volume 5
DESCRIPTION
TRANSCRIPT
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Volume 5
Malignant Chondroid Tumors
Primary central chondrosarcoma----------Case 125 & 652-678
Secondary peripheral chondrosarcoma---Case 126 & 679-686
Dedifferentiated chondrosarcoma---------Case 127 & 687-689
Clear cell chondrosarcoma-----------------Case 128 & 690
Mesenchymal chondrosarcoma------------Case 129 & 691
Cartilaginous pseudotumors---------------Case 692-699
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Chondrosacoma
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Primary Central
Chondrosarcoma
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Primary Central Chondrosarcoma The primary or central conventional chondosarcoma is a low
grade but malignant cartilagenous tumor found typically in adults
between the ages of 30 and 60 years. The tumor arises from the
medullary canal of a large bone such as the pelvis, femur, tibia or
proximal humerus. Because the tumor is slow growing, there is
little symptomatology and the tumor frequently becomes quite
sizable before a physician is consulted. Primary chondrosarcoma
is extremely rare in small bones of the hand or foot. The meta-
physeal portion of a long bone is the most common location
although diaphyseal locations are not unusual. 85% of central
chondrosarcomas are low grade lesions which on radiographic
examination demonstrate matrix calcification similar to that seen
in benign enhondromas, whereas the high grade chondrosarcomas,
which are rare, are frequently noncalcified and take on the
permeative appearance similar to other high grade sarcomas such
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as fibrosarcoma and Ewing’s sarcoma. Histologically, the low
grade central chondrosarcoma has a fairly well differentiated
chondroid matrix like that of an enchondroma but shows evidence
of permeative invasion into the adjacent cortical and cancellous
structures. There is rarely any mitotic activity in the low grade
lesions. They have larger nuclear patterns with a higher degree
of atypicism compared to benign enchondromas.
These low grade tumors have a good prognosis in terms of a
low metastatic incidence to the lung but they must be treated
aggressively with a wide resection in order to prevent local
recurrence. One cannot rely on adjuvant therapy such as radiation
or systemic chemotherapy because these low grade lesions are
notoriously resistant to adjuvant therapy.
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CLASSIC Case #125
50 year female with chondrosarcoma prox humerus
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Axial T-1 MRI
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Axial T-2 MRI
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Proximal humeral
resection tumor bulge
humeral head
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Macro section
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Close up macro section
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Photomic
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Surgical defect
following wide
resection
glenoid
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Proximal humeral
allograft ready for
implantation
rotator cuff
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Allograft placed
over long stem
Neer prosthesis
pectoralis Neer
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Alloprosthetic
reconstruction
completed
rotator
cuff
pectoralis
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Post op X-ray
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Case #652
74 female
chondrosacoma
proximal humerus
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Bone scan
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Coronal T-1 MRI
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Coronal T-2 MRI tumor
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Wide resection
proximal humerus
glenoid
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Resected specimen cut in path lab
cortical erosion
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Photomic
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Suturing down the
allograft rotator cuff
as part of the alloprosthetic
reconstruction
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Post op x-ray with
cemented Neer
alloprosthesis
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Case #653
19 year male
chondrosarcoma
proximal humerus
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Coronal proton density MRI
tumor
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Resected specimen
cut in path lab
tumor
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Macro section
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Photomic
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Case #654
28 year female with chondrosarcoma prox humerus
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Coronal T-1 MRI
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Axial proton density MRI
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Axial T-2 MRI
tumor
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Case #656
72 year male
chondrosarcoma
femur
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Bone scan
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Widely resected
distal femur specimen
cut in path lab
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Close up showing
cortical break thru
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Photomic
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Case #657
83 year male
chondrosarcoma femur
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Case #658
82 year female
chondrosarcoma
proximal femur
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X-ray resected
proximal femoral
tumor with path
fractures
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Macro section
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Close up macro
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Photomic
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Case #659
52 year male
chondrosarcoma
mid femur
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Another view
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Bone scan
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Coronal T-1 MRI
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Macro section from
intercalary resection
tumor
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Photomic showing bony permeation
tumor
bone
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Photomic
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Higher power
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Post op X-ray
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Case #660
54 year female with chondrosarcoma distal femur
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Resected distal femur including entire knee joint
patella
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Distal femur cut in path lab
tumor
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Macro section
tumor
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Photomic
tumor
tumor
articular cartilage
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Close up photomic showing bone permeation by tumor
tumor bone
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Post op x-ray with
excisional arthrodesis
I.M.
