DOI: 10.1148/rg.245045009
Radiographic, CT, and MR Imaging Features of Dedifferentiated Chondrosarcomas: A Retrospective Review of 174 De Novo Cases1
Laurel A. Littrell, MD,
Doris E. Wenger, MD,
Lester E. Wold, MD,
Franco Bertoni, MD,
K. Krishnan Unni, MD,
Lawrence M. White, MD,
Rita Kandel, MD and
Murali Sundaram, MD
1 From the Departments of Radiology (L.A.L., D.E.W., M.S.) and Laboratory Medicine and Pathology (L.E.W., K.K.U.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; the Departments of Radiology and Pathology, Mount Sinai Hospital, Toronto, Ontario, Canada (L.M.W., R.K.); and the Department of Radiology, Istituto Ortopedico Rizzoli, Bologna, Italy (F.B.). Presented as an education exhibit at the 2002 RSNA scientific assembly. Received January 14, 2004; revision requested February 17 and received June 17; accepted June 17. All authors have no financial relationships to disclose. Address correspondence to L.A.L. (e-mail: littrell.laurel@mayo.edu).
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Figure 1. Schematic illustrates the distribution of dedifferentiated chondrosarcoma by patient age, patient gender, and lesion site. Numbers on drawing of skeleton indicate number of patients with disease affecting the corresponding anatomic location.
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Figure 2a. Radiograph (a) and axial CT scan (b) demonstrate a large mass that arises from the surface of the right iliac wing. The mass contains chondroid calcifications (arrows) that suggest chondrosarcoma, as well as unmineralized areas of dedifferentiation (arrowheads in b). The dedifferentiated component in this tumor proved to be malignant fibrous histiocytoma.
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Figure 2b. Radiograph (a) and axial CT scan (b) demonstrate a large mass that arises from the surface of the right iliac wing. The mass contains chondroid calcifications (arrows) that suggest chondrosarcoma, as well as unmineralized areas of dedifferentiation (arrowheads in b). The dedifferentiated component in this tumor proved to be malignant fibrous histiocytoma.
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Figure 3a. (a) Photograph shows a gross specimen with a bimorphic pattern consisting of areas of lobulated gray-white hyaline cartilage adjacent to regions of yellow-brown soft tumor, as well as a soft-tissue mass. (b, c) Photomicrographs (hematoxylin-eosin stain) also show the tumor with a bimorphic pattern. The low-grade hyaline cartilage component demonstrates the typical features of ordinary chondrosarcoma, with sheetlike regions of malignant high-grade spindle cells (arrow) immediately adjacent to the well-differentiated chondrosarcoma (arrowhead).
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Figure 3b. (a) Photograph shows a gross specimen with a bimorphic pattern consisting of areas of lobulated gray-white hyaline cartilage adjacent to regions of yellow-brown soft tumor, as well as a soft-tissue mass. (b, c) Photomicrographs (hematoxylin-eosin stain) also show the tumor with a bimorphic pattern. The low-grade hyaline cartilage component demonstrates the typical features of ordinary chondrosarcoma, with sheetlike regions of malignant high-grade spindle cells (arrow) immediately adjacent to the well-differentiated chondrosarcoma (arrowhead).
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Figure 3c. (a) Photograph shows a gross specimen with a bimorphic pattern consisting of areas of lobulated gray-white hyaline cartilage adjacent to regions of yellow-brown soft tumor, as well as a soft-tissue mass. (b, c) Photomicrographs (hematoxylin-eosin stain) also show the tumor with a bimorphic pattern. The low-grade hyaline cartilage component demonstrates the typical features of ordinary chondrosarcoma, with sheetlike regions of malignant high-grade spindle cells (arrow) immediately adjacent to the well-differentiated chondrosarcoma (arrowhead).
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Figure 4a. (a) Radiograph of the left hip demonstrates a periacetabular lytic lesion with a suggestion of punctate chondroid calcifications (arrow). (b) CT scan of the pelvis shows an expansile soft-tissue mass in the left ilium (arrowheads) and helps confirm the presence of chondroid matrix in the bone and mass (arrows). The cortical destruction and the size of the mass are indicative of a high-grade chondrosarcoma.
