Chondrosarcoma of the foot: imaging, surgical and pathological correlation of three new cases

The foot is an uncommon location for chondrosarcoma. The presentation, diagnosis, pathological findings, surgical treatment and follow-up of three patients with chondrosarcoma in this rare location are presented. Though nonspecific, MR imaging findings were of aid in the diagnosis and treatment planning of these patients. If the diagnosis of this tumor is rapidly made, a tumor excision instead of limb amputation may be sufficient treatment at surgery. Received: 28 May 1998 Revision requested: 23 June 1998 Revision received: 19 October 1998 Accepted: 12 November 1998     

去分化软骨肉瘤的影像分析

目的分析去分化软骨肉瘤的X线及CT表现，探讨去分化成分的X线、CT表现特点。方法回顾性分析13例去分化软骨肉瘤的X线及CT表现，并结合临床及组织学特点进行分析研究。结果去分化软骨肉瘤不仅具有典型软骨肉瘤的表现，而且还具有去分化成分的影像特点。13例中8例显示有骨化，11例有骨膜反应，12例有软组织肿快，10例有钙化，其中8例钙化位于病灶中央部位。结论去分化软骨肉瘤具有典型软骨肉瘤所不具备的去分化成分的影像特点，认识这些特殊的影像特点有助于提高对该病的正确诊断。     

软骨肉瘤的影像诊断与鉴别诊断

目的:探讨软骨肉瘤的影像学表现,提高对本病诊断的准确性。方法:回顾性分析25例经手术病理证实的软骨肉瘤的X线、CT和MRI资料。结果:25例软骨肉瘤中原发23例,其中普通型20例,去分化型、黏液型及透明细胞型各1例;继发2例。X线及CT表现:原发的23例中溶骨性骨破坏5例,混合性骨破坏18例,形成软组织肿块20例,其中表现为低密度19例,等密度1例。20例普通型及1例黏液型见散在钙化。MRI表现:普通型软骨肉瘤T1WI呈等或稍低信号,T2WI呈等或稍高信号;黏液型T1WI呈等、低混杂信号,T2WI呈稍高、低的混杂信号,钙化T2WI呈低信号;透明细胞型病例T1WI及T2WI呈近乎等信号;去分化型T1WI呈等低混杂信号,T2WI呈不均匀高信号。6例普通型及1例继发型出现环形、间隔样中等-明显强化,黏液型及去分化型呈不均匀中等-明显强化。结论:普通X线及CT是软骨肉瘤影像诊断及鉴别诊断的主要手段,MRI显示软骨信号为重要提示。MRI显示病变范围更为清楚、准确,为临床治疗提供可靠依据。     

Calcified renal metastases: their etiology, pathogenesis, computed tomographic aspects and differential diagnosis

PURPOSE: To describe CT findings of calcified renal metastases focusing on differential diagnosis problems. MATERIAL AND METHODS: We retrospectively reviewed abdominal CT scans of 8000 patients with tumor, performed from 1984 to 1998. Among the 58 renal metastases, 9 showed a calcific component. We evaluated the location, morphostructural pattern, histology of the primary lesion, the synchronous or metachronous character and the type of treatment. All the lesions were pathologically proved. RESULTS: The primary histotype of the 9 metastases was as follows: 4 mucin-producing adenocarcinomas of the large bowel, 1 gastric mucinous adenocarcinoma, 1 chondrosarcoma, 1 osteosarcoma, 1 melanoma, 1 papillary thyroid carcinoma. In all the cases the renal metastasis was unilateral and unifocal. Granular multiple calcifications were demonstrated within the metastases of mucin-producing adenocarcinoma of the large bowel (3), within the metastasis of chondrosarcoma (1) and of melanoma (1). Diffuse "star-like" calcifications were demonstrated in renal metastases of mucin-producing adenocarcinoma of the large bowel and of gastric mucinous adenocarcinoma (1). Peripheral "egg-shell" calcifications were demonstrated in renal metastasis from papillary thyroid carcinoma (1). Completely calcified monofocal calcification was demonstrated in renal metastasis from osteosarcoma (1). DISCUSSION AND CONCLUSIONS: Calcified renal metastases are rare lesions related to specific oncotypes. The differential diagnosis (carcinoma with calcifications, osteosarcoma, chondrosarcoma, nephrocalcinosis, granulomatosis, hydatidosis etc.) is particularly difficult because of the aspecificity of the morphostructural pattern. Diagnosis is based on a history of specific oncotypes (papillary and mucin-secreting carcinomas, osteosarcoma and chondrosarcoma), but in most cases it requires pathologic confirmation.     

