Primary dedifferentiated chondrosarcoma of the lung with a 4-year history of breast cancer:A case report

BACKGROUND Primary dedifferentiated chondrosarcoma(DDCS)of the lung is extremely rare and has a poor prognosis,especially in patients with a history of carcinomas and related treatment.Herein,we report a case of primary DDCS of the lung in a patient with a 4-year history of breast cancer and related treatment.CASE SUMMARY A 49-year-old woman was admitted to our hospital with complaints of headache,dizziness,slurred speech,and dyskinesia in May 2021.Computed tomography(CT)examinations showed multiple nodules in the brain,vertebral body,and both lungs with multiple enlarged lymph nodes in the right hilum and mediastinum,which were considered metastases of breast cancer.No obvious mass was discovered in the right hilum.After several months of related administration,the patient's headache disappeared,and her condition improved.However,new problems of asthma,dyspnea,cough,and restricted activity appeared in late November 2021.Although the CT scan indicated that the lesions in the brain,lung,and vertebral body had shrunk or disappeared,a soft tissue density lesion appeared in her right hilum and blocked the bronchial lumen.To relieve her dyspnea,part of the mass was resected,and a stent was placed via fiberoptic bronchoscopy.Following a complete pathological examination of the tumor,it was confirmed to be a primary DDCS of the lung.The patient then received two rounds of systemic chemotherapy with a regimen of cisplatin+ifosfamide+doxorubicin hydrochloride liposome,palliative radiotherapy for the tumor in her right lung,and four cycles of systemic chemotherapy and targeted therapy with a regimen of temozolomide combined with bevacizumab successively.She was in stable condition after the completion of the systemic chemotherapy and targeted therapy but underwent rapid progression after lung radiotherapy.The CT examinations showed multiple nodules in the brain and in both lungs,and the tumor in the right hilum was increased in size.CONCLUSION This case revealed a rare primary DDCS of the lung with a medical history of breast cancer,meaning a worse prognosis and making it more difficult to treat.

CLEAR CELL CHONDROSARCOMA OF BONE (A REPORT OF THREE CASES WITH IMMUNOHISTOCHEMICAL AND AFFINITY HISTOCHEMICAL OBSERVATIONS)

Clear cell chondrosarcoma, a subtype and separate entity from the traditional chondrosarcoma, is characterized by its special histologic features, site of predilection, slow growth and better prognosis. Three cases are presented with elucidation of clinicopathologic correlation and detection by the ABC immunohistochemical method using several antibodies. The observation of positive reaction to S-100 pretein (S-100), vimentin(Vim), alpha 1-antichymotrypsin (AACT) and lysozyme (Lyso) by the tumor cells of clear cell chondrosarcoma, similar to traditional chondrosarcoma and chondroblastoma, proves that this tumor has its origin from the cartilaginous tissue. It was found for the first time that the clear cell chondrosarcoma was positive for wheat germ agglutinin (WGA) and concanavalin A (Con A). The authors believe that clear cell chondrosarcoma may result from the anaplastic changes of chondroblastoma cells Into another subtype of that tumor. The osteoclast-like multinucleated giant cells (MGC), retaining the antigens of phagocytes, are not considered to be neoplastic.

Clinicopathological Features of Extraskeletal Myxoid Chondrosarcoma:An Analysis of 9 Cases

