Peripheral intermediate and high-grade chondrosarcoma
Updates to Article Attributes
Peripheral chondrosarcomas grade 2 and 3 are malignant intermediate and high-grade cartilagineous or chondroid matrix-generating neoplasms originating from the bony surface in the chondral cap of pre-existing osteochondromas as a result of malignant transformation, thus the name secondary peripheral chondrosarcoma 1,2. Secondary peripheral low-grade chondrosarcomas are not covered in this article.
Terminology
The term ‘chondrosarcoma secondary to osteochondroma’ is discouraged 1.
Epidemiology
Intermediate and high-grade chondrosarcomas make up for ~9-10% 3 of secondary peripheral chondrosarcomas the remainder being peripheral low-grade chondrosarcomas. Similarly to their low-grade counterparts, peripheral chondrosarcomas grades 2 and 3 are most often seen in the 3rd and 4th decades of life 1,4.
Associations
Intermediate and high-grade peripheral chondrosarcomas are associated with solitary osteochondromas and hereditary multiple exostoses from which they progress 1-3.
Diagnosis
The diagnosis of secondary peripheral chondrosarcoma is made by a combination of clinical information, the location of the tumour and typical imaging features such as the size of the cartilaginous cap 1, 5,6. In addition to imaging features pointing to a high-grade tumour such as a sizeable chondral cap, a diffusely thickened cap type and intraosseous extension of the chondral tumour 5 the presence of mitoses and nuclear pleomorphism on histology aid in establishing the correct diagnosis 6. However, it is important to note that tumour grade determined by preoperative biopsy seems to be inaccurate in a significant number of cases 7.
Diagnostic criteria
Diagnostic criteria according to the WHO classification of soft tissue and bone tumours (5th edition)1:
cartilaginous tumour originating from a pre-existing osteochondroma or evidence of a precursor lesion stalk
cartilaginous cap with a size exceeding 2 cm, perpendicular to the bone-cartilage interface (tidemark)
presence of mitoses and/or nuclear pleomorphism
Clinical presentation
A longstanding mass lesion with recent enlargement and/or pain are typical symptoms. Tumour growth after puberty or skeletal maturity is suspicious 1. Depending on the location of the tumour limited joint motion or neurological symptoms might occur 1.
Pathology
Peripheral chondrosarcomas grades 2 and 3 are malignant intermediate and high-grade cartilaginous neoplasms evolving at the surface of bone within the cartilaginous cap of pre-existing osteochondromas 1-3.
Aetiology
Individuals with osteochondromas in particular multiple osteochondromas at risk of tumour progression with an estimated risk of ~5%.
Location
The most common sites involved are the pelvis, trunk and proximal femur 1,3.
Macroscopic appearance
Grossly, peripheral chondrosarcomas grades 2 and 3 are characterised by the following features 1:
lobular translucent blue-white tumour
focal areas with myxoid and cystic changes
lobular cartilaginous cap exceeding 2 cm
possibly recognisable osteochondroma stalk
Microscopic appearance
Histomorphologically, peripheral intermediate and high-grade chondrosarcomas are identical to central intermediate and high-grade chondrosarcomas and display the following microscopical features 1,6:
cartilaginous matrix-producing tumour
coarse and irregular calcifications
lobular pattern
presence of nuclear pleomorphism and mitoses
sometimes evidence of endochondral ossification and a pre-existing osteochondroma
cystic spaces with mucoid material
binucleated cells, areas of necrosis
Immunophenotype
Immunohistochemistry stains are reactive for S100 1.
Genetics
Similar to central intermediate and high-grade chondrosarcomas, secondary peripheral intermediate and high-grade chondrosarcomas are associated with chromosomal instability and complex karyotypes probably due to alterations in p53 and RB1 signalling pathways. As opposed to peripheral low-grade chondrosarcomas where EXT-mutant and EXT-wildtype cells coexist, EXT-wildtype cells predominate in peripheral intermediate and high-grade chondrosarcomas 1. Mutations in IDH1 and IDH2 are absent 1.
Radiographic features
General radiographic signs of secondary peripheral high-grade chondrosarcoma overlap with the imaging features of other peripheral cartilaginous tumours especially low-grade peripheral chondrosarcoma and periosteal chondrosarcoma.
