Juxtacortical Chondrosarcoma

Kathleen S Lee, MD
Madeleine D Kraus, MD
Piran Aliabadi, MD

Presentation

Imaging Findings

Plain radiographs of the shoulder show an eccentrically located lesion in the proximal humeral metaphysis (arrow). This lesion has a sclerotic rim and an indistinct inferior border. Central ill-defined opacities indicate a calcified or ossified matrix. A small amount of periosteal reaction may be present inferiorly (arrow).

Computed tomography (CT) of the shoulder shows the bony lesion at the peripheral aspect of the bone, presumably arising from the periosteum or cortex, with no apparent medullary involvement. A calcified or ossified tumor matrix is visible within the lesion (arrow). There is no associated soft tissue mass.

Differential Diagnosis

Diagnosis

Discussion

Juxtacortical chondrosarcomas have radiologic and clinical findings similar to those of osteosarcomas. They are rare tumors often arising peripherally from a long bone metaphysis as a lucent lesion with central calcified tumor matrix, and there may be accompanying periosteal reaction.

Pathology

Classic chondrosarcoma, the second most common malignant bone neoplasm, occurs most commonly in the pelvic and shoulder girdles of adults. The gross tumor is an off-white to light blue color, is firm in consistency, has crisp borders, and is often associated with thickening of the bony cortices. These tumors exhibit varying degrees of cartilaginous differentiation and are a challenge to diagnose with purely histologic criteria. Resolution of the differential diagnosis of chondroblastic osteosarcoma versus chondrosarcoma frequently requires correlation with clinical and radiologic data. In addition to the classic type, several variants exist -- periosteal, clear cell, mesenchymal, and de-differentiated -- each with a distinctive clinicopathologic profile.

References

2. Manaster. Skeletal Radiology. 1989.

3. Shiller AL . Diagnosis of borderline cartilaginous lesions of bone. Semin Diagn Pathol 1985;2(1):42-62.

4. Reiman. Cartilaginous and bone forming tumors of the soft tissue. Semin Diagn Pathol 1986;3(4):288-305.

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