nail
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Case #660.1
33 year male with painless mass in popliteal space for 1 yr
and restricted flexion of knee for 3 yrs
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Sag T-1 T-2
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Cor T-2 Axial T-2
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Surgical specimen Compress rotating hinge
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PO x-rays
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Case #661
58 year male
chondrosarcoma
proximal tibia tumor
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Lateral view
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Resected specimen cut in path lab
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Photomic
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Proximal tibial allograft
placed over long stem
total knee replacement
with wires for patellar
tendon attachment
spherocentric knee
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Patellar tendon
sutured to proximal
tibial allograft
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Completion of
retinacular closure
patella
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Post op x-ray
allograft
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9 years later
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Case #662
43 year male with chondrosarcoma proximal tibia
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Coronal T-2 MRI
tumor
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Sagittal Gad C MRI
tumor
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Axial T-1 MRI tumor
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Proximal tibial resection with tumor breakout posterior
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Proximal tibial resection prosthesis with Compress System
spindle
anchor plug drill
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Resected proximal tibia next to prosthesis
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Drilling holes for
anchor plug pins
in tibia
guide
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Placement of anchor plug and traction bar
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Milling the proximal tibial stump
mill
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Milling process
completed ready
for spindle placement
over traction bar
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Spindle secured with 600 lbs of spring pressure
spindle
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Femoral component of rotating hinge cemented in place
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Components assembled ready for patellar ligament attachment
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Spiked washers secure patellar ligament
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Soft tissue reconstruction completed ready for closure
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Post op x-ray
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Case #663
63 year female
chondrosarcoma
pelvis
![Page 95: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/95.jpg)
Internal hemipelvectomy resection specimen
acetabulum
sciatic
notch
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Resected specimen after autoclaving
sciatic notch
acetabulum
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Autoclaved specimen
replaced with routine
cemented total hip
![Page 98: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/98.jpg)
Immediate post op
X-ray showing rebar
and cement fixation
upper resection line
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15 years later
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Case #664
54 year male with chondrosarcoma mid pelvis
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CT scan
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Bone scan
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Type II internal hemipelvectomy resection
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Type II resection
specimen tumor
femoral head
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Photomic
![Page 106: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/106.jpg)
Autoclaved specimen
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Autoclaved specimen
reimplanted with
cemented total hip &
recon plates
![Page 108: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/108.jpg)
Nine years later
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Case #665
47 year female with chondrosarcoma mid pelvis
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CT scan
tumor
![Page 111: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/111.jpg)
Coronal T-1 MRI
tumor
![Page 112: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/112.jpg)
Coronal T-2 MRI
tumor
![Page 113: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/113.jpg)
Photomic
![Page 114: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/114.jpg)
X-ray 1 year post op internal hemipelvectomy & THA
![Page 115: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/115.jpg)
4 years post op
![Page 116: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/116.jpg)
8 yrs PO with slight lateral shift of cup
![Page 117: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/117.jpg)
Case #666
45 year female with chondrosarcoma mid pelvis
![Page 118: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/118.jpg)
Coronal T-2 MRI
![Page 119: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/119.jpg)
Cutting ilium with Gigli saw
![Page 120: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/120.jpg)
ilium
Placement of 6.5 screws in ilium, ischium & ant ramus
ischium
ant ramus
![Page 121: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/121.jpg)
Reconstruction of pelvic ring with recon plates