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Figure 4b. (a) Radiograph of the left hip demonstrates a periacetabular lytic lesion with a suggestion of punctate chondroid calcifications (arrow). (b) CT scan of the pelvis shows an expansile soft-tissue mass in the left ilium (arrowheads) and helps confirm the presence of chondroid matrix in the bone and mass (arrows). The cortical destruction and the size of the mass are indicative of a high-grade chondrosarcoma.
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Figure 5. Radiograph of the left hip in a patient with histologically proved dedifferentiated chondrosarcoma demonstrates a nonspecific, malignant, purely osteolytic destructive lesion in the periacetabular region with extensive cortical destruction medially (arrows) and a soft-tissue mass along the pelvic side wall (arrowheads). The differential diagnosis would also include metastasis, lymphoma, and multiple myeloma.
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Figure 6. Radiograph demonstrates a cartilage tumor with punctate chondroid calcifications (large arrow), cortical endosteal scalloping (small arrows), mild cortical thickening (arrowhead), and no evidence of periosteal new bone.
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Figure 7a. Anteroposterior (a) and lateral (b) radiographs of the tibia reveal a lytic and sclerotic lesion in the tibial diaphysis with cartilage matrix (arrows in b), a finding that is indicative of a chondrosarcoma. Thick, solid, unilaminar periosteal new bone (arrowhead in a), which is characteristic of a low-grade chondrosarcoma, is seen adjacent to a more superior area of spiculated new bone (arrow in a), a finding that is suggestive of a more aggressive tumor type.
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Figure 7b. Anteroposterior (a) and lateral (b) radiographs of the tibia reveal a lytic and sclerotic lesion in the tibial diaphysis with cartilage matrix (arrows in b), a finding that is indicative of a chondrosarcoma. Thick, solid, unilaminar periosteal new bone (arrowhead in a), which is characteristic of a low-grade chondrosarcoma, is seen adjacent to a more superior area of spiculated new bone (arrow in a), a finding that is suggestive of a more aggressive tumor type.
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Figure 8a. Lateral radiograph (a), CT scan (b), and sagittal MR image (c) demonstrate a large destructive lesion that involves a long segment of the femoral diaphysis, with cartilage matrix (small arrows in a, arrow in b). There is evidence of a permeative pattern of cortical destruction (large white arrows in a, arrows in c) with periosteal new bone formation (black arrow in a). A massive associated soft-tissue mass (large arrowheads in b, arrowheads in c) with scattered punctate foci of cartilage matrix (small arrowheads in b) are also seen. Size of the soft-tissue mass relative to the extent of destruction in a and the large unmineralized areas within the mass should suggest dedifferentiation in a malignant cartilage tumor. The dedifferentiated component proved to be osteoblastic osteosarcoma.
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Figure 8b. Lateral radiograph (a), CT scan (b), and sagittal MR image (c) demonstrate a large destructive lesion that involves a long segment of the femoral diaphysis, with cartilage matrix (small arrows in a, arrow in b). There is evidence of a permeative pattern of cortical destruction (large white arrows in a, arrows in c) with periosteal new bone formation (black arrow in a). A massive associated soft-tissue mass (large arrowheads in b, arrowheads in c) with scattered punctate foci of cartilage matrix (small arrowheads in b) are also seen. Size of the soft-tissue mass relative to the extent of destruction in a and the large unmineralized areas within the mass should suggest dedifferentiation in a malignant cartilage tumor. The dedifferentiated component proved to be osteoblastic osteosarcoma.
