What Factors Are Associated with Treatment Outcomes of Japanese Patients with Clear Cell Chondrosarcoma?

Clear cell chondrosarcoma: a review of clinicopathologic characteristics, differential diagnoses, and patient management

Clear cell chondrosarcoma (CCC), an extremely rare primary bone tumor, is currently classified by the World Health Organization as a low-grade malignant cartilaginous neoplasm. Clinically, CCC occurs primarily in males with a peak incidence in the third to fifth decades of life, and occasionally, it presents in skeletally immature patients. Unlike conventional chondrosarcoma, CCC has a predilection for the epiphysis of long bones and often displays radiologic features reminiscent of chondroblastoma. The recommended treatment is wide operative resection. CCC has a local recurrence rate of approximately 30%, and nearly 20% cases metastasize mainly to bone and lung often a decade after surgical intervention. Incomplete excision or curettage is associated with a high rate of recurrence. Histologically, the process is characterized by infiltrative lobules and sheets of round to oval cells with abundant cleared cytoplasm and well-defined cell borders associated with trabecula of osteoid and woven bone, scattered osteoclasts, and foci of conventional low-grade chondrosarcoma in about one-half of cases. Correlation with clinical and radiologic characteristics, such as epiphyseal location and young patient age, assists in establishing a correct diagnosis. Pathologic diagnosis of CCC is complicated by the low diagnostic accuracy of core needle biopsy, overlapping histologic features with other matrix-rich primary bone tumors, and a lack of a specific immunohistochemical and molecular profile. DNA methylation-based profiling classifier (sarcoma classifier) is one recent technologic advancement that may help to confirm the histopathological diagnosis of CCC or indicate the need for thorough reassessment in cases where results contradict previous conventional findings.

Chondrosarcoma: A Clinical Review

Chondrosarcomas are a diverse group of malignant cartilaginous matrix-producing neoplasms. Conventional chondrosarcomas are a continuum of disease based on the biologic activity of the tumor. The tumors range from the relatively biologically benign low-grade tumors or intermediate atypical cartilaginous tumors (ACTs), to malignant, aggressive high-grade tumors. The clinical presentation, radiographic and pathologic findings, treatments and outcomes vary significantly based on the histologic grade of the tumor. Chondrosarcomas present a diagnostic dilemma, particularly in the differentiation between high- and intermediate-grade tumors and that of low-grade tumors from benign enchondromas. A multidisciplinary team at a tertiary sarcoma centre allows for optimal care of these patients.

The Epidemiology of Chondrosarcoma in Iran Based on Iran National Cancer Registry

Background: Chondrosarcoma is regarded as the second most common primary bone malignancy following osteosarcoma. Objectives: The present study aimed at determining the epidemiology, incidence, and survival rate of chondrosarcoma in the Iranian population, according to the Iran National Cancer Registry (INCR). Methods: In an epidemiological study, patients with limb chondrosarcoma were evaluated based on INCR data between 2008 and 2015. Data included patients’ demographic characteristics, date of diagnosis, location of the tumor, patient’s survival, and type of tumor based on the International Classification of Diseases for Oncology (ICD-O-3; first revision, third edition) were collected and analyzed. Results: Out of 732 enrolled patients, 425 patients (58.06%) were male and 307 (41.94%) were female with a mean age of 44.08 (SD = 19.31) and 45.06 (SD = 18.72), respectively. Age-standardized incidence rates (ASIR) were 1.73 and 1.27 per 1 million person-years for males and females, respectively. Conventional chondrosarcoma was the most common subtype with ASIR 1.28 and constituted 84.7% of patients with chondrosarcoma. About 71.03% of all Chondrosarcoma patients (70.35% of males and 71.99% of females) were between 20 to 59 years old. The 1-, 3-, 5-, and 7-year survival rates of patients were 0.87, 0.73, 0.57, and 0.47, respectively. Also, the mean survival time was 6.12 years (95% CI: 5.85 - 7.39). Conclusions: The incidence of chondrosarcoma in Iran is not as high as in other countries, but as patients are younger in Iran, the survival rate is worse compared to other countries. Therefore, better case findings and better care are needed to improve the patients' outcomes in Iran.

Systemic treatment for primary malignant sarcomas arising in craniofacial bones

Introduction

Craniofacial bones may be the site of origin of various sarcomas. We review the various malignancies affecting this region of the body and attempt to put systemic treatment approaches into perspective.

Material and methods

Non-systematic literature review

Results

Conventional types of osteosarcoma, Ewing sarcoma, and chondrosarcoma are the most frequent bone sarcomas occurring in craniofacial region, but variants may occur. The tumors’ biologies and the resulting treatment strategies vary distinctly. As a general rule, local control remains paramount regardless of histology. The efficacy of antineoplastic chemotherapy varies by type of malignancy. It is clearly indicated in Ewing sarcoma and related tumors, potentially of benefit in high-grade osteosarcoma, undifferentiated pleomorphic sarcoma, dedifferentiated and mesenchymal chondrosarcoma, and of no proven benefit in the others.

