Abstract
A 15-year-old boy reported a 2-month history of severe left thigh pain Physical examination revealed left thigh swelling measuring 6x5 cm. X-ray of the region showed mixed lytic and sclerotic lesion involving the femoral head and neck. A Computed Tomography scan showed mixed lytic and sclerotic lesion involving the femoral head and neck with cortical irregularity and mild periosteal reaction with associated soft tissue in the anterior aspect. Magnetic resonance imaging demonstrated heterogeneous signal intensity lesion with areas of sclerosis involving the femoral head and neck. The large associated soft tissue in the anterior aspect appears predominantly hyperintense on T2W images. On post-contrast axial and sagittal images, heterogeneous enhancement with areas of necrosis involving soft tissue was seen. A presumptive radiological differential diagnosis of Ewing Sarcoma and Osteosarcoma was made. However, on histopathology, it was a case of mesenchymal chondrosarcoma.
Highlights
Mesenchymal Chondrosarcoma (MCS), first described by Lichtenstein and Bernstein[1] in 1959 is a rare tumor representing less than 4% of all chondrosarcomas.[2,3,4,5]
We present the characteristic clinical, radiographic, and histopathologic features of MCS seen in a 15 years old patient
The histology of MCS shows a paradoxical histological picture of highly cellular zones composed of anaplastic small cells along with islands of relatively hypocellular chondroid areas
Summary
Mesenchymal Chondrosarcoma (MCS), first described by Lichtenstein and Bernstein[1] in 1959 is a rare tumor representing less than 4% of all chondrosarcomas.[2,3,4,5] Mesenchymal chondrosarcoma is a poorly understood entity and the only consistently described features of MCS are the unique, biphasic histology and the poor prognosis, despite variable lengths of disease-free survival.[4] The rarity of this tumor leads to substantial diagnostic, prognostic, and management challenges. X-ray of the region showed mixed lytic and sclerotic lesion involving the femoral head and neck (fig.1A). A Computed Tomography (CT) scan showed mixed lytic and sclerotic lesion involving the femoral head and neck with cortical irregularity and mild periosteal reaction with associated soft tissue in the anterior aspect. Though the patient had pulmonary metastasis three years back for which the patient underwent surgical excision, the patient is doing well as of October 2020
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