软骨肉瘤的临床X线诊断（附98例报告）

本文报道９８例软骨肉瘤，其中股骨３４例，髂、耻、坐骨和肩胛骨２０例，胫骨１１例，肱骨１０例，肋骨７例，胸骨６例，骶骨４例，跖骨２例，尺骨、腓骨、指骨和上颌骨各１例。临床上以疼痛和肿块为主要症状。所有患者均经病理和手术证实。并进行了５年以上的随访。软骨肉瘤的Ｘ线征象包括：（１）骨质破坏，边缘不规则，界限不清；（２）在病骨周围出现肿瘤性软组织肿块；（３）在肿瘤区和软组织内呈现不同类型的钙化；（４）局限     

Soft-tissue chondromas

Soft-tissue chondromas are benign, relatively rare lesions. The clinicopathologic and radiologic features in six cases are presented and the literature is reviewed. Five of six cases had calcifications. Peripheral curvilinear calcification was seen in two cases, multiple ringlike areas characteristic of cartilage in one, and discrete ossification in another. Histopathologically, they were diverse, ranging from an immature pattern with a preponderance of chondroblasts to a more mature form with chondrocytes. Although these lesions resemble a wide variety of other soft-tissue lesions, they can usually be differentiated by their small size, characteristic location in the extremities, the nature of their calcifications, and the histopathologic features. The importance of this lesion is that it is benign. It must be distinguished from more aggressive soft-tissue neoplasms such as soft-tissue chondrosarcoma so as to spare the patient unnecessary radical therapy.     

骨盆部软骨肉瘤的X线平片及CT影像分析(附20例报告)

目的：评价ＣＴ在骨盆部软骨肉瘤中的诊断价值。材料与方法：分析总结经手术及病理证实的２０例骨盆部软骨肉瘤的平片及ＣＴ表现（包括７例复发）。结果：ＣＴ能显示所有病例中的软组织包块及肿块内的不同密度,而平片只能在１４例中显示有肿块影。ＣＴ能显示全部病例的肿瘤内有不同形态的钙化,而平片只显示１５例有钙化。ＣＴ能清楚显示肿瘤的范围,而平片显示不清楚。ＣＴ还能对７例术后复发做出可靠诊断。结论：在骨盆部软骨肉瘤中,ＣＴ对肿瘤的定位、瘤内密度的显示、病灶范围及毗邻关系的显示等方面均优于传统Ｘ线平片,而且ＣＴ对复发的判断很有价值。     

MRI of mesenchymal chondrosarcoma of the orbit: case report and review of the literature

Extraskeletal mesenchymal chondrosarcoma is a relatively uncommon entity, an orbital location being extremely rare. A review of the literature revealed 16 reported cases of primary orbital mesenchymal chondrosarcoma demonstrated by plain film and CT. To the best of our knowledge, the MRI features of orbital extraskeletal mesenchymal chondrosarcoma have not been previously reported. We present the case of an 18-year-old man with a 2-year history of progressive proptosis of the right eye who underwent CT, dynamic CT, MRI without and with gadolinium enhancement, and magnetic resonance angiography of the orbits. CT of orbital mesenchymal chondrosarcoma demonstrates a well-defined mass with multiple areas of fine and coarse calcification and shows moderate contrast enhancement. The noncalcified portions of the mass demonstrate signal intensity lower than or equal to gray matter on T1-weighted images and are isointense to the gray matter on T2-weighted images. Dynamic CT reveals delayed contrast enhancement. MRI has proven to be a valuable diagnostic tool in the diagnosis and differentiation of well-defined intraorbital masses. By a combination of CT and MRI, it appears mesenchymal chondrosarcoma can be differentiated from other intraorbital lesions, such as cavernous hemangioma, hemangiopericytoma, orbital amyloidosis and fibrous histiocytoma. Received: 29 February 1996 Accepted: 18 June 1996     

