PMC7453529_01
Serial imaging of the patient with pelvic chondrosarcoma. Baseline Radiograph of 2014 a showed permeative lytic destruction of left ischium with associated soft tissue component showing chondroid pattern of matrix mineralization. Corroborative MRI b showed similar findings with hyperintense mass (Asterisk) displacing the pelvic structures, not extending to hip joint. In December 2016, patient developed lung and bone metastases (arrow in c, d) after which patient was put on Trabectedin. These lesions remained stable on Trabectedin till December 2017 (e, f). CT images of January 2018 showed progression in form of appearance of new lesions in lung and bone (arrows in g, h). The disease progressed further with appearance of new lung lesions in August 2018 (arrow in i) and at local site in October 2018 (arrow in j)
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Fig1
He was evaluated elsewhere where MRI pelvis was suggestive of a soft tissue lesion in left pubic bone involving the body, superior and inferior rami, extending into ischiopubic rami, ischial tuberosity and sub-articular margin of anterior pillar of acetabulum with dimension 10 x 6.5 x 10.3 cm consistent with chondrosarcoma in view of chondroid pattern of matrix mineralization (Fig. 1a, b). On improvement of his condition, he was given liposomal doxorubicin however post four cycles, imaging showed progression in the pulmonary and bone metastases (Fig. 1c, d). The disease showed stable disease radiologically (Fig. 1e, f) on interim assessments and he went on to receive 13 cycles of trabectedin. PFS of 12 months, he progressed with both local and distant disease showing pulmonary and vertebral metastatic disease (Fig. 1g, h). Pazopanib was given for 6 months but there was progression in form of appearance of new lung lesions in August 2018 (Fig. 1j) followed by change of therapy to liposomal doxorubicin and ifosfamide. However, the patient progressed while on treatment (Fig. 1i, j) and shifted to best supportive care from October 2018.