Nouh Mohamed Ragab, Amr Hanan Abd El-Aziz, Ali Rola H
1 Department of Radiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
2 Department of Radiology, Faculty of Medicine, Ain-Shams, University, Giza, Egypt.
Acta Radiol. 2018 Jun;59(6):700-708. doi: 10.1177/0284185117732100. Epub 2017 Sep 14.
Background Soft-tissue chondroma (STC) is a rare benign soft tissue tumor that arises primarily in acral extra-skeletal locations. Occasionally, STCs may arise in more proximal non-acral locations, accompanied by non-classic features that label them as indeterminate lesions and pose diagnostic challenge for both radiologists and pathologists alike. Purpose To explicate the potential of diagnostic imaging in the identification and characterization of appendicular non-acral STCs with emphasis on their morphologic magnetic resonance imaging (MRI) enhancement. Material and Methods Our clinical database records were searched for patients with histologically proven primary soft-tissue chondroid lesions over a five-year period. Two musculoskeletal (MSK) trained radiologists evaluated the imaging studies and an MSK pathologist revised the pathological findings. Results The study included six cases of appendicular non-acral STCs (mean age = 40.5 years). The mean size of the tumors was 5.6 cm, with four localized to the knee region, one in the thigh, and one in the sternoclavicular region. All cases showed high signal intensity matrix with low-signal intensity septa on T2-weighted MRI and post-contrast marginal/septal enhancement. The lesions were lobulated and lacked host tissue reaction except for one showing subjacent mild soft-tissue edema. Histologically, the cases lacked overt features of malignancy although one was originally misdiagnosed as chondrosarcoma. Conclusion Non-acral STCs are benign cartilaginous tumors that may pose a diagnostic challenge, both radiologically and pathologically. Collaborative imaging and pathologic workup is needed for better characterization of non-aggression of these lesions, and to avoid diagnostic pitfalls and unnecessary radical resections.
背景 软组织软骨瘤（STC）是一种罕见的良性软组织肿瘤，主要发生于肢体远端的骨骼外部位。偶尔，STC也可能出现在更近端的非肢体远端部位，伴有一些非典型特征，使其被归类为不确定性病变，给放射科医生和病理科医生都带来了诊断挑战。目的 阐述诊断性影像学在识别和特征化附肢非肢体远端STC中的潜力，重点关注其形态学磁共振成像（MRI）增强表现。材料与方法 在我们的临床数据库记录中搜索五年内组织学确诊的原发性软组织软骨样病变患者。两名接受过肌肉骨骼（MSK）培训的放射科医生评估影像学研究，一名MSK病理科医生复查病理结果。结果 该研究包括6例附肢非肢体远端STC患者（平均年龄 = 40.5岁）。肿瘤平均大小为5.6 cm，其中4例位于膝关节区域，1例位于大腿，1例位于胸锁关节区域。所有病例在T2加权MRI上均显示高信号强度基质和低信号强度间隔，增强后呈边缘/间隔强化。病变呈分叶状，除1例显示下方轻度软组织水肿外，均无宿主组织反应。组织学上，这些病例缺乏明显的恶性特征，尽管有1例最初被误诊为软骨肉瘤。结论 非肢体远端STC是良性软骨肿瘤，在放射学和病理学上都可能构成诊断挑战。需要进行协作性的影像学和病理检查，以更好地表征这些病变的非侵袭性，避免诊断陷阱和不必要的根治性切除。