iliac screws
![Page 122: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/122.jpg)
Placement of constrained cup prior to cementing
![Page 123: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/123.jpg)
Cup cemented
![Page 124: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/124.jpg)
Resected ilium & socket lying next to reconstruction
![Page 125: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/125.jpg)
Hip relocated ready for greater troch attachment
![Page 126: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/126.jpg)
Skin closure including biopsy site
![Page 127: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/127.jpg)
Post op x-ray
![Page 128: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/128.jpg)
Post op x-ray
![Page 129: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/129.jpg)
Case #667
50 year male
chondrosarcoma
anterior acetabulum
![Page 130: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/130.jpg)
Bone scan
![Page 131: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/131.jpg)
Axial T-1 MRI
![Page 132: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/132.jpg)
Type II & III resection and rebar and cement total hip
![Page 133: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/133.jpg)
Case #667.1
78 yr male with primary chondrosarcoma pelvis
![Page 134: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/134.jpg)
Axial T-1 MRI
![Page 135: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/135.jpg)
Axial T-2 MRI
![Page 136: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/136.jpg)
Axial Gad MRI showing rim enhancement
![Page 137: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/137.jpg)
Coronal T-1 MRI
![Page 138: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/138.jpg)
Coronal T-2 MRI
![Page 139: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/139.jpg)
Coronal Gad MRI
![Page 140: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/140.jpg)
Case #667.2
56 yr old female with prior excision of pelvic tumor 4 yrs ago
Recurrent chondrosarcoma
![Page 141: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/141.jpg)
Cor T-1 T-2 Gad
Current MRI
![Page 142: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/142.jpg)
Axial T-1 T-2
Gad
![Page 143: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/143.jpg)
Sag gad Surgical specimen
![Page 144: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/144.jpg)
Case #668
43 year male with chondrosarcoma body of scapula
![Page 145: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/145.jpg)
7 years later
![Page 146: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/146.jpg)
CT scan
![Page 147: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/147.jpg)
Another CT cut
tumor
![Page 148: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/148.jpg)
Coronal T-2 MRI
tumor
![Page 149: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/149.jpg)
Axial T-2 MRI
tumor
![Page 150: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/150.jpg)
Total scapular prosthesis
![Page 151: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/151.jpg)
Cementing humeral component
![Page 152: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/152.jpg)
Scapular component positioned in muscle cuff
![Page 153: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/153.jpg)
Closure of muscle cuff over scapular component
![Page 154: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/154.jpg)
Resected scapula and humeral head
tumor
bulge
![Page 155: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/155.jpg)
Post op x-ray
![Page 156: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/156.jpg)
Case #669
47 year male with chondrosarcoma scapular body
tumor
![Page 157: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/157.jpg)
Another CT cut
tumor
![Page 158: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/158.jpg)
Axial proton density MRI
tumor
![Page 159: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/159.jpg)
Axial proton density MRI
tumor
![Page 160: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/160.jpg)
Axial T-2 MRI
tumor
![Page 161: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/161.jpg)
Coronal proton density MRI
tumor
![Page 162: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/162.jpg)
Case #670
52 year male with chondrosarcoma elbow
![Page 163: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/163.jpg)
Cut specimen in path lab
![Page 164: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/164.jpg)
Photomic
![Page 165: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/165.jpg)
Case #670.1
76 year female with slow growing chondrosarcoma elbow
![Page 166: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/166.jpg)
Axial
T-1
T-2 T-2
![Page 167: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/167.jpg)
Sag T-1 Sag STIR
![Page 168: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/168.jpg)
Cor T-1 Cor STIR
![Page 169: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/169.jpg)
Surgical debulking
![Page 170: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/170.jpg)
Case #671
26 year male
chondrosarcoma
radius
![Page 171: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/171.jpg)
Coronal T-1 MRI
![Page 172: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/172.jpg)
Photomic
![Page 173: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/173.jpg)
Case #672
36 year male with chondrosarcoma distal radius
![Page 174: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/174.jpg)
CT scan
![Page 175: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/175.jpg)
Case #673
56 year male
enchondroma
2nd metacarpal
![Page 176: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/176.jpg)
3.5 years later with
chondrosarcoma
![Page 177: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/177.jpg)
Photomic
