Clear cell chondrosarcoma - L4

Case contributed by A.Prof Frank Gaillard

Patient Data

Age: 34 yrs
Gender: Female
Modality: X-ray

See below

Modality: CT

Lytic destructive lesion with matrix calcification and erosion of the posterior vertebral cortex and extending into the left pedicle noted in the L4 vertebra. There is extension into the spinal canal. No evidence of errosion of anterior and lateral margins of the vertebra. 

Modality: MRI

Heterogenous lesion that is predominantly hypointense on T1 and isointense on T2 with areas of calcification/coarse trabeculations seen as signal voids and heterogenous enhancement is seen in the body and left pedicle of L4, with erosion of the posterior cortex, but confined by posterior longitudinal ligament with no extension to soft tissue.

Case Discussion

Clear cell chondrosarcoma of the L4 vertebra in a 34 year old woman.

Final Diagnosis:

Complex resection of L4 vertebral body including left side posterior elements and associated soft tissues, adjacent intervertebral discs, inferior body of L3 and superior body of L5:

  1. Clear cell chondrosarcoma
  2. Low grade, grade 1/3
  3. Maximum size 3.6 cm
  4. Based in the body and left pedicle of L4, with erosion of the posterior cortex, but confined by posterior longitudinal ligament with no extension to soft tissue. Focal erosion of anterior cortex in two foci, with microscopic invasion of anterior longitudinal ligament
  5. Positive for vascular invasion adjacent to tumor
  6. Negative for dedifferentiation
  7. Two examined lymph nodes negative for malignancy

Microscopic Description:

Sections show a clear cell neoplasm arranged as sheets and as lacunae within a cartilaginous matrix. Some woven bone is produced, osteoclasts are present and the lesion is more vascular than a conventional chondrosarcoma. Cells have abundant clear and faintly eosinophilic cytoplasm which is PAS positive in a strong, granular pattern. Nuclei are centrally-located and show low grade atypia, with occasional mitoses identified. Immunostains demonstrate the lesional cells to be intensely positive for S100, but negative for keratins, EMA, synaptophysin and chromogranin.

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Case Information

rID: 6176
Case created: 2nd May 2009
Last edited: 8th Apr 2017
Tag: spine
Inclusion in quiz mode: Included

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