Moderator :Director & HOD

PROF.DR.K.PRAKASAM M.S.Ortho,D.Ortho,DSC (HON)

PRESENTOR:DR.THOUSEEF.A.MAJEED

M S Ortho PG

VMKVMCH Salem

CHONDROsARCOMA

• It is a malignant bone tumour of cartilageneous origin

• 9% of all primary malignancies of bone

• Primary chondrosarcoma - Between 40 and 60 years

• Secondary chondrosarcoma-Between 25 and 45

years

Classification

• PRIMARY CHONDROSARCOMA

• SECONDARY CHONDROSARCOMA

PRIMARY CHONDROSARCOMA

• Central (medullary)

• Intra cortical

• Clear cell

• Mesenchymal

• Dedifferentiated

SECONDARY CHONDROSARCOMA (from pre existing lesions)

• Multiple enchondromas & Exostosis

• Chondroblastoma

• Irradiation induced

• Fibrous dysplasia

Location

Types according to the site

• CENTRAL

• PERIPHERAL (surface type)

COMMON SITES

• Pelvis

• Proximal femur

• Proximal humerus.

• Ribs

• Rarely occur in the hand

• Incidence is higher among males

CLINICAL FEATURES

• A palpable mass with

increasing pain

• Hard in consistency with

lobulated surface

• Continuous with the bone

• slow growing .

• Mechanical restriction of joint

movements.

Secondary chondrosarcomas

• Arise at the site of a pre-existing benign cartilage

lesion.

• Most frequently in the enchondromas and

multiple hereditary exostoses.

INCIDENCE –

• 5% for patients with multiple hereditary exostoses

• Approximately 1% for patients with solitary

osteochondromas

RADIOLOGY

• It is arising in the medullary

cavity with irregular matrix

calcification.

• Calcification is a specific sign

• Gives a “punctate,”

“popcorn,” or “comma-

shaped.” calcification

• The size of the cartilaginous cap of an osteochondroma,

is to be evaluated with Computerised Tomography (CT-

Scan) or Magnetic resonance imaging (MRI).

• It is important in evaluating the possibility of a

secondary chondrosarcoma.

HISTOLOGY

CONVENTIONAL CHONDROSARCOMA

• Composed of malignant cells

with abundant cartilaginous

matrix.

• If malignant osteoid is present

the diagnosis should be

chondroblastic osteosarcoma

Diagnosing Factors that favor the malignant transformation

• Hypercellularity

• Plump nuclei

• More than occasional binucleate cells

• Entrapment of bony trabeculae.

Histological subtypes

• Clear cell chondrosarcoma

• Mesenchymal chondrosarcoma

• Dedifferentiated chondrosarcoma

Clear cell chondrosarcoma

• Low-grade malignancy.

• Round cells with abundant

clear cytoplasm

• Distinct cytoplasmic

borders with a background

of cartilaginous matrix.

• Multinucleated giant cells

are usually apparent.

• Clear cell Chondrosarcoma has a strong tendency to

arise in an epiphysis

• Benign radiographic features and can be confused with

chondroblastoma or giant cell tumor.

Mesenchymal chondrosarcoma

• High-grade tumor

• Small round blue cells

• Islands of benign-appearing

cartilage.

• The cellular portions have a

“Hemangiopericytomatous” pattern

of growth with “staghorn-like”

vessels.

Dedifferentiated chondrosarcoma

High-grade sarcoma

• ( Commonly osteosarcoma followed

in frequency by fibrosarcoma and

malignant fibrous histiocytoma)

• The radiography shows aggressive

radiolucent area

Teatment

Low-grade chondrosarcoma

• Extended curettage with the use of intraoperative

adjuvant treatments.

High-grade chondrosarcoma

• Wide or radical resection

• Amputation.

• The local recurrence rate after intraoperative

tumor contamination is high.

• For lesions in an expendable locations, Primary

wide resection without a biopsy may be

indicated

• It is to decrease the chance of tumor

contamination.

• After wide resection local recurrence is

less than 10%

• Pulmonary metastases Treated with

surgical resection if possible.

• Chemotherapy has no role in the treatment of

conventional chondrosarcoma

• Radiotherapy is used only as a palliative measure

for surgically inaccessible lesions.

Inaccessible areas include

• Tumour arising from floor of pelvis

Vertebrae &spinous process

PROGNOSIS

The prognosis depends on

• Size

• Grade

• Location of the lesion.

Low-grade lesions • Greater than 90% 10-year survival rate

High-grade conventional chondrosarcoma

• 20% to 40% 10-year survival rate

THANK YOU