![Page 178: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/178.jpg)
Case #674
77 year female with chondrosarcoma os calcis
![Page 179: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/179.jpg)
Os calcis view
![Page 180: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/180.jpg)
T-1 MRI
![Page 181: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/181.jpg)
T-2 MRI
tumor
![Page 182: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/182.jpg)
Sagittal T-2 MRI
tumor
![Page 183: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/183.jpg)
Photomic
![Page 184: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/184.jpg)
Case #674.1
55 year male with slight pain and swelling about ankle for 2 years
![Page 185: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/185.jpg)
Bone scan
![Page 186: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/186.jpg)
CT Scan
![Page 187: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/187.jpg)
Sag PD T-2
Gad
![Page 188: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/188.jpg)
Axial PD T-2
Gad
![Page 189: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/189.jpg)
Case #675
72 year male with chondrosarcoma chest wall
tumor
![Page 190: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/190.jpg)
Lateral view
tumor
![Page 191: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/191.jpg)
CT scan
![Page 192: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/192.jpg)
Another CT cut
![Page 193: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/193.jpg)
Photomic
![Page 194: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/194.jpg)
Case #676
52 year male with chondrosarcoma rib
![Page 195: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/195.jpg)
Macro section of resected specimen
tumor
rib
![Page 196: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/196.jpg)
Photomic
![Page 197: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/197.jpg)
Case #676.1
38 year male
chondrosarcoma
L-1 with block on
myelogram
![Page 198: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/198.jpg)
CT scan
![Page 199: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/199.jpg)
Photomic
![Page 200: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/200.jpg)
Case #676.2
74 yr male with low grade chondrosarcoma LD spine 2 yrs
![Page 201: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/201.jpg)
CT scan
![Page 202: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/202.jpg)
Sag T-1 Sag T-2 Sag Gad
![Page 203: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/203.jpg)
Axial T-1 Axial T-2 Axial Gad
![Page 204: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/204.jpg)
Case #676.3
48 year old male with low back pain for 1 year
Chondrosarcoma L-3
![Page 205: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/205.jpg)
Bone scan
![Page 206: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/206.jpg)
Axial T-1 T-2
![Page 207: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/207.jpg)
Sag T-2
![Page 208: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/208.jpg)
Case #677
46 year male with chondrosarcoma mandible
![Page 209: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/209.jpg)
Photomic
![Page 210: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/210.jpg)
Case #678
39 year male
chondrosarcoma
mandible
![Page 211: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/211.jpg)
Secondary
Peripheral
Chondrosarcoma
![Page 212: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/212.jpg)
Secondary Peripheral Chondrosarcoma
The vast majority of secondary peripheral chondrosarcomas arise
from a prexisting osteochondroma and do not occur before puberty.
These lesions tend to be slow growing with minimal to mild
symptoms. The most common site is the pelvis, followed by the
proximal femur, proximal humerus, and ribs. Plain radiographs show
a large calcifying mass on the surface of bone that measure over
5 cm in girth. When one sees an osteochondroma with a cartilagenous
cap over 3 cm in thichness, there is a strong likelihood for a
secondary chondrosarcoma. The overall prognosis for the secondary
peripheral chondrosarcoma is much better than that for the primary
central chondrosarcoma and usually requires only a simple wide
resection with little chance for local recurrence.
![Page 213: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/213.jpg)
CLASSIC Case #126
56 year male with 2ndary peripheral chondrosarcoma ilium
tumor exostosis
![Page 214: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/214.jpg)
Coronal T-2 MRI
tumor
![Page 215: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/215.jpg)
Resected specimen cut in path lab
ilium
![Page 216: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/216.jpg)
Macro section
ilium
![Page 217: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/217.jpg)
Low power photomic
![Page 218: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/218.jpg)
Higher power with ditto forms
![Page 219: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/219.jpg)
Case #679
60 year female with chondrosarcoma pubic area
![Page 220: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/220.jpg)
Gross resection specimen
tumor
![Page 221: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/221.jpg)
Gross specimen cut in path lab
pubic bone
tumor
![Page 222: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/222.jpg)
Macro section
pubic bone
tumor
![Page 223: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/223.jpg)
Close up macro section
pubic bone
![Page 224: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/224.jpg)
Photomic
![Page 225: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/225.jpg)
Post op x-ray
![Page 226: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/226.jpg)
Case #680
31 year male
chondrosarcoma
ilium in multiple
exostosis patient
tumor
exostosis
