Bone Pathology Case Studies


CASE 8: Low grade chondrosarcoma


Clinical History:

A 46-year-old man comes to her physician because of progressive pain and swelling of his right hip region for the past 6 months. The swelling is worse than the pain. On physical examination, he is mildly obese and it is difficult to assess the right hip region. Laboratory studies show serum calcium 9.3 mg/dL, phosphorus 3.5 mg/dL, alkaline phosphatase 148 U/L, albumin 4.2 g/dL, and total protein 6.3 g/dL. A radiograph of the pelvis is performed and reveals a lesion. A pelvic CT scan demonstrates similar findings. A bone scan is performed. A resection of the lesion is performed.
  1. What is the lesion?

    2. This is a low-grade chondrosarcoma. A radiograph shows a mass arising in the right pelvic wing that extends into adjacent soft tissue, with fluffy areas of calcification. A pelvic CT scan demonstrates similar findings. A bone scan shows a large area of increased uptake in the right pelvic wing.It is called "low-grade" because the cellular anaplasia is not marked. In fact, this is a difficult lesion to distinguish from a benign process. In general, a helpful fact to know is that more centrally located cartilagenous tumors tend to be more aggressive than distal ones.

    Chondrosarcomas have a male predominance and are seen over a broad age spectrum from teenage to the elderly, but with a peak in middle age. They are more common in "central" locations of the axial skeletal system, rather than at "peripheral" sites such as the bones of the hands, where benign chondromas occur.

  2. Name a condition in which multiple cartilagenous tumors are found.

    3. This is Ollier's disease. In about a third to half of such cases, there is malignant transformation to chondrosarcoma.