Chondro sarcoma: MR Imaging with Pathologic C Datla G. K Varma, MD Alberto G. Ayala, MD Cesar H. Carrasco, MD Shan-Qun Guo, MD Rajendra Kumar, MD Jack Edeiken, MD

Magnetic

resonance

sarcomas

were

diographs

and

pathologic

(MR)

Size

type.

visually

similar

of lesion

was

not

and

depicted

at surgery

and

chondrosarcoma

is excellent

U INTRODUCTION Chondrosarcomas (1,2)

and

merus,

are

gion

from

TR

that

surface

Abbreviations:

GRASS

repetition

time

Index

terms:

Bone

coma,

40.3211

=

RadioGraphics I

From

1992;

the

Departments

Texas M.D. Anderson ogy, University ofTexas ary

15, 1992;

or ribs

revision

arise

from bone.

gradient

neoplasms.

In all cases,

(1,2);

central

The

latter

recalled

40.321

1

acquisition

Bone

#{149}

of tumor or

grade

on

the

basis

delineation

of tumor

iO%-15% sites

of malignant

commonly

include

in bone

the

are

usually

or medullary lesions

are

in the steady

neoplasms.

cavity

[I.E

40.3211

and

and

of

extent.

tumors

in the

femur,

craniofacial

divided

referred

state,

diagnosis.

neck

of

How-

bone

occur

into

those

that

hematoxylin.eosin,

Bone

#{149}

re-

arise or juxta-

TE

neoplasms,

hu-

two

to as peripheral

=

acnoted

type

exact

rarer

the

MR imaging

extent

characterized

more

that was

MR images.

that

of

mimicked

on routine

occurring

of the

appearances

noted

approximately

Chondrosarcomas

those the

for

neoplasms

scapula,

(1,3,4).

groups:

constitute

slow-growing

pelvis,

be

on T2-

of pathologic

The

Histologic

cannot

intensity

inten-

chondrosarcoma

soft-tissue

examination.

of signal

imaging

of grade.

ra-

signal

high

regardless

mass. and

plain with

and

chondrosarcomas

soft-tissue

generally

analysis MR

all lesions,

Extraskeletal

pathologic

with

correlated

lobulated,

an indicator

intraosseous

chondro-

on Ti-weighted,

for

dedifferentiated

as a lobulated

curately

and

appeared

chondrosarcoma.

visualized

confirmed

in conjunction scans

(intermediate

was

of conventional

ever,

tumors

images),

mesenchymal

visual

reviewed tomographic

The

as analyzed

sity,

of 2 1 surgically

retrospectively computed

findings.

weighted

images

=

echo

MR. 40.1214

time,

Sar.

#{149}

12:687-704 ofl)iagnostic

Radiology

Cancer Center, Box 57, 1515 Medical Branch. Galveston,

requested

February

(D.G.K.V..

C.H.C.,

Holcombe Tex (R.K.).

14 and received

S.Q.G..

J.E.)

Blvd. Houston, From the 1991

March

13; accepted

and

Pathology

TX 77030 and RSNA scientific

March

(A.G.A.),

University

of

the Department of Radiolassembly. Received Janu.

17. Address

reprint

requests

to

D.G.K.V. (

RSNA,

1992

687

Table

1

Classification

of Chondrosarcoma Usual

or Conventional

Nonconventional

Primary Central Juxtacortical Secondary Arising from solitary osteochondroma Arising in patients with multiple osteochondromatosis Arising in patients with Oilier disease (enchondromatosis) or Maffucci syndrome (enchondromatosis accompanied by hemangiomas)

Dedifferentiated Mesenchymal Clear cell Extraskeletal

cortical chondrosarcomas. Most chondrosarcomas are central in origin and primary, but some may be secondary, arising from an osteochondroma or enchondroma ( 1 2,5,6). Chondrosarcomas occur most frequently in adulthood or old age and are more commonly seen in men. The usual presenting symptoms are pain and swelling (1). Chondrosarcomas may be pathologically classified as conventional or nonconventional, including dedifferentiated, mesenchymal,

U PATIENTS The MR imaging

clear

1 chondrosarcoma of the proximal was noted incidentally on a routine

surgically

cell,

and

(1,2,7-10). tion

extraskeletal

Table

myxoid

1 summarizes

of chondrosarcoma.

the

lesions

having

Grade hibit ing

best

nuclei,

grade

moderate-sized

nuclei

rate.