Plain radiograph/CT
Radiographic features of peripheral chondrosarcomas include the following 9,10:
enlargement of a previously non-growing osteochondroma after skeletal maturation
irregular or indistinct lesion surface
intralesional focal osteolytic areas
irregular lesion calcification
extensive erosion or destruction of the adjacent bone
soft tissue mass with scattered or irregular chondral calcifications
MRI
The cartilage cap of peripheral chondral tumours including osteochondromas, and peripheral low-grade and high-grade chondrosarcomas is best evaluated with fat-saturated T2 weighted images9-12. The cut-off thickness of the chondral cap >2 cm measured from the tidemark of the subchondral bone plate has high accuracy for the differentiation towards osteochondromas 10.
Additional features indicating peripheral high-grade chondrosarcoma include the following 5:
diffuse cap type (>75% of the circumference of the cartilage cap thickened)
greater cap thickness
intraosseous extension
Signal characteristics
T1: low signal vs muscle
T2/STIR: high signal intensity with punctate or curvilinear signal voids indicating matrix mineralisation 9,10
T1 C+ (Gd): peripheral and septal enhancement
Nuclear medicine
Increased uptake on bone scintigraphy indicates peripheral chondrosarcoma 7.
Radiology report
The radiological report should include a description of the following 5,9-12:
tumour size and location (tubular bones of extremities, axial skeleton)
tumour margins/surface
intralesional calcifications with irrelugalities and/or lytic zones
-
the thickness of the cartilaginous cap 5
measured from the tidemark of the subchondral bone plate: cut-off value >2 cm, but high-grade tumours tend to have thicker caps
estimation of the abnormally thickened cap type (focal/regional/diffuse) 5
involvement of the stalk
adjacent bone destruction
presence of metastases
Treatment and prognosis
Surgical excision with wide margins is the treatment of choice 1,13. Prognosis is significantly worse than for their low-grade counterparts with 5-year and 10-year survival rates of ~87% and ~74% 13.
Like in peripheral low-grade chondrosarcoma, recurrences are a major problem with multiple recurrences being quite common 13.
Complications
The main complication is local and distant tumour recurrences 1. Peripheral high-grade chondrosarcoma might have metastases.
History and etymology
Chondrosarcomas as well as their differentiation into central and peripheral chondrosarcomas was first described by the American bone pathologists Louis Liechtenstein and Henry Lewis Jaffe in 1942 14. The designation of secondary peripheral intermediate and high-grade chondrosarcomas as a separate entity within the WHO classification of bone tumours happened in the fourth edition 15.
Differential diagnosis
The main differential diagnoses of low-grade peripheral chondrosarcomas are 5,9-11:
dedifferentiated chondrosarcoma: bi-morphic histomorphology
high-grade central chondrosarcoma: no stalk or evidence of osteochondroma,
low-grade peripheral chondrosarcoma: smaller cap thickness, focal or regional cap type
osteochondroma: cap thickness <2 cm
periosteal chondrosarcoma: no precursor osteochondroma, association with the periosteum
periosteal chondroma: originates from periosteum or the bony surface; lesion size <3 cm 16
See also
-<p><strong>Peripheral chondrosarcomas grade 2 and 3 </strong>are malignant <strong>intermediate</strong> and <strong>high-grade</strong> cartilagineous or chondroid matrix-generating neoplasms originating from the bony surface in the chondral cap of pre-existing osteochondromas as a result of malignant transformation, thus the name <strong>secondary peripheral chondrosarcoma</strong> <sup>1,2</sup>. Secondary peripheral low-grade chondrosarcomas are not covered in this article.