Chondrosarcoma

Author: Patrick O'Donnell

Topic updated on 03/08/13 9:49pm


Introduction
Malignant chondrogenic lesions can occur in two forms primary chondrosarcoma which includes low-grade, high-grade, de-differenitated chondrosarcoma clear cell chondrosarcoma (see below) mesenchymal chondrosarcoma (see below) secondary chondrosarcoma arises from benign cartilage lesions including osteochondroma (<1% risk of malignant transfomation) multiple hereditary exostosis (1-10% risk of malignant transformation) enchondromas (1% risk of malignant transformation) Ollier's disease (25-40% risk of malignant transformation) Maffucci's (100% risk of malignant transformation) Age & location typically, chondrosarcomas are found in older patients (40-75 yrs) there is a slight male predominance most common locations include the pelvis, proximal femur, scapula tumor location is important for diagnosis as the same histology may be diagnosed as benign in the hand but malignant if located in the long bones Grade 85% of chondrosarcomas are grade 1 or 2 15% of chondrosarcomas are grade 3 or dedifferentiated chondrosarcoma de-differentiated chondrosarcomas are high grade lesions which develop from low grade chondroid lesions Prognosis axial and proximal extremity lesions have a more aggressive course histologic grade correlates with survival Grade I: 90% survival Grade II: 60-70% survival Grade III: 30-50% survival De-differentiated chondrosarcoma: 10% survival increased telomerase activity in chondrosarcoma, as determined by reverse transcriptase-polymerase chain reaction (RT-PCR), has been shown to directly correlate with the rate of recurrence Chondrosarcoma sub-types Clear cell chondrosarcoma malignant immature cartilaginous tumor accounting for <2% of all chondrosarcomas most common in 3rd and 4th decades of life commonly presents with insidious onset of pain presents as an epiphyseal lesion and can be mistaken for low-grade chondroblastoma locally destructive with potential to metastasize Mesenchymal chondrosarcoma chondrosarcoma variant which presents with a biphasic pattern of neoplastic cartilage with associated neoplastic small round blue cell component occurs in younger patients than typical chondrosarcomas may occur at several discontinuous sites at presentation and can occur in the soft tissues treatment includes neo-adjuvant chemotherapy followed by wide surgical resection

Presentation

Symptoms
- pain is the most common symptom
- may present with slowly growing mass or symptoms of bowel/bladder obstruction due to mass effect in the pelvis
- 50% of de-differentiated chondrosarcomas present with a pathologic fracture

Imaging

Radiographs
- lytic or blastic lesion with reactive thickening of the cortex
  - low-grade chondrosarcomas show
    - similar appearance to enchondromas with additional cortical thickening/expansion and endosteal erosion
  - high-grade chondrosarcomas show
    - cortical destruction and a soft tissue mass
- intra-lesional "popcorn" mineralization may be seen
  - described as rings, arcs, and stipples of mineralization
- de-differentiated chondrosarcomas radiographically show a lower grade chondroid lesion with superimposed highly destructive area consistent with the high grade transformed dedifferentiated chondrosarcoma
MRI or CT
- helpful to determine cortical destruction, marrow involvement, and the soft tissue involvement
Bone scan
- is usually very hot in all grades of chondrosarcoma

Histology

Chondrosarcoma
- needle biopsy is not indicated for cartilage tumors due to difficulties with diagnosis
  - it is often difficult to determine malignancy based on histology alone
- characteristic histology
  - low-grade chondrosarcomas show
    - few mitotic figures with a bland histologic appearance
    - enlarged chondrocytes with plump multinucleated lacunae
  - high-grade chondrosarcomas show
    - hypercellular stroma consisting of characteristic "blue-balls" of a cartilage lesion which permeate the bone trabeculae
- enchondromas of hand, Ollier's disease, Maffucci's disease, periosteal chondromas, and chondrosarcoma may all have similar histology
De-differentiated chondrosarcomas
- characterized by a bimorphic histology
  - low grade chondroid component
  - high grade spindle cell component (similar histology to osteosarcoma, fibrosarcoma, MFH)