3 lesions

mitotic with

mitotic

Grade

foci rate

of dense

with

have

cellularity

areas

and

to our

on the findings article

late assess tion

them the

with role

and

pathologic ofMR

findings

imaging

of chondrosarcoma.

in the

to come-

in order evalua-

Patients

presented

in one

occurred The

to

rest

in origin.

patient,

a grade

humerus chest ra-

in a patient of the

grade

were

with

neoplasms

As determined

there

1, two nonconventional dedifferentiated,

little

of chondrosarcoma

scapula)

grade

a high

has been written magnetic resonance (MR) imaging in these tumors. The purpose of this is to review the MR findings observed

in 2 1 cases

(40%).

swelling;

examination,

(ii).

knowledge,

or

disease.

primary

flu-

Although much has been published about the radiologic appearance of chondrosarcomas,

patients pain

tier

a low large

(one

in the

contain

but

20 patients

cx-

(11-13).

2 lesions

included

of the

stain-

be 1

densely

group

knowledge

ret-

diograph. The tumors arose in the extremities (n = 13), pelvis (n = 2), scapula (n = 3), ribs (n = 2), and paraspinal region (n = i). One tumor arose secondarily from an osteochondroma; two tumors (one in the humerus, one

may grade

histologically of small,

while

female with

pni-

prognosis

a preponderance

with dci,

the

i chondrosarcomas

with

of

were

had two tumors), ranging in age from 17 to 77 years, with a mean age of46.6 years. There were 12 male patients (60%) and eight

classifica-

mary or secondary chondrosarcoma histologically graded as 1 to 3, with

reviewed findings.

The study

in 2 1 cases

chondrosarcoma

patient

types

Conventional

METhODS

examinations

resected

rospectively pathologic

,

AND

myxoid

i2

at pathologic conventional

MR images

were

(one

(six

2, four grade 3) and nine (three mesenchymal, three two extraskeletal myxoid,

one clear cell) chondrosarcomas. were surgically excised. sentation

01-

were

patient

generally

tumors

All

obtained

with

at pre-

mesenchymal

chondrosarcoma received radiation therapy and chemotherapy for 3 months before undergoing MR imaging). Plain radiographs were obtained in all cases, and computed tomographic (CT) scans were available in 13 cases.

In i7 tumors, MR imaging with a i.5-T superconducting

GE Medical tumors

688

U

RadioGraphics

U

Varma

et a!

were

Systems, imaged

was performed magnet (Signa;

Milwaukee). with

0.3-T

Volume

The (n

12

=

other 1) and

Number

4

Table Tumor

2

Location

of 12 Conventional

Chondrosarcomas

Grade

Site

1 1 1 2

Proximal humerus Proximal tibia Rib (extending into Humerus

2

Scapula Femur Rib (chest Pelvis

3 3 3

Table Tumor

L ocation

of Nine

abdomen)

wall)

0.5-T

(n

in axial

either

performed

or

routine

and

echo

(TEs)

time

of

images

tients,

the

images

Knolls,

NJ)

at a dose

recalled

(GRASS) msecj,

acquisition imaging

20#{176} flip

in the

(200/20 angle)

was

also

The

MR images

were

of the findings

in two

diographs

and

assessed

for

signal

CT

scans.

characteristics

intensity,

reviewed

with

know!-

on correlative The

images such

calcifications,

histologic

original

in

slides

were

re-

diagnoses

In the

not

four

available

pathologist,

cases

in

viewing,

of tumor,

experienced was

to

de-

for

subtyping

by an

14

and

to previously

histologic

performed

review

musculoskeletal

to verify

(1 1). were

at the

for

muscu-

accepted

as the

diagnosis.

state

msec/TE

performed

noted

obtained

available

according

criteria slides

final

patients.

edge

tumors

loskeletal

Gradi-

steady

[TR

17 cases,

with

However,

photographs were

(A.G.A.)

scribed

were

in conjunction

specimens.

by an experienced

grade

injection of (Berlex; Cedar

of 0. 1 mmol/kg.

