Updated: 12/27/2021

Chondrosarcoma

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  • Snapshot
    • A 68-year-old man presents to his primary care physician for left leg pain. His pain has been progressively worsening over the course of a month and is present at night. Physical examination demonstrates impaired left lower extremity weakness limited by pain. A radiograph of the left hip and femur demonstrates lytic lesions and intralesional calcifications.
  • Introduction
    • Overview
      • malignant tumor that produces chondroid matrix by chondrocytes
  • Epidemiology
    • Incidence
      • 3rd most common primary malignancy of bone
  • ETIOLOGY
    • Pathophysiology
      • primary chondrosarcoma
        • arises de novo
      • secondary chondrosarcoma
        • arises from preexisting cartilage lesions
          • osteochondroma
          • endochondroma
      • has a predilection for the axial skeleton
        • pelvis and ribs
        • femur
        • humerus
  • Presentation
    • Symptoms
      • pain at the site of involvement
        • can be present at night
    • Physical exam
      • tenderness to palpation at the site of involvement
      • neurologic dysfunction if there are pelvic lesions close to the neurovascular bundle
  • Imaging
    • Radiography
      • indication
        • initial imaging study
      • findings
        • lytic lesions
        • intralesional calcifications
          • e.g., "popcorn calcifications"
    • CT scan
      • indication
        • to detect subtle lesions or lesions that are found in anatomically complex areas
    • MRI
      • indication
        • to evaluate the extent of the disease and soft tissue involvement
  • Studies
    • Invasive studies
      • fine needle aspiration or core biopsy
        • indication
          • confirms the diagnosis
        • findings
          • malignant chondrocytes in gelatious cartilaginous matrix
            • it is often difficult to determine malignancy based on histology alone
  • Differential
    • Osteosarcoma
      • differentiating factors
        • histology demonstrates pleomorphic osteoid-producing cells
    • Ewing sarcoma
      • differentiating factors
        • anaplastic small, round, and blue cells with scant cytoplasm
        • typically affects the diaphysis
  • Treatment
    • Surgical
      • intralesional curettage
        • indications
          • low-grade chondrosarcoma
      • wide en bloc local excision
        • indication
          • intermediate- and high-grade tumors
  • Complications
    • Fractures
    • Metastasis (however, has low metastatic potential)
  • Prognosis
    • Prognostic variable
      • favorable
        • location where complete wide resection can be performed
        • the lower the tumor grade

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