</p>- +<p><strong>Peripheral chondrosarcomas grade 2 and 3 </strong>are malignant <strong>intermediate</strong> and <strong>high-grade</strong> cartilagineous or chondroid matrix-generating neoplasms originating from the bony surface in the chondral cap of pre-existing osteochondromas as a result of malignant transformation, thus the name <strong>secondary peripheral chondrosarcoma</strong> <sup>1,2</sup>. <a href="/articles/peripheral-atypical-cartilaginous-tumour-low-grade-peripheral-chondrosarcoma-1" title="Secondary peripheral atypical cartilaginous tumour">Secondary peripheral low-grade chondrosarcomas</a> are not covered in this article.</p><h4>Terminology</h4><p>The term ‘chondrosarcoma secondary to osteochondroma’ is discouraged <sup>1</sup>.</p><h4>Epidemiology</h4><p>Intermediate and high-grade chondrosarcomas make up for ~9-10% <sup>3</sup> of secondary peripheral chondrosarcomas the remainder being peripheral low-grade chondrosarcomas. Similarly to their low-grade counterparts, peripheral chondrosarcomas grades 2 and 3 are most often seen in the 3<sup>rd</sup> and 4<sup>th</sup> decades of life <sup>1,4</sup>.</p><h5>Associations</h5><p>Intermediate and high-grade peripheral chondrosarcomas are associated with solitary <a href="/articles/osteochondroma" title="Osteochondromas">osteochondromas</a> and <a href="/articles/hereditary-multiple-exostoses" title="Hereditary multiple exostoses">hereditary multiple exostoses</a> from which they progress <sup>1-3</sup>.</p><h4>Diagnosis</h4><p>The diagnosis of secondary peripheral chondrosarcoma is made by a combination of clinical information, the location of the tumour and typical imaging features such as the size of the cartilaginous cap <sup>1, 5,6</sup>. In addition to imaging features pointing to a high-grade tumour such as a sizeable chondral cap, a diffusely thickened cap type and intraosseous extension of the chondral tumour <sup>5</sup> the presence of mitoses and nuclear pleomorphism on histology aid in establishing the correct diagnosis <sup>6</sup>. However, it is important to note that tumour grade determined by preoperative biopsy seems to be inaccurate in a significant number of cases <sup>7</sup>.</p><h5>Diagnostic criteria</h5><p>Diagnostic criteria according to the <a href="/articles/who-classification-of-tumors-of-bone" title="WHO classification of bone tumours">WHO classification of soft tissue and bone tumours (5<sup>th</sup> edition)</a> <sup>1</sup>:</p><ul>
- +<li><p>cartilaginous tumour originating from a pre-existing <a href="/articles/osteochondroma" title="Osteochondroma">osteochondroma</a> or evidence of a precursor lesion stalk</p></li>
- +<li><p>cartilaginous cap with a size exceeding 2 cm, perpendicular to the bone-cartilage interface (tidemark)</p></li>
- +<li><p>presence of mitoses and/or nuclear pleomorphism</p></li>
- +</ul><h4>Clinical presentation</h4><p>A longstanding mass lesion with recent enlargement and/or pain are typical symptoms. Tumour growth after puberty or skeletal maturity is suspicious <sup>1</sup>. Depending on the location of the tumour limited joint motion or neurological symptoms might occur <sup>1</sup>.</p><h4>Pathology</h4><p>Peripheral chondrosarcomas grades 2 and 3 are malignant intermediate and high-grade cartilaginous neoplasms evolving at the surface of bone within the cartilaginous cap of pre-existing osteochondromas <sup>1-3</sup>.</p><h5>Aetiology</h5><p>Individuals with osteochondromas in particular multiple osteochondromas at risk of tumour progression with an estimated risk of ~5%.</p><h5>Location </h5><p>The most common sites involved are the pelvis, trunk and proximal femur <sup>1,3</sup>.</p><h5>Macroscopic appearance</h5><p>Grossly, peripheral chondrosarcomas grades 2 and 3 are characterised by the following features <sup>1</sup>:</p><ul>
- +<li><p>lobular translucent blue-white tumour</p></li>
- +<li><p>focal areas with myxoid and cystic changes</p></li>
- +<li><p>lobular cartilaginous cap exceeding 2 cm</p></li>
- +<li><p>possibly recognisable osteochondroma stalk</p></li>