Objective： To investigate the Clinicopathological （EMC）. Methods： Nine cases of extraskeletal characteristics of extraskeletal myxoid chondrosarcoma myxoid chondrosarcoma were studied. Extensive immunohistochemical analysis was performed in all the cases and ultrastructural studies were done in 2 extraskeletal myxoid chondrosarcomas. Follow-up information was available for seven patients. Results： There were 7 males and 2 females whose ages ranged from 31 to 69 years （median 52.78 years）. Local pain or tenderness and the presence of a palpable mass were the main complaints of the patients. The tumors were located mainly in the lower extremities （66.7%）. Most tumors were deep-seated. They usually had a distinct multinodular configuration delineated by fibrous connective tissue. The tumor cells were arranged in delicate intersecting strands, rings, and garlands for the most part. The myxoid matrix was abundant in most cases. Immunohistochemical analysis was performed in all the cases and ultrastructural studies were done in 2 extraskeletal myxoid chondrosarcomas. EMC expressed vimentin （100%, 9/9）, neuron-specific enolase （77.8%, 7/9）, S-100 protein （66.7%, 6/9）, synaptophysin and chromogranin A （22.2%, 2/9）. None of the tumors expressed EMA and desmin. Ultrastructurally： EMC was characterized by distinct cords of cells immersed in a glycosaminoglycan rich matrix. The cells were rich in mitochondria, had well-developed Golgi apparatus and there were numerous smooth vesicles. In many cells, there were also prominent glycogen deposits and lipid droplets. Some tumor cells had intracisternal microtubules. In one of the 2 extraskeletal myxoid chondrosarcomas there were 140-180 nm diameter membrane-bound dense-core secretory granules in cell bodies. Conclusion： Extraskeletal myxoid chondrosarcoma （EMC） is a rare soft tissue sarcoma characterized by distinctive morphological and cytogenetical features. However, the chondroid nature has been a subject of controversy, and its line of differentiation remains to be determined. A substantial proportion of EMC shows immunophenotypic and/or ultrastructural evidence of neuroendocrine differentiation. EMC has high potential of local recurrence and metastasis, and a high disease-associated death rate.

Low grade chondrosarcoma of the nasal septum

Chondrosarcoma of the nasal septum is extremely rare. In some cases, it may be diff icult to preoperatively differentiate low grade chondrosarcoma from benign cartilaginous tumors such as chondroma. We report a case of low grade chondrosarcoma of the nasal septum with characteristic radiologic f indings. Characteristic radiologic f indings such as calcif ications on computed tomography scan and a ring-and-arc pattern on enhanced T1 weighted image were useful in the preoperative diagnosis of low grade chondrosarcoma of the septum. Awareness of radiologic f indings of low grade chondrosarcoma can help to make an accurate diagnosis and perform appropriate excision, leading to successful local control.

Primary intracranial extraskeletal myxoid chondrosarcoma:A case report and review of literature

BACKGROUND Primary intracranial extraskeletal myxoid chondrosarcoma(EMC)is an extremely rare low-to intermediate-grade malignant soft tissue sarcoma,and only 15 cases have been reported in the literature.Due to its rarity,clinical data and research on this tumor type are extremely limited,the pathogenesis and histological origin are still unclear,and the diagnostic and standard clinical treatment strategies for intracranial EMC remain controversial and undefined.CASE SUMMARY We reported a case of a 52-year-old male who was admitted to the hospital with headache and dizziness for 1 mo,and his health status deteriorated during the last week.CT of the head showed a well-defined low-density lesion situated in the left cavernous sinus.Brain magnetic resonance imaging(MRI)showed a 3.4 cm×3.0 cm sized,well-defined,round-shaped and heterogeneously enhanced lesion located in the left cavernous sinus.The entire lesion was removed via supratentorial craniotomy and microsurgery.Postoperative pathological diagnosis indicated primary intracranial EMC.Subsequently,the patient underwent 45 Gy/15 F stereotactic radiotherapy after discharge.At present,it is 12 mo after surgery,with regular postoperative follow-up and regular MRI examinations,that there are no clinical symptoms and radiographic evidence indicating the recurrence of the tumor,and the patient has returned to normal life.CONCLUSION Currently,the most beneficial treatment for primary intracranial EMC is gross total resection combined with postoperative radiotherapy.Long-term follow-up is also necessary for patients.

Metaplastic breast cancer with chondrosarcomatous differentiation combined with concurrent bilateral breast cancer:A case report

BACKGROUND Metaplastic breast carcinoma(MBC)is a rare subtype of invasive breast cancer comprising malignant epithelial and mesenchymal cells.Compared with other invasive breast cancers,MBC is not only histologically distinctly heterogeneous but also has a rapid and aggressive growth pattern,which leads to a significant risk of recurrence and mortality.CASE SUMMARY In this study,we report the case of a patient with a large left breast mass diagnosed with bilateral invasive ductal carcinoma in both breasts after a preoperative core needle aspiration biopsy of the bilateral breast mass.The patient received neoadjuvant chemotherapy and underwent bilateral breast modified radical mastectomy.Postoperative pathology suggested carcinosarcoma with predominantly chondrosarcoma in the left breast and invasive ductal carcinoma(luminal B)in the right breast.As the patient did not achieve complete pathological remission after six cycles of neoadjuvant chemotherapy,we administered six months of intensive capecitabine treatment.Then the patient was switched to continuous treatment with endocrine therapy using letrozole+goserelin,and the patient is currently in stable condition.However,as MBC of the breast is concurrently diagnosed with chondrosarcoma differentiation,our case is sporadic.CONCLUSION Given the variety of immunohistochemical types of bilateral breast cancer,achieving effective chemotherapy should be a key research focus.