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Figure 8c. Lateral radiograph (a), CT scan (b), and sagittal MR image (c) demonstrate a large destructive lesion that involves a long segment of the femoral diaphysis, with cartilage matrix (small arrows in a, arrow in b). There is evidence of a permeative pattern of cortical destruction (large white arrows in a, arrows in c) with periosteal new bone formation (black arrow in a). A massive associated soft-tissue mass (large arrowheads in b, arrowheads in c) with scattered punctate foci of cartilage matrix (small arrowheads in b) are also seen. Size of the soft-tissue mass relative to the extent of destruction in a and the large unmineralized areas within the mass should suggest dedifferentiation in a malignant cartilage tumor. The dedifferentiated component proved to be osteoblastic osteosarcoma.
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Figure 9. CT scan of the pelvis demonstrates a mixed lytic and sclerotic destructive lesion in the right acetabulum with cartilage matrix (small arrows) and an unmineralized soft-tissue mass (arrowheads), findings that are typical of a dedifferentiated chondrosarcoma. An associated pathologic fracture is also seen (large arrow).
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Figure 10a. (a) Anteroposterior radiograph of the pelvis shows a large soft-tissue mass in a periacetabular location with a suggestion of chondroid matrix (arrow). The differential diagnosis would include chondrosarcoma. (b) CT scan more clearly demonstrates the soft-tissue mass (arrowheads) and chondroid matrix (arrows).
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Figure 10b. (a) Anteroposterior radiograph of the pelvis shows a large soft-tissue mass in a periacetabular location with a suggestion of chondroid matrix (arrow). The differential diagnosis would include chondrosarcoma. (b) CT scan more clearly demonstrates the soft-tissue mass (arrowheads) and chondroid matrix (arrows).
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Figure 11a. Sagittal T2-weighted MR image of the distal femur (a) and coronal gradient-echo MR image of the right shoulder (b) obtained in two different patients with dedifferentiated chondrosarcoma demonstrate high-signal-intensity medullary calcific lobules (arrows) and punctate low-signal-intensity foci representing medullary calcifications (arrowheads). These MR imaging features are typical of chondroid matrix.
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Figure 11b. Sagittal T2-weighted MR image of the distal femur (a) and coronal gradient-echo MR image of the right shoulder (b) obtained in two different patients with dedifferentiated chondrosarcoma demonstrate high-signal-intensity medullary calcific lobules (arrows) and punctate low-signal-intensity foci representing medullary calcifications (arrowheads). These MR imaging features are typical of chondroid matrix.
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Figure 12a. (a) Radiograph demonstrates a subtrochanteric lytic lesion in the right femur with cortical thickening (arrowheads), endosteal scalloping (small arrows), and chondroid matrix (large arrow), findings that are typical of chondrosarcoma. (b, c) Coronal T1-weighted (b) and axial T2-weighted (c) MR images help suggest a diagnosis of dedifferentiated chondrosarcoma by depicting a large soft-tissue mass (arrows) that was not detectable on the radiograph.
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Figure 12b. (a) Radiograph demonstrates a subtrochanteric lytic lesion in the right femur with cortical thickening (arrowheads), endosteal scalloping (small arrows), and chondroid matrix (large arrow), findings that are typical of chondrosarcoma. (b, c) Coronal T1-weighted (b) and axial T2-weighted (c) MR images help suggest a diagnosis of dedifferentiated chondrosarcoma by depicting a large soft-tissue mass (arrows) that was not detectable on the radiograph.
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Figure 12c. (a) Radiograph demonstrates a subtrochanteric lytic lesion in the right femur with cortical thickening (arrowheads), endosteal scalloping (small arrows), and chondroid matrix (large arrow), findings that are typical of chondrosarcoma. (b, c) Coronal T1-weighted (b) and axial T2-weighted (c) MR images help suggest a diagnosis of dedifferentiated chondrosarcoma by depicting a large soft-tissue mass (arrows) that was not detectable on the radiograph.
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Figure 13. CT scan of the pelvis demonstrates a large mixed lytic and sclerotic destructive lesion in the right ilium without evidence of chondroid matrix. The large unmineralized soft-tissue mass (arrows) is typical of a dedifferentiated chondrosarcoma.
