Clear cell chondrosarcoma: radiographic, computed tomographic, and magnetic resonance findings in 34 patients with pathologic correlation

• Published in: Skeletal radiology Vol. 32; no. 12; pp. 687 - 694
• Main Authors: COLLINS, Mark S, KOYAMA, Takashi, SWEE, Ronald G, INWARDS, Carrie Y
• Format: Journal Article
• Language: English
• Published: Berlin Springer 01.12.2003; Springer Nature B.V
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Bone Cysts, Aneurysmal - diagnostic imaging; Bone Cysts, Aneurysmal - pathology; Bone marrow; Bone Neoplasms - classification; Bone Neoplasms - diagnostic imaging; Bone Neoplasms - pathology; Calcification, Physiologic; Child; Chondrosarcoma - classification; Chondrosarcoma - diagnostic imaging; Chondrosarcoma - pathology; Diagnosis, Differential; Diseases of the osteoarticular system; Epiphyses - diagnostic imaging; Epiphyses - pathology; Female; Femur - diagnostic imaging; Femur - pathology; Humans; Humerus - diagnostic imaging; Humerus - pathology; Investigative techniques, diagnostic techniques (general aspects); Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; Osteolysis - diagnostic imaging; Osteolysis - pathology; Retrospective Studies; Ribs - diagnostic imaging; Ribs - pathology; Sarcoma, Clear Cell - classification; Sarcoma, Clear Cell - diagnostic imaging; Sarcoma, Clear Cell - pathology; Scapula - diagnostic imaging; Scapula - pathology; Severity of Illness Index; Spine - diagnostic imaging; Spine - pathology; Statistics as Topic; Tarsal Bones - diagnostic imaging; Tarsal Bones - pathology; Tibia - diagnostic imaging; Tibia - pathology; Tomography, X-Ray Computed; Traumas. Diseases due to physical agents; Tumors of striated muscle and skeleton; Human; Nuclear medicine; Clear cell chondrosarcoma; Chondrosarcoma; Correlation; Radiodiagnosis; Sarcoma; Computed tomography Histopathology; Magnetic resonance; Diseases of the osteoarticular system; Exploration; Retrospective study; Malignant tumor; Nuclear magnetic resonance imaging; Retrospective; Radiography; Cartilage; Clear cell; Anatomic pathology; Histopathology; Orthopedics; Radiology; Medical imagery; Computerized axial tomography
• ISSN: 0364-2348; 1432-2161
• DOI: 10.1007/s00256-003-0668-3

To describe the radiographic features of clear cell chondrosarcoma (CCCS), including the computed tomographic (CT) and magnetic resonance (MR) findings, and to correlate them with the histopathologic findings. A retrospective review was carried out of 72 patients with histopathologically confirmed CCCS. Imaging studies were available for 34 patients: conventional radiographs (n=28), CT scans (n=14), and MR images (n=15). Radiographic studies were reviewed by three radiologists who rendered a consensus opinion; the studies were correlated with the histopathologic findings. Of the 34 patients with imaging studies, 30 were male and 4 were female (mean age 38.6 years; range 11-74 years). Twenty-two lesions were in long bones (15, proximal femur; 1, distal femur; 1, proximal tibia; 5, proximal humerus) and 11 were in flat bones (5, vertebra; 4, rib; 1, scapula; 1, innominate). One lesion occurred in the tarsal navicular bone. Typically, long bone lesions were located in the epimetaphysis (19/22) and were lucent with a well-defined sclerotic margin and no cortical destruction or periosteal new bone formation. More than one-third of the long bone lesions contained matrix mineralization with a characteristic chondroid appearance. Pathologic fractures were present in six long bone lesions (4, humerus; 2, femur). Lesions in the proximal humerus were more likely to have indistinct margins (4/5) and extend into the diaphysis. Flat bone lesions were typically lytic and expansile and occasionally demonstrated areas of cortical disruption. Typically, matrix mineralization, when present, was amorphous. MR imaging, when available, was superior to conventional radiographs for demonstrating the intramedullary extent of a lesion as well as soft tissue extension. CT images better delineated the presence of cortical destruction and the character of matrix mineralization patterns. CCCS lesions were typically low signal intensity on T1-weighted images and moderately or significantly bright on T2-weighted images. Areas of lesion heterogeneity on T1- and T2-weighted images and on post-gadolinium T1-weighted images corresponded pathologically to areas of mineralization, intralesional hemorrhage, and cystic changes. Adjacent bone marrow edema was typically absent (12/15) or only minimally observed in a few cases (3/15). No cases examined with MR imaging demonstrated periosteal new bone formation. CCCS typically presents radiographically as a geographic lytic lesion located in the epimetaphyseal region of long bones. Most commonly lesions are found in the proximal femur, followed by the proximal humerus. Lesions within the proximal humerus may exhibit more aggressive features. Lesions in the axial skeleton are typically expansile and destructive, often with soft tissue extension and lack of mineralization. MR imaging may show the presence or absence of bone marrow edema.