In

pathologist

which

Ti-weighted

gross

viewed

of 20-30

interpreted

resected

of surgery

cases.

were obtained with TRs of 1,714-2,571 msec and TEs of 30-80 msec. Surface coil imaging was performed as appropriate. In two paadditional

be

gross

correlative

images (TRs)

T2-weighted

obtained following intravenous gadopentetate dimeglumine

not

recent

planes

multisection

times

and

of Cases 2 1 2 1 1 1 1

could

imaging

sagittal

Ti-weighted repetition times

Intermediate

No.

Scapula Paraspinal Femur Pelvis Arm Thigh Femur

In all patients,

with

msec

msec.

Site

coronal

spin-echo techniques. were obtained with

500-857

Chondrosarcomas

nal

myxoid myxoid

3) magnets.

=

and

Nonconventio

Type

Mesenchymal Mesenchymal Dedifferentiated Dedifferentiated Extraskeletal Extraskeletal Clear cell

ent

3 2 1 1 1 2 1 1

3 Tumor

was

of Cases

No.

U RESULTS The tumors

ranged

determined

at MR

imaging

The

locations

examination.

ma-

summarized generally

were

in size

in Tables lobulated.

and

tumors

3. Tumors

of tumor

as

pathologic

of the

2 and Size

4 to 36 cm,

from

was

are were not

an

as lobulation, degenerative

or

necrotic foci, and intraosseous and soft-tissue extent of tumor. These characteristics werecorrelated with the histologic subtype and findings

noted

rospective

July

1992

nature

at surgery. of the

Because analysis,

of the the

ret-

images

Varma

et a!

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RadioGrapbics

U

689

Table 4 Visualization

of Calcificati

ons

in Chondrosarcomas

Type

Grade Grade Grade

Amount Diffuse,

2 3

Minimal (n 1), none (n Prominent (n = 1), minimal Diffuse (n = 3) Prominent None

myxoid

cell

indicator

of grade,

as the

MR signal

component relative

to that

MR

was

from

an os-

of the

a

=

1), none

(n

=

1)

skeletal

and

high

were

best

muscle

on

on

(n

2)

=

mas was best

depicted

also

delineated

endosteal

tical

permeation.

MR

lineated

the

intraosseous

noted

at surgery

and

on the within

in Table chondrosarco-

by MR imaging, scalloping imaging

accurately

extent

pathologic

4.

which and

of tumor examination.

IMAGING

exhibited

(similar

FINDINGS

tense high

intermediate

to that

were

muscle)

minimally

on intermediate

images,

intensity

six tu-

signal

of adjacent

images,

signal

corde-

well

on

were

fested (Fig

1). Three

MR images into jacent

the

and

of signal small

humerus were enchondroma (Fig abdomen, structures

nal MR images The largest

on

and

void

Ti-

exhibited

T2-weighted

widespread

as areas

intensity

hyperinimages.

scalloping noted in one visualized on MR images (Fig

cations

of Cases 6 2 4 3 3 2 1

Endosteal

plain

and CT scans, they were not visualized MR images. The extent of calcifications lesions is summarized extension of the

MR

weighted

on T2-weighted

seen

U

mors

was intermediate

and CT scans; when only minimal were noted on plain radiographs

individual Soft-tissue

1) (n

. Conventional Chondrosarcoma Grade 1 Cbondrosarcoma.-The

cartilaginous

similar in all pathologic types. (visualized as areas of signal

images)

radiographs calcifications

tumor

arising

of adjacent

images

images and was Calcifications on

=

2), minimal

=

largest

intensity

of the tumor

Ti-weighted

void

(n

No.

