Chondrosarcoma

Case contributed by Ammar Ashraf

Presentation

Left shoulder pain, decreased range of movements of the left shoulder, and left shoulder mass. No history of trauma.

Patient Data

Age: 55 years
Gender: Female
x_ray

An ill-defined bony outgrowth is seen along the glenoid/spine of the scapula. A small soft tissue density is seen in the left supraclavicular region. Mildly hyperinflated lungs and mild bilateral apical pleural thickening. No suspicious pulmonary mass/nodule, pleural effusion, or pneumothorax is seen.

One year later

x_ray

The patient was lost to follow-up and presented one year later with worsening symptoms. An expansile radiolucent lesion with a partially calcified matrix extends along the superior aspect of the scapula. This lesion has increased in size when compared with the previous study. Radiographic features are suggestive of an aggressive bone lesion, like a chondrosarcoma.

mri

FINDINGS: A large lobulated chondroid lesion (predominantly of high signal intensity on T2 and predominantly of low signal intensity on T1-weighted images), measuring 7 x 9 x 10 cm, arises from the anterior scapula and glenoid. High T2 signal intensity, suspicious of the partial encasement/invasion is around the proximal subclavian artery and brachial plexus. Diffuse edematous changes in the supraspinatus muscle and no clear fat plane between the lesion and supraspinatus, subscapularis & anterolateral upper chest wall muscles are noted; these features are suspicious of invasion of these muscles by the lesion.

OPINION: Large lobulated chondroid matrix mass lesion of the left scapula. MR imaging features in correlation with the plain radiograph are in keeping with a chondrosarcoma

ct

Aggressive lesion with expansile and destruction, of the left scapula with an associated soft tissue component containing rings and arcs calcification. Multiple patchy nodular infiltrates with a tree in bud appearance are seen in both lungs, particularly in bilateral upper and left lower lobes. Mild bilateral apical pleural thickening.

Two years later

ct

FINDINGS: An interval increase in the primary tumor of the left scapula which now measures 12 x 16 cm. Multiple scattered soft tissue density nodules in both lungs, suggestive of pulmonary metastases. A large thick-walled cavitary lesion is seen in the left lower lobe, which is suspicious for a cavitating pulmonary metastasis; another possible differential is lung abscess which cannot be ruled out and needs follow up. No definite osseous metastatic lesion is seen.

CONCLUSION: Progressive disease.

Case Discussion

Specimen source: Ultrasound-guided Tru-Cut biopsy of the left shoulder mass with a 15 G needle.

Diagnosis: Chondrosarcoma.

Differentiating enchondroma vs low-grade chondrosarcoma can be challenging but appropriate follow up imaging can aid diagnosis over time.  

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