Treatment

Operative
- intra-lesional curettage
  - indications
    - Grade 1 lesions
    - treatment of grade 1 lesions located in the pelvis or axial skeleton is controversial
      - many authors recommend wide excision of all chondrosarcomas (even grade 1) if located in the pelvis
- wide surgical excision
  - indications
    - grade 2 or 3 lesions
    - some say grade 1 lesions in pelvis
  - historically, there is no significant role for radiation or chemotherapy in typical intramedullary chondrosarcoma
- wide surgical excision combined with multi-agent chemotherapy
  - indications
    - mesenchymal chondrosarcoma
    - the role of chemotherapy in de-differentiated chondrosarcoma is very controversial

Differentials & Groups

	Malignant lesion in older patient(1)	May have similar chondrogenic histology	Sacral lesions in older patients	Treated with wide resection alone (2)
Chondrosarcoma	•	•	•	•
Metastic disease	•		•
Lymphoma	•		•
Myeloma	•		•
MFH	•		•
Secondary sarcoma	•
Enchondroma / Olliers / Marfuccis		•
Periosteal chondroma		•
Osteochondroma (MHE)		•
Parosteal osteosarcoma				•
Adamantinoma				•
Chordoma			•	•
Squamous cell(3)			•	•
ASSUMPTIONS: (1) Older patient is > 40 yrs; (2) assuming no impending fracture (3) assuming no squamous cell metastatic disease

IBank

	Location	Xray	Xray	CT	B. Scan	MRI	MRI	Histo(1)
Case A	scapula
Case B	femur
Case C	pelvis
Case D	tibia
Case E	prox femur
Case F	prox. humerus
Case H	pelvis (dedifferentiated)
Case I	femur (dedifferentiated)

(1) - histology does not always correspond to case

Please Rate Educational Value!

4.0

Average 4.0 of 8 Ratings

Qbank (11 Questions)

TAG

(OBQ10.3) A 38-year-old male complains of progressive right groin pain over the past year. Initially, the pain occurred only with weight-bearing, but is now beginning to bother him while sitting and has awoken him from sleep on a few occasions. A radiograph demonstrates a mixed lucent and sclerotic lesion within the femoral head just below the articular surface. An MRI is shown in figure A. A histology slide from an open biopsy is provided in figure B. Which of the following is the most likely diagnosis? Topic

Review Topic

FIGURES: A

1. Lymphoma
2. Clear cell chondrosarcoma
3. Chondroblastoma
4. Giant cell tumor
5. Osteosarcoma

PREFERRED RESPONSE ▶

DISCUSSION: The clinical presentation, MRI, and histology are consistent with clear cell chondrosarcoma. The histology demonstrates chondrocytes with a clear, vacuolated cytoplasm in a chondroid matrix, which is characteristic of clear cell chondrosarcoma. In addition, the lesion is in the epiphysis which is also typical of clear cell chondrosarcoma. Radiographs of clear cell chondrosarcoma usually demonstrate mixed lucent and sclerotic lesions with a paucity of matrix densities or calcifications. "Popcorn calcifications" typically seen in classic chondrosarcoma are not prevalent on radiographs of clear cell chondrosarcoma. Chondroblastoma and giant cell tumors are two other epiphyseal lesions that must be differentiated from clear cell chondrosarcoma. Chondroblastomas are predominantly found in teenagers and young adults. Giant cell tumors will demonstrate classic giant cells on pathology.

REFERENCES:

1. Seo SW, Remotti F, Lee FYI. Chondrosarcoma of bone. In: Schwartz HS, ed. Orthopaedic Knowledge Update: Musculoskeletal Tumors 2. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2007:185-195.

2. Damron TA. Orthopaedic Surgery Essentials, Oncology and Basic Science. Philadelphia, PA: Lippincott Williams & Wilkins; 2008:201.

Question Authors:

John Badylak MD, Michael Hughes MD,

Please Rate Educational Value!

