Metastatic chondrosarcoma

Case contributed by Dr Nicoletti Domenico Nicoletti

Presentation

Left hip pain.

Patient Data

Age: 45 years
Gender: Male
x_ray

Left femoral neck large sclerotic and lytic lesion with punctate chondroid calcifications and pathological fracture.

ct

CT chest with contrast (before the surgery)

No parenchymal or pleural lesions.

x_ray

Postoperative Rx left hip

Postoperative radiograph after resection of the proximal femur and hip capsule and reconstruction of the proximal femur with a modular resection prosthesis.

pathology

Histological report (translation from Italian to English)

Resection of the head and femoral neck proximal to the fracture. Sections of bone tissue with central chondrosarcoma infiltration G2 sec. WHO.

ct

CT chest without contrast (one year after surgery)

Appearance of a small calcific pleural lesion in the right upper lobe.

ct

CT chest without contrast (three years after surgery)

Enlargement of the calcific pleural lesion in the right upper lobe.

x_ray

Xray left hip (three years after surgery)

After three years rapid growth of loco-regional calcific recurrence in the left gluteal muscles. A large periarticular fluid collection is also appreciable.

ct

CT pelvis

Large local calcific recurrence in the left gluteal muscles with a large periprosthetic collection.

ct

CT chest with contrast  (five years after surgery)

Small calcific parenchymal lesion in the apical segment of the right lower lobe. Right subpleural calcification is unchanged. 

ct

CT chest without contrast  (six years after surgery) 

Bilateral pulmonary calcification masses and nodules with, on both sides, pleural calcified metastasis, pleural effusion and right upper lobe atelectasis due to a central mass. There is a calcific lymph node in the abdomen. 

Transbronchial biopsy revealed pulmonary metastasis from chondrosarcoma (hematoxylin and eosin staining of the biopsy sample showed a bone tumor in the lumen structure, with the same histological features as the primary bone tumor).

Case Discussion

Chondrosarcoma is a malignant tumor of hyaline cartilage. It can be classified as primary or secondary (arising from a benign osteochondroma or enchondroma). Tumors are classified on a scale of 1–3, on the basis of nuclear size, hyperchromasia, mitotic activity and cellularity. Metastases are most frequently in the lung and less so in the regional lymph nodes and the liver. Surgical resection is the best treatment. Chemotherapy is considered ineffective, particularly in low-grade tumors.

Radiographer: TSRM Fabio Imola.

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