![Page 227: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/227.jpg)
Axial proton density MRI
tumor
exostosis
![Page 228: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/228.jpg)
Axial T-2 MRI
tumor
![Page 229: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/229.jpg)
tumor
Axial T-2 MRI
![Page 230: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/230.jpg)
Photomic
![Page 231: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/231.jpg)
X-ray of knees with multi exostoses
![Page 232: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/232.jpg)
Case #681
18 year female
chondrosarcoma
pelvis and multi
hereditary exostoses
![Page 233: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/233.jpg)
Oblique view
![Page 234: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/234.jpg)
CT scan
![Page 235: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/235.jpg)
Bone scan
tumor
![Page 236: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/236.jpg)
Resected specimen
tumor
![Page 237: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/237.jpg)
Macro section
![Page 238: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/238.jpg)
Photomic
![Page 239: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/239.jpg)
Multi exostoses knee
![Page 240: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/240.jpg)
Lateral view
![Page 241: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/241.jpg)
Several years after type I resection
![Page 242: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/242.jpg)
Case #682
38 year female with osteochondroma C-spine
![Page 243: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/243.jpg)
CT scan
![Page 244: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/244.jpg)
Surgical photo at at same time
![Page 245: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/245.jpg)
Surgical specimen cut in path lab
cap
![Page 246: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/246.jpg)
Recurrence 3 years
later
![Page 247: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/247.jpg)
Recurrence CT scan
![Page 248: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/248.jpg)
Coronal T-1 MRI
of recurrence and
chondrosarcoma
tumor
![Page 249: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/249.jpg)
Chondrosarcoma photomic
![Page 250: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/250.jpg)
Case #683
42 year female with 2ndary chondrosarcoma ilium
![Page 251: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/251.jpg)
CT scan
![Page 252: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/252.jpg)
Coronal T-1 MRI
tumor
![Page 253: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/253.jpg)
Axial T-1 MRI
tumor
![Page 254: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/254.jpg)
Axial T-2 MRI
tumor
![Page 255: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/255.jpg)
Case #684
33 year male
2ndary chondrosarcoma
os calcis
![Page 256: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/256.jpg)
Lateral view
![Page 257: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/257.jpg)
CT scan
![Page 258: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/258.jpg)
Soft tissue CT scan
exostosis
chondrosarc
![Page 259: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/259.jpg)
Coronal proton density MRI
tumor
![Page 260: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/260.jpg)
Coronal T-2 MRI
tumor
![Page 261: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/261.jpg)
Surgical specimen cut in path lab
![Page 262: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/262.jpg)
Photomic
![Page 263: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/263.jpg)
Case #685
30 year male with multi exostoses & chondrosarcoma chest wall
![Page 264: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/264.jpg)
Case #686
42 year male with 2ndary chondrosarcoma
![Page 265: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/265.jpg)
Macro section
bone stock
chondrosarc
![Page 266: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/266.jpg)
Case #686A
42 year male with peripheral chondrosarcoma ulna
![Page 267: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/267.jpg)
Dedifferentiated
Chondrosarcoma
![Page 268: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/268.jpg)
Dedifferentiated Chondrosarcoma
Of all the chondrosarcoma variants, by far the most malignant and
potentially fatal is the dedifferentiated chondrosarcoma that
accounts for approximately 5-10% of all chondrosarcomas. It
most likely arises as a result of a second mutation within a pre-
existing low to intermediated grade chondrosarcoma, resulting in
the formation of a malignant fibrous histiocytoma or osteo-
sarcoma immediately adjacent to the lower grade chondrosarcoma
Histologically, the low and high grade portions of this tumor are
geographically separated by sharp margins. These tumors usually
occur in patients between the ages of 50 and 70 years in the
same areas where primary centeral chondrosarcomas are found:
the pelvis, femur and proximal humerus. The characteristic
radiographic appearance is that of a flocculated calcific lytic
lesion arising from the central area of bone with an adjacent area
with more extensive infiltration into the surrounding cortical bone.
![Page 269: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/269.jpg)
There is no evidence of calcification in the high grade portion of the
lesion and it typically breaks out through the cortex and into the
subperiosteal space.
The prognosis for this variant of chondrosarcomqa is extremely
poor, most patients dying from metastatic disease within one or two
years after the diagnosis is established. Adjavent chemotherapy or
radiation therapy is not very effective, mainly because of the older
age group in which the tumor occurs. The primary treatment
modality is wide surgical resection.
