CHONDROsARCOMA

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
 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