Primary mesenchymal chondrosarcoma of the adult lumbar spine: a case report and review of the literature

Abstract

Background: Primary mesenchymal chondrosarcoma (PMC) is a relatively rare malignancy that can occur in bone or soft tissue, but rarely in the lumbar spine; there is currently no unified treatment. We report a case of mesenchymal chondrosarcoma originating from the L1 vertebra.Case Description: A 47-year-old female patient was admitted to the hospital with intermittent low back pain for 20 years, accompanied by intermittent headache and radiating pain in both lower limbs. After admission, magnetic resonance imaging (MRI) showed bone destruction of the L1 vertebral body and accessories and a surrounding soft tissue mass. Enhanced MRI revealed significant enhancement of the L1 vertebral body and soft tissue mass. Technetium 99 m-methylene diphosphonate (99 m Tc-MDP) bone scan showed abnormally high metabolism in the L1 vertebral body, which is highly suspicious of malignancy, and vertebral biopsy revealed a soft tissue malignancy originating from the mesenchymal tissue. Total vertebrectomy combined with postoperative adjuvant radiotherapy was planned, but the patient refused radiotherapy for financial reasons. Intraoperative frozen sections indicated mesenchymal chondrosarcoma, as confirmed by postoperative pathological examination. After 1 year of outpatient follow-up, the patient had no related symptoms, and normal motor and sensory function, and her condition had improved.Conclusions: Total tumor resection is an effective treatment for PMC, and increased attention to this disease in the clinic is essential.

Mesenchymal Chondrosarcoma from Diagnosis to Clinical Trials

“…In terms of bone or soft cell origin, 13 cases (56.5%) were in the bones, while the observed cases (43.5%) were extraskeletal and localized in soft tissues. It should be noted that there were no age or gender differences in the distribution of skeletal and EMC [ 13 , 14 ].…”

“…There have also been discovered such cases as of dumbbell-shaped intramedullary MCS with isolated punctate calcification (only 7 cases of this type have been described since 1978) [ 15 ], secondary pancreatic MCS (a total of 13 cases have been reported) [ 4 ], primary renal EMC (only 16 patients with renal EMC have been described) [ 14 ], primary orbital intraocular MCS (40 cases reported in the literature) [ 16 ], and secondary thyroid MCS (only one case of this metastases has been reported in the literature) [ 17 ]. Nevertheless, MCS commonly present as large masses (>10 cm) and often present with chondroid calcifications (80%).…”

Brief overview of primary mesenchymal chondrosarcoma and discussion of a case report

“…As discussed by Lin et al, there are limited options for the management of this tumor. The majority of the current literature does support treatment of non-metastatic cases in the spine with surgical resection (3)(4)(5)(6)(7)(8), with adjuvant radiotherapy post operatively as needed (9). The authors do not remark on the use of neoadjuvant chemotherapy (7).…”

“…In the article entitled “Primary mesenchymal chondrosarcoma of the adult lumbar spine: a case report and review of the literature” the authors provide an overview of PMC as well as specific details of the management of non-metastatic PMC in the lumbar spine. This case report is of particular importance for several reasons: tumor location in the lumbar spine, age of patient, and inconclusive immunohistochemical staining results on initial biopsy ( 7 ). There are only a small number of case reports of PMC in the lumbar spine as noted by the authors ( 3 - 6 ).…”

“…The majority of the current literature does support treatment of non-metastatic cases in the spine with surgical resection ( 3 - 8 ), with adjuvant radiotherapy post operatively as needed ( 9 ). The authors do not remark on the use of neoadjuvant chemotherapy ( 7 ). As stated in other case reports, neoadjuvant chemotherapy may be used in the management of this disease with limited success in the literature, however, there are reports of positive response in individual patients ( 3 - 6 ).…”