3.0

Average 3.0 of 16 Ratings

TAG

(OBQ10.136) A 60-year-old female complains of progressive right hip pain. A pelvis radiograph is shown in Figure A and a biopsy specimen is shown in Figure B. What is the most appropriate treatment? Topic

Review Topic

FIGURES: A

1. Neoadjuvant radiation followed by surgical resection
2. Neoadjuvant chemotherapy followed by surgery followed by adjuvant chemotherapy
3. Wide surgical resection
4. Chemotherapy followed by radiation therapy
5. Radiation therapy

PREFERRED RESPONSE ▶

DISCUSSION: The history, radiographs, and biopsy specimen are consistent with the diagnosis of a chondrosarcoma. The oblique pelvis view shows a periacetabular lytic lesion with cortical destruction and reactive thickening of the surrounding cortex. The biopsy specimen shows enlarged chondrocytes with plump multinucleated lacunae and hyperchromic nuclear pleomorphism. Chondrosarcoma is primarily treated with wide surgical resection. There is a very limited role for chemotherapy or radiation.

Donati et al reviewed 124 patients with pelvic chondrosarcoma and found that the most significant prognostic factor for distant metastases was the histologic grade of the tumor. They report that limb-sparing resection or hemipelvectomy are acceptable techniques of resection and that central, high-grade tumors need aggressive surgical treatment in order to achieve adequate surgical margins.

REFERENCES:

1. Donati D, El Ghoneimy A, Bertoni F, Di Bella C, Mercuri M. Surgical treatment and outcome of conventional pelvic chondrosarcoma. J Bone Joint Surg Br. 2005 Nov;87(11):1527-30. PMID:16260673 (Link to Abstract)

2. Seo SW, Remotti F, Lee FYI. Chondrosarcoma of bone. In: Schwartz H, ed. Orthopaedic Knowledge Update: Musculoskeletal Tumors 2. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2007:185-195

Question Authors:

Michael Hughes MD, Ben Taylor MD,

Please Rate Educational Value!

4.0

Average 4.0 of 8 Ratings

TAG

(OBQ09.41) What is the preferred definitive treatment for biopsy proven grade 2 chondrosarcoma of the distal femur without evidence of metastases? Topic

Review Topic

1. Curettage
2. Marginal excision
3. Wide excision
4. Chemotherapy then wide excision
5. Hip disarticulation amputation

PREFERRED RESPONSE ▶

DISCUSSION: The treatment of choice for chondrosarcoma is wide excision, which has better survival than marginal resection or intralesional resection. The rate of recurrence is variable with grade 3 or dedifferentiated tumors having the worst prognosis.

Lee et al describe outcomes based on resection type and tumor stage and grade. Adjuvant radiation and chemotherapy are generally only used in patients with mesenchymal or dedifferentiated chondrosarcoma or in grade 3 pelvic chondrosarcomas where complete resection is technically difficult and these adjuvant treatments are intended to reduce local recurrence.

REFERENCES:

1. Menendez LR (ed): Orthopaedic Knowledge Update: Musculoskeletal Tumors. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2002, pp 187-202

2. Lee FY, Mankin HJ, Fondren G, Gebhardt MC, Springfield DS, Rosenberg AE, Jennings LC. Chondrosarcoma of bone: an assessment of outcome. J Bone Joint Surg Am. 1999 Mar;81(3):326-38. PMID:10199270 (Link to Abstract)

Question Authors:

Charles Jobin MD,

Please Rate Educational Value!

3.0

Average 3.0 of 10 Ratings

TAG

(OBQ07.89) Rates of recurrence for patients with chondrosarcoma are most directly related to which of the following? Topic

Review Topic

1. Increased telomerase activity
2. Expression of major histocompatibility complex type II
3. Gadolinium uptake on MRI
4. Increased tumor apoptosis on histology
5. Technetium activity on bone scan

PREFERRED RESPONSE ▶

DISCUSSION: Rates of reccurrence for patients with chondrosarcoma are most directly related to increased telomerase activity in tumor samples. Telomerase is a nuclear enzyme that elongates chromosomes leading to cellular growth and proliferation. Therefore, tumor cells with increased telomerase activity show increased growth and proliferation. Martin et al performed immunohistochemistry to compare telomerase reverse transcriptase expression (an enzyme necessary and related to telomerase activity) in a collection of 61 tumors consisting of malignant chondrosarcomas of varying grade and benign enchondromas. They found that telomerase reverse transcriptase directly correlated with tumor grade and recurrence.