骨盆软骨肉瘤影像特征及其病理基础

目的 分析骨盆软骨肉瘤的影像表现及其病理基础,以提高诊断准确性.方法 回顾分析经手术病理证实的骨盆软骨肉瘤12例,术前分别经X线平片、XT平扫、MR SE T,WI、T2WI和增强T1WI,仔细复习影像学扫描结果并和手术病理作对照.结果 12例骨盆软骨肉瘤,普通型11例,去分化型1例.发病部位包括髂骨2例,髋臼3例,坐骨和耻骨6例,骶尾骨1例.肿瘤直径4.7～17.0 cm,<5.0 cm者1例,5.0～10.0 cm者6例,>10.0 cm者5例.病灶呈轻度膨胀性或溶骨性骨质破坏,11例边缘呈扇贝状分叶,1例境界不清.X线平片检查8例中,弓环状钙化1例,隐约钙化6例,无钙化1例,显著软组织肿块3例,骨膜增生1例.cT检查5例,肿瘤密度等于或低于肌肉密度,5例均可见轻度弓环状钙化和软组织肿块.MR检查7例,T1WI等低信号7例,T2WI显著高信号7例,其中6例T2WI高信号内可见弓环状低信号分隔,1例见低信号结节,7例见明显软组织肿块.增强T1WI 6例,所有小叶分隔呈进行性持续强化,小叶自身不强化.结论 MRI可直接显示骨盆软骨肉瘤的病理特征,优于CT和平片.CT对显示解剖学复杂的骨盆病灶及轻微钙化等有明显价值.     

原发性软骨肉瘤的影像诊断

目的探讨原发性软骨肉瘤影像特点及诊断要点。方法回顾性分析13例病理证实的原发性软骨肉瘤的X线、CT、MRI表现,并与病理对照。结果13例中,常见型9例,黏液型3例,去分化型1例。发病部位：长骨7例（股骨6例,肱骨上端1例）,躯干骨6例（骨盆3例,肋骨2例,胸椎1例）。X线及CT表现：呈斑片状、大片状溶骨性骨质破坏,周围骨质密度增高,骨皮质破坏、中断,局部软组织肿块。11例病灶内出现钙化。MRI表现：5例病灶T1WI呈稍低及等信号,T2WI呈显著高信号,增强后呈分隔状强化。结论X线、CT、MRI检查的综合运用,对原发性软骨肉瘤的诊断有重要的价值。     

DWI对颅底脊索瘤与软骨肉瘤鉴别诊断的应用价值

目的 探讨扩散加权成像(DWI)在颅底脊索瘤与颅底软骨肉瘤鉴别诊断中的应用价值.方法 回顾性分析经病理证实的14例经典型颅底脊索瘤、9例未分化型颅底脊索瘤及18例软骨肉瘤的临床及影像学资料.分析瘤体组织的部位、T2WI相对灰质的信号、强化方式及表观扩散系数(ADC).增强扫描未见强化记为0分,不均匀强化为1分,90％以上瘤体均匀强化为2分.采用非参数检验进行统计.结果 3种肿瘤病灶的平均ADC值、最小ADC值、最大ADC值及T2 WI信号强度均存在显著差异(P＜o.05).瘤体的强化方式在病例数量方面存在显著差异(P＜0.05),但强化方式的得分及发病部位无显著差异(P＞0.05).结论 DWI对颅底肿瘤的鉴别诊断具有重要的临床价值,结合T2 WI信号可提高颅底肿瘤的诊断率.     