Conclusions

Various histologies demand various and distinct treatment approaches, with local control remaining paramount in all. The efficacy of systemic treatments varies by type of tumor. Prospective trials would help in all of these to better define systemic treatment strategies.

Clinical Characteristics, Prognostic Factor and a Novel Dynamic Prediction Model for Overall Survival of Elderly Patients With Chondrosarcoma: A Population-Based Study

Background

Chondrosarcoma is the most common primary bone sarcoma among elderly population. This study aims to explore independent prognostic factors and develop prediction model in elderly patients with CHS.

Methods

This study retrospectively analyzed the clinical data of elderly patients diagnosed as CHS between 2004 and 2018 from the Surveillance, Epidemiology, and End Results (SEER) database. We randomly divided enrolled patients into training and validation group, univariate and multivariate Cox regression analyses were used to determine independent prognostic factors. Based on the identified variables, the nomogram was developed and verified to predict the 12-, 24-, and 36-month overall survival (OS) of elderly patients with CHS. A k-fold cross-validation method (k=10) was performed to validate the newly proposed model. The discrimination, calibration and clinical utility of the nomogram were assessed using the Harrells concordance index (C-index), receiver operating characteristic (ROC) curve and the area under the curve (AUC), calibration curve, decision curve analysis (DCA), the integrated discrimination improvement (IDI) and net reclassification index (NRI). Furthermore, a web-based survival calculator was developed based on the nomogram.

Results

The study finally included 595 elderly patients with CHS and randomized them into the training group (419 cases) and validation group (176 cases) at a ratio of 7:3. Age, sex, grade, histology, M stage, surgery and tumor size were identified as independent prognostic factors of this population. The novel nomogram displayed excellent predictive performance, which can be accessible by https://nomoresearch.shinyapps.io/elderlywithCHS/, with a C-index of 0.800 for the training group and 0.789 for the validation group. The value AUC values at 12-, 24-, and 36-month of 0.866, 0.855, and 0.860 in the training group and of 0.839, 0.856, and 0.840 in the validation group, respectively. The calibration curves exhibited good concordance from the predicted survival probabilities to actual observation. The ROC curves, IDI, NRI, and DCA showed the nomogram was superior to the existing AJCC staging system.

Conclusion

This study developed a novel web-based nomogram for accurately predicting probabilities of OS in elderly patients with CHS, which will contribute to personalized survival assessment and clinical management for elderly patients with CHS.

Successful en bloc resection for femoral head clear cell chondrosarcoma without biopsy: A case report

Clear cell chondrosarcoma (CCCS) is a rare, low-grade, malignant chondrogenic bone tumour. This tumour commonly affects the epiphysis of long bones, particularly in the proximal femur. The present study reported on the case of a 58-year-old male with right hip pain of five months duration. Plain radiography, magnetic resonance imaging and computed tomography scan revealed the characteristic appearance of chondroid mineralisation in the right femoral head, suggesting typical CCCS. Although biopsy is the gold standard for definite diagnosis prior to treatment, wide resection with removal of the biopsy tract is thought to negatively affect the surgical margin and postoperative hip function. Therefore, en bloc resection without any biopsy and a hip hemiarthroplasty were performed. The pathological diagnosis was CCCS and an adequate surgical margin was obtained. No local recurrence or distant metastases were detected and postoperative function was excellent at the final follow-up. The femoral head is a typical location of CCCS. Wide resection with adequate margins is the main treatment strategy for CCCS and when radiological features are typical, en bloc resection without a biopsy is an acceptable treatment option to improve patient outcomes.

Conventional Cartilaginous Tumors: Evaluation and Treatment

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Enchondromas are benign cartilaginous lesions that rarely require surgical intervention.

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Atypical cartilaginous tumors (ACTs), also referred to as grade-1 chondrosarcomas, may be managed without any intervention or with extended intralesional curettage and bone-void filling.

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High-grade chondrosarcomas, or grade-2 and 3 chondrosarcomas, should be managed aggressively with wide resection.

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Chemotherapy and radiation do not currently play a role in the treatment of chondrosarcomas.

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Differentiating an enchondroma from an ACT and an ACT from a high-grade chondrosarcoma can be difficult and requires clinical experience, radiographic and advanced imaging, and possibly a biopsy. Ultimately, a multidisciplinary team that includes a musculoskeletal oncologist, a radiologist, and a pathologist is needed to make the most appropriate diagnosis and treatment plan for each patient.

Clear Cell Chondrosarcoma with Rib Cage Metastasis: Case Report

Clear cell chondrosarcoma is a rare histological subtype of chondrosarcoma, usually with a relatively non-aggressive clinical course. However, infrequently they may relapse and metastasize. We describe a case of a male patient, 53 years old, with rib cage metastases of a clear cell chondrosarcoma 11 years after the first surgical intervention, and review the literature.