REFERENCES:

1. Martin JA, DeYoung BR, Gitelis S, Weydert JA, Klingelhutz AJ, Kurriger G, Buckwalter JA. Telomerase reverse transcriptase subunit expression is associated with chondrosarcoma malignancy. Clin Orthop Relat Res. 2004 Sep;(426):117-24. PMID:15346061 (Link to Abstract)

Question Authors:

Patrick O'Donnell MD/PhD,

Please Rate Educational Value!

2.0

Average 2.0 of 14 Ratings

TAG

(OBQ07.203) A 72-year-old male presents with increasing thigh pain. Radiographs and high power biopsy are shown in Figures A and B. Staging studies demonstrate no further sites of disease. What is the next step in treatment? Topic

Review Topic

FIGURES: A

1. Neoadjuvant chemotherapy
2. Neoadjuvant radiation therapy
3. Marginal excision
4. Wide surgical excision and reconstruction
5. Palliative care

PREFERRED RESPONSE ▶

DISCUSSION: The history, radiograph, and biopsy are consistent with a high grade chondrosarcoma of the proximal thigh.

As described in the review by Marco et al, cartilage tumors are resistant to chemotherapy and radiotherapy and as such the best treatment is wide surgical excision and reconstruction.

Lee et al review one institutions experience with a chondrosarcoma specifically examining the predictors of outcome. They found that adjuvant therapy did not affect overall outcome.

REFERENCES:

1. Marco RA, Gitelis S, Brebach GT, Healey JH. Cartilage tumors: evaluation and treatment. J Am Acad Orthop Surg. 2000 Sep-Oct;8(5):292-304. Review. PMID:11029557 (Link to Abstract)

Question Authors:

Patrick O'Donnell MD/PhD, Jan Szatkowski MD, Michael Hughes MD,

Please Rate Educational Value!

3.0

Average 3.0 of 10 Ratings

TAG

(OBQ07.273) A 65-year-old man undergoes a biopsy from his pelvis for a suspicious lesion. The biopsy is shown in Figure A. What is the preferred treatment for this condition? Topic

Review Topic

FIGURES: A

1. Observation
2. Wide excision
3. Wide excision plus chemotherapy
4. Radiation therapy
5. Cyrotherapy

PREFERRED RESPONSE ▶

DISCUSSION: The pathological lesion seen in Figure A is that of chondrosarcoma. Unfortunately chondrosarcomas, the second most common primary malignant bone tumor (osteosarcoma being number one) are not chemosensitive or radiosensitive. Patients with this type of tumor who wish to have a chance of cure need to have wide excision of the lesion if possible. No increase in survival rates has been shown with any additional treatment beyond wide local excision.

Donati et al reviewed 124 cases of conventional chondrosarcoma and noted that high-grade tumors require aggressive surgical excision while grade 1 peripheral chondrosarcomas may be treated with contaminated margins in order to reduce morbidity. Low grade tumors with contaminated margins had no difference in survival.

REFERENCES:

2. Donati D, El Ghoneimy A, Bertoni F, Di Bella C, Mercuri M. Surgical treatment and outcome of conventional pelvic chondrosarcoma. J Bone Joint Surg Br. 2005 Nov;87(11):1527-30. PMID:16260673 (Link to Abstract)

Question Authors:

Jan Szatkowski MD, John Badylak MD, Michael Hughes MD,

Please Rate Educational Value!

3.0

Average 3.0 of 9 Ratings

TAG

(OBQ06.23) Which of the following statements regarding dedifferentiated chondrosarcoma is CORRECT? Topic

Review Topic

1. Survival rates of 10% at 10 years are common
2. These tumors arise de novo from an intramedullary location
3. Histologically these tumors consist of homogeneous intermediate grade chondroid tissue
4. Treatment involves intra-lesional curettage, cementation, and internal fixation
5. The most common age of presentation is the young adolescent

PREFERRED RESPONSE ▶

DISCUSSION: Dedifferentiated chondrosarcoma is the most malignant form of chondrosarcoma with a 10 year survival rate of 10%.

