This document discusses chondrosarcoma, a type of bone cancer. It is a malignant tumor originating from cartilage that makes up 9% of primary bone cancers. The document covers the classification, most common sites in the body, clinical features, diagnosis using imaging like CT and MRI, histological examination, treatment including wide resection or amputation, and prognosis which depends on grade and size of the tumor. Chondrosarcoma can be primary, arising directly in bone, or secondary from pre-existing benign cartilage lesions. Low-grade lesions have over 90% 10-year survival while high-grade have 20-40% 10-year survival.

1. Moderator :Director & HOD
PROF.DR.K.PRAKASAM M.S.Ortho,D.Ortho,DSC (HON)
PRESENTOR:DR.THOUSEEF.A.MAJEED
M S Ortho PG
VMKVMCH Salem
CHONDROsARCOMA

2. • It is a malignant bone tumour of cartilageneous
origin

3. • 9% of all primary malignancies of bone
• Primary chondrosarcoma - Between 40 and 60 years
• Secondary chondrosarcoma-Between 25 and 45
years

4. Classification
• PRIMARY CHONDROSARCOMA
• SECONDARY CHONDROSARCOMA

5. PRIMARY CHONDROSARCOMA
• Central (medullary)
• Intra cortical
• Clear cell
• Mesenchymal
• Dedifferentiated

6. SECONDARY CHONDROSARCOMA (from
pre existing lesions)
• Multiple enchondromas & Exostosis
• Chondroblastoma
• Irradiation induced
• Fibrous dysplasia

7. Location
Types according to the site
• CENTRAL
• PERIPHERAL (surface type)

8. COMMON SITES
• Pelvis
• Proximal femur
• Proximal humerus.
• Ribs
• Rarely occur in the hand
• Incidence is higher among males

9. CLINICAL FEATURES
• A palpable mass with
increasing pain
• Hard in consistency with
lobulated surface
• Continuous with the bone
• slow growing .
• Mechanical restriction of joint
movements.

10. Secondary chondrosarcomas
• Arise at the site of a pre-existing benign cartilage
lesion.
• Most frequently in the enchondromas and
multiple hereditary exostoses.

11. INCIDENCE –
• 5% for patients with multiple hereditary exostoses
• Approximately 1% for patients with solitary
osteochondromas

12. RADIOLOGY
• It is arising in the medullary
cavity with irregular matrix
calcification.
• Calcification is a specific sign
• Gives a “punctate,”
“popcorn,” or “comma-
shaped.” calcification

14. • The size of the cartilaginous cap of an
osteochondroma, is to be evaluated with
Computerised Tomography (CT-Scan) or Magnetic
resonance imaging (MRI).
• It is important in evaluating the possibility of a
secondary chondrosarcoma.

15. HISTOLOGY

16. CONVENTIONAL CHONDROSARCOMA
• Composed of malignant cells
with abundant cartilaginous
matrix.
• If malignant osteoid is present
 the diagnosis should be
chondroblastic osteosarcoma

17. Diagnosing Factors that favor the malignant
transformation
• Hypercellularity
• Plump nuclei
• More than occasional binucleate cells
• Entrapment of bony trabeculae.

18. Histological subtypes
• Clear cell chondrosarcoma
• Mesenchymal chondrosarcoma
• Dedifferentiated chondrosarcoma

19. Clear cell chondrosarcoma
• Low-grade malignancy.
• Round cells with abundant
clear cytoplasm
• Distinct cytoplasmic
borders with a background
of cartilaginous matrix.
• Multinucleated giant cells
are usually apparent.

20. • Clear cell Chondrosarcoma has a strong tendency to
arise in an epiphysis
• Benign radiographic features and can be confused with
chondroblastoma or giant cell tumor.

21. Mesenchymal chondrosarcoma
• High-grade tumor
• Small round blue cells
• Islands of benign-appearing
cartilage.
• The cellular portions have a
“Hemangiopericytomatous” pattern
of growth with “staghorn-like”
vessels.

22. Dedifferentiated chondrosarcoma
High-grade sarcoma
• ( Commonly osteosarcoma followed
in frequency by fibrosarcoma and
malignant fibrous histiocytoma)
• The radiography shows aggressive
radiolucent area

23. Teatment
Low-grade chondrosarcoma
• Extended curettage with the use of intraoperative
adjuvant treatments.

24. High-grade chondrosarcoma
• Wide or radical resection
• Amputation.

25. • The local recurrence rate after intraoperative
tumor contamination is high.
• For lesions in an expendable locations,
Primary wide resection without a biopsy may
be indicated
• It is to decrease the chance of tumor
contamination.

26. • After wide resection  local recurrence is
less than 10%
• Pulmonary metastases Treated with
surgical resection if possible.

27. • Chemotherapy has no role in the treatment of
conventional chondrosarcoma
• Radiotherapy is used only as a palliative measure
for surgically inaccessible lesions.
Inaccessible areas include
• Tumour arising from floor of pelvis
Vertebrae &spinous process

28. PROGNOSIS
The prognosis depends on
• Size
• Grade
• Location of the lesion.

29. Low-grade lesions
• Greater than 90% 10-year survival rate
High-grade conventional chondrosarcoma
• 20% to 40% 10-year survival rate