![Page 270: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/270.jpg)
CLASSIC
Case #127
44 year male
dedifferentiated
chondrosarcoma
proximal femur
![Page 271: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/271.jpg)
2 years later with
increased size
![Page 272: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/272.jpg)
Coronal T-1 MRI
tumor
![Page 273: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/273.jpg)
Axial T-2 MRI
tumor
![Page 274: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/274.jpg)
Photomic at juncture of high and low grade tumor
![Page 275: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/275.jpg)
Low grade chondrosarcoma portion
![Page 276: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/276.jpg)
High grade OGS portion
osteoid
![Page 277: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/277.jpg)
Case #127.1
63 yr male with recent
hip fracture
Dedifferentiated chondrosarc
![Page 278: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/278.jpg)
Bone scan
![Page 279: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/279.jpg)
Cor T-1
![Page 280: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/280.jpg)
Sag T-1 STIR
![Page 281: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/281.jpg)
Axial PD
Axial PD
![Page 282: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/282.jpg)
Surgical resection
![Page 283: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/283.jpg)
Rconstruction completed
![Page 284: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/284.jpg)
Post op X-ray
![Page 285: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/285.jpg)
Case #687
73 year female
dedifferentiated
chondrosarcoma
distal femur
high
grade
low
grade
![Page 286: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/286.jpg)
Lateral view
high grade
low grade
![Page 287: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/287.jpg)
Bone scan
![Page 288: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/288.jpg)
Coronal T-1 MRI high
low
![Page 289: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/289.jpg)
Resected distal femur cut in path lab
high grade
low grade
![Page 290: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/290.jpg)
Photomic showing low grade left & high grade right
![Page 291: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/291.jpg)
Low grade chondrosarcoma
![Page 292: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/292.jpg)
High grade OGS
osteoid
![Page 293: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/293.jpg)
Post op x-ray with
prosthetic recon
![Page 294: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/294.jpg)
Case #688
33 year female
dedifferentiated
chondrosarcoma
distal femur
![Page 295: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/295.jpg)
Reconstruction with Compress system after wide resection
400 lbs pressure
![Page 296: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/296.jpg)
Completion of rotating hinge arthroplasty
![Page 297: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/297.jpg)
Immediate post op x-ray
![Page 298: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/298.jpg)
X-ray at 2 months showing
early callous formation
![Page 299: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/299.jpg)
Early osseointegration
at 5 months
spindle
anchor
plug
![Page 300: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/300.jpg)
X-ray at one year
![Page 301: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/301.jpg)
Stable osseointegration
at 5 years with no signs
of stress shielding
AP view
![Page 302: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/302.jpg)
Lateral view
anterior
cortex
![Page 303: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/303.jpg)
10 years post op
![Page 304: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/304.jpg)
14 years post op
![Page 305: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/305.jpg)
Case #688.1 Dedifferentiated chondrosarcoma
89 year male with mild knee pain 3 months
![Page 306: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/306.jpg)
Coronal T-1 T-2 Sagittal T-2
![Page 307: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/307.jpg)
Axial
T-1 T-2
Gad
![Page 308: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/308.jpg)
Immediate Post Op x-rays
![Page 309: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/309.jpg)
Case #689
42 year female
dedifferentiated
chondrosarcoma
pelvis
![Page 310: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/310.jpg)
Bone scan
![Page 311: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/311.jpg)
Sagittal T-1 MRI
tumor
post column
acetabulum
![Page 312: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/312.jpg)
Axial T-1 MRI
![Page 313: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/313.jpg)
Coronal T-2 MRI
tumor
![Page 314: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/314.jpg)
Low power photomic
![Page 315: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/315.jpg)
Low grade chondrosarcoma
![Page 316: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/316.jpg)
High grade portion
![Page 317: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/317.jpg)
Internal hemipelvectomy reconstruction
recon plate
![Page 318: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/318.jpg)
Post op x-ray
![Page 319: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/319.jpg)
Case #689.1
42 year male with right hip pain for 3 months
![Page 320: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/320.jpg)
Bone scan
![Page 321: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/321.jpg)
CT scan
![Page 322: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/322.jpg)
Cor T-1 STIR
Gad Gad
![Page 323: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/323.jpg)
Axial T-1 T-2
T-2 Gad
![Page 324: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/324.jpg)
Clear Cell
Chondrosacoma
![Page 325: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/325.jpg)
Clear Cell Chondrosarcoma
The clear cell chondrosarcoma is one of the rarest variants of the
chondrosarcoma. It is found more commonly in males than females
between the ages of 20 and 50 years. The most common location
for this tumor is in the femoral head. Radiographically the clear cell
chondrosarcoma has the appearance of a lytic lesion in the epiphysis,
similar to the chondroblastoma in a younger age group for which it
is frequently misdiagnosed. It has a geographic pattern with central
stippled calcification similar to that of a chondroblastoma. Histo-
locally it also has the appearance of a chondroblastoma with the
presence of benign macrophages and polyhedral stem cells with a
clear cell chicken wire appearance. But in some areas one will see
evidence of a low grade chondrosarcoma in which giant cells are not
seen, clearly separating it from the chondroblastoma.