Riedel et al review the diagnosis and treatment for all chondrosarcomas, including dedifferentiated chondrosarcoma. They argue wide surgical resection represents the primary and preferred treatment modality for individuals with localized disease. Systemic chemotherapy may be considered in variant forms such as mesenchymal or dedifferentiated chondrosarcomas but high-quality data supporting its use is limited.

Illustration A shows one such tumor in the proximal femur. The stippled calcifications of the low grade component are shown with the large black arrow and the high grade destructive portion is shown by the arrow heads. The small white arrow also points to where the tumor breaches the cortex of the proximal femur. Illustration B shows the radiograph after wide resection and reconstruction.

Illustration C shows the typical histology of a de-differentiated chondrosarcoma, with consists of two components: a low grade chondrosarcoma component juxtaposed to a high grade spindle cell sarcoma component thought to arise from the low grade neoplastic component.

Incorrect Answers:
Answer 2: These tumors are thought to arise from a pre-existing low-grade chondroid lesion, not de novo from within the medullary canal.
Answers 3: Histologically, this tumor are characterized by a combination of two components: a low grade chondrosarcoma component juxtaposed to a high grade spindle cell sarcoma.
Answer 4: There is no role for intra-lesional curettage which may be indicated in low grade chondrosarcoma, but not de-differentiated chondrosarcoma.
Answer 5: Like other chondroid tumors, the young adolescent is an uncommon age of presentation. Rather, these tumors tend to occur in older adults.

Illustrations: A

REFERENCES:

1. Riedel RF, Larrier N, Dodd L, Kirsch D, Martinez S, Brigman BE. The clinical management of chondrosarcoma. Curr Treat Options Oncol. 2009 Apr;10(1-2):94-106. PMID:19238552 (Link to Abstract)

Question Authors:

Patrick O'Donnell MD/PhD, Derek Moore, Patrick McCulloch MD,

Please Rate Educational Value!

3.0

Average 3.0 of 12 Ratings

TAG

(OBQ05.219) Patients with which of the following conditions have the highest risk of malignant transformation? Topic

Review Topic

1. Single enchondroma
2. Single osteochondroma
3. Multiple hereditary exostosis
4. Ollier's disease
5. Maffucci's syndrome

PREFERRED RESPONSE ▶

DISCUSSION: Of all the listed cartilage lesions, patients with Maffucci's syndrome have the highest risk of malignant transformation - estimated to be 100% over the lifetime of the patient. Single enchondromas and osteochondromas have a 1% risk of malignant transformation. Multiple hereditary exostosis patients have approximately a 10% life time risk of malignant transformation. Ollier's disease is one of multiple enchondromas and carries a 30% risk of malignant transformation (Illustration A) while Maffucci's syndrome is multiple enchondromas with hemangiomas (Illustration B). While patients with enchondromas and osteochondromas do have a slight elevation in the risk for malignant transformation, it is not as great as those patients with Ollier's disease or Maffucci's syndrome. Distinguishing enchondromas from low grade chondrosarcomas can be done by looking at radiograph features such as the degree of endosteal scalloping on radiographs and the clinical presence of pain, both associated with low grade chondrosarcomas. Ryzewicz et al review the diagnosis, pathology, and recommended treatment for patients with benign cartilage lesions. They recommend periodic follow-up even for the most benign lesions to track for malignant degeneration.

Illustrations: A

REFERENCES:

1. Ryzewicz M, Manaster BJ, Naar E, Lindeque B. Low-grade cartilage tumors: diagnosis and treatment. Orthopedics. 2007 Jan;30(1):35-46; quiz 47-8. Review. PMID:17260660 (Link to Abstract)

Question Authors:

Patrick O'Donnell MD/PhD,

Please Rate Educational Value!

