To describe imaging and clinical features of primary mesenchymal chondrosarcoma (MCS) and evaluate for presence of a distinct biphasic pattern on imaging.
Material and methods
Patients with a pathologic diagnosis of MCS were identified along with imaging of their primary tumor. Size, location, appearance (lytic, sclerotic, or mixed), presence, extent and distribution of calcifications, cortical destruction, soft tissue extension, periosteal reaction, contrast enhancement, and radiotracer uptake were recorded. The presence of T2-hyperintense tumor lobules on MRI and a biphasic morphology (distinct calcified and non-calcified components) on CT were assessed. Presence and location of metastases were documented.
Twenty-three patients (mean age 28.0 ± 13.8 years) were reviewed (13 skeletal, 10 extraskeletal). Overall mean tumor size was 10.2 ± 7.2 cm, 7.1 ± 7.3 cm in non-metastatic and 13.2 ± 5.9 cm (p = 0.004) in metastatic cases. Locations were extremities (n = 11), head/neck (n = 4), chest wall (n = 4), pelvis (n = 3), and retroperitoneum (n = 1). Skeletal MCS were aggressive mixed lytic and sclerotic (n = 8), purely lytic (n = 4), or juxtacortical (n = 1) lesions with cortical destruction and soft tissue extension. Chondroid calcifications were common (80%). On MRI, the presence of T2-hyperintense lobules was seen in 35%. A biphasic morphology on imaging was seen in 30%. Metastases were common (52%) with the most common site being the lungs (75%). All tumors were hypermetabolic with a mean SUVmax of 14.3 (5.6–34) on PET/CT.
Skeletal MCS commonly present as aggressive lytic bone lesions with chondroid calcifications. A biphasic morphology was seen in one-third of cases. Metastases were common at initial presentation and more commonly seen with larger tumors.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Lichtenstein L, Bernstein D. Unusual benign and malignant chondroid tumors of bone. A survey of some mesenchymal cartilage tumors and malignant chondroblastic tumors, including a few multicentric ones, as well as many atypical benign chondroblastomas and chondromyxoid fibromas. Cancer. 1959;12(6):1142–57.
Bertoni F, Picci P, Bacchini P, Capanna R, Innao V, Bacci G, et al. Mesenchymal chondrosarcoma of bone and soft tissues. Cancer. 1983;52(3):533–41.
Nakashima Y, Unni KK, Shives TC, Swee RG, Dahlin DC. Mesenchymal chondrosarcoma of bone and soft tissue. A review of 111 cases. Cancer. 1986;57(12):2444–53.
Cesari M, Bertoni F, Bacchini P, Mercuri M, Palmerini E, Ferrari S. Mesenchymal chondrosarcoma. An analysis of patients treated at a single institution. Tumori. 2007;93(5):423–7.
Schneiderman BA, Kliethermes SA, Nystrom LM. Survival in mesenchymal chondrosarcoma varies based on age and tumor location: a survival analysis of the SEER database. Clin Orthop Relat Res. 2017;475(3):799–805.
Hameed M. Small round cell tumors of bone. Arch Pathol Lab Med. 2007;131(2):192–204.
Wang L, Motoi T, Khanin R, Olshen A, Mertens F, Bridge J, et al. Identification of a novel, recurrent HEY1-NCOA2 fusion in mesenchymal chondrosarcoma based on a genome-wide screen of exon-level expression data. Genes Chromosom Cancer. 2012;51(2):127–39.
Nakayama R, Miura Y, Ogino J, Susa M, Watanabe I, Horiuchi K, et al. Detection of HEY1-NCOA2 fusion by fluorescence in-situ hybridization in formalin-fixed paraffin-embedded tissues as a possible diagnostic tool for mesenchymal chondrosarcoma. Pathol Int. 2012;62(12):823–6.
Huvos AG, Rosen G, Dabska M, Marcove RC. Mesenchymal chondrosarcoma a clinicopathologic analysis of 35 patients with emphasis on treatment. Cancer. 1983;51(7):1230–7.
Dobin SM, Donner LR, Speights VO Jr. Mesenchymal chondrosarcoma. A cytogenetic, immunohistochemical and ultrastructural study. Cancer Genet Cytogenet. 1995;83(1):56–60.
Shakked RJ, Geller DS, Gorlick R, Dorfman HD. Mesenchymal chondrosarcoma: clinicopathologic study of 20 cases. Archives of Pathology & Laboratory Medicine. 2012;136(1):61–75.
Bishop MW, Somerville JM, Bahrami A, Kaste SC, Interiano RB, Wu J, et al. Mesenchymal Chondrosarcoma in children and young adults: a single institution retrospective review. Sarcoma. 2015;2015:608279.
Chen S, Wang Y, Su G, Chen B, Lin D. Primary intraspinal dumbbell-shaped mesenchymal chondrosarcoma with massive calcifications: a case report and review of the literature. World J Surg Oncol. 2016;14(1):203.
Kumar M, Suresh K, Patil M, Pramod R, Yusuf R, Bilahari N. Mesenchymal chondrosarcoma of posterior maxilla: report of a case with brief literature review. Ann Med Health Sci Res. 2014;4(Suppl 1):S49–52.
Singh P, Singh A, Saxena S, Singh S. Mesenchymal chondrosarcoma of mandible: a rare case report and review. J Oral Maxillofac Pathol. 2014;18(Suppl 1):S167–70.
