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Age / Sex : 22 / M
Chief complaint : slow growing huge palpable mass in the back area and back pain for 1 year.
1) What is your impression?
Two weeks later, you can see the final diagnosis with a brief discussion of this case.
* Send Application Answers to Ja-Young Choi, MD (drchoi01@gmail.com)
Courtesy : Jee Young Kim, MD. Vincent’s Hospital, The Catholic University of Korea
Diagnosis: chondrosarcoma
Discussion
Findings: (a) CT scan shows a large hypodense mass arising from the posterior element of lumbar spine with cortical disruption and ring and arc calcifications. (b) Coronal T1-weighted MR image shows a large hypoSI mass. (c) T2-weighted image shows a high –signal intense, lobulated mass with linear striagions. There are several signal void nodules within the mass, suggesting chondroid calcifications. (d,e) Sagittal and axial T2-weighted MR image shows a high-signal-intensity lobulated mass with invasion into thecal sac and neural foramina focally. (f,g) Gadolinium enhanced coronal and axial T1-weighted image shows peripheral rim enhancement and focal septal and nodular enhancement in this mass.
Diagnosis: chondrosarcoma in lumbar spine
Discussion:
Chondrosarcoma is the second most common nonlymphoproliferative primary malignant tumor of the spine in adults. Peak prevalence occurs between 30 and 70 years of age. Men are affected two to four times more frequently than women. The thoracic and lumbar spine are most frequently affected, with the sacrum being affected only rarely. Chondrosarcoma originates in the vertebral body (15% of cases), posterior element (40%), or both (45%) at presentation. The clinical course of primary chondrosarcoma originating in the spine is usually long because most tumors are low-grade lesions. Chondrosarcomas of the spine usually manifest as a large, calcified mass with bone destruction. Chondroid matrix mineralization is better demonstrated with CT. Calcified matrix is detected as areas of signal void at MR imaging. The nonmineralized portion of the tumor has low attenuation on CT scans, low to intermediate signal intensity on T1-weighted MR images, and very high signal intensity on T2-weighted images due to the high water content of hyaline cartilage. An enhancement pattern of rings and arcs at gadolinium-enhanced MR imaging reflects the lobulated growth pattern of these cartilaginous tumors. Extension through the intervertebral disk has been reported in 35% of cases.
References:
1. Rodallec MH, Feydy A, Larousserie F, Anract P, Campagna R, Babinet A, Zins M, Drape JL. Diagnostic imaging of solitary tumors of the spine. RadioGraphics 2008;28:1019-1041.
2. Lloret I, Server A, Bierkehagen B. Primary spinal chondrosarcoma: radiologic findings with pathologic correlation. Acta Radiol. 2006;47:77-84
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