The treatment for this condition consists of a wide resection which
in the femoral head would be a transcervical resection and replace-
![Page 326: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/326.jpg)
ment with a bipolar prosthesis. If the lesion is treated by simple
curettement, the recurrence rate is quite high compared to the
chondroblastoma. The chance for pulmonary metastasis is very
unlikely and local recurrence is rare following a wide resection.
![Page 327: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/327.jpg)
CLASSIC Case #128
25 year male with clear cell chondrosarcoma femoral head
![Page 328: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/328.jpg)
Low power photomic
![Page 329: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/329.jpg)
Higher power showing clear cells
![Page 330: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/330.jpg)
Case #690
51 year male with clear cell chondrosarcoma femoral head
![Page 331: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/331.jpg)
Frog leg lateral
![Page 332: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/332.jpg)
Post op x-ray following
head & neck resection
and total hip replacement
![Page 333: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/333.jpg)
Case #690.1
Post reduction
Acute pathologic fracture left shoulder in 43 yr female
Clear cell chondrosarcoma
![Page 334: Volume 5](https://reader030.vdocument.in/reader030/viewer/2022020921/5455d23baf7959664b8b763d/html5/thumbnails/334.jpg)
CT scan
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Cementation PO
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Case #690.1
20 year female with clear cell chondrosarc prox tibia
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Lateral view
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Coronal T-1 MRI
tumor
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Sagittal T-1 MRI
tumor
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Mesenchymal
Chondrosarcoma
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Mesenchymal Chondrosarcoma
The mesenchymal chondrosarcoma is another rare variant of the
chondrosarcoma. It consists of low grade chondrosarcoma com-
ponents with an infiltration of primitive mesenchymal cells giving
it the histological appearance of a Ewing’s sarcoma or a hemangio-
pericytoma. It can be seen in soft tissue as well as bone in young
adults, more often in females. The most common location is in the
jaw, followed next by the spine or ribs, with a very few cases seen
in long bones. Because of the high grade component of this lesion,
it is treated as a high grade sarcoma with adjavent chemotherapy
and radiation therapy along with a wide resection if possible.
Despite this aggressive program of treatment, the prognosis is very
poor because of a high incidence of pulmonary metastases and
local recurrence.
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CLASSIC
Case #129
34 year female
mesenchymal
chondrosarcoma
LD spine & paraplegia tumor
Sagittal MRI
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Photomic showing low grade chondroid portion
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High grade round cell portion of tumor
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Case #691
36 year male with mesenchymal chondrosarc humeral head
tumor
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CT scan
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Post op x-ray
following humeral
head resection and
prosthetic recon
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Cartilagenous
Pseudotumors
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Case #692
8 year female with multi focal TBc looking like Ollier’s
Pseudotumor
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Geographic lesions in both elbows
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Photomic showing tuberculous granuloma
Langhans giant cell
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Case #693
10 year child
TBc granuloma
proximal tibia looking
like chondroblastoma
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Case #694
54 year female with tumoral calcinosis looking like chondrsarc
hip
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Sagittal T-1 MRI
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Axial T-1 MRI
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Amorphous calcium
phosphate flowing
from biopsy site
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Resected specimen cut in path lab
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Photomic showing heavy calcifcation
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Case #695
64 yr male with giant bone island looking like chondrosarc
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CT scan
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Case #696
55 yr female with geode(DOA) looking like chondrosarc
AP x-ray hip
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Axial CT scan
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Sagittal CT scan
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Bone scan
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Coronal T-1 MRI
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Axial proton density MRI
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Axial T-2 MRI
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Case #697
52 yr female with bone infarct looking like enchondroma
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Sagittal T-1 MRI
knee joint
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Case #697.1 Sag & Cor T-1
74 yr female with tender lump mid pretibial area for 1 year
Bone infarcts
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Cor T-2
Gad
Gad
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Axial T-1
T-2
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Axial T-2
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Case #698
45 yr female with epiphyseal infarct looking like
chondroblastoma
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Case #699
77 year female
rheumatoid arthritis
shoulder looking like
chondrosarcoma
proximal humerus
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AP x-ray shoulder
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Bone scan
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CT scan
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Another CT cut
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Axial T-1 MRI
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Axial T-1 MRI
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Sagittal T-2 MRI
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Coronal T-2 MRI
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Resected proximal
humerus specimen