Primary Chondrosarcoma of the Chest Wall— A Case Report

A 60-year-old Hispanic male presented to his primary care physician office with an asymptomatic, but palpable right anterior chest wall mass. Initial work up of the finding included a CT scan of the chest which revealed a non-calcified, solid right anterior chest wall mass with invasion of the anterior fifth rib and intercostal space. The patient was presented at multidisciplinary conference with the patient’s primary physician, a medical oncologist, radiologist, pathologist and oncologic surgeon in attendance. The decision was to perform surgical resection of the mass to treat this primary mesenchymal malignancy. The anterior aspect of the fifth rib and intercostal muscles were resected with negative margins. Pathology confirmed the mass to be a low-grade chondrosarcoma. Due to the low-grade nature, low metastatic potential and negative margins of the tumor, the decision was made not to pursue adjuvant chemotherapy or radiation therapy. The patient made full recovery.

Treatment of Massive Low-Grade Chondrosarcoma of Nasal Septum with Helical Tomotherapy: A Case Report

Chondrosarcomas are malignant bone tumors which develop as a cartilaginous differentiation of primary mesenchymal cells and the second most frequently seen malignant tumor of the bone after osteosarcoma. These malignancies are slowly growing non-epithelial tumors with unknown etiology and most frequently seen during the 4 decades of life. They are frequently localized on pelvis, ribs and long bones. Nasal septum CSs are very rarely seen malignancies. They originate from septal mucosa or cartilage and it is difficult to make a diagnosis unless they reach a certain size. A few cases of CSs with nasal septum have been reported in the literature. In cases of CSs, surgery is the gold standard treatment modality;however in surgically unresectable cases or close to margins, radiotherapy plays a significant role in primary and adjuvant treatment. Based on the position of the tumor in head and neck and extremely closeness of the tumor to vital organs as optic nerve, chiasm and brain, image guided-intensity modulated radiation therapy (IG-IMRT) becomes very effective and reliable modalities and may be a favorable treatment alternative.

Histological Changes and Differential Diagnosis of Mesenchymal Chondrosarcoma

Eight cases of mesenchymal chondrosarcoma either of skeletal(5 cases) or extrasketetalorigin (3 cases) are reported. According to histopathological and diagnostic criteria,mesenchymal chondrosarcoma were classified into two types cartilage isiand cell type andundifierentiated small cell type It is believed that the application of this classification in the study ofmesenchymal chondrosarcoma is helptul the estimation of its malignancy and choice of treatmentas well al in the prediction of its prognosis. Mesenchymal chondrosarcoma is a highly malignant neoplasm with poor prognosis. None ofthe patients in this series survived more than five years after they were diagnosed. The diffentialdiagnosis of malignant lymphoma, chondrosarcoma, hemangiopericytosarcoma, etc. was discussed.My data support the assumption that mesenchymal chondrosarcoma originates from the secondarymesenchyme rather than the primary mesenchyme.

Primary maxillary chondrosarcoma: A case report

BACKGROUND Sarcomas of the head and neck region are rare tumors,constituting less than 1%of malignant neoplasms in this area,of which few cases(20%)originate from bone or cartilage.Chondrosarcoma is a malignant neoplasm that develops in bone,with a predilection for the pelvis,chest wall,and scapula,and is uncommon in the maxilla and jaw.Although this type of lesion has locally aggressive behavior,destroying the affected bone,it can metastasize when it is not diagnosed early and compromise the patient's life.CASE SUMMARY On intraoral examination of a 32-year-old female with a tumor in the middle third of the face,a well-defined rise in volume of approximately 3 cm in diameter was observed.Computed tomography with 3-dimensional reconstruction was performed,and we observed that the osteolytic lesion affected the vestibular cortex as the palatal bone.Hematoxylin and eosin staining revealed an appearance that was similar to mature hyaline cartilage,hypercellularity,nuclear and cellular pleomorphism,and multinucleated cells,with significant vacuolization.CONCLUSION Determination of the clinical and histopathological characteristics of rare neoplasms in the maxillofacial region,such as chondrosarcomas,allows the pathologist and surgeon to make the appropriate therapeutic decisions,optimizing the patient’s prognosis.

