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From the Archives of the AFIP

Imaging of Primary Chondrosarcoma: Radiologic-Pathologic Correlation¹

¹ From the Departments of Radiologic Pathology (M.D.M., E.A.W., A.J.W.) and Orthopedic Pathology (F.H.G.), Armed Forces Institute of Pathology, 6825 16th Street NW, Bldg 54, Rm M-133A, Washington, DC 20306; Departments of Radiology and Nuclear Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (M.D.M.); Department of Radiology, University of Maryland School of Medicine, Baltimore (M.D.M.); Department of Radiology, Harborview Medical Center, Seattle, Wash (A.J.W.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.J.K.); and Department of Orthopedic Surgery, University of Miami School of Medicine, Miami, Fla (H.T.T.). Received May 19, 2003; revision requested June 10 and received June 20; accepted June 23. Address correspondence to M.D.M. (e-mail: murphey@afip.osd.mil).

Chondrosarcoma is a malignant tumor that produces cartilage matrix, and lesions that arise de novo are called primary. Primary chondrosarcoma is the third most common primary malignant tumor of bone, constituting 20%–27% of all primary malignant osseous neoplasms. There are numerous types of primary chondrosarcomas, including conventional intramedullary, clear cell, juxtacortical, myxoid, mesenchymal, extraskeletal, and dedifferentiated. The conventional intramedullary chondrosarcoma is the most frequent type, and it most commonly involves the long bones or pelvis in up to 65% of cases. Although the pathologic appearance varies with specific lesion type, chondrosarcomas grow with lobular type architecture, and these hyaline cartilage nodules demonstrate high water content and peripheral enchondral ossification. Imaging features directly reflect this pathologic appearance, and the various subtypes often show distinctive features. Radiographic findings often suggest the diagnosis of chondrosarcoma because of identification of typical "ring-and-arc" chondroid matrix mineralization (representing the enchondral ossification) and aggressive features of deep endosteal scalloping and soft-tissue extension. These latter features are usually best assessed, as is lesion staging, with computed tomography (CT) or magnetic resonance (MR) imaging. CT is optimal to detect the matrix mineralization, particularly when it is subtle or when the lesion is located in anatomically complex areas. Both CT and MR imaging depict the high water content of these lesions as low attenuation and very high signal intensity with T2-weighting, respectively. Understanding and recognizing the spectrum of appearances of the various types of primary chondrosarcoma allow improved patient assessment and are vital for optimal clinical management including diagnosis, biopsy, staging, treatment, and prognosis.

Index Terms: Bone neoplasms, 40.321 • Bone neoplasms, CT, 40.1211 • Bone neoplasms, MR, 40.12141 • Sarcoma, 40.321

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