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Age / Sex : 33 / M
Chief complaint : Right shoulder pain, weakness, tingling sensation
at right 2nd finger for 2 weeks
What is your impression?
Two weeks later, you can see the final diagnosis with a brief discussion of this case. (Please submit only one answer)
Courtesy : Song You Seon, Pusan National University Hospital
Diagnosis: Mesenchymal chondrosarcoma
Discussion
Answer: Mesenchymal chondrosarcoma
Findings:
Plain
radiograph : Osteolytic lesion with ring and arc calcification is seen at right
lateral mass of C3-5
CT : Mass
with lobulated shape, ill-defined margin and chondroid matrix mineralization is
located at right lateral mass and transverse process of C3-5 with bone
destruction
MRI : Mass shows
intermediate signal intensity on T1 and T2WI, enhancement and diffusion
restriction. This mass results in central canal stenosis, C3/4, C4/5, C5/6
right neural foraminal stenosis, epidural extension, and encases right
vertebral artery.
Differential Diagnosis:
Chondrosarcoma,
malignant change of neurogenic tumor (giant schwannoma or neurofibroma)
Diagnosis:
Mesenchymal
chondrosarcoma
Discussion:
The
incidence of spinal chondrosarcomas is estimated to be from 2% to 12% in
various series. The thoracic spine is the most frequent localization, followed
by the cervical and lumbar region. Chondrosarcoma originates in the vertebral
body (15% of cases), posterior element (40%), or both (45%) at presentation.
Plain
radiographs demonstrate spinal chondrosarcoma as a large, calcified mass with
bone destruction. CT is able to depict chondroid matrix mineralization, namely,
“rings and arcs” calcification. MRI demonstrates the tumor as a low to
intermediate signal intensity on T1WI and heterogeneous low and high-signal
intensities on T2WI and STIR images, suggesting mineralized and nonmineralized
matrices. Enhancement patterns are rim enhancement or ring and arc septal
pattern.
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: What to do and say. RadioGraphics
2008;28:1019-1041.
2. Katonis
P, Alpantaki K, Michail K, Lianoudakis S, Christoforakis Z, Tzanakakis G,
Karantanas A. Spinal Chondrosarcoma: A Review. Sarcoma. 2011;2011:378957.
3. Kang et
al. Musculoskeletal radiology. 2013 by Panmun Education.
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