Chondrosarcoma - chest wall

Case contributed by Dr Yasser Asiri

Presentation

Posterior swelling in the left upper back, noted by her family 3 months ago.

Patient Data

Age: 30 years
Gender: Female
X-ray

There is a large left upper lung zone partially defined mass with internal calcifications exerting mass effect on the trachea and the adjacent lung parenchyma and extending above the clavicle suggesting a posterior location (cervicothoracic sign). The adjacent ribs are not well visualized representing rib destruction. No airspace consolidation or lung masses. Heart is normal in size. No pleural effusion or pneumothorax seen.

CT

Large left-sided chest wall mass lesion with intra and extrathoracic extension developed mainly on the left 2nd rib, but involving the left 3rd rib. The mass causes bony erosion of the T2 and to a lesser extent T3 vertebral body, the tumoral tissues extending to the left neural foramen of T2-T3 with mild extension to the epidural space without significant compression of the spinal cord.

The mass is well-defined, predominantly hypodense with central calcified component. It is extending to the mediastinum, abutting the left subclavian artery, aortic arch, and the left pulmonary artery.  The mass is causing compression and narrowing of the left brachiocephalic vein although it is patent; however, the left subclavian vein is not well seen. 

The mass is also compressing and displacing the upper mediastinal structures, including the esophagus and trachea. Preserved fat planes between the mass and the erector spinae muscles, which are compressed on the left side, as well as the trapezius and rhomboid muscles on the left side. 

Mild collapse of the left lung parenchymal tissue inferior to the tumor. No suspicious lung nodules or masses. Small cervical lymph nodules are likely reactive nodes. No visualized lymphadenopathy.  The imaging appearance of the mass is suggestive of chondrosarcoma.

MRI

MRI of the spine was performed to assess the spinal cord and canal, and again demonstrates the complex heterogeneous large lobulated mass with central calcification/ossification possibly arising from the left side 3rd rib and its costovertebral junction. The mass demonstrates high T2 and intermediate T1 signal intensity with peripheral enhancement on the post contrast administration images. There is extension to the left foramen of T3 vertebra with foraminal widening and minimal extension into the left lateral epidural space. There is left side T3 vertebral lateral element involving by the lesion. There is spacious bony spinal canal and thecal sac and no appreciable spinal cord compromise.

The appearance of the lesion with central calcification-ossification and the signal characteristic is most consistent with chondrosarcoma.

Case Discussion

Chondrosarcoma is one of the most common primary chest wall tumors. It usually arises in the anterior wall (near the costochondral junction) or the paravertebral location. The presence of rings and arcs calcification on CT, and MRI signal characteristics of low T1 compared to muscles and high T2 signal intensity are suggestive of a chondroid origin of the tumor.

The patient underwent CT guided biopsy and the histopathology result was: 

" LOW GRADE CARTILAGINOUS NEOPLASM CONSISTENT WITH CHONDROSARCOMA"

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Case information

rID: 65192
Published: 29th Dec 2018
Last edited: 4th Mar 2019
Inclusion in quiz mode: Included

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