- +</ul><h5>Microscopic appearance</h5><p>Histomorphologically, peripheral intermediate and high-grade chondrosarcomas are identical to central intermediate and high-grade chondrosarcomas and display the following microscopical features <sup>1,6</sup>:</p><ul>
- +<li><p>cartilaginous matrix-producing tumour</p></li>
- +<li><p>coarse and irregular calcifications</p></li>
- +<li><p>lobular pattern</p></li>
- +<li><p>presence of nuclear pleomorphism and mitoses</p></li>
- +<li><p>sometimes evidence of <a href="/articles/endochondral-ossification" title="Endochondral ossification">endochondral ossification</a> and a pre-existing osteochondroma</p></li>
- +<li><p>cystic spaces with mucoid material</p></li>
- +<li><p>binucleated cells, areas of necrosis</p></li>
- +</ul><h5>Immunophenotype</h5><p><a href="/articles/immunohistochemistry" title="Immunohistochemistry">Immunohistochemistry</a> stains are reactive for <a href="/articles/s100" title="S100 protein">S100 </a><sup>1</sup>.</p><h5>Genetics</h5><p>Similar to central intermediate and high-grade chondrosarcomas, secondary peripheral intermediate and high-grade chondrosarcomas are associated with chromosomal instability and complex karyotypes probably due to alterations in p53 and RB1 signalling pathways. As opposed to peripheral low-grade chondrosarcomas where EXT-mutant and EXT-wildtype cells coexist, EXT-wildtype cells predominate in peripheral intermediate and high-grade chondrosarcomas <sup>1</sup>. Mutations in <em>IDH1</em> and <em>IDH2</em> are absent <sup>1</sup>.</p><h4>Radiographic features</h4><p>General radiographic signs of secondary peripheral high-grade chondrosarcoma overlap with the imaging features of other peripheral cartilaginous tumours especially <a href="/articles/peripheral-atypical-cartilaginous-tumour-low-grade-peripheral-chondrosarcoma-1" title="Peripheral atypical cartilaginous tumour/ low-grade peripheral chondrosarcoma">low-grade peripheral chondrosarcoma</a> and periosteal chondrosarcoma.</p><h5>Plain radiograph/CT</h5><p>Radiographic features of peripheral chondrosarcomas include the following <sup>9,10</sup>:</p><ul>
- +<li><p>enlargement of a previously non-growing osteochondroma after skeletal maturation</p></li>
- +<li><p>irregular or indistinct lesion surface</p></li>
- +<li><p>intralesional focal osteolytic areas</p></li>
- +<li><p>irregular lesion calcification</p></li>
- +<li><p>extensive erosion or destruction of the adjacent bone</p></li>
- +<li><p>soft tissue mass with scattered or irregular chondral calcifications</p></li>
- +</ul><h5>MRI</h5><p>The cartilage cap of peripheral chondral tumours including osteochondromas, and peripheral low-grade and high-grade chondrosarcomas is best evaluated with fat-saturated <a href="/articles/t2-weighted-image" title="T2 weighted image">T2 weighted images</a> <sup>9-12</sup>. The cut-off thickness of the chondral cap >2 cm measured from the tidemark of the <a href="/articles/subchondral-bone-plate" title="Subchondral bone plate">subchondral bone plate</a> has high accuracy for the differentiation towards osteochondromas <sup>10</sup>.</p><p>Additional features indicating peripheral high-grade chondrosarcoma include the following <sup>5</sup>:</p><ul>
- +<li><p>diffuse cap type (>75% of the circumference of the cartilage cap thickened)</p></li>
- +<li><p>greater cap thickness</p></li>
- +<li><p>intraosseous extension</p></li>
- +</ul><h6>Signal characteristics</h6><ul>
- +<li><p><strong>T1:</strong> low signal vs muscle</p></li>
- +<li><p><strong>T2/STIR:</strong> high signal intensity with punctate or curvilinear signal voids indicating matrix mineralisation <sup>9,10</sup></p></li>
- +<li><p><strong>T1 C+ (Gd): </strong>peripheral and septal enhancement</p></li>
- +</ul><h5>Nuclear medicine</h5><p>Increased uptake on <a href="/articles/bone-scintigraphy-1" title="Bone scintigraphy">bone scintigraphy</a> indicates peripheral chondrosarcoma <sup>7</sup>.</p><h4>Radiology report</h4><p>The radiological report should include a description of the following <sup>5,9-12</sup>:</p><ul>
