Chondrosarcoma of bone is a malignant tumor that originates in cartilage tissue, and can be divided into central and peripheral types in terms of its site of occurrence. The former occurs in the bone marrow cavity or inside the cortex, while the latter occurs in the subperiosteal cortex or periosteum. According to the development process of the tumor, it can be further divided into primary and secondary. The former has an early age of onset, high degree of malignancy, rapid development and poor prognosis, while the latter is a malignant transformation of benign tumors such as osteochondroma and chondrosarcoma, which has a late onset, slow development and a slightly better prognosis, accounting for 4% of the chondrosarcomas.
Aetiopathology:
The main components of chondrosarcoma are tumorigenic chondrocytes, calcified cartilage and chondrogenic bone. In the main tumor tissue, occasionally see a small amount of osteosarcoma-like bone-like tissue or tumor bone islets, in addition or still have a small amount of mucus-like tissue and fibrous tissue, in a few cases, mucus-like tissue increased, pathology is sometimes diagnosed as mucinous sarcoma. On internal visual observation, the shape of the bone where the tumor is located is slightly swollen, and the surface of the bone cortex is thickened, rough, and pitted. In some cases, complete destruction of the local bone cortex is also seen, forming an expanded and prominent tumor mass attached to the bone tissue. Some tumors form pseudocysts or mucinous changes due to degenerative changes. Peripheral chondrosarcoma may be spherical or coarse nodular. Numerous multifaceted vesicles, firm and bluish-white in color, are seen on section.
Chondrosarcoma under the microscope, the main visible tumor tissue line is disordered, the size of the chondrocytes, and a few mucus-like cells, widely dispersed in the stroma of the cartilage-forming tissue. Some cartilage has irregular calcification or ossification. Different parts of the same tumor