Abstract
BackgroundDistinguishing grade 1 chondrosarcoma from grade 2 chondrosarcoma is critical both for planning the surgical procedure and for predicting the outcome. We aimed to review the preoperative radiographic and histologic findings, and to evaluate the reliability of preoperative grading.MethodsWe retrospectively reviewed the medical records of 17 patients diagnosed with central chondrosarcoma at our institution between 1996 and 2011. In these cases, we compared the preoperative and postoperative histologic grades, and evaluated the reliability of the preoperative histologic grading. We also assessed the preoperative radiographic findings obtained using plain radiography, computed tomography (CT), and magnetic resonance imaging (MRI).ResultsPreoperative histologic grade was 1 in 12 patients, 2 in 4 patients, and 3 in 1 patient. However, 6 of the 12 cases classified as grade 1 before surgery were re-classified as grade 2 postoperatively. In the radiographic evaluation, grade 1 was suspected by the presence of a ring-and-arc pattern of calcification on plain radiography and CT and entrapped fat and ring-and-arc enhancement on MRI. Grades 2 and 3 were suspected by the absence of calcification and the presence of cortical penetration and endosteal scalloping on plain radiography and CT, as well as soft-tissue mass formation on MRI.ConclusionAlthough the combination of radiographic interpretation and histologic findings may improve the accuracy of preoperative grading in chondrosarcoma, the establishment of a standard evaluation system with the histologic and radiographic findings and/or the development of new biologic markers are necessary for preoperative discrimination of low-grade chondrosarcoma from high-grade chondrosarcoma.
Highlights
Chondrosarcoma is the second most frequent primary malignant bone tumor after osteosarcoma [1] and represents a heterogeneous group of tumors, ranging from indolent, low-grade lesions to aggressive, high-grade neoplasms
On plain radiography and computed tomography (CT), we evaluated the findings of low-grade chondrosarcoma, such as a ring-and-arc pattern of calcification, and those of high-grade chondrosarcoma, such as the absence of calcification and the presence of cortical penetration and endosteal scalloping [18]
On magnetic resonance imaging (MRI), we evaluated the findings of low-grade chondrosarcoma, such as entrapped fat within the tumor, lobular architecture, and ring-and-arc enhancement, and those of high-grade chondrosarcoma, such as central high signal on T1-weighted images, soft-tissue mass formation, and central non-enhancement portion [19]
Summary
Chondrosarcoma is the second most frequent primary malignant bone tumor after osteosarcoma [1] and represents a heterogeneous group of tumors, ranging from indolent, low-grade lesions (grade 1) to aggressive, high-grade neoplasms (grades 2, 3). Biopsy specimens do not always determine a correct diagnosis of grade [13, 14] For this reason, it is important to combine radiographic interpretation with histologic findings. The purpose of this study was to review the preoperative radiographic and histologic findings that differentiate low-grade chondrosarcoma (grade 1) from high-grade chondrosarcoma (grades 2, 3), and to evaluate the reliability of preoperative grading. Methods We retrospectively reviewed the medical records of 17 patients diagnosed with central chondrosarcoma at our institution between 1996 and 2011 In these cases, we compared the preoperative and postoperative histologic grades, and evaluated the reliability of the preoperative histologic grading. Conclusion the combination of radiographic interpretation and histologic findings may improve the accuracy of preoperative grading in chondrosarcoma, the Keywords Chondrosarcoma · Imaging features · Histopathology · Surgical staging
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