History and Physical Examination
Deep, dull, achy pain is a common symptom in chondrosarcomas. Pain at night is another feature. Although the finding of pain is important for distinguishing malignant lesions from benign cartilaginous lesions, it can be somewhat unreliable when the small bones of the hands and feet are involved.
If the lesion is near a neurovascular bundle, as pelvic lesions are, the patient may present with nerve dysfunction of the lumbosacral plexus or the sciatic or femoral nerves. If a chondrosarcoma is close to a joint, it may limit the joint’s range of motion and disturb its function. These signs are common with juxtacortical chondrosarcomas, though they can also be present with pathologic fractures. More than half of all patients with dedifferentiated chondrosarcomas present with a pathologic fracture.
The mean interval from pain to diagnosis is 19.4 months for grade I and grade II chondrosarcomas and 15.5 months for grade III chondrosarcomas, as per the Rizzoli institute experience. [19]
Clear cell chondrosarcomas and mesenchymal chondrosarcomas can produce symptoms for longer than 1 year because of their low-grade nature. Mesenchymal chondrosarcomas can manifest as a soft-tissue mass.
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Plain radiograph shows low-grade chondrosarcoma in pelvis (B). Incidental finding is that proximal femur contains benign enchondroma (A).
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T1-weighted MRI shows low-signal-intensity lesion in pelvis: chondrosarcoma.
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T2-weighted MRI shows high-signal-intensity lesion in pubis: chondrosarcoma.
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MRI of chondrosarcoma (B) shows contrast enhancement of lesion. Enchondroma (A) is also present.
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Plain radiograph shows chondrosarcoma.
Tables
Chondrosarcoma |
Male-to-Female Ratio |
Age of Peak Incidence |
Conventional |
Almost 1:1 (slight male predominance) |
50-70 y (most common >50 y, gradual increase with age) |
Dedifferentiated |
Similar to the ratio above |
>50 y |
Clear cell |
2.4:1 |
20-40 y (common 10-90 y) |
Mesenchymal |
1:1 |
20-30 y (common in teenagers and young adults) |
Juxtacortical |
1:1 |
20-40 y |
