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Review Question - QID 4502

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QID 4502 (Type "4502" in App Search)
A 52-year-old Asian male presents with pain in his right hip worse with activity. He is otherwise healthy and denies any history of trauma or constitutional symptoms. Radiographs, CT, and MRI are shown in Figure A, B, and C respectively. A CT guided biopsy is performed and low power and high power histology images are shown in Figure D and E respectively. A CT scan of the chest, abdomen, and pelvis is performed and there is no evidence of metastatic disease. Which of the following is the most appropriate treatment?
  • A
  • B
  • C
  • D
  • E

radiation followed by surgical excision followed by chemotherapy

10%

364/3571

chemotherapy followed by surgical excision followed by chemotherapy

15%

536/3571

neoadjuvant radiation followed by chemotherapy

3%

98/3571

wide surgical excision alone

68%

2442/3571

radical resection and brachytherapy followed by reconstruction

3%

103/3571

  • A
  • B
  • C
  • D
  • E

Select Answer to see Preferred Response

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Chondrosarcoma of the pelvis is treated with wide surgical excision alone.

There are different grades and types of chondrosarcoma, all of which are treated with wide surgical excision. Cartilage in general is very slow growing and therefore not very chemo or radiation sensitive. That being said however, adjuvant chemotherapy is added for mesenchymal chondrosarcoma with some controversy surrounding chemotherapy for de-differentiated chondrosarcoma.

Donati et al. reviewed the treatment of 124 patients with conventional chondrosarcoma of the pelvis treated over a 20 year time period. The cases were stratified based on tumor location/type (central or peripheral), operation performed, grade, and local recurrence and or metastases. High grade tumors were found to have the worst outcomes and required aggressive surgical treatment with wide margins, especially those involving the SI joint.

Figure A, B, and C show a lytic lestion. Figure D shows a low power view demonstrating the lobulated architecture with abundant cartilaginous matrix that is characteristic of chondrosarcoma. Figure E shows a high power view of tumor cells in lacunar spaces with small pyknotic nuclei and surrounded by an abundant cartilaginous matrix

Incorrect Answers:
Answer 1,2,3,5: All considered incorrect because as stated chondrosarcoma is not radiation or chemo sensitive


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