Chondrosarcoma of the Appendicular Skeleton

Abstract

Chondrosarcoma is the second most common primary malignancy of bone next to osteosarcoma but shares very few features in common with its osteogenic counterpart. It can occur as a primary lesion de novo or arise from a preexisting benign cartilage lesion. Conventional chondrosarcoma classically arises from the medullary cavity and will grow outward. It is a tumor of adult patient populations, characterized by the production of hyaline cartilage by malignant chondrocytes. However, the highest grades of chondrosarcoma may produce very little cartilage matrix at all. This breadth in tumor grades leads to clinical presentations that vary in symptomatology, radiographic and clinical findings, and biologic aggression making patient management across the continuum of chondrosarcoma challenging. Chondrosarcoma is generally considered a surgical disease because it is resistant to both chemotherapy and radiation, although rare histologies and inoperable sites will still be treated with these modalities. Notable controversies persist in the surgical treatment of low-grade chondrosarcoma, in the feasibility of limb salvage in the setting of pathologic fracture, and in the management of chondrosarcoma of the hands and feet.