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https://upload.medbullets.com/topic/120476/images/case_e_-_prox_femur_-_xray_-_parsons.jpg
https://upload.medbullets.com/topic/120476/images/chondrosarcoma..jpg
https://upload.medbullets.com/topic/120476/images/chondrosarcoma.high_power.histology.jpg
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
  • 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
  • Prognosis
    • prognostic variable
      • favorable
        • location where complete wide resection can be performed
        • the lower the tumor grade
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)

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