Innovative chest wall reconstruction with a locking plate and cement spacer after radical resection of chondrosarcoma in the sternum: A case report

BACKGROUND Chondrosarcoma,a cartilage matrix producing tumor,is the second most commonly observed primary bone tumor after osteosarcoma,accounting for 15%of all chest wall malignancies.We herein report the case of a patient with chondrosarcoma of the sternum and our management of the chest wall defects that presented following radical tumor resection.CASE SUMMARY A 31-year-old patient presented to our hospital with dull pain and a protruding mass overlying the chest for 3 mo.The presence of nocturnal pain and mass size progression was reported,as were overhead arm elevation-related limitations.Computed tomography showed a focal osteoblastic mass in the sternum with bony exostosis and adjacent soft tissue calcification.Positron emission tomography-computed tomography revealed hypermetabolic activity with a mass located over the upper sternum.Magnetic resonance imaging showed a focal illdefined bony mass of the sternum with cortical destruction and periosteal reaction.Preoperative biopsy showed a consistent result with chondrosarcoma with immunohistochemical positivity for S100 and focal positivity for IDH-1.The grade II chondrosarcoma diagnosis was confirmed by postoperative pathology.The patient underwent radical tumor resection and chest wall reconstruction with a locking plate and cement spacer.The patient was discharged 1 wk after surgery without any complications.At the 1-year follow-up,there was no local recurrence on imaging.The functional scores,including Constant Score,Nottingham Clavicle Score,and Oxford Shoulder Score,showed the absence of pain in the performance of daily activities or substantial functional disabilities.CONCLUSION The diagnosis of chondrosarcoma must be considered when chest wall tumors are encountered.The surgical reconstructive materials,with a locking plate and cement spacer,used in our study are cost-effective and readily-available for the sternum defect.

Multimodal therapy in the management of primary orbital mesenchymal chondrosarcoma

AIM:To evaluate the ophthalmic manifestations,radiographic features,and prognosis of Chinese patients with primary orbital mesenchymal chondrosarcoma(MCS).METHODS:The study included 6 cases with primary orbital MCS treated at Tianjin Eye Hospital from January 2009 to December 2019.Patitent ophthalmic manifestations,radiographic features,diagnosis,pathology,therapeutic regimens,and prognosis were retrospectively reviewed.RESULTS:Six patitents with primary orbital MCS were identified.The mean age at the first visit was 33y(range,25-42y).All six patients displayed manifestations of exophthalmos,diplopia,limitation of eye displacement,upper eyelid oedema,decreased visual acuity and ptosis.The mean disease history and range were 5 and 2-8mo,respectively.The tumors were located in the superonasal extraconal compartment(2/6,33.3%),intraconal compartment(2/6,33.3%),and bitemporal extraconal compartment(2/6,33.3%),respectively.Radiographic features were a well-defined,orbital mass with calcification and ossification on computed tomography(CT),and marked heterogenous enhancement on dynamic magnetic resonance imaging(MRI).Five patients were treated with tumor resection and one patient received orbital exenteration.Five patients in the cohort received postoperative radiation therapy,two patients received chemotherapy,and one patient did not receive postoperative adjuvant therapy because he refused.The histopathologic classification revealed a tumour composed of a mixture of mature chondroid tissue surrounded by small,round,and undifferentiated mesenchymal cells.Immunohistochemistry revealed Bcl-2,vimetin,CD99,and S-100 were expressed were expressed.After surgeries,two patients have developed a local recurrence.The median recurrence time of 58 mo(52-64 mo).One patient had distant recurrence included the lungs occurred 52mo after the initial surgery.CONCLUSION:The possibilty of orbital MCS need to be considered when a painless,slowly growing orbital mass with calcification and ossification.From our experience,trimodality treatment of radiation therapy,chemotherapy and surgery maybe the best option.Orbital MCS has a high tendency for late recurrence,regular long-term follow-up after complete excision is mandatory.

