Presentation
Tender left chest swelling for 4 months
Patient Data
Targeted sonographic assessment was performed in the left breast.
Findings:
the clinical abnormality corresponds to a firm, well-circumscribed, ovoid shaped solid mass in the left breast measuring approximately 10.9 x 8.3 x 4.7 cm
the mass extends quite deep into the chest wall, the most posterior aspect of which is difficult to confidently visualize
the mass demonstrates internal vascularity and multifocal internal shadowing calcification
Impression:
partially calcified 10.9 cm mass in the left breast extending deep into the chest wall. The diagnosis of exclusion is a malignant chest wall neoplasm
urgent ultrasound-guided core biopsy is recommended
BI-RADS 4 Suspicious Abnormality RESULTCODE: BR-4
Destruction of the anterior left fifth rib with associated ill-defined soft tissue mass, corresponding with the mass seen on the previous study.
Normal cardiomediastinal contours. Normal pulmonary vascular pattern. The lungs are clear.
No acute bony abnormality.
Findings:
Corresponding to the sonographic finding, there is an expansile destructive lesion centered around the left fifth rib which measures 124 x 95 x 82 mm. There are internal linear bands of calcification. Adjacent rib cortices appear preserved.
No other aggressive appearing osseous lesion is demonstrated. The central airways are clear. There is no pleural or pericardial effusion. There are no suspicious pulmonary nodules.
There is moderate coronary calcification. The great vessels measure within normal limits for technique. No intrathoracic lymph nodes are enlarged by CT criteria. The limited views of the upper abdomen demonstrate no significant abnormality.
Impression:
Expansile lesion centered around the anterior left fifth rib with significant osseous destruction. Significant soft tissue expansion with internal calcifications. This could represent a primary arcomatous lesion or metastatic lesion. There is no CT evidence of nodal disease.
The left chest wall mass measures 13 x 8 x 10.1cm. It demonstrates mild to moderate heterogenous accumulation throughout with a maximum SUV measurement of 6.3.
Ultrasound guided biopsy was performed.
Pathology report: The sections show features of a chondrosarcoma. The neoplasm shows an infiltrative pattern entrapping lamellar bone trabeculae. It is composed of lobules of atypical chondroid material with chondrocytes showing loss of the normal nested architecture, binucleation, and presence of scattered large irregular hyperchromatic nuclei. The overall morphology is that of a chondrosarcoma grade 2 in this material.
Sarcoma conference multidisciplinary discussion: En bloc surgical resection recommended.
Case Discussion
Typical features of chondrosarcoma in this case include bony destruction, soft tissue mass and ring and arc pattern calcification representing chondroid matrix.