chondrosarcoma, clear cell chondrosarcoma, diagnosis clear cell chondrosarcoma, radiology clear cell chondrosarcoma, pathology clear cell chondrosarcoma, surgery clear cell chondrosarcoma, prognosis clear cell chondrosarcoma, epiphyseal tumor, cartilage cancer, bone cancer, bone sarcoma, low grade bone sarcoma, sarcoma

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dr james c wittig, orthopedic oncologist, new york, new jersey
About Dr. Wittig
Clear Cell Chondrosarcoma
Clear Cell Chondrosarcoma

General Information

  • Malignant tumor
  • Comprised of neoplastic chondrocytes
  • With abundany, clear cytosplasm
  • Little interveining matrix
  • Foci of conventional chondrosarcoma may be present

Clinical Presentation

Signs/Symptoms:

  • Pain and swelling
  • There may be interference with motion
  • Often of long duration
Prevalence:
  • ~2% of all chondrosarcomas
  • 2 to 1 male predilection
Age:
  • Adolescence to old age
  • Most common in third and fourth decades
Sites:
  • Epiphyses of long bones
  • Most commonly proximal femur, proximal humerus, distal femur, proximal tibia

Radiographic Presentation

  • Usually osteolytic, expansile lesion
  • May be focally calcified
  • Often a sharp interface between tumor and surrounding bone
  • Sclerotic rim is uncommon
  • Overlying cortex is usually thin, but intact
Roll over the images for more information
Geographic, epiphyseal lesion, skeletally mature, no sclerotic rim AP pelvis
T1-weighted MRI proximal femur: clear cell chondrosarcoma MRI T2 Weighted Image
bone scan: increased uptake in region of proximal femur, clear cell chondrosarcoma Left proximal femur: clear cell chondrosarcoma
Plain X-ray of clear cell chondrosarcoma of proximal femur Plain X-ray:   Proximal femur clear cell chondrosarcoma
Proximal humerus clear cell chondrosarcoma

Gross Pathology

  • Cut surface
  • Typically lacks appearance of conventional chondrosarcoma
  • Usually red, soft and granular
  • Possibly multiple cysts
  • Small areas of gray or white cartilage may be irregularly interspersed

Microscopic Pathology

  • May have inconspicuous lobular pattern
  • Sometimes microlobules are separated by delicate fibrovascular stroma
  • Dominant cell is chondrocyte
  • Variably clear cytoplasm
  • Condensation of powdery cytoplasm near membrane or nucleus
  • Sharply defined cell borders
  • Nuclei are enlarged and rarely binuclear
  • Matrix formation is sparse
  • Small deposits of chondroid material between clear cells
  • May be focally calcified
  • More abundant m,atrix may be found in areas of conventional chondrosarcoma
  • These areas found in about half of clear cell variants


Roll over the images for more information
gross specimen histology: clear cell chondrosarcoma
pathology pathology
pathology pathology

Biological Behavior

  • Slightly aggressive
  • Destructive cortical penetration is rare, but possible
  • Recurrence rare
  • Metastasis somewhat common

Treatment and Prognosis

  • En bloc resection with wide margin of normal bone and soft tissue
  • Procedure of choice
  • Recurrence rare
  • Simple excision or curettage
  • 80% risk of local recurrence
  • Amputation always a possible back up
  • Metastasis
  • No microscopic or clinical differences from original lesion
  • Somewhat common
  • Even if treated with amputation
  • Death rate low to moderate
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