Clear Cell Chondrosarcoma With Chondroblastoma-Like Features: A Case for Team Diagnosis

Abstract

Clear cell chondrosarcoma (CCCS) is a rare variant of conventional chondrosarcoma with low-grade malignant features that may be confused radiographically and histologically with chondroblastoma. We report a case of a 50-year-old female who presented with 6 months of left hip pain. Initial radiographs demonstrated an osteolytic lesion with adjacent area of sclerosis in the proximal left femur. Magnetic resonance imaging demonstrated a marrow-infiltrative lesion with periosteal reaction and thickened enhancing periosteum. Biopsy of the sclerotic area demonstrated chondroblastoma-like findings, whereas biopsy of the lytic area showed features suggestive of CCCS. The patient eventually underwent en bloc resection and reconstruction with a proximal femoral megaprosthesis. The final diagnosis was CCCS. We present this unusual case with review of the radiographic and histologic features of CCCS with attention to its ability to mimic chondroblastomas. This case highlights the importance of sampling radiographically heterogeneous areas within a bone lesion to facilitate accurate diagnosis and appropriate management.

Dog 1 Expression in Differential Diagnosis of Chondroblastomas and Its Histological Mimickers

“…Histological appearance reveals proliferation of nests of chondroblast like cells with grooved coffee bean nuclei along with chic-ken wire calcifications 18 , osteoclast like giant cells and sometimes aneurysmal bone CYST like areas (fig-5) 19 . A definitive diagnosis is essential for appropriate management due to high recurrence rate of this disease 18,20,21 . Many cases have characteristic histological and radiological features making possible a definitive diagnosis however in few cases the histological features overlap with chondromyxoid fibroma, clear cell chondrosarcoma, giant cell tumors and aneurysmal bone cyst 22 . In those cases, application of immunohistochemistry may be helpful for establishing a diagnosis.…”

A Case Report of Clear Cell Chondrosarcoma (CCC) Sparing the Epiphysis and Literature Review of CCC

“…Since the recurrence rate is high following curettage, “en bloc” resection is the preferred surgical procedure for CCC [4]. Unni et al [5] first described the condition in 1976 and to date radiological diagnosis of CCC has been a challenge as it has to be differentiated from other benign lesions of the epiphysis such as giant cell tumour and chondroblastoma [6, 7]. We report a case of CCC of the proximal femur where the tumour was located in the metaphysis and completely sparing the epiphysis, which is extremely unusual for a CCC.…”