Advertisement

Archives of Orthopaedic and Trauma Surgery

, Volume 129, Issue 2, pp 161–166 | Cite as

Dedifferentiated chondrosarcoma of the thumb: a case report

  • Basak DoganavsargilEmail author
  • Mehmet Argin
  • Murat Sezak
  • Dundar Sabah
  • Banu Sarsik
  • Ozgur Omur
  • Fikri Oztop
Orthopaedic Surgery

Abstract

Dedifferentiated chondrosarcoma (DDCS) comprises approximately 10% of all chondrosarcomas and has the worst outcome with 5-year survival of 10%. The preferred localizations are femur, humerus and pelvis. We report a case of DDCS that arose in proximal phalanx of left-hand thumb of a 66-year-old man. He was admitted with a 2-month history of pain and swelling in his thumb. He had experienced a fracture 15 years ago in the same localization with a history of suspected preexisting enchondroma. Plain radiographs showed an expansive osteolytic lesion with milimetric calcifications while magnetic resonance imaging revealed intraosseous focal globular hyperintense spots consistent with chondroid areas as well as a surrounding soft tissue mass with intermediate signal intensity. In biopsy specimen we observed a low-grade chondrosarcoma next to a spindle cell sarcoma with an abrupt transition. He was treated with amputation and died of the disease within 9 months following the surgery. The presence of dedifferented chondrosarcoma in bones of hands was not previously reported. The presented case was provided with the macroscopic and microscopic features observed in amputation specimen in comparison with radiological findings.

Keywords

Dedifferentiated chondrosarcoma MRI Scintigraphy Histology Outcome Hand 

Notes

Acknowledgments

The authors would like thank Prof. Dr. Gulsen Kandiloglu from Ege University Faculty of Medicine, Department of Pathology for her contribution to the case.