6)

=

None

grade 1 chondrosarcoma teochondroma. The

prominent =

Mesenchymal Dedifferentiated Extraskeletal

Clear

of Calcification

(n

1

were

tumor was 1). Calcifimani-

on MR images

tumors

in the

proximal

similar in appearance to an on both plain radiographs and 2). A large and was

tumor

extended

its relationship clearly

to ad-

depicted

(Fig 3). tumor in the series

by

coro-

was a grade

1

chondrosarcoma arising from an osteochondroma. In this tumor, MR images obtained after the administration of contrast material revealed slight enhancement with some foci

of ringlike

690

U

RadioGrapbics

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Varma

et a!

enhancement,

findings

Volume

that

12

corre-

Number

4

.

b. Figure

ulated

d.

c.

1. Primary central and anteromedial oblique some endosteal scalloping

lesion.

Calcifications

grade (right) (arrow).

1 chondrosarcoma in a 65-year-old woman. (a) Anterolateral radiographs of the right proximal tibia reveal a cartilaginous (b) Sagittal intermediate MR image reveals a minimally

are visualized

as areas

ofsignal

void

(arrow).

(c) Sagittal

oblique (left) lesion with hypenintense lob-

T2-weighted

MR image

reveals a high-signal-intensity lesion. Note smooth endosteal scalloping with no cortical permeation (arrow). (d) Photograph of the resected specimen reveals the characteristically lobulated cartilaginous lesion with endosteal scalloping and no cortical permeation. (e) Photomicrograph (original magnification, x 80; hematoxylin-eosin (H.EJ stain) demonstrates hyaline cartilage cells with small dark pyknotic nuclei.

July

1992

Varma

et a!

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RadioGrapbic.s

U

691

a. Figure

b. 2.

Primary

central

grade

1 chondrosarcoma in a 40-year-old woman. (a) Radiograph of the upper left arm reveals a cartilaginous lesion in the proximal humerus. (b) Sagittal Ti-weighted MR image reveals an intermediate-signal-intensity lesion. Calcifications are poorly visualized. Exact marrow extent is well depicted. (c) Axial T2weighted MR image reveals a lobulated, chiefly high-signal-intensity lesion. The lesion mimics the appearance of an enchondroma on both the radiograph and MR images.

692

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RadioGrapbics

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Varma

et a!

Volume

12

Number

4

a.

C.

Figure bly nal large

(b) ment

3.

Large grade 1 chondrosarcoma that had probaarisen from the 12th rib and extended into the abdomicavity of a 32-year-old man. (a) Axial CT scan reveals a calcified lesion and its relationship to the adjacent rib. Inferior vena cavographic findings suggest caval involve-

by a large

calcified

mass.

(c) Coronal

Ti-weighted

MR

image reveals relationship of the mass (*) to the inferior vena cava (arrow) and renal vein (arrowhead). A plane is noted between the mass and the inferior vena cava. At surgery, the tumor was adherent to but did not involve the inferior vena cava.

b.

July

1992

Varma

et a!

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RadioGraphics

U

693

Figure

4. Secondary grade 1 chondrosarcoma arising from an osteochondroma in a 77-year-old man. (a) Lateral radiograph reveals a large calcified mass in the tibia. An osteochondroma had been documented at this site at an early age. (b) Sagittal Ti-weighted MR image reveals a large mass of intermediate signal intensity. (c) Sagittal contrast material-enhanced Tiweighted MR image reveals minimal enhancement within the lesion arising from the osteochondroma (black arrow). Note ringlike foci of enhancement superiorly (white arrow). (d) Coronal T2-weighted MR image reveals lobulated high-signal-intensity mass with septations and foci of low-signal-intensity calcification. (Fig 4 continues.) a.

b.

d.