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Figure 14a. Radiograph (a) and coronal T1-weighted MR image (b) demonstrate a dedifferentiated chondrosarcoma with bimorphic features in the subtrochanteric femur. The radiograph demonstrates cartilage matrix mineralization (black arrow) adjacent to a more aggressive-appearing osteolytic area (arrowheads) with focal cortical destruction (white arrow). The MR image demonstrates an area of low-signal-intensity foci (arrow) that corresponds to the mineralized portion of the tumor, with an unmineralized area inferiorly (arrowheads).
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Figure 14b. Radiograph (a) and coronal T1-weighted MR image (b) demonstrate a dedifferentiated chondrosarcoma with bimorphic features in the subtrochanteric femur. The radiograph demonstrates cartilage matrix mineralization (black arrow) adjacent to a more aggressive-appearing osteolytic area (arrowheads) with focal cortical destruction (white arrow). The MR image demonstrates an area of low-signal-intensity foci (arrow) that corresponds to the mineralized portion of the tumor, with an unmineralized area inferiorly (arrowheads).
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Figure 15. Radiograph shows a mixed lytic and sclerotic lesion with punctate calcifications (arrow) and with evidence of cartilage matrix inferiorly. In addition, there is a denser region of amorphous mineralization superiorly (arrowhead) with features that are more suggestive of osteoid matrix. Pathologic examination revealed a grade 4 osteosarcoma arising within a grade 1 chondrosarcoma.
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Figure 16a. (a) Radiograph demonstrates a mixed lytic and sclerotic lesion with a permeative, aggressive, nonspecific pattern. A subtle intertrochanteric and subtrochanteric fracture is also seen (arrow). (b) CT scan reveals intraosseous chondroid matrix (arrow) and an unmineralized soft-tissue mass (arrowheads). (c, d) Coronal T1-weighted (c) and axial T2-weighted (d) MR images more clearly show the size and extent of the large unmineralized soft-tissue mass (arrowheads), which represents the dedifferentiated component of a bimorphic cartilage tumor.
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Figure 16b. (a) Radiograph demonstrates a mixed lytic and sclerotic lesion with a permeative, aggressive, nonspecific pattern. A subtle intertrochanteric and subtrochanteric fracture is also seen (arrow). (b) CT scan reveals intraosseous chondroid matrix (arrow) and an unmineralized soft-tissue mass (arrowheads). (c, d) Coronal T1-weighted (c) and axial T2-weighted (d) MR images more clearly show the size and extent of the large unmineralized soft-tissue mass (arrowheads), which represents the dedifferentiated component of a bimorphic cartilage tumor.
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Figure 16c. (a) Radiograph demonstrates a mixed lytic and sclerotic lesion with a permeative, aggressive, nonspecific pattern. A subtle intertrochanteric and subtrochanteric fracture is also seen (arrow). (b) CT scan reveals intraosseous chondroid matrix (arrow) and an unmineralized soft-tissue mass (arrowheads). (c, d) Coronal T1-weighted (c) and axial T2-weighted (d) MR images more clearly show the size and extent of the large unmineralized soft-tissue mass (arrowheads), which represents the dedifferentiated component of a bimorphic cartilage tumor.
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Figure 16d. (a) Radiograph demonstrates a mixed lytic and sclerotic lesion with a permeative, aggressive, nonspecific pattern. A subtle intertrochanteric and subtrochanteric fracture is also seen (arrow). (b) CT scan reveals intraosseous chondroid matrix (arrow) and an unmineralized soft-tissue mass (arrowheads). (c, d) Coronal T1-weighted (c) and axial T2-weighted (d) MR images more clearly show the size and extent of the large unmineralized soft-tissue mass (arrowheads), which represents the dedifferentiated component of a bimorphic cartilage tumor.
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Figure 17. Contrast material-enhanced CT scan of the pelvis demonstrates a mixed lytic and sclerotic dedifferentiated chondrosarcoma of the right ilium with an associated large unmineralized soft-tissue mass (arrowheads). The mass demonstrates heterogeneous enhancement with a large area of low-attenuation myxoid change centrally.
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Copyright © 2004 by the Radiological Society of North America.
