Kiefer Ryan M, Wojcik John, Cooper Kumarasen, Weber Kristy L, Sebro Ronnie
1 University of Pennsylvania, Philadelphia, PA, USA.
Int J Surg Pathol. 2018 Dec;26(8):766-771. doi: 10.1177/1066896918776092. Epub 2018 May 18.
Clear cell chondrosarcoma (CCCS) is a rare variant of conventional chondrosarcoma with low-grade malignant features that may be confused radiographically and histologically with chondroblastoma. We report a case of a 50-year-old female who presented with 6 months of left hip pain. Initial radiographs demonstrated an osteolytic lesion with adjacent area of sclerosis in the proximal left femur. Magnetic resonance imaging demonstrated a marrow-infiltrative lesion with periosteal reaction and thickened enhancing periosteum. Biopsy of the sclerotic area demonstrated chondroblastoma-like findings, whereas biopsy of the lytic area showed features suggestive of CCCS. The patient eventually underwent en bloc resection and reconstruction with a proximal femoral megaprosthesis. The final diagnosis was CCCS. We present this unusual case with review of the radiographic and histologic features of CCCS with attention to its ability to mimic chondroblastomas. This case highlights the importance of sampling radiographically heterogeneous areas within a bone lesion to facilitate accurate diagnosis and appropriate management.
透明细胞软骨肉瘤(CCCS)是传统软骨肉瘤的一种罕见变体,具有低度恶性特征,在影像学和组织学上可能与软骨母细胞瘤混淆。我们报告一例50岁女性,她出现左髋部疼痛6个月。最初的X线片显示左股骨近端有一个溶骨性病变,其相邻区域有硬化。磁共振成像显示一个骨髓浸润性病变,伴有骨膜反应和增厚的强化骨膜。硬化区域的活检显示出类似软骨母细胞瘤的表现,而溶骨区域的活检则显示出提示CCCS的特征。患者最终接受了整块切除,并使用股骨近端大型假体进行重建。最终诊断为CCCS。我们展示这个不寻常的病例,并回顾CCCS的影像学和组织学特征,同时关注其模仿软骨母细胞瘤的能力。这个病例强调了对骨病变内影像学异质区域进行采样以促进准确诊断和适当治疗的重要性。