PMC4900123_01
67-year-old male with clear-cell chondrosarcoma of the humerus. A. Plain radiograph of proximal right humerus demonstrates diffuse sclerosis. Also evident are articular margins, irregularities reconstituted by tumor matrix, ill-defined glenoid, and increase in matrix density in the subcoracoid bursal space. B. Axial CT of proximal humerus at tip of coracoids demonstrates intra-articular bodies and tumor matrix in the medullary canal with disorganized cortical margination and reactive sclerosis. C and D. Comparable axial T1 and T2 with fat saturation at inferior glenoid. Note complete fat marrow replacement and extension of tumor into anteromedial joint recess and expansion of lesser tuberosity. E. Coronal inversion recovery demonstrates diffuse marrow involvement, and tumor involving the articular segment and extending into the metadiaphyseal junction with permeation of the cortices and medial subcoracoid extension into the joint. F. Postgadolinium imaging shows heterogeneous enhancing tumor, replacement of marrow cavity cortices, and periosteal surface with extension along undersurface of the supraspinatus tendon of the rotator cuff and diaphyseal satellite lesions.
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There was also likely involvement of the right shoulder joint and glenoid (Fig. 1A). This showed an extensive chondroid matrix and extraosseous extension of the tumor compatible with intermediate- to high-grade bone tumor, suspicious for chondrosarcoma (Fig. 1B-F).
67-year-old male with clear-cell chondrosarcoma of the humerus. Technetium MDP total body bone scan with notable uptake in primary tumor location in right shoulder, secondary site uptake in mid left femur, and right transverse process of T1 consistent with metastatic disease.
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Further workup with a whole-body bone scan (Fig. 2) identified a worrisome lesion in the right T1 transverse process, and another worrisome lesion in the contralateral left femur (measuring 6 x 8 mm), which was subsequently biopsied under CT guidance and proved to be metastatic clear-cell chondrosarcoma.
67-year-old male with clear-cell chondrosarcoma of the humerus. A. Resection specimen shows epi-metaphyseal-based lesion with cortical invasion. B. Resection specimen shows intra-articular tumor loose bodies (arrows). C. Sheets of clear cells with scattered multinucleated giant cells and bony trabeculae (H&E x200). D. Transition to hyaline cartilage-rich foci (H&E x200).
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The patient underwent extra-articular proximal humerus resection (Figs. 3A-B) and segmental proximal humeral endoprosthetic reconstruction and radiofrequency ablation of the left femoral lesion and transverse process lesions. Histologic examination revealed typical features of clear-cell chondrosarcoma (Figs 3C-D).