References

  1. 1.
    Aigner T, Dertinger S, Neureiter D, Kirchner T (1998) De-differentiated chondrosarcoma is not a ‘de-differentiated’ chondrosarcoma. Histopathology 33:11–19PubMedCrossRefGoogle Scholar
  2. 2.
    Aigner T, Unni KK (1999) Is dedifferentiated chondrosarcoma a ‘de-differentiated’ chondrosarcoma? J Pathol 189:445–447PubMedCrossRefGoogle Scholar
  3. 3.
    Aigner T (2002) Towards a new understanding and classification of chondrogenic neoplasias of the skeleton—biochemistry and cell biology of chondrosarcoma and its variants. Virchows Arch 441:219–230PubMedCrossRefGoogle Scholar
  4. 4.
    Bovee JV, van der Heul RO, Taminiau AH, Hogendoorn PC (1999) Chondrosarcoma of the phalanx: a locally aggressive lesion with minimal metastatic potential: a report of 35 cases and a review of the literature. Cancer 86:1724–1732PubMedCrossRefGoogle Scholar
  5. 5.
    Bovee JV, Cleton-Jansen AM, Rosenberg C, Taminiau AH, Cornelisse CJ, Hogendoorn PC (1999) Molecular genetic characterization of both components of a dedifferentiated chondrosarcoma, with implications for its histogenesis. J Pathol 189(4):454–462PubMedCrossRefGoogle Scholar
  6. 6.
    Bruns J, Fiedler W, Werner M, Delling G (2005) Dedifferentiated chondrosarcoma—a fatal disease. J Cancer Res Clin Oncol 131:333–339PubMedCrossRefGoogle Scholar
  7. 7.
    Culver JE Jr, Sweet DE, McCue FC (1975) Chondrosarcoma of the hand arising from a pre-existent benign solitary enchondroma. Clin Orthop Relat Res 113:128–131PubMedCrossRefGoogle Scholar
  8. 8.
    Dahlin DC, Beabout JW (1971) Dedifferentiation of low-grade chondrosarcomas. Cancer 28:461–466PubMedCrossRefGoogle Scholar
  9. 9.
    Donati D, Yin JQ, Colangeli M, Colangeli S, Bella CD, Bacchini P, Bertoni F (2007) Clear cell chondrosarcoma of bone: long time follow-up of 18 cases. Arch Orthop Trauma Surg May 24; [Epub ahead of print]Google Scholar
  10. 10.
    Exner GU, Dumont CE, Malinin TI, von Hochstetter AR (2003) Recurrent aggressive chondrosarcoma of the middle phalanx of the index finger: excision and reconstruction with an osteocartilaginous allograft. Arch Orthop Trauma Surg 123:425–428PubMedCrossRefGoogle Scholar
  11. 11.
    Fechner RE, Mills SE (1993) Tumors of the bones and joints. Armed Forces Institute of Pathology, BethesdaGoogle Scholar
  12. 12.
    Frassica FJ, Unni KK, Beabout JW, Sim FH (1986) Dedifferentiated chondrosarcoma. A report of the clinicopathological features and treatment of seventy-eight cases. J Bone Joint Surg 68:1197–1205PubMedGoogle Scholar
  13. 13.
    Goto T, Motoi T, Komiya K, Motoi N, Okuma T, Okazaki H, Takatori Y, Tange T, Nakamura K (2003) Chondrosarcoma of the hand secondary to multiple enchondromatosis; report of two cases. Arch Orthop Trauma Surg 123:42–47PubMedGoogle Scholar
  14. 14.
    Grimer RJ, Gosheger G, Taminiau A, Biau D, Matejovsky Z, Kollender Y, San-Julian M, Gherlinzoni F, Ferrari C (2007) Dedifferentiated chondrosarcoma: prognostic factors and outcome from a European group. Eur J Cancer 43:2060–2065PubMedCrossRefGoogle Scholar
  15. 15.
    Littrell LA, Wenger DE, Wold LE, Bertoni F, Unni KK, White LM, Kandel R, Sundaram M (2004) Radiographic, CT, and MR imaging features of dedifferentiated chondrosarcomas: a retrospective review of 174 de novo cases. Radiographics 24:1397–1409PubMedCrossRefGoogle Scholar
  16. 16.
    MacSweeney F, Darby A, Saifuddin A (2003) Dedifferentiated chondrosarcoma of the appendicular skeleton: MRI-pathological correlation. Skeletal Radiol 32:671–678PubMedCrossRefGoogle Scholar
  17. 17.
    Miyake A, Morioka H, Yabe H, Anazawa U, Morii T, Miura K, Mukai M, Takayama S, Toyama Y (2006) A case of metacarpal chondrosarcoma of the thumb. Arch Orthop Trauma Surg 126:406–410PubMedCrossRefGoogle Scholar
  18. 18.
    Murphey MD, Walker EA, Wilson AJ, Kransdorf MJ, Temple HT, Gannon FH (2003) From the archives of the AFIP: imaging of primary hondrosarcoma:radiologic-pathologic correlation. Radiographics 23:1245–1278PubMedCrossRefGoogle Scholar
  19. 19.
    Müller PE, Dürr HR, Nerlich A, Pellengahr C, Maier M, Jansson V (2004) Malignant transformation of a benign enchondroma of the hand to secondary chondrosarcoma with isolated pulmonary metastasis. Acta Chir Belg 104:341–344PubMedGoogle Scholar
  20. 20.
    Patil S, de Silva MV, Crossan J, Reid R (2003) Chondrosarcoma of small bones of the hand. J Hand Surg [Br] 28:602–608Google Scholar
  21. 21.
    Peiper M, Zornig (1997) Chondrosarcoma of the thumb arising from a solitary enchondroma. Arch Orthop Trauma Surg 116:246–248PubMedCrossRefGoogle Scholar
  22. 22.
    Ropke M, Boltze C, Neumann HW, Roessner A, Schneider-Stock R (2003) Genetic and epigenetic alterations in tumor progression in a dedifferentiated chondrosarcoma. Pathol Res Pract 199:437–444PubMedCrossRefGoogle Scholar
  23. 23.
    Rywlin AM, Robb JA (1982) Chondrosarcoma of bone with ‘dedifferentiation’. Hum Pathol 13:963–964PubMedCrossRefGoogle Scholar
  24. 24.
    Saifuddin A, Mann BS, Mahroof S, Pringle JA, Briggs TW, Cannon SR (2004) Dedifferentiated chondrosarcoma: use of MRI to guide needle biopsy. Clin Radiol 59:268–272PubMedCrossRefGoogle Scholar
  25. 25.
    Sanerkin NG, Woods CG (1979) Fibrosarcomata and malignant fibrous histiocytomata arising in relation to enchondromata. J Bone Joint Surg Br 61:366–372PubMedGoogle Scholar
  26. 26.
    Schauer H, Fiedler B, Walker B, Müller C (2006) Secondary malignant transformation of an enchondroma of the hand. Handchir Mikrochir Plast Chir 38:188–193PubMedCrossRefGoogle Scholar
  27. 27.
    Sopta J, Dordevic A, Tulic G, Mijucic V (2007) Dedifferentiated chondrosarcoma: our clinico-pathological experience and dilemmas in 25 cases. J Cancer Res Clin Oncol [Epub ahead of print]Google Scholar
  28. 28.
    Staals EL, Bacchini P, Bertoni F (2006) Dedifferentiated central chondrosarcoma. Cancer 106:2682–2691PubMedCrossRefGoogle Scholar
  29. 29.
    Tetu B, Ordonez NG, Ayala AG, Mackay B (1986) Chondrosarcoma with additional mesenchymal component (dedifferentiated chondrosarcoma) II. An immunohistochemical and electron microscopic study. Cancer 58:287–298PubMedCrossRefGoogle Scholar
  30. 30.
    Unni KK (1996) Dahlin’s bone tumors: general aspects and data on 11,087 cases, 5th edn. Lippincott-Raven Publishers, Philadelphia, pp 71–108Google Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Basak Doganavsargil
    • 1
    Email author
  • Mehmet Argin
    • 2
  • Murat Sezak
    • 1
  • Dundar Sabah
    • 3
  • Banu Sarsik
    • 1
  • Ozgur Omur
    • 4
  • Fikri Oztop
    • 1
  1. 1.Department of PathologyEge University Faculty of MedicineBornova, IzmirTurkey
  2. 2.Department of RadiodiagnosticsEge University Faculty of MedicineIzmirTurkey
  3. 3.Department of OrthopedicsEge University Faculty of MedicineIzmirTurkey
  4. 4.Department of Nuclear MedicineEge University Faculty of MedicineIzmirTurkey

Personalised recommendations