Chondrosarcoma of H&N



Chondrosarcoma of H&N


H. Ric Harnsberger, MD










(Left) H&E shows normal cartilage image next to the increased cellularity of low-grade CSa image. Note the difference in cell size and lacunar distribution. (Courtesy L. Thompson, MD.) (Right) Clinical photograph of mandibular CSa reveals a smooth, multilobular, submucosal mass image causing significant distortion of the posterior mandibular body, resulting in teeth displacement image. Notice that the surface epithelium is intact, excluding diagnosis of retromolar trigone SCCa. (Courtesy L. Thompson, MD.)






(Left) Axial CECT reveals a large left masticator space mass with typical “popcorn” calcifications image containing both “rings & arcs.” Chondrosarcoma with visible chondroid calcifications usually indicate a lower grade tumor is present. (Right) Axial T2WI MR in the same patient shows the CSa image with characteristic pronounced T2 hyperintensity of chondroid tumors. Note bowing of the posterior wall of the maxillary sinus image along with linear low signal areas within the tumor secondary to intramural calcifications.



TERMINOLOGY


Abbreviations



  • Chondrosarcoma of head & neck (CSa H&N)


Definitions



  • Malignant tumor arising from H&N cartilage or bone characterized by formation of cartilaginous matrix by neoplastic cells


IMAGING


General Features



  • Best diagnostic clue



    • H&N tumor demonstrating chondroid tumor matrix leads directly to radiologic diagnosis of CSa


  • Location



    • Multiple H&N locations



      • Difficult to determine relative frequencies


    • Larynx ≈ skull base (petrooccipital fissure) > mandible (including temporomandibular joint [TMJ], masticator space) > maxilla ≈ nasal septum



      • Laryngeal CSa: 72% cricoid, 20% thyroid, 8% arytenoid cartilage, hyoid bone


  • Size



    • Variable, usually > 3 cm


  • Morphology



    • Well-circumscribed, lobulated margins


CT Findings



  • CECT



    • Variable, heterogeneous enhancement


    • Soft tissue extension is late finding


  • Bone CT



    • Characteristic chondroid calcification in tumor matrix



      • ˜ 50% have matrix calcification


      • Descriptive terms for chondroid calcifications include “ring & arc” & “popcorn” calcifications


    • Cartilage or bone involvement by CSa variable



      • Expansion of cartilage or bone present


      • Tumor margin variable from abrupt, benign appearance to destructive margins with local invasion



        • ˜ 50% show cartilage or bone destruction


MR Findings

Sep 20, 2016 | Posted by in HEAD & NECK IMAGING | Comments Off on Chondrosarcoma of H&N
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