鼻眶部软骨肉瘤的CT和MRI诊断

目的探讨鼻眶部软骨肉瘤的CT和MRI表现,提高其诊断准确性.方法回顾性分析12例经病理证实的鼻眶部软骨肉瘤的影像学资料.结果12例中起源于鼻腔4例,鼻窦5例,眼眶3例.普通型软骨肉瘤8例,去分化型和间叶型软骨肉瘤各2例.CT表现：肿瘤呈卵圆形2例,分叶形6例,不规则形4例;内见散在点、环、结节、斑片状或不定型钙化;边界清楚9例,模糊3例;3例增强后呈不均匀低度强化.7例鼻软骨肉瘤出现骨质破坏,并侵犯周围结构;眼眶软骨肉瘤骨质破坏1例,并侵犯同侧额部.MRI表现：普通型和去分化型软骨肉瘤在T1WI上表现为低信号6例（与脑组织比较,以下同）,等信号4例,T2WI表现为高信号8例,等信号2例,信号不均匀,内见散在低信号区,增强后呈轻到中度不均匀强化,其中5例普通型软骨肉瘤边缘及间隔呈明显强化,内部不强化,呈斑驳状3例,蜂窝状2例;间叶型软骨肉瘤在T1、T2WI均呈等信号,增强后呈均匀和不均匀显著强化各1例.结论CT是鼻眶部软骨肉瘤诊断和鉴别的主要影像检查方法;典型间隔及边缘强化的MRI表现也能够提示诊断,MRI可更清楚、准确地显示病变侵犯的范围,为治疗提供可靠依据.     

Subperiosteal (juxtacortical) chondroma of the hand. Apropos of 2 cases. Review of the literature

Subperiosteal chondroma (juxta-cortical) is unusual benign cartilaginous neoplasm with characteristic radiographic features. We report two cases occurring in uncommon location: the hand. Radiologic differential diagnosis with others bone tumors is easy but it could be difficult with some soft-tissue tumors, especially chondrosarcoma and extraarticular chondromatosis.     

液性成分为主的软组织病变MRI诊断

目的：了解MRI对液性成分为主的软组织病变的诊断能力。资料与方法：分析53个病变的部位，信号等MR征象。结果：皮脂腺囊肿等位于皮肤和皮下，神经纤维瘤，弹力纤维瘤等位于肌间隙，腱鞘囊肿和滑膜肉瘤位于关节旁，软骨肉瘤等位于肌肉内，脓肿，转移瘤和血肿有灶周水肿，前二者的坏死区呈水样信号；血管瘤T1WI呈略低信号，T2WI呈高信号；亚急性期血肿T1WI与T2WI均呈高信号，粘液变性区T1WI呈略低，等或略高信号，T2WI呈高信号。结论：依据液性成分的MRI信号特征可推测其性质，结合其他MRI表现，可以正确推断多数液性为主软组织病变的组织来源。     

胸壁原发恶性肿瘤的CT诊断

目的　分析胸壁原发恶性肿瘤的CT表现 ,探讨CT对其定位、定性及鉴别诊断的价值和限度。方法　对经手术、活检证实的 7例原发胸壁恶性肿瘤的CT表现 ,结合病理所见进行回顾性分析。结果　 7例胸壁恶性肿瘤中 ,5例发生于胸壁软组织 (脂肪肉瘤和纤维肉瘤各 2例 ,横纹肌肉瘤 1例 ) ,2例发生于胸壁骨组织 (胸骨骨肉瘤、肋软骨肉瘤各 1例 )。CT表现 :肿瘤向胸壁外生长 3例 ,向胸壁内生长 2例 ,同时向胸壁内外生长 2例 ,其中 5例有明显的胸壁骨质破坏 ,4例伴有肺转移。结论　CT对胸壁原发恶性肿瘤的部位、范围以及肺脏是否受侵等有较大的诊断价值。     

Extensive skeletal metastases from chondrosarcoma without pulmonary involvement

Among 251 patients who presented to our orthopedic oncology unit over the last 20 years with chondrosarcoma, we identified two patients with low to intermediate grade conventional chondrosarcoma who developed multifocal bone metastases in the absence of pulmonary spread. The metastatic lesions were of a similar histologic grade to the primary site. One of the patients had synchronous foci, while the other developed the bone lesions 3 years after initial presentation. The unusual behavior of these cases, as well as the possibility that they may represent instances of multicentric chondrosarcoma, is discussed.     