C.

sponded lobules This

pathologically surrounded pattern

to hyaline cartilage by fibrous septa (Fig

of contrast

been recently chondrosarcoma

reported (14).

In general,

enhancement

in enchondroma

has

2 Cbondrosarcoma.-There

two

grade

in the

and

her

are frequent

in

and the presence of small, nuclei is a characteristic fea-

2 lesions

humerus)

disease

lated,

calcifications

grade i tumors, densely staining ture (Figs 1, 4).

Grade

4).

and

humeral radiograph ages. plain

in the (Fig

the

5).

lesion

were in the

same

The

calcifications

was

was

best

one with

were

on the plain on MR imnoted

in the

visualized

on

radiographs.

Grade prognosis

2 chondrosarcoma than

grade

has i lesions.

a poorer Histologically,

the mitotic rate is low, but a substantial portion of the nuclei are at least moderate sized

694

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01-

lobuin the

discernible be visualized

scalloping

and

scapula,

patient

tumors

minimal

lesion faintly could not

Endosteal

humeral

(one

(Fig

pro-

5).

Volume

12

Number

4

f.

C.

Figure

4 (continued).

tumor. reveals

Note small

Figure 5. concurrent the humeral

(e) Photograph

correlation with the MR images. nuclei typical ofgrade 1 lesions.

(original taming

July

Note

magnification, relatively

1992

(f)

specimen

Photomicrograph

shows

small

focal X

220; -.

cartilaginous

(original

Grade 2 chondrosarcoma of the right humerus in a 25-year-old grade 2 lesion in the right scapula. (a) Radiograph of the right diaphysis with endosteal scalloping and no evidence oflarge

cation is suspected (arrow). (b) intensity in the humerus (arrow).

the humerus.

of the nesected

lobules

magnification,

woman

with

area

of increased

H-E stain)

signal

of a specimen

intensity from

in the scapula the

humeral

Ollier

humerus reveals foci of calcification.

Axial Ti-weighted MR image reveals lobulated focus (c) Axial T2.weighted MR image reveals lobulated lesion

within

x 120;

the

H-E stain)

disease

and

a

a lytic lesion in Minimal calcifi-

of intermediate signal high signal intensity in

(arrow). shows

(d) Photomicrograph a myxoid

tumor

con-

cells.

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.

e. Figure 6. Grade 3 chondrosarcoma left pelvis that contains central areas mass of intermediate acetabulum (arrow).

change lip ofthe

within

the tumor

tensity

within

the

tumor.

change

within

the tumor

nification, x 120; H-E stain) an ill-defined proliferation

696

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(black

(white

Varma

(e)

(d)

Photograph

(arrow),

man.

of low attenuation

arrows).

arrow).

left

Note

enhancement

Axial

T2-weighted

of the

corresponding

(a) Axial

(arrow).

pelvis, with Ti-weighted

resected

..

CT scan

intraosseous MR image

ofan

a soft-tissue mass in the MR image reveals a involvement also noted in the left reveals necrotic foci with cystic

intraosseous

MR image specimen

reveals

(b) Axial T 1 -weighted

reveals reveals

to the MR appearances.

reveals a nodule of relatively of pleomorphic spindle cells.

et a!

.

f. in a 49-year-old

signal intensity in the (c) Axial contrast-enhanced

acetabulum

.,.

well-differentiated

component central necrotic

in the posterior

areas

ofhigh

regions

with

(f) Photomicrograph chondrosarcoma

Volume

12

signal

in-

cystic

(original

mag-

surrounded

by

Number

4

S

#{149}, I

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q.

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.,.

Figure

Grade

7.

3 chondrosarcoma

in a 49-year-old

man.

