Radiologic-Pathologic

Conferences

of the Massachusetts

General

Hospital

Chondrosarcoma Felix S. Chew1

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A 69-year-old

and David woman

had

G. Disler

an abdominal

mass

and

pain

in the

right

of tumor

lower extremity. A radiograph of the pelvis showed a 1 5-cm softtissue mass with an underlying lesion in the right iliac wing (Fig. 1). CT showed

two growth

intraosseous

expansion

extension reaction.

patterns

within

of the

iliac

the tumor,

cortex

an indolent,

and

a rapidly

into the soft tissues with a sunburst The intraosseous tumor tissue was

extraosseous tumor tissue was uncalcified showed discrete regions in the soft-tissue

lobular,

MR

mass of high and low signal intensity on both Ti- and T2-weighted images. Hemipelvectomy was performed. The final pathologic diagnosis was chondro-

sarcoma

with

hemorrhage.

hyaline

and

Regions

of

myxoid both

high

regions, and

extensive low

necrosis,

and

grade

were

histologic

destructive,

is often

with

mineralized,

cartilaginous with

tumor

rings-and-arcs

replacing

bone.

calcifications

The

lesions

Fig. 1.-A,

have

Radiograph

B, Coronal TI-weighted

permeated

bone

destruction

cortical

breaks,

concen-

central necrosis

expands.

Chondrosarcomas

[2].

are avascular

images,

whereas

myxoid

signal [3]. rare, chondrosarcoma

regions

is the second

may

have

most

common

mary bone tumor in adults older than 30. Approximately in the

pelvis.

is sometimes

may not be manifest

requires

complete

is related

matrix

Growth

surgery

or

to tumor

surgical

slow,

and

local

of the tumor.

or

pri-

25% arise

recurrences

for 5-1 0 years. Adequate

removal

dark

after

treatment

Long-term

survival

of muscu!oske!eta!

lesions.

grade.

REFERENCES

(corresponding

(from

MR

intermediate Although

1 . Hudson TM. Radiologic-pathologic correlation Baltimore: Williams & Wilkins, 1987:153-175

to enchondral ossification of lobules of hyaline cartilage), or with amorphous or punctate calcifications (corresponding to calcification of tumor tissue). Attenuation of uncalcified lesions is similar to that of water. Low-grade lesions have slow, eccentric growth that conforms generally to the shape ofthe host bone; dense calcification is frequent. High-grade

systems),

and sometimes

Sunburst periosteal reaction extending from the cortical surface results from fragments of active periosteum leaving streamers of

weighted

present. Chondrosarcoma is a primary bone tumor composed of malignant cells and chondroid matrix [1] thought by most authorities to arise from preexisting hyaline cartilaginous lesions such as enchondroma or osteochondroma. On plain radiographs the lesions are radiolucent and

haversian

hypovascular. The tumors are often heterogeneous, with low-grade or even benign lobules of mature ossifying hyaline cartilage adjacent to high-grade myxoid regions that have less mature chondroid matrix and greater cellularity. Hyaline regions have bright signal on T2-

of periosteal calcified; the

and heterogeneous.

along

in the soft tissues,

bone as the tumor

aggressive

pattern partially

growing

tric growth

2. Rosenthal radiological

and histological

grade.

Radiology

correlation

soft-tissue neoplasms: ogy 1988:167:477-481

MR appearance

and histologic

correlation.

bone and Radio!-

signal intensity.

FH = femoral head. C, CT scan shows densely calcified lobular intraosseous lesion, sunburst periosteal reaction (arrow), and soft-tissue mass (M). 0, Axial T2-weighted MR image shows bright signal (arrows) in noncalcified portions of intraosseous lesion and mixed signal in soft-tissue mass. E, Axial pathologic section through iliac wing and sacroiliac joint (arrow) shows intraosseous tumor and soft-tissue mass (M) with necrosis and hemorrhage.

From

editors:

the weekly

radiologic-pathologic

correlation

William E. Palmer, Daniel P. Barboriak,

‘All authors: to F. S. Chew.

Department

AJR 156:1016,

May

of Radiology,

Massachusetts

1991 0361-803X/91/1565-1016

conferences

Daniel I. Rosenthal, General © American

conducted

by Jack

Wittenberg.

Pathology

editor:

Andrew

E. Rosenberg.

Radiology

Felix 5. Chew.

Hospital Roentgen

and Harvard Ray Society

Medical

School,

32 Fruit St. , Boston,

of

1984:1 50:21 -26

3. Cohen EK, Kressel HY, Frank TS, et al. Hyaline cartilage-origin

tongues

shows lesion in iliac wing. MR image shows 15-cm mass with heterogeneous

DI, Schiller AL, Mankin HJ. Chondrosarcoma:

MA 021 1 4. Address

reprint

requests