Dedifferentiated chondrosarcoma of the middle finger arising from a solitary enchondroma:A case report

BACKGROUND Dedifferentiated chondrosarcoma(DDCS)accounts for 10%of all chondrosarcomas and has the poorest outcome,with a 5-year survival rate of 7%-25%.DDCS commonly occurs in the femur and pelvis,whereas DDCS of the finger is extremely rare.Furthermore,the histological findings of preexisting solitary enchondroma samples are important and valuable for diagnosing malignant transformations.CASE SUMMARY We report our experience with DDCS in the proximal phalanx of the left middle finger of an 87-year-old woman.She had undergone surgery for enchondroma,with curettage and artificial bone grafting,11 years ago,in the same location.Several years after the primary surgery,the left middle finger gradually started to enlarge,and the growth speed increased in the past year.Plain radiographs showed an expansive osteolytic lesion with calcifications and residual grafting material.Owing to the suspicion of malignancy,we performed ray amputation.Histological findings revealed an abrupt transition between the low-grade chondrosarcoma and dedifferentiated sarcoma components.The dedifferentiated components showed the features of a high-grade undifferentiated pleomorphic sarcoma.The patient was diagnosed with DDCS arising from a preexisting enchondroma.She had no local recurrence or distant metastasis and died of pneumonia 6 years and 10 months after the second surgery.CONCLUSION The histological findings of a precursor lesion showed a typical enchondroma,suggesting that DDCS can arise from enchondroma.

Chondrosarcoma of the toe:A case report and literature review

BACKGROUND Chondrosarcoma of the foot is a rare malignant bone tumour,and it is even rarer when it originates in a toe bone.Surgical excision is the only effective treatment.The osteolytic destruction of the tumour severely affects limb function and carries the risk of distant metastasis.Most such tumours are removed surgically to minimize local recurrence and distant metastases,maximize limb function,and prolong the patient’s tumour-free survival time.The main objective of this article is to present the case of a chondrosarcoma that invaded the first phalanx of the left foot and formed a large phalangeal mass with osteolytic destruction of the distal bone.CASE SUMMARY A 74-year-old man suffered from swelling of his left toe for six months,with pain and swelling for two months.Computed tomography and magnetic resonance imaging showed that the tumour on the first phalanx of the left foot was approximately 54.9 mm×44.6 mm,surrounded by a significant soft tissue signal mass,with osteolytic destruction of the distal phalanx and a speckled bone-like highdensity shadow within it.CONCLUSION Chondrosarcoma occurring in a toe bone is extremely rare.In this case,extensive surgical resection of the large low-grade chondrosarcoma,which showed osteolytic destruction and invaded the distal metatarsal bone,was safe and effective.

X-ray DIAGNOSIS OF EXTRASKELETAL (SOFT TISSUE) CHONDROSARCOMA (A REPORT OF 8 CASES)

Eight cases of surgically and pathologically verified extraskeletal (soft tissue) chondrosarcoma were analyzed with regard to clinical and X-ray features. The cardinal clinical aspects of this series are: presence of a local soft tissue mass; gradual enlargement of the mass accompanied by increasing pain. The X-ray signs were summarized as follows: formation of a soft tissue mass; various forms of calcifications concentrated in the central area of the tumor; in some instances, presence of a saucer-like defect on the cortical surface of neighbouring bone and periosteal proliferation with mound-like new bone on both sides as well as bending deformity of the affected bone. The incidence and sites of predilection, the main X-ray findings, radiological diagnosis and differential diagnosis of the tumor were discussed. The Roentgen features of synovial chondrosarcoma of the knee joint were especially analyzed.

