central chondrosarcoma
Introduction
Introduction to central chondrosarcoma Chondrosarcoma refers to the differentiation of cells into cartilage, which is divided into central chondrosarcoma, peripheral chondrosarcoma, and periosteal chondrosarcoma. Chondrosarcoma grows slowly. The disease occurs in the proximal end of the femur, pelvis, humerus, scapula, and tibia. The clinical symptoms are deep pain, not severe, non-sustainable, oppressive nerves, causing severe pain with radiation pain. The treatment was mainly surgical resection, and the cure rate was high. Local recurrence and metastasis could still occur after the primary tumor was resected for more than 10 years. Central chondrosarcoma is a chondrosarcoma that originates in the bone and ranks 4th in the primary malignant bone tumor. It is listed in plasmacytoma, osteosarcoma and Ewing's sarcoma. For the femur (especially the proximal end), the pelvis, the proximal humerus, the scapula, and the proximal humerus. basic knowledge The proportion of illness: 0.005%-0.01% Susceptible people: no specific population Mode of infection: non-infectious Complications: fracture
Cause
Central chondrosarcoma etiology
Cause:
Central chondrosarcoma is a chondrosarcoma that originates in the bone and ranks 4th in the primary malignant bone tumor. It is listed in plasmacytoma, osteosarcoma and Ewing's sarcoma. For the femur (especially the proximal end), the pelvis, the proximal humerus, the scapula, and the proximal humerus.
Prevention
Central chondrosarcoma prevention
Grade I central chondrosarcoma usually does not metastasize. If the surgical resection is not extensive enough, the tumor may recur locally. If the grade I central chondrosarcoma invades the visceral cavity or spinal canal, it may cause death. Although the course is slow, the histological performance is not obvious. The vicious features.
Grade II central chondrosarcoma can metastasize early, and there is a high possibility of local recurrence after surgery. If the surgical treatment is timely and sufficient, the cure rate is about 60%.
Grade III central chondrosarcoma has a poor prognosis with a survival rate of approximately 40%.
The prognosis of central chondrosarcoma depends essentially on two factors: the histologic malignancy and the correct surgical plan (wide or radical resection, no contamination).
Complication
Central chondrosarcoma complications Complications
The disease is a malignant disease. Clinically, a series of complications are often caused by the destruction of adjacent tissues. The most common is the destruction of bone tissue, which can cause loosening of the cortex. Therefore, the disorder of the trabecular bone causes the hardness of the bone to decrease, the fragility increases, and even directly leads to spontaneous Pathological fracture. The disease can also be transferred to other major tissues and organs to cause secondary tumors.
Symptom
Central chondrosarcoma symptoms common symptoms bone pain, long bone swelling, pain, extramedullary mass, central calcification, erosion, bone destruction
There are obvious areas of good hair, followed by the femur (especially the proximal end), the pelvis, the proximal humerus, the scapula, the proximal humerus, the other parts of the trunk with soft torso, the humerus, the ulna, the foot and the hand (chondroma Common in the hand, rare in the trunk bone), the central chondrosarcoma in the long bone usually originates from one end of the backbone or the metaphysis. Since the patient is generally an adult whose growth cartilage has disappeared, the tumor often invades the ankle and sometimes invades the joint. Central chondrosarcoma originating in the middle of the backbone is rare. At the time of diagnosis, the tumor may have invaded 1/3, 1/2 or more of the entire long bone; the central chondrosarcoma of the pelvis occurs in the area around the acetabulum ( The humerus, ischial or pubic bone; the central chondrosarcoma of the scapula occurs in the condyle-joint area, and the central chondrosarcoma of the pelvis and scapula can also invade most of the bone.
Symptoms are mild and slow to develop, with a long history, sometimes manifested as a "chondroma-like" tumor that recurs after local surgery. The main symptoms are deep pain, not severe, non-sustainable, because the tumor has not expanded into soft tissue, often cannot be touched. Extra-bone mass, with only slight bone enlargement; large spherical extra-bone mass can be formed during the progression of the tumor.
Examine
Central chondrosarcoma examination
X-ray findings: for osteolytic lesions in the bone, there may be calcium salt deposition, most of the tumors grow slowly, a few grow rapidly, in the -dry metaphysis, the tumor is eccentric; in the backbone, it is located in the center of the backbone .
Central chondrosarcoma can be characterized by blurred border osteolysis, with or without cortical bone disruption. Because cartilage tends to be calcified and ossified, X-ray areas can appear in the tumor, and calcification often occurs around the cartilage lobules. Structure characterized by irregular hazy particles, nodules or X-ray opaque rings.
