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Review Question - QID 1113

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QID 1113 (Type "1113" in App Search)
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?
  • A
  • B
  • C
  • D
  • E

Repeat CT scan in 3 months

3%

55/2168

Neoadjuvant radiation followed by marginal surgical resection followed by adjuvant chemotherapy

6%

126/2168

Marginal surgical resection

16%

357/2168

Wide surgical resection

67%

1447/2168

Neoadjuvant chemotherapy followed by marginal surgical resection followed by adjuvant chemotherapy

8%

164/2168

  • A
  • B
  • C
  • D
  • E

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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)."

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