(a) Radiograph

of the left femur

‘,

reveals

a lytic

lesion with endosteal scalloping and no evidence of calcification. (b) Axial intermediate MR image reveals a slightly hypenintense lesion replacing bone marrow, with endosteal scalloping and cortical permeation (arrow). (c) Sagittal GRASS image reveals a high-signal-intensity intraosseous abnormality secondary to trabeculan bone loss with endosteal scalloping (arrow) . (d) Photograph of the resected specimen shows the cartilaginous lobulated lesion. (e) High-power photomicrograph (original magnification, x 300; H-E stain) reveals two mitoses (arrows). The presence ofat least two mitoses per 10 high-power fields represents a criterion for the diagnosis of grade 3 lesions.

Grade from

a rib,

vis.

The

in the femur, and

pelvic

lesion was

mass

noted

in the

adjacent

of necrosis

with

within

the

with

one lesion

tissue eas

gross

well depicted which

July

were arose

3 Cbondrosarcoma.-There

two lesions

included

1992

one

tumor

occurred visualized

intraosseous

specimen

pd-

as a soft-

abnormality

acetabulum cystic

in the

(Fig

change

of this

in the MR imaging a contrast-enhanced

(Fig

6).

Ar-

noted

6). The extent

of intraosseous

involve-

ment of the left acetabulum was best visualized on the MR images. Endosteal scalloping and cortical permeation were noted in the two central femoral lesions

(Figs

demonstrated

7, 8). Sagittal the

extent

GRASS

images

of intraosseous

well

in-

tumor were examination, study

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a.

C.

Figure

8.

scalloping, age reveals

Grade 3 chondrosarcoma some foci ofcalcification, an intermediate-signal-intensity

weighted

MR image

permeation.

The

power with

reveals

extent

nuclear

secondary

focus

A mitotic

of high

to trabeculam

bone

soft-tissue

visualized

extension;

on the

The lesion diffuse

icked

that

arose

calcifications,

that

the

MR image

from and

of a grade

latter

(Fig

was

maalong best

8).

the rib contained

its appearance

i lesion

signal loss

(Fig 7). In one of these lesions, the plain diograph revealed minimal calcification with

x 300;

(Fig

mim-

9). At histo-

Radiograph of the left femur reveals endosteal reaction. (b) Coronal Ti-weighted MR imfemoral medullary canal. (c) Axial T2-

in the femur

is excellently

magnification,

pleomorphism.

as an abnormal

intensity

tumor

involvement

(original

exhibiting

volvement

a high-signal-intensity

of soft-tissue

photomicrograph cells

in a 63-year-old man. (a) and a spiculated peniosteal mass replacing the

H-E stain) figure

logic

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shows

and cortical

(arrow).

increased

(d)

High.

cellularity,

(arrow).

analysis,

the

tumor

proved

to be mainly

lesions have the poorest prognosis. cally, the nuclei are larger in size

power

RadioGrapbics

scalloping

MR image

a grade i chondmosarcoma with a focus of grade 3 tumor. In this lesion, sagittal and coronal MR imaging accurately depicted the extent of soft-tissue involvement adjacent to the chest wall (Fig 9). Of conventional chondrosarcomas, grade 3

may

U

endosteal on the

of the lesion

is seen

found

698

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depicted

in grade be

two

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or

2 chondrosarcomas. more

(Figs

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July1992

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pamaspinal

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appearance

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1 i).

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Cbondrosarcoma.-Two

in the scapula

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into

intensity

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signal

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lage admixed

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soft

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muscle

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to extension

presentation years (iO).

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coma.-The two extraskeletal myxoid tumoms were visualized as lobulated soft-tissue masses in the arm and thigh and exhibited intermediate signal intensity and high signal Ti-

foci

mimicked

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chondrosarcoma occurs in the 2nd and

is composed

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an intermediate-signal-intensity mass with interspersed foci of low-signal-intensity calcifications (arrow). (c) Axial CT scan

reveals

the

calcified

posterior

paravertebral the mass

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(original

magnification,

the low-grade hyaline and the undifferentiated

(arrow). x 120;

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Dedifferentiated Cbondrosarcoma.-Two dediffementiated tumors contained prominent foci of calcification, and one other tumor contamed minimal calcifications. On MR images, the signal intensity of these lesions mimicked that seen in conventional chondrosarcoma, and two lesions exhibited soft-tissue extension

(Fig

July

1992

i2).