- +<li><p>tumour size and location (tubular bones of extremities, axial skeleton)</p></li>
- +<li><p>tumour margins/surface</p></li>
- +<li><p>intralesional calcifications with irrelugalities and/or lytic zones</p></li>
- +<li>
- +<p>the thickness of the cartilaginous cap <sup>5</sup></p>
- +<ul>
- +<li><p>measured from the tidemark of the subchondral bone plate: cut-off value >2 cm, but high-grade tumours tend to have thicker caps</p></li>
- +<li><p>estimation of the abnormally thickened cap type (focal/regional/diffuse) <sup>5</sup></p></li>
- +</ul>
- +</li>
- +</ul><ul>
- +<li><p>involvement of the stalk</p></li>
- +<li><p>adjacent bone destruction</p></li>
- +<li><p>presence of metastases</p></li>
- +</ul><h4>Treatment and prognosis</h4><p>Surgical excision with wide margins is the treatment of choice <sup>1,13</sup>. Prognosis is significantly worse than for their low-grade counterparts with 5-year and 10-year survival rates of ~87% and ~74% <sup>13</sup>.</p><p>Like in peripheral low-grade chondrosarcoma, recurrences are a major problem with multiple recurrences being quite common <sup>13</sup>.</p><h5>Complications</h5><p>The main complication is local and distant tumour recurrences <sup>1</sup>. Peripheral high-grade chondrosarcoma might have metastases.</p><h4>History and etymology</h4><p>Chondrosarcomas as well as their differentiation into central and peripheral chondrosarcomas was first described by the American bone pathologists <strong>Louis Liechtenstein</strong> and <strong>Henry Lewis Jaffe</strong> in 1942 <sup>14</sup>. The designation of secondary peripheral intermediate and high-grade chondrosarcomas as a separate entity within the WHO classification of bone tumours happened in the fourth edition <sup>15</sup>.</p><h4>Differential diagnosis</h4><p>The main differential diagnoses of low-grade peripheral chondrosarcomas are <sup>5,9-11</sup>:</p><ul>
- +<li><p><a href="/articles/dedifferentiated-chondrosarcoma" title="Dedifferentiated chondrosarcoma">dedifferentiated chondrosarcoma</a>: bi-morphic histomorphology</p></li>
- +<li><p>high-grade central chondrosarcoma: no stalk or evidence of osteochondroma,</p></li>
- +<li><p><a href="/articles/peripheral-atypical-cartilaginous-tumour-low-grade-peripheral-chondrosarcoma-1" title="Peripheral atypical cartilaginous tumour/ low-grade peripheral chondrosarcoma">low-grade peripheral chondrosarcoma</a>: smaller cap thickness, focal or regional cap type</p></li>
- +<li><p><a href="/articles/osteochondroma" title="Osteochondroma">osteochondroma</a>: cap thickness <2 cm</p></li>
- +<li><p><a href="/articles/juxta-cortical-chondrosarcoma" title="Periosteal chondrosarcoma">periosteal chondrosarcoma</a>: no precursor osteochondroma, association with the periosteum</p></li>
- +<li><p><a href="/articles/juxtacortical-chondroma-1" title="Periosteal chondroma">periosteal chondroma</a>: originates from periosteum or the bony surface; lesion size <3 cm <sup>16</sup></p></li>
- +<li><p><a href="/articles/periosteal-osteosarcoma" title="Periosteal osteosarcoma">periosteal osteosarcoma</a></p></li>
- +</ul><h4>See also</h4><ul>
- +<li><p><a href="/articles/chondrosarcoma" title="Chondrosarcoma">chondrosarcoma</a></p></li>
- +<li>
- +<p><a href="/articles/chondrosarcoma-grading" title="Chondrosarcoma grading">chondrosarcoma grading</a></p>
- +<p></p>
- +</li>
- +</ul>
References changed:
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- 2. Gelderblom H, Hogendoorn P, Dijkstra S et al. The Clinical Approach Towards Chondrosarcoma. Oncologist. 2008;13(3):320-9. <a href="https://doi.org/10.1634/theoncologist.2007-0237">doi:10.1634/theoncologist.2007-0237</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/18378543">Pubmed</a>
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- 4. Fei L, Ngoh C, Porter D. Chondrosarcoma Transformation in Hereditary Multiple Exostoses: A Systematic Review and Clinical and Cost-Effectiveness of a Proposed Screening Model. J Bone Oncol. 2018;13:114-22. <a href="https://doi.org/10.1016/j.jbo.2018.09.011">doi:10.1016/j.jbo.2018.09.011</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/30591865">Pubmed</a>
