Age / Sex : 61 / M

61/M
C.C.; Left side weakness of ankle and knee since 3 days ago

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 In Sook Lee, MD ([email protected])

Courtesy : Jee Young Kim. MD. St. Vincent's Hospital, The Catholic University of Korea

Chondrosarcoma

Discussion

Diagnosis

Chondrosarcoma

 DDx; metastasis, osteosarcoma

Figure legends

T-spine AP view shows absent Lt pedicle and paravertebral soft tissue mass. (1)

CT shows moth-eaten osteolytic lesion in Lt pedicle, lamina, transverse process and focal vertebral body, spinous process, and adjacent Lt rib, with soft tissue mass, which has several flocculent calcifications, suggesting chondroid calcifications. This mass extends to epidural space. Post-contrast image shows wall and septal enhancement in this mass. (8,9: precontrast, 10 postcontrast)

MR imaging shows a large lobulated soft tissue mass with bone destruction. This mass shows hypointense SI with several small  hyperSI nodular portions on T1WI, hyperSI with low SI septa and tiny hypoSI nodules on T2WI and heterogeneous enhancement with focal nonenhanced portion on gadolinium enhanced image.

(2,3: sagittal T2WI, 4 axial T2WI, 5 axial T1WI, 6: constrast enhanced T1WI.

Discussion

5% of chondrosarcoma occur in spine and sacrum, primary or malignant degeneration of osteochondroma or enchondroma. The age of patient ranges in 20-90 years, peak age in 40-60 years. The ratio of male to female is 2:1, male preponderance.

Primary spinal chondrosarcoma divided into 4 types, conventional intramedullary, juxtacortical, clear cell and mesenchymal types. The involved site is thoracic spine(3), and cervical(1), lumbar(1) spine in order. Neurological deficit is complained  in some patients. 

Plain radiography shows lytic mass with or without chondroid matrix, cortical disruption and extension into soft tissue. MR imaging findings show low to intermediate SI on T1-weighted image, very high signal intense on T2-weighted image, with low signal intense by areas of mineralization and septal enhancement on gadolinium enhanced T1-weighted image.