Figure 1
Plain radiograph of the scapula
Large soft tissue mass containing ring-like calcification.
Clinical History
The patient presented with a history of right shoulder pain and swelling for two and a half years. She mentioned worsening of the symptoms during the last year. Physical examination showed hyposensitivity of the right upper extremity.
Imaging Findings
The patient presented with a history of right shoulder pain and swelling for two and a half years. She mentioned worsening of the symptoms during the last year.
Physical examination showed hyposensitivity of the right upper extremity, but no muscle weakness or deep joint reflex abnormality was indicated.
Radiographs of the right scapula revealed a large soft tissue mass containing ring-like calcification.
CT of the scapula showed a lytic lesion arising from the scapula with disruption of the cortex and an extensive soft tissue mass containing calcification and ossification.
MR showed a large lobulated mass with intermediate signal intensity on T1-weighted images and high signal intensity on T2-weighted images with smaller areas of low signal corresponding to areas of calcification/ossification.
A CT-guided fine needle aspiration (FNA) was performed and confirmed the diagnosis of a grade 1 chondrosarcoma.Finaly,histological diagnosis was also grade 1 chondrosarcoma.
Physical examination showed hyposensitivity of the right upper extremity, but no muscle weakness or deep joint reflex abnormality was indicated.
Radiographs of the right scapula revealed a large soft tissue mass containing ring-like calcification.
CT of the scapula showed a lytic lesion arising from the scapula with disruption of the cortex and an extensive soft tissue mass containing calcification and ossification.
MR showed a large lobulated mass with intermediate signal intensity on T1-weighted images and high signal intensity on T2-weighted images with smaller areas of low signal corresponding to areas of calcification/ossification.
A CT-guided fine needle aspiration (FNA) was performed and confirmed the diagnosis of a grade 1 chondrosarcoma.Finaly,histological diagnosis was also grade 1 chondrosarcoma.
Discussion
Chondrosarcoma is a malignant bone tumour that usually occurs in patients over the age of 40. Chondrosarcoma affects children rarely, often as a malignant degeneration of an osteochondroma or an enchondroma (more often in diaphyseal aclasia or dyschondrodysplasia respectively).
Chondrosarcomas can be subdivided according to their location into:
(a) central: arising within the medullary space and
(b) cortical-based: arising on the surface of the affected bone.
There are also some rare types of chondrosarcoma such as mesenchymal, dedifferentiated, and clear cell chondrosarcoma.
On plain radiographs chondrosarcomas appear as a lytic central or peripheral lesion usually with peripheral scalloping with or without mineralisation. The differential diagnosis of a mineralised chondrosarcoma includes only enchondroma and bone infarction. On the other hand, the differential diagnosis of a non-mineralised chondrosarcoma is wide and includes almost any bone malignancy such as fibrosarcoma, malignant fibrous histiocytoma, plasmacytoma, metastasis and osteolytic osteosarcoma.
CT can better assess the soft tissue mass; the distribution, configuration and the extent of calcification and ossification as well as the integrity of the overlying cortex.
Furthermore, MR images define the extent of intraosseous and soft tissue involvement. Recent studies also suggest that contrast–enhanced MR imaging may assist in the differentiation between benign and malignant cartilaginous tumours.
Chondrosarcomas can be subdivided according to their location into:
(a) central: arising within the medullary space and
(b) cortical-based: arising on the surface of the affected bone.
There are also some rare types of chondrosarcoma such as mesenchymal, dedifferentiated, and clear cell chondrosarcoma.
On plain radiographs chondrosarcomas appear as a lytic central or peripheral lesion usually with peripheral scalloping with or without mineralisation. The differential diagnosis of a mineralised chondrosarcoma includes only enchondroma and bone infarction. On the other hand, the differential diagnosis of a non-mineralised chondrosarcoma is wide and includes almost any bone malignancy such as fibrosarcoma, malignant fibrous histiocytoma, plasmacytoma, metastasis and osteolytic osteosarcoma.
CT can better assess the soft tissue mass; the distribution, configuration and the extent of calcification and ossification as well as the integrity of the overlying cortex.
Furthermore, MR images define the extent of intraosseous and soft tissue involvement. Recent studies also suggest that contrast–enhanced MR imaging may assist in the differentiation between benign and malignant cartilaginous tumours.
Differential Diagnosis List
Chondrosarcoma of the scapula
Final Diagnosis
Chondrosarcoma of the scapula
References
[1]
Geirnaerdt MG , Hogendoorn PC, Bloem JL, Taminiau AH, van der Woude HJ.
Cartilaginous tumors: fast contrast-enhanced MR imaging.
Radiology 2000 Feb;214(2):539-46. (PMID: 10671608)
[2] Giudici MA, Moser RP Jr, Kransdorf MJ. Cartilaginous bone tumors. Radiol Clin North Am 1993 Mar;31(2):237-59. (PMID: 93189814)
[3]
Masciocchi C, Sparvoli L, Barile A.
Diagnostic imaging of malignant cartilage tumors.
Eur J Radiology 1998 May;27 Suppl 1:S86-90. (PMID: 9652507)
Case information
| URL: | https://www.eurorad.org/case/1879 |
| DOI: | 10.1594/EURORAD/CASE.1879 |
| ISSN: | 1563-4086 |
Plain radiograph of the scapula
Large soft tissue mass containing ring-like calcification.