MR

imaging

did

not

enable

dif-

fementiation

of the

small

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ventional portions Dedifferentiated posed of a grade contiguous

from

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dedifferentiated

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tional

chondrosarcoma.

veals

a left femoral

A few

lesion.

Note

low-signal-intensity

the cortical

calcifications

break

signal-intensity intraosseous tumor with soft-tissue shows the soft-tissue extension and a pathologic aging had been performed. (e) Photomicrograph

component reveals (f) Photomicrograph case is osteosarcoma,

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(b)

MR image

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CT scan

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re-

a high.

extension. (d) Photograph of the resected specimen fracture that the patient had sustained 10 days after MR im(original magnification, x 100; H-E stain) ofthe low-grade

composed of small X 100; H-E stain) irregular osteoid.

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of the left proximal

femur

a lyric lesion with a rim of sclerosis in the femoral head (arrow) . The lesion mimics a chondroblasThe lesion had grown slowly over a period of 4 years. (b) Coronal Ti-weighted MR image reveals a loblesion of intermediate signal intensity in the left proximal femur. (c) Coronal T2-weighted MR image a slightly lobulated, high-signal-intensity tumor. (d) Photomicrograph (original magnification, x 250;

shows toma. ulated reveals

H-E stain) placed

reveals

nucleus

clear within

cells

scattered

a clear

within

cytoplasm.

tumor

Giant

cells

occurs in approximately iO% of conventional chondrosarcomas, can occur in primary or secondary lesions (1,7). Prognosis is poor.

stroma.

The clear

are

present.

also

Clear malignant

cell

in male

patients

4th

Clear Cell Cbondrosarcoma.-The occurred in the proximal femur

alized

as a lobulated

intensity

noted

on

13). sion

The radiographic mimicked that

July

1992

tumor T2-weighted

with

and

high

was

lesion visu-

signal

images

appearance of the of a chondroblastoma.

(Fig

Ic-

cells

decades

are large

chondrosamcoma tumor, occurring and oflife

mom is composed and giant cells

(Fig

a centrally

is a low-grade more commonly

generally

(9).

in the

Histologically,

3rd

and

the tu-

of cells with clear cytoplasm i3). Foci of conventional

low-grade chondrosarcoma Clear cell chondrosarcoma neoplasm ventional

cells with

with a better chondrosarcoma.

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3.

CONCLUSIONS

Visual

analysis

routine

one

of signal

MR images

intensity

generally

to characterize

noted

does

histologic

on

not

type

allow

or grade

of

chondrosarcoma. Criteria for the grading of central conventional chondrosarcoma based on degree of calcification, soft-tissue extension,

and

viously

cortical

CT (i5-i7). generally without

for

lesions areas

widespread extension, may

The calcifications

AJNR

5.

large

6.

noncalci7.

extension.

visualized

by means

depicts

8.

may prove

useful

9.

whether

clear

cell

toma

(reported

intensity

on

to exhibit

relatively by

mass

in the

extraskeletal the has

lesion added

ment

extremities

should

means

chondrosarcoma,

especially

is lobulated. MR imaging to the radiologist’s role

of chondrosarcoma

Acknowledgment:

The assistance

Cancer

Gd-DTPA

if

15.

by

manuscript

1986;

17.

FH,

1977;

40:818-831.

enhancement.

J Comput

Assist Tomogr

Lodwick

GS,

Wilson

AJ, Farrell

Determining

growth

tnich

F.

sions

of bones

from

C, Vertama

rates

radiographs.