Dedifferentiated chondrosarcoma: use of MRI to guide needle biopsy

AIM: To describe the use of MRI to identify and biopsy areas of dedifferentiation in patients with a suspected diagnosis of dedifferentiated chondrosarcoma. MATERIALS AND METHODS: Low-grade chondrosarcoma is characterized at magnetic resonance imaging (MRI) as having a lobulate, hyperintense appearance on T2-weighted spin-echo sequences. T2-weighted MR images were assessed in 15 patients with a final pathological diagnosis of dedifferentiated chondrosarcoma for regions of atypical reduced signal intensity. Information regarding the site of ultrasound or computed tomography (CT)-guided biopsy was available in 10 cases. RESULTS: Nine patients were male and six female with a mean age of 60 years (range 25-77 years). The sites involved were the distal femur (n+4) pelvis (n=3) proximal femur (n=4) femoral diaphysis (n=1) proximal humerus (n=2) and proximal tibia (n=1). The dedifferentiated component consisted of osteosarcoma (n=5) malignant fibrous histiocytoma (n=6) spindle cell sarcoma (n=1) leiomyosarcoma (n=1) and pleomorphic sarcoma (n=1). In 14 of the 15 cases, areas of lower signal intensity lacking in lobulation were identified. In nine of the 10 cases, biopsy site included such areas and yielded high-grade sarcoma. CONCLUSIONS: Dedifferentiation within chondrosarcoma may be identified on T2-weighted MRI as areas of reduced signal intensity. These areas should be the preferred site of biopsy.     

Chondrosarcoma of the short tubular bones of the hands and feet

Objective. To report 12 cases of chondrosarcoma in a rare location, the short tubular bones of the hands and feet, as well as 12 cases of enchondroma in similar locations, emphasizing the radiologic and histopathologic features. Design and patients. All relevant cases that had both histologic slides and radiographs available were taken from the files of one orthopedic referral hospital and the personal files of one of the authors. A similar number of enchondroma cases was selected at random from the files. Results and conclusions. One malignancy arose in a background of enchondromatosis, with all the others being solitary lesions. A pathologic diagnosis of malignancy is often difficult in the absence of radiologic signs of malignancy (cortical destruction with or without soft tissue extension). However, three cases were unusual in that the initial radiograph demonstrated a benign appearance. Another group of three malignancies was surprisingly indolent biologically. The treatment of choice is ray resection (or more limited amputation in a lesion of the middle or distal phalanx).     

Unusual behavior of clear cell chondrosarcoma

We report two unusual cases of clear cell chondrosarcoma. Both emphasize the slow-growing nature of the lesion and the need for long-term follow-up. Additionally, the clinical, radiologic and histologic characteristics of this neoplasm are discussed.     

Enchondroma vs. chondrosarcoma: A simple,easy-to-use,new magnetic resonance sign

Introduction

There is no clear radiologic or pathologic agreement on the differences between enchondroma and conventional chondrosarcoma, which has huge therapeutic consequences. Microscopically, an enchondroma is composed of “islands of intramedullary hyaline cartilage surrounded by marrow fat”, and a chondrosarcoma a “diffuse cartilaginous replacement (invasion) of the marrow which leads to complete ‘trapping’ of host lamellar bone trabeculae.” The marrow around islands of cartilage should be detectable on magnetic resonance imaging (MR). Enchondroma may be the precursor of chondrosarcoma; benign cartilaginous islands are often seen microscopically at the periphery of chondrosarcoma. We attempted to detect these islands at the periphery of chondrosarcomas on MR and correlate them microscopically.

Materials and methods

We examined our database for all patients with a chondrosarcoma of the long and flat bones between 1990 and 2007. Only those with a preoperative MR who underwent an en bloc resection were included, yielding 32 patients. We looked for low-signal islands surrounded by high (fat) signal on T1-weighted images, and high-signal islands surrounded by low signal on T2-weighted fat saturated images at the periphery of the main tumour mass. Microscopic correlation was performed in all cases.

Results

On microscopy, there were 23 conventional chondrosarcomas, nine dedifferentiated. Peripheral islands surrounded by fat were detected on MR in 19 cases, corresponding to benign cartilage in 18 cases and to the benign scar of a needle biopsy tract in one. There were no peripheral islands detected radiographically or microscopically in 13 cases.

Conclusion

Cartilaginous islands microscopically detected at the periphery of some chondrosarcomas are easily and reliably diagnosed on MR.