4.0

Average 4.0 of 7 Ratings

TAG

(OBQ05.227) A 44-year-old male reports a mass at his right iliac crest that bothers him when he wears a belt. He denies constitutional symptoms and has no bowel function disturbance. His ESR and CRP are normal. His chest CT is normal. Pelvis radiograph, CT, and MRI images are shown in Figures A-D. A biopsy is performed with histology shown in Figure E. What is the next most appropriate step in management? Topic

Review Topic

FIGURES: A

1. Repeat CT scan in 3 months
2. Neoadjuvant radiation followed by marginal surgical resection followed by adjuvant chemotherapy
3. Marginal surgical resection
4. Wide surgical resection
5. Neoadjuvant chemotherapy followed by marginal surgical resection followed by adjuvant chemotherapy

PREFERRED RESPONSE ▶

DISCUSSION: The history, imaging, and biopsy is consistent with chondrosarcoma and is appropriately treated with wide surgical resection. Chondrosarcoma is a malignant tumor of cartilaginous origin. It can be a primary lesion but may also develop from a preexisting cartilaginous lesion (e.g., osteochondroma, enchondroma). On plain radiographs, chondrosarcoma is typically visualized as a destructive, lytic lesion. Extension into surrounding soft tissues is frequently seen and delineated well on MRI. The characteristic chondroid matrix (rings and arcs) can be seen on radiographs (70%), and better visualized by CT. The histology generally demonstrates enlarged, pleomorphic chondrocytes with multinucleated lacunae.

Level 4 evidence by Lee et al reviewed 227 patients with chondrosarcoma with an average follow-up of 6 years. They found that “patients who had had a resection with wide margins (margins extending outside the reactive zone) had a longer duration of survival than did those who had had a so-called marginal resection (margins extending outside the tumor but within the reactive zone) or an intralesional resection (margins within the lesion) (p < 0.04)."

REFERENCES:

1. Lee FY, Mankin HJ, Fondren G, et al: Chondrosarcoma of Bone: An Assessment of Outcome. J Bone Joint Surg Am 1999 81: 326-38 PMID:10199270 (Link to Abstract)

Question Authors:

Michael Hughes MD, John Badylak MD, Ben Taylor MD,

Please Rate Educational Value!

4.0

Average 4.0 of 11 Ratings

TAG

(OBQ04.166) A 79-year-old healthy male has 1 year of progressively worse left hip pain. He denies any significant weight loss but does complain of night pain. Radiograph and MRI are shown in Figures A & B. Bone scan and histology is shown in Figures C-E. What is the definitive treatment of this? Topic

Review Topic

FIGURES: A

1. observation
2. radiation therapy alone
3. wide resection and reconstruction
4. wide resection, reconstruction and chemotherapy
5. wide resection, reconstruction and local radiation therapy.

PREFERRED RESPONSE ▶

DISCUSSION: The history, imaging and pathology points to chondrosarcoma as the diagnosis, and therefore wide resection and reconstruction is the most appropriate treatment.

Chondrosarcoma tends to occur in an older individuals and the most common sites of origin are the femur, tibia, humerus, ribs, scapula then pelvis. Chondrosarcomas grow slowly and patients present with dull aching pain.

X-rays typically have a subtle, radiolucent, permeative lesion or may have hazy or speckled calcifications with either a diffuse "salt & pepper" pattern or a more discrete "popcorn" pattern. The MRI defines the amount of marrow and soft-tissue involvment, and typically has high T2 signal intensity. Bone scintigraphy will be positive.

In pathological sections, low-power imaging demonstrates lobulated clusters of chondrocytes, and high-power imaging demonstrates a bland cellular appearance, extensive basophilic cytoplasm, and no mitotic figures (low grade chondrosarcoma).

In terms of treatment, low-grade tumors usually respond well to wide resection and reconstruction of limb. Chemotherapy is usually not used except in rare cases of certain chondrosarcoma subtypes (mesenchymal chondrosarcoma). Radiation therapy is not very effective against chondrosarcoma.

