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Chondrosarcoma - Foot and Ankle

Summary

Chondrosarcoma is the most common malignant bone tumor in the foot in some reported series. Most chondrosarcomas are low grade, but dedifferentiated chondrosarcoma can occur in the setting of a longstanding benign cartilage lesion such as enchondroma.

The peak age of presentation is in the 50's and 60's, and the to female ratio of 1.5 to 1. It is most common in the femur, humerus, ribs and on the surface of the pelvis. Patients with Ollier's disease (multiple enchondromatosis) or Maffucci's syndrome (multiple enchondromas and hemangiomas) are at much higher risk of chondrosarcoma than the normal population and often present in the third and fourth decade. Symptoms and Presentation:
The lesion presents as a slow growing mass with mild pain.
The radiographs will show a lytic lesion which may demonstrate ring and arc formations.
Treatment for low grade chondrosarcoma may include curettage or marginal excision.
Complete Information on this Tumor
Introduction and Definition: 

Chondrosarcoma is the most common malignant bone tumor in the foot in some reported series. Patients with multiple cartilage lesions, such as Ollier's disease, or multiple enchondromas are at increased risk. This tumor has several subtypes, including clear cell chondrosarcoma, and mesenchymal chondrosarcoma, which can occur in bone and in the soft tissues, where it presents as as an innocent bump. Most chondrosarcomas are low grade, but dedifferentiated chondrosarcoma can occur in the setting of a longstanding benign cartilage lesion such as enchondroma.

Incidence and Demographics: 
The peak age of presentation is in the 50's and 60's.
Symptoms and Presentation: 

The lesion presents as a slow growing mass with mild pain.

X-Ray Appearance and Advanced Imaging Findings: 
The radiographs will show a lytic lesion which may demonstrate ring and arc formations. Cortical expansion, breakthrough, and a soft tissue mass are signs of malignant behavior. On plain radiographs, chondrosarcoma of the long bones is a fusiform, lucent defect with scalloping of the inner cortex and periosteal reaction. Extension into the soft tissue may be present as well as punctate or stippled calcification of the cartilage matrix. MRi shows high signal intensity on T2 sequences, and low intensity signal on T1 sequences. Calcification within the mass, if it occurs, will appear as very low signal areas.
Laboratory Findings: 
no labs are helpful in the diagnosis
Differential Diagnosis: 
Osteosarcoma, benign cartilage lesions such as CMF, chondroblastoma
Preferred Biopsy Technique for this Tumor: 
open - incisional
Histopathology findings: 
On gross examination, chondrosarcoma is a grayish-white, lobulated mass. It may have focal calcification, mucoid I degeneration, or necrosis.Histologically, chondrosarcoma is differentiated from benign cartilage growths by enlarged plump nuclei, multiple cells per lacunae, binucleated cells, and hyperchromic nuclear pleomorphism. Chondrosarcoma is graded from 1 (low) to 3 (high). Low grade chondrosarcoma is very close in appearance to enchondromas and osteochondromas and has occasional binucleated cells. High grade chondrosarcomas have increased cellularity, atypia and mitoses. There is an inverse relationship between histologic grade and prognosis with higher grades having a worse prognosis and early metastases.
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