Chondrosarcoma is a tumor of adults. It rarely is encountered in the adolescent and almost never in a child.
There are four different types of chondrosarcoma
- Primary
- Secondary
- Mesenchymal
- Dedifferentiated.
The great majority of cases are primary or secondary chondrosarcoma. The mesenchymal and dedifferentiated types are extremely rare.
The secondary chondrosarcoma arises from either osteochondroma or enchondroma both of which are benign cartilaginous lesions of childhood. The sarcomatous change takes place in adult life.
About one fourth to one third of all chondrosarcomas are of the secondary type.
Malignant transformation is more common in multiple hereditary exostosis and multiple enchondromatosis (Ollier’s or Maffucci’s syndrome) than in solitary exostosis or enchondroma.
In exostosis, malignant transformation takes place more commonly in the regions of the pelvic or shoulder girdle, whereas the enchondromas that become malignant are usually located in the metaphyses of long bones.
The chondrosarcoma is peripheral in the case of exostosis and central in that of enchondroma. The presenting complaint is a dull aching pain in the centrally located chondrosarcoma. In case of peripheral lesions the clinical picture of a peripheral chondrosarcoma is a mass or deformity of the limb.
Radiography
Radiographic features of secondary chondrosarcoma show evidence of the pre-existing benign cartilaginous lesion-i.e., exostosis or enchondroma.
For a long time the radiographic picture of chondrosarcoma shows an irregular mass of calcification of varying density around the periphery of the exostosis with minimal or no permeative reaction of the underlying cortex.
Eventually there will be increased radiolucency of the underlying bone, indicating destruction.
When an enchondroma undergoes malignant transformation into chondrosarcoma radiographic features manifest themselves early in the form of vaguely marginated areas of radiolucency that extend into the surrounding cancellous bone.
Computed tomography and nuclear magnetic resonance imaging are of great value in delineating the internal details of malignant transformation.
Bone scanning with technetium—99m shows increased uptake at sites of mineralization. Serial scanning may show progressive increase in uptake of the radionuclide.
Angiography is helpful to detect proximity to neurovascular structures.
Treatment
Surgical ablation of the involved part with the surgical margin depending on the stage of the disease is the treatment. Limb preservation is possible in most cases. The prognosis for survival is good.
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