P, Dit-

of focal

le-

Radiology

1980; 134:577-583. Rosenthal DI, SchillerAL, Mankin HJ. Chondrosarcoma: correlation of radiological and histological grade. Radiology 1984; 150:21-26. Hudson TM. Radiological analysis of musculoskeletal lesions. In: Hudson TM, ed. Radiologic-pathologic correlation of musculoskeletal Baltimore:

Williams

& Wilkins,

1987;

1-7.

18.

227-259.

Cartilage forming tumors. In: F, ed. Tumors and tumonlike lesions of bone and joints. New York: Springer-Verlag, 1981; i60-204. F.

Sim

1991; 15:1011-1016.

lesions.

Ill: Thomas,

Schajowicz Schajowicz

KK,

Clear cell chondrosarcoma of bone: in 47 cases. Am J Sung Pathol 1984;

Sanenkin NG. Diagnosis and grading of chondrosarcoma of bone: a combined cytologic and histologic approach. Cancer 1980; 45:582-594. AokiJ, Sone S, Fujioka F, et al. MR of enchondroma and chondrosarcoma: rings and arcs of

an

Dahlin DC, Unni KK. Chondrosarcoma (pni. mary, secondary, dedifferentiated, and clear cell). In: Dahlin DC, Unni KK, eds. Bone tumors: general aspects and data on 8,542 cases. 4th ed. Springfield,

2.

.

Unni

of Can-

13.

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Pritchard DJ, Lunke RJ, Taylor WF, Dahlin DC, Medley BE. Chondrosarcoma: a clinicopathologic and statistical analysis. Cancer 1980; 45:

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8:223-230. Enzinger FM, Shiraki MS. Extraskeletal myxoid chondrosarcoma: an analysis of 34 cases. Hum Pathol 1972; 3:421-435. Evans HL, Ayala AG, Romsdahl MM. Prognostic factors in chondrosarcoma of bone: a clinicopathologic analysis with emphasis on histologic grading.

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(20).

Debbie Smith in the preparation is gratefully acknowledged.

U

1 1

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Y,

Dahlin

delineating areas of necrosis within chondrosarcoma and thus may provide a guide to biopsy of sites likely to yield diagnostic material (18). This hypothesis needs to be further evaluated. The appearances ofmesenchymal and dedifferentiated chondrosarcomas on MR images may mimic that of conventional chondrosarcoma. Further experience is needed to assess

70:60-69.

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intraosseous

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Garrison RC, Unni KK, McLeod RA, Pritchard DJ, Dahlin DC. Chondrosarcoma arising in osteochondroma. Cancer 1982; 49:1890-1897. MirraJM. Intramedullary cartilage and chondroid producing tumors. In: MirraJM, ed. Bone tumors: clinical, radiologic, and pathologic conrelations. Philadelphia: Lea & Febiger, 1989; 439-690. Capanna R, Bertoni F, Bettelli G, et al. Dedifferentiated chondrosarcoma. J Bone Joint Sung

preand

lesions

soft-tissue

are best

4.

calcification while high-

have

have

of plain radiography sue extension is best

MR imaging

been

radiography

conventional

generally

and

have

plain

Low-grade exhibit soft-tissue

grade fled

permeation

described

Sen NC, Sekhar LV, Schramm VI, Janecka lP. Chordoma and chondrosarcoma of the cranial base: an 8-year experience. Neurosurgery 1989; 25:931-941. Lee YY, Van Tassel P. Craniofacial chondrosarcoma: imaging findings in i5 untreated cases.

19.

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Hanna SL, Magill HL, Parham DM, Bowman LC, Fletcher BD. Childhood chondrosarcomas: MR imaging with gadolinium-DTPA. Magn Reson Imaging 1990; 8:669-672. Fobben ES, Dalinka MK, Scheibler ML, et al. The magnetic resonance imaging appearance at 1 . 5 tesla of cartilaginous tumors involving the epiphysis. Skeletal Radiol 1987; i6:647-65i. Lodwick

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agement

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704

U

RadioGraphics

U

Varma

et a!

Volume

12

Number

4