PMC6180831_01
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1 weighted pre-contrast axial (a) sagittal (c) and corresponding post-contrast MRI axial (b) and sagittal (d) from May 2003 show a low-signal lesion with extensive destruction and expansion of the bone; following contrast medium, the lesions have an inhomogeneous, multilobulated, peripheral enhancement but also areas of non-enhancement predominate centrally, consistent with the cartilaginous nature of the lesion. This is associated with a soft-tissue mass and an extraosseous component, primarily on the dorsal aspect. Coronal short tau inversion-recovery image (e) from May 2003 shows a lesion of high signal with a thin and irregular septae, which involves the entire shaft of the first metacarpal bone. Axial CT image from May 2003 (f) shows a lytic lesion involving the first metacarpal of the left hand with significant expansion and thinning of the cortex circumferentially; there is a breach in the cortex and some new bone formation on the dorsal aspect. Some soft-tissue swelling on the dorsal aspect of the metacarpal shaft is also seen.
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MR scan (Figure 1) showed extensive destruction with expansion of the shaft of the first metacarpal of the left hand, associated with a soft-tissue mass and an extraosseous component, primarily on the dorsal aspect. The CT scan (Figure 1f) demonstrated a lytic lesion involving virtually the entire shaft of the first metacarpal of the left hand and reaching the subchondral bone plate at both ends.
Chest CT image from June 2003 (a) shows no pathological findings in the anterior part of the middle lobe of the right lung. Chest CT scan from June 2004 (b) of the same location, as in Figure 2a, shows a subpleural, spiculated nodule (arrow) in the anterior part of the right lung middle lobe. The chest radiograph from August 2006 (c) shows multiple lung metastases from chondrosarcoma.
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There was no evidence of pulmonary metastases on the CT scan (Figure 2a) at initial diagnosis. In June 2004, a CT scan of the chest was performed and a solitary tiny nodule in the right middle lobe (Figure 2b), which was suspicious for lung metastasis, was seen. In January 2005, she received palliative chemotherapy, but even after three cycles, the pulmonary lesions continued to increase in size and number (Figure 2c) and it was decided to discontinue further treatment.
Anteroposterior radiographs of the specimen after ray amputation that show an expansile lytic lesion occupying most of the metacarpal and reaching the subchondral bone plate at both ends without joint involvement. Periosteal reaction and cortical destruction is noted.
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Microscopic examination of the sections (Figure 3) confirmed a grade II chondrosarcoma, which showed an extensive permeative growth beyond the cortical bone.
Gradient echo axial MRI from May 2004, above (a), at the level of (b) and below (c) the subcutaneous lesion in the proximal upper arm. The lesion (arrow) is well defined, demonstrates high signal and is closely related to the cephalic vein (arrow heads). T
1 weighted axial spin-echo pre-contrast (d) and post-contrast T
1 fat-saturated coronal (e) MRI from 2004 reveal a well-defined subcutaneous nodule that is of intermediate low signal on T
1 weighted pre-contrast images and after intravenous gadolinium administration shows peripheral rim enhancement.
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An MRI scan demonstrated a subcutaneous lesion (Figure 4) on the medial aspect above the elbow with signal characteristics similar to the previous chondrosarcoma in the ipsilateral hand.