Due to the tumor wall epiphysis, the tumor can produce a bubble-like or breadcrumb-like appearance, such as calcification dense, the tumor can be X-ray-imposing metal, such as when the tumor infiltrates into the medullary canal of the cancellous bone without destroying the trabecular bone. Calcium deposition and reactive bone hyperplasia may be uniform in sponge X-ray. If the tumor infiltrates the cancellous bone without destroying the trabecular bone and there is no calcification, the tumor part of the bone may not be developed. In this case, The diagnosis of central chondrosarcoma is difficult and late without bone scan, CT and MRI.
Well-differentiated central chondrosarcoma is more calcified, while grade III central chondrosarcoma and dedifferentiated central chondrosarcoma have less calcification and more mucus areas.
Cortical bone can be very thin, scalloped inside, interrupted in some areas, sometimes due to slow tumor expansion, cortical bone hyperplasia, can appear thickening, this thickened cortical bone is quite typical, indicating that it has been tumor Infiltrated.
Central chondrosarcoma tends to dilate to less resistant areas, such as the medullary cavity of the backbone. In almost half of the cases, radiographic imaging shows that the tumor invades 1/3, 1/2 or more of the entire long bone, but in the early stages of the tumor. There may be no display on the image. This feature is very important. Otherwise, the surgical plan may be inappropriate. The resection edge may not be enough. The tumor may recur after the bone resection or amputation. In order to avoid this, a bone scan must be performed before surgery. CT and MRI were used to determine the extent of the tumor within the medullary cavity.
In aggressive cases, central chondrosarcoma can have extensive cortical disruption in the early stage, large soft tissue masses, calcification of tumor mass invading soft tissues is not obvious, and the periosteum that is infiltrated by the infiltration can be reactively produced. The thin, slightly opaque X-ray band is perpendicular to the cortex, but there is never a typical "toothbrush" image in the osteosarcoma and the Codman triangle.
Diagnosis
Diagnosis and diagnosis of central chondrosarcoma
diagnosis
When diagnosing central chondrosarcoma, clinical and imaging data are more important than other tumors. Cartilage tumors with the same histological findings can be benign or malignant. They must refer to age, location, symptoms, imaging, bone scan, Features such as CT.
Preoperative diagnosis of central chondrosarcoma is often easy, but differential diagnosis involves a large number of tumors and tumor-like lesions. First, central chondrosarcoma must be differentiated from chondromas, especially grade I central chondrosarcoma, borderline malignant chondrosarcoma. Distinguish, chondroma occurs in children and stops growing in adulthood. It can be changed for many years. Unless pathological fracture occurs, chondroma is painless, usually medium in size, cortical bone is not scalloped, and cortical bone is uninterrupted. There is no soft tissue swelling. In short, except for the small tubular bone located in the hands and feet, the chondroma often maintains the cortical bone integrity. Since the cartilage tumor of the hand is almost always benign, the diagnosis of central chondrosarcoma at this site must be cautious. It can only be diagnosed when clinical, imaging, and histology show clear malignancy. Conversely, cartilage tumors located in the trunk bone are often malignant. Unless other lesions have been proven, cartilage tumors at these sites should be considered central cartilage. In the diagnosis of sarcoma, extensive resection is performed in suspicious cases.
In multiple chondromas and chondromatosis, chondromas can grow to a considerable extent and continue to grow in adulthood, characterized by hyperactive histological manifestations, which are quite likely due to their conversion to central chondrosarcoma. Therefore, in adulthood, when the symptoms and imaging of chondromatosis are changed, the possibility of central chondrosarcoma should be suspected. A biopsy should be performed immediately to confirm the diagnosis.
Typical (chondrocyte type) osteosarcoma occurs in childhood, and central chondrosarcoma rarely exists before puberty. Even in adults, the images and gross pathology of these two tumors are different, but the main difference is the difference in histology. In osteosarcoma, even if the tumor cells are mainly chondroblasts, it is certain that osteogenic differentiation and tumor cells directly produce bone-like substances, and the malignancy (class IV) of chondrocytes in osteosarcoma is higher than that of central chondrosarcoma. However, in some rare cases, it is difficult or even impossible to make a differential diagnosis by limited biopsy specimens. In this case, it is best to repeat the biopsy before deciding whether to administer chemotherapy. The specimens should be more and more specific.
Differential diagnosis
The gross pathology of chondral mucinous fibroma can be the same as that of central chondrosarcoma. Histologically, the central-lobular cells of chondroma fibroma can be misdiagnosed as grade I or II central chondrosarcoma, but chondral mucinous sarcoma. Infancy occurs, images and typical histological features are available for differential diagnosis.