REFERENCES:

1. Menedez LR (ed): Orthopaedic Knowledge Update: Musuloskeletal Tumors. Rosemont, IL, American Academy of Orthopedic Surgeons, 2002, pp 305-312

2. Simon MA, Springfield D (eds): Surgery for bone and soft-tissue tumors. Philadelphia, PA Lippincott-Raven, 1998, 756pp.

Question Authors:

Paul D. Kim MD, Guillem Lomas MD, Derek Moore,

Please Rate Educational Value!

3.0

Average 3.0 of 15 Ratings

TAG

(OBQ04.185) Which of the following tumors is chemotherapy and radiation therapy resistant? Topic

Review Topic

1. Ewing's sarcoma
2. Classic intramedullary chondrosarcoma
3. Synovial sarcoma
4. Chordoma
5. Dermatofibrosarcoma protuberans

PREFERRED RESPONSE ▶

DISCUSSION: Classic intramedullary chondrosarcoma is a slow-growing tumor of neoplastic cartilage that is chemotherapy and radiation therapy resistant. The accepted treatment is therefore wide surgical excision. Dedifferentiated chondrosarcoma on the other hand may be treated with adjuvant chemotherapy. Ewing's sarcoma and synovial sarcoma are both treated with chemotherapy, radiation therapy, and surgical excision. Chordoma and dermatofibrosarcoma protuberans (DFSP), while slow growing, low-grade sarcomas are both treated with surgery and adjuvant radiation therapy (chordoma) or chemotherapy and radiation therapy (DFSP). Springfield et al review the current diagnosis and treatment of chondrosarcoma and discuss molecular mechanisms explaining the resistant nature of chondrosarcoma to modern chemotherapy and radiation therapy.

REFERENCES:

1. Springfield DS, Gebhardt MC, McGuire MH. Chondrosarcoma: a review. Instr Course Lect. 1996;45:417-24. Review. PMID:8727760 (Link to Abstract)

2. Simon MA, Springfield D (eds):Surgery for bone and soft tissue tumors. Philadelphia, PA, Lippinicott-Raven, 1998, pp 275-286

Question Authors:

Patrick O'Donnell MD/PhD,

Please Rate Educational Value!

4.0

Average 4.0 of 12 Ratings

Posts

Surgical treatment and outcome of conventional pelvic chondrosarcoma. Includes Poll

Donati D, El Ghoneimy A, Bertoni F, Di Bella C, Mercuri M
J Bone Joint Surg Br. 2005 Nov;87(11):1527-30. PMID: 16260673 (Link to Pubmed)

Pathology - Journal Club - Chondrosarcoma

5/17/2013

22 responses

See More Posts

Groups

ABOS II: Chondrosarcoma

General - Oral Boards Review

7/29/2011

0 responses

See More Groups

Evidence & References Show References

Level of Evidence 3 (Retrospective Cohort Study or Case-Control Study)

Lee FY, Mankin HJ, Fondren G, Gebhardt MC, Springfield DS, Rosenberg AE, Jennings LC. Chondrosarcoma of bone: an assessment of outcome. J Bone Joint Surg Am. 1999 Mar;81(3):326-38. PMID:10199270 (Link to Abstract)

Level of Evidence 4 (Case Series)

Donati D, El Ghoneimy A, Bertoni F, Di Bella C, Mercuri M. Surgical treatment and outcome of conventional pelvic chondrosarcoma. J Bone Joint Surg Br. 2005 Nov;87(11):1527-30. PMID:16260673 (Link to Abstract)
Donati D, El Ghoneimy A, Bertoni F, Di Bella C, Mercuri M. Surgical treatment and outcome of conventional pelvic chondrosarcoma. J Bone Joint Surg Br. 2005 Nov;87(11):1527-30. PMID:16260673 (Link to Abstract)
Lee FY, Mankin HJ, Fondren G, et al: Chondrosarcoma of Bone: An Assessment of Outcome. J Bone Joint Surg Am 1999 81: 326-38 PMID:10199270 (Link to Abstract)
Lee FY, Mankin HJ, Fondren G, Gebhardt MC, Springfield DS, Rosenberg AE, Jennings LC. Chondrosarcoma of bone: an assessment of outcome. J Bone Joint Surg Am. 1999 Mar;81(3):326-38. PMID:10199270 (Link to Abstract)