- 5. Tilden W, Andrei V, O'Donnell P, Saifuddin A. Peripheral and Periosteal Chondrosarcoma: MRI-Pathological Correlation in 58 Cases. Skeletal Radiol. 2022;51(6):1189-99. <a href="https://doi.org/10.1007/s00256-021-03947-w">doi:10.1007/s00256-021-03947-w</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/34714386">Pubmed</a>
- 6. de Andrea C, Kroon H, Wolterbeek R et al. Interobserver Reliability in the Histopathological Diagnosis of Cartilaginous Tumors in Patients with Multiple Osteochondromas. Mod Pathol. 2012;25(9):1275-83. <a href="https://doi.org/10.1038/modpathol.2012.78">doi:10.1038/modpathol.2012.78</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/22555180">Pubmed</a>
- 7. Tsuda Y, Evans S, Stevenson J et al. Is the Width of a Surgical Margin Associated with the Outcome of Disease in Patients with Peripheral Chondrosarcoma of the Pelvis? A Multicenter Study. Clin Orthop Relat Res. 2019;477(11):2432-40. <a href="https://doi.org/10.1097/CORR.0000000000000926">doi:10.1097/CORR.0000000000000926</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/31453886">Pubmed</a>
- 8. de Andrea C, Reijnders C, Kroon H et al. Secondary Peripheral Chondrosarcoma Evolving from Osteochondroma as a Result of Outgrowth of Cells with Functional EXT. Oncogene. 2012;31(9):1095-104. <a href="https://doi.org/10.1038/onc.2011.311">doi:10.1038/onc.2011.311</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/21804604">Pubmed</a>
- 9. Douis H & Saifuddin A. The Imaging of Cartilaginous Bone Tumours. II. Chondrosarcoma. Skeletal Radiol. 2013;42(5):611-26. <a href="https://doi.org/10.1007/s00256-012-1521-3">doi:10.1007/s00256-012-1521-3</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/23053201">Pubmed</a>
- 10. Soldatos T, McCarthy E, Attar S, Carrino J, Fayad L. Imaging Features of Chondrosarcoma. J Comput Assist Tomogr. 2011;35(4):504-11. <a href="https://doi.org/10.1097/RCT.0b013e31822048ff">doi:10.1097/RCT.0b013e31822048ff</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/21765311">Pubmed</a>
- 11. Bernard S, Murphey M, Flemming D, Kransdorf M. Improved Differentiation of Benign Osteochondromas from Secondary Chondrosarcomas with Standardized Measurement of Cartilage Cap at CT and MR Imaging. Radiology. 2010;255(3):857-65. <a href="https://doi.org/10.1148/radiol.10082120">doi:10.1148/radiol.10082120</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/20392983">Pubmed</a>
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- 13. Righi A, Pacheco M, Cocchi S et al. Secondary Peripheral Chondrosarcoma Arising in Solitary Osteochondroma: Variables Influencing Prognosis and Survival. Orphanet J Rare Dis. 2022;17(1):74. <a href="https://doi.org/10.1186/s13023-022-02210-2">doi:10.1186/s13023-022-02210-2</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/35193636">Pubmed</a>
- 14. Lichtenstein L & Jaffe H. Chondrosarcoma of Bone. Am J Pathol. 1943;19(4):553-89. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2033092">PMC2033092</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/19970709">Pubmed</a>
- 15. Doyle L. Sarcoma Classification: An Update Based on the 2013 World Health Organization Classification of Tumors of Soft Tissue and Bone. Cancer. 2014;120(12):1763-74. <a href="https://doi.org/10.1002/cncr.28657">doi:10.1002/cncr.28657</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/24648013">Pubmed</a>
- 16. Robinson P, White L, Sundaram M et al. Periosteal Chondroid Tumors. AJR Am J Roentgenol. 2001;177(5):1183-8. <a href="https://doi.org/10.2214/ajr.177.5.1771183">doi:10.2214/ajr.177.5.1771183</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/11641198">Pubmed</a>
Tags changed:
- chondroid tumour
- chondrosarcoma
Systems changed:
- Musculoskeletal
- Oncology
Image 2 MRI (T2) ( create )
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