42 Chondrosarcoma



George Nomikos, Anthony G. Ryan, Peter L. Munk, and Mark Murphey

Clinical Presentation

A 53-year-old man presented with pain in the proximal humerus for 3 months.


Figure 42A


Figure 42B


Figure 42C


Figure 42D

Radiologic Findings

A radiograph (Fig. 42A) shows a lytic destructive lesion in the proximal femur. There is associated cortical thickening and periosteal reaction, as well as expansile remodeling and lobular endosteal scalloping. The density in the greater trochanter represents a methylmethacrylate plug from a prior biopsy. The CT (Fig. 42B) shows cortical destruction, faint internal mineralization, and soft-tissue thickening around the femur. The sagittal inversion recovery MRI (Fig. 42C) shows the extent of the lesion. The lesion is predominantly high signal intensity. The lower signal intensity foci within the lesion represent areas of mineralization. The postcontrast image (Fig. 42D) shows peripheral and septal enhancement, a characteristic pattern seen in hyaline cartilage lesions. There is also enhancement within the periosteal reaction around the femur.



Differential Diagnosis

  • Bone infarction with secondary malignancy (malignant fibrous histiocytoma/fibrosarcoma)
  • Enchondroma (effectively excluded in this case because of the presence of cortical destruction)



Chondrosarcomas account for ~8 to 17% of biopsied primary bone tumors. They may arise in the medullary canal (central type) or on the surface of the bone (peripheral type). Chondrosarcomas represent malignant cartilage lesions. They may arise de novo or from a preexisting cartilage lesion, such as an enchondroma or osteochondroma. Common locations include the pelvis, femur, humerus, ribs, tibia, scapula, and spine.

Clinical Findings

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Feb 14, 2016 | Posted by in MUSCULOSKELETAL IMAGING | Comments Off on 42 Chondrosarcoma

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