Level of Evidence 5 and Other Journal Articles (includes Case Reports, Expert Opinions, Personal Observations, and Biomechanic Studies)

Marco RA, Gitelis S, Brebach GT, Healey JH. Cartilage tumors: evaluation and treatment. J Am Acad Orthop Surg. 2000 Sep-Oct;8(5):292-304. Review. PMID:11029557 (Link to Abstract)
Riedel RF, Larrier N, Dodd L, Kirsch D, Martinez S, Brigman BE. The clinical management of chondrosarcoma. Curr Treat Options Oncol. 2009 Apr;10(1-2):94-106. PMID:19238552 (Link to Abstract)
Ryzewicz M, Manaster BJ, Naar E, Lindeque B. Low-grade cartilage tumors: diagnosis and treatment. Orthopedics. 2007 Jan;30(1):35-46; quiz 47-8. Review. PMID:17260660 (Link to Abstract)
Springfield DS, Gebhardt MC, McGuire MH. Chondrosarcoma: a review. Instr Course Lect. 1996;45:417-24. Review. PMID:8727760 (Link to Abstract)

Textbooks

Review of Orthopaedics, 6th Edition, Mark D. Miller MD, Stephen R. Thompson MBBS MEd FRCSC, Jennifer Hart MPAS PA-C ATC, an imprint of Elsevier, Philadelphia, Copyright 2012
AAOS Comprehensive Orthopaedic Review, Jay R. Leiberman. Published by American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2009
Orthopaedic Knowledge Update 10, John M Flyn. Published by American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2011
Hoppenfeld SP. Surgical Exposures in Orthopaedics: The Anatomic Approach. Lipponcott, Williams, and Wilkins, Philadelphia, PA, Copyright 2009
Orthopaedic In-training Examination (OITE) Questions 2004-2012, American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2004-2012
Self-Assessment Examination (SAE) Questions 2004-2012, American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2004-2012
Damron TA. Orthopaedic Surgery Essentials, Oncology and Basic Science. Philadelphia, PA: Lippincott Williams & Wilkins; 2008:201.
Orthopaedic Knowledge Update 9, Jeffrey S Fischgrund (Editor). Published by American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2008
Seo SW, Remotti F, Lee FYI. Chondrosarcoma of bone. In: Schwartz H, ed. Orthopaedic Knowledge Update: Musculoskeletal Tumors 2. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2007:185-195
Seo SW, Remotti F, Lee FYI. Chondrosarcoma of bone. In: Schwartz HS, ed. Orthopaedic Knowledge Update: Musculoskeletal Tumors 2. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2007:185-195.
Simon MA, Springfield D (eds):Surgery for bone and soft tissue tumors. Philadelphia, PA, Lippinicott-Raven, 1998, pp 275-286

Undefined

Martin JA, DeYoung BR, Gitelis S, Weydert JA, Klingelhutz AJ, Kurriger G, Buckwalter JA. Telomerase reverse transcriptase subunit expression is associated with chondrosarcoma malignancy. Clin Orthop Relat Res. 2004 Sep;(426):117-24. PMID:15346061 (Link to Abstract)
Menedez LR (ed): Orthopaedic Knowledge Update: Musuloskeletal Tumors. Rosemont, IL, American Academy of Orthopedic Surgeons, 2002, pp 305-312
Menendez LR (ed): Orthopaedic Knowledge Update: Musculoskeletal Tumors. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2002, pp 187-202
Simon MA, Springfield D (eds): Surgery for bone and soft-tissue tumors. Philadelphia, PA Lippincott-Raven, 1998, 756pp.

Topic Comments

Subscribe status: On Off

Recent on Bottom | Recent on Top

Page:1

Chondrosarcoma

Qbank (11 Questions)

Question Comments

Question Comments

Question Comments

Question Comments

Question Comments

Question Comments

Question Comments

Question Comments

Question Comments

Question Comments

Question Comments

Posts

Groups

Evidence & References Show References

Topic Comments