Taori K, Patil P, Attarde V, Chandanshive S, Rangankar V, Rewatkar N. Primary retroperitoneal extraskeletal mesenchymal chondrosarcoma: a computed tomography diagnosis. Br J Radiol. 2007;80(959):e268–70.
White DW, Ly JQ, Beall DP, McMillan MD, McDermott JH. Extraskeletal mesenchymal chondrosarcoma: case report. Clin Imaging. 2003;27(3):187–90.
Dantonello TM, Int-Veen C, Leuschner I, Schuck A, Furtwaengler R, Claviez A, et al. Mesenchymal chondrosarcoma of soft tissues and bone in children, adolescents, and young adults: experiences of the CWS and COSS study groups. Cancer. 2008;112(11):2424–31.
Hashimoto N, Ueda T, Joyama S, Araki N, Beppu Y, Tatezaki S, et al. Extraskeletal mesenchymal chondrosarcoma: an imaging review of ten new patients. Skelet Radiol. 2005;34(12):785–92.
Lee AF, Hayes MM, LeBrun D, Espinosa I, Nielsen GP, Rosenberg AE, et al. FLI-1 distinguishes Ewing sarcoma from small cell osteosarcoma and mesenchymal chondrosarcoma. Appl Immunohistochem Mol Morphol. 2011;19(3):233–8.
Shapeero LG, Vanel D, Couanet D, Contesso G, Ackerman LV. Extraskeletal mesenchymal chondrosarcoma. Radiology. 1993;186(3):819–26.
Salvador AH, Beabout JW, Dahlin DC. Mesenchymal chondrosarcoma—observations on 30 new cases. Cancer. 1971;28(3):605–15.
Murphey MD, Walker EA, Wilson AJ, Kransdorf MJ, Temple HT, Gannon FH. From the archives of the AFIP. RadioGraphics. 2003;23(5):1245–78.
Tsuchiya M, Masui T, Otsuki Y, Sakahara H. 18F-FDG PET/CT findings of mesenchymal chondrosarcoma of the orbit. Clin Nucl Med. 2018;43(2):e43–5.
Lee E, Lee HY, Choe G, Kim KJ, Lee WW, Kim SE. Extraskeletal intraspinal mesenchymal chondrosarcoma; 18F-FDG PET/CT finding. Clin Nucl Med. 2014;39(1):e64–6.
Uppaluri SA, Yin LH, Goh GH. Maxillary mesenchymal chondrosarcoma presenting with epistaxis in a child. J Radiol Case Rep. 2015;9(8):33–8.
Feldman F, Heertum RV, Saxena C, Parisien M. 18FDG-PET applications for cartilage neoplasms. Skelet Radiol. 2005;34(7):367–74.
Yamamoto H, Watanabe K, Nagata M, Honda I, Watanabe S, Soda H, et al. Surgical treatment for pancreatic metastasis from soft-tissue sarcoma: report of two cases. Am J Clin Oncol. 2001;24(2):198–200.
Tsukamoto S, Honoki K, Kido A, Fujii H, Enomoto Y, Ohbayashi C, et al. Chemotherapy improved prognosis of mesenchymal chondrosarcoma with rare metastasis to the pancreas. Case Reports in Oncological Medicine. 2014;2014:249757.
Paasch C, De Santo G, Boettge KR, Strik MW. Mesenchymal chondrosarcoma metastasising to the pancreas. BMJ Case Reports. 2018;11(1):e226369.
Chatzipantelis P, Karvouni E, Fragoulidis GP, Voros D, Pafiti A. Clinicopathologic features of two rare cases of mesenchymal metastatic tumors in the pancreas: review of the literature. Pancreas. 2006;33(3):301–3.
Huang H-Y, Hsieh M-J, Chen W-J, Ko S-F, Yang B-Y, Huang S-C. Primary mesenchymal chondrosarcoma of the lung. Ann Thorac Surg. 2002;73(6):1960–2.
Hsing CT, Oh SY, Lee S, Kwon HC, Kim SH, Park TH, et al. Extraskeletal mesenchymal chondrosarcoma of the heart responded to systemic chemotherapy: a case report. Cancer Res Treat. 2007;39(3):131–3.
Salehipour M, Hosseinzadeh M, Sisakhti AM, Parvin VAM, Sadraei A, Adib A. Renal extra skeletal mesenchymal chondrosarcoma: a case report. Urology Case Reports. 2017;12:23–5.
Gherman V, Tomuleasa C, Bungardean C, Crisan N, Ona V-D, Feciche B, et al. Management of renal extraskeletal mesenchymal chondrosarcoma. BMC Surg. 2014;14(1):107.
The authors would like to thank Joanne Chin for her editorial support on this manuscript.
This study was supported in part through the National Institutes of Health/National Cancer Institute Cancer Center Support Grant P30 CA008748.
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.
The requirement for informed consent was waived for this study.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Ghafoor, S., Hameed, M.R., Tap, W.D. et al. Mesenchymal chondrosarcoma: imaging features and clinical findings. Skeletal Radiol 50, 333–341 (2021). https://doi.org/10.1007/s00256-020-03558-x
- Mesenchymal chondrosarcoma
- Magnetic resonance imaging
- Computed tomography
- Biphasic morphology