diagnosis of calcified orbital lesions.

Mesenchymal Chondrosarcoma of the Orbit Attached to the Optic Nerve

Mesenchymal chondrosarcoma (MCS) is a rare tumor in the orbit. Although optic nerve displacement is a common finding in intraorbital MCS, optic nerve tissue involvement in tumor has rarely been reported in huge tumors associated with intracranial extension. Herein the authors report a patient with MCS involving optic nerve tissue without intracranial extension. A 59-year-old woman with a 2-month history of progressive proptosis and normal vision presented to us. Computed tomography revealed a clearly outlined heterogeneous mass with calcified foci in its center, which was attached to the optic nerve, magnetic resonance imaging showed the mass to be isointense to gray matter on T1- and T2-weighted images. She underwent lateral orbitotomy and partial tumor excision. Histopathologic study confirmed MCS. She refused exenteration till 1 year but the tumor recurred and her vision decreased to no light perception. Then exenteration was performed with obtaining free margin and she is now free of tumor after 6 months without radiotherapy or chemotherapy. Mesenchymal chondrosarcoma must be differentiated from more common calcified tumors attached to optic nerve like meningioma.

Mesenchymal chondrosarcoma of the orbit: imaging features of CT and MRI

OBJECTIVE:

Mesenchymal chondrosarcoma (MCS) of the orbit is a rare and aggressive form of chondrosarcoma. The purpose of this study was to retrospectively identify the imaging features of mesenchymal chondrosarcoma of the orbit.

METHODS:

This study included five patients with histologically confirmed MCS of the orbit who had undergone either CT, MRI, or both. Images were evaluated for the following: location, size, margin, CT density and presence or absence of calcification and/or ossification, MRI findings including dynamic contrast-enhancement and time-intensity curves.

RESULTS:

CT was performed in four of the five patients, and all four (100%) demonstrated calcification and ossification of the mass. MRI was performed in all five patients. In two patients (40%), the mass demonstrated areas of hyperintensity on T₁ weighted images.

CONCLUSION:

The presence of a well-defined, orbital mass with calcification and ossification on CT and, marked heterogenous enhancement and a rapid-washout pattern on dynamic MRI indicate a high probability of MCS of the orbit. In addition, MCS of the orbit can demonstrate areas of hyperintensity on T₁ weighted images, representing bone marrow fat tissue of ossification.

ADVANCES IN KNOWLEDGE:

MCS of the orbit is a highly malignant tumor, and early diagnosis by imaging is important. Radiologists should be aware of the imaging features of MCS of the orbit.

Mesenchymal Chondrosarcoma of the Lacrimal Gland

A 23-year-old woman presented with right-sided painless proptosis that developed in 12 months. MRI studies demonstrated a well-delineated tumorous enlargement of the right lacrimal gland with homogenous signal intensity and compressing the globe. The tumor was removed totally and in 1 piece with the tentative diagnosis of a pleomorphic adenoma. Pathologic examination revealed biphasic neoplastic elements, which were composed of the cartilaginous matrix and small round cell component. Immunohistopathological examination showed positive CD99 staining and negative reaction to S100, panCK, and CD15. The patient then received a total of 64 Gy orbital radiotherapy in 32 fractionations. There has been no recurrence or metastasis during 14 months of follow up. This case showed that mesenchymal chondrosarcoma may arise from the lacrimal gland and must be considered in the differential diagnosis of lacrimal gland tumors in young adults.

Mesenchymal chondrosarcoma of the orbit: A case report with 5 years of follow-up

Mesenchymal chondrosarcoma is a rare orbital tumor. Several case reports of this rare tumor have been published in the literature but only 6 cases have documented a follow up of 5 years or more. We report a case of 28 year-old female who presented with left orbital mass. Computed Tomography (CT) revealed a lobulated mass in the superior extraconal space with dense intralesional calcification. Patient underwent complete resection of the mass and histopathology was suggestive of mesenchymal chondrosarcoma. He was given adjuvant radiotherapy and there was no recurrence or metastasis at 5 years of follow-up. The case highlights that a complete resection with adjuvant radiotherapy in cases of orbital mesenchymal chondrosarcoma offers excellent prognosis.

Extraskeletal orbital mesenchymal chondrosarcoma: surgical approach and mini review

Extraskeletal orbital mesenchymal chondrosarcoma (MC) is an extremely rare and highly aggressive tumour. It has characteristic radiological features and pathognomic histological biphasic pattern. Radical resection with negative margins is the mainstay of treatment; role of adjuvant chemotherapy and radiotherapy is yet not well defined. We report a rare case of 18-year-old man who was diagnosed to have orbital MC. He presented with locally advanced disease with no vision in the affected eye. He underwent right orbital exenteration; a transcranial intradural approach was used to divide the optic nerve, and the temporalis muscle flap was utilised to fill the exenterated orbit. Though optic nerve involvement is rare in orbital MCs, a transcranial approach may be used effectively to avoid traction on optic chiasma and ensure margin-free resection in case of optic nerve involvement up to orbital apex. Unfortunately, prognosis remains dismal in MCs despite treatment.

Primary retroperitoneal extraskeletal mesenchymal chondrosarcoma involving the vena cava: A case report

The current study presents a case of extraskeletal mesenchymal chondrosarcoma (ESMC) involving the vena cava that originally occurred in the retroperitoneum of a 61-year-old female. Following excision of the masses, pathological examination confirmed a diagnosis of primary ESMC. Mesenchymal chondrosarcomas are extremely rare in comparison to conventional chondrosarcomas and even more so when arising in an extraskeletal location. In the current report, the major characteristics of ESMC are discussed and a review of the current knowledge regarding this rare disease entity is presented.

Orbital masses: CT and MRI of common vascular lesions, benign tumors, and malignancies

A wide variety of space occupying lesions may be encountered in the orbit. CT and MR imaging frequently help confirm the presence of a mass and define its extent. Characteristic imaging features may help distinguish among lesions that have overlapping clinical presentations. This review focuses on some of the common orbital masses. Common vascular lesions that are reviewed include: capillary (infantile) hemangioma, cavernous hemangioma (solitary encapsulated venous-lymphatic malformation), and lymphangioma (venous-lymphatic malformation). Benign tumors that are reviewed include: optic nerve sheath meningioma, schwannoma, and neurofibroma. Malignancies that are reviewed include: lymphoma, metastasis, rhabdomyosarcoma, and optic glioma. Key imaging features that guide radiological diagnosis are discussed and illustrated.