Low-grade chondrosarcoma of the larynx: A case report

BACKGROUND Chondrosarcomas of the larynx are malignant tumours that most commonly originate from the hyaline cartilage.Chondrosarcoma of the larynx,the most common type of low-grade tumour,accounts for 1%of all laryngeal neoplasms.CASE SUMMARY We present the case of a 60-year-old female patient who developed progressive hoarseness and shortness of breath over a 2-mo period.The patient had undergone resection of a laryngeal tumour 14 years before the aforementioned symptoms occurred,and histopathological analysis indicated that it was a chondroma.During the assessment of the patient,a submucosal,oval-shaped tumour was detected that was predominantly located on the left side of the larynx and was approximately 6 cm in size.The decision to perform left partial vertical laryngectomy was made.A pathohistological diagnosis of low-grade chondrosarcoma was made.Considering the results of pathohistological analysis and the positive margins of the resection,a total laryngectomy was performed.During the 12-mo follow-up,no local relapse or regional or distant metastases was detected.CONCLUSION Chondrosarcoma of the larynx must be considered in the differential diagnosis of laryngeal submucosal tumours.It is crucial to carefully sample of tumour tissue,differentiate chondroma and chondrosarcoma,and consider the possibility of malignant changes from chondroma to chondrosarcoma.

Chondrosarcoma of the Hand: A Literature Review

Chondrosarcoma (CS) is a malignant neoplasm of mesenchymal origin characterized by the formation of cartilaginous matrix by neoplastic cells. It is very variable in presentation, clinical, genetic and anatomo-pathological features. CS is more often found in the pelvis and the proximal long bones (femur, humerus). Localization to the small bones of the hand is very rare and it represents a diagnostic and therapeutic challenge. CSs are malignancies resistant to both radiation and chemotherapy . Surgical treatment is the only mean available. As opposed to CSs located elsewhere, CS of the hand is characterized by local recurrence and very low metastatic potential. In order to definitely set a diagnosis of chondrosarcoma in this region, comparison of histological and radiological findings is paramount. The principle goal of surgery shall be minimizing functional impairment. This provides the rationale for performing curettage, local adjuvant therapy and bone grafting in low-grade lesions.

Primary chondrosarcoma of the liver:A case report

BACKGROUND Primary chondrosarcoma of the liver are extremely rare.Moreover,there are few reports focusing on typical clinical symptoms and imaging characteristics.Therefore,the diagnosis of chondrosarcoma of the liver remains a challenge.CASE SUMMARY A 59-year-old male was admitted due to a lesion occupying the right liver lobe that was found by physical examination.Magnetic resonance imaging showed a lobular mass with high T2 weighted image and low T1 weighted image with enhanced internal separation and edge in the right liver.He was diagnosed with liver cystadenoma by using magnetic resonance imaging.At 3 mo later,the magnetic resonance scan showed that the mass was enlarged.Laparoscopic liver tumor resection was performed with a pathological diagnosis of liver chondrosarcoma.Then he received a surgical resection for the recurrent lesion.However,intrahepatic and abdominal metastases were found again at 8 mo after the second operation.The patient then received conservative management and is now under follow-up.CONCLUSION Primary liver chondrosarcoma generally is presented as lobulated and heterogeneous density/signal,cystic,solid masses without calcification with enhanced edge,internal septa and solid part.The imaging features are closely related to pathology,which may be helpful for clinical diagnosis.

Primary Chondrosarcoma of the Mammary Gland of a Spayed American Akita Bitch: A Case Report

An eleven-year-old spayed American Akita bitch rapidly developed a mammary tumour which was surgically removed. The histological examination revealed the tumour to be a sarcoma that presented positive immunohistochemical staining against vimentin and protein S 100. There was no staining against pan-actin. Based on the histological aspect and the pattern of immunohistochemical staining the diagnosis of primary extraskeletal chondrosarcoma of the mammary gland was considered most probable. Two months later the patient was euthanized with recurrent local tumour and metastases in the lungs.

Mesenchymal Chondrosarcoma of the Infratemporal Fossa—A Rare Case Report

Chondrosarcoma is a malignant neoplasm that results in abnormal bone and cartilage growth. Although Chondrosarcoma is rare, it is the second most common primary bone malignancy. Mesenchymal Chondrosarcoma (MCS) is a rare histological variant of Chondrosarcoma (CS) that accounts for only 1% of all CS and has high predilection for the head and neck region with a peak incidence in 2nd and 3rd decade of life. There is comparable male to female ratio with two thirds of the cases arising from bone and one third from soft tissue. The tumor is unique because of its aggressive growth with a high tendency for late recurrence and delayed metastasis. We present a case of this highly malignant lesion arising from the infratemporal fossa and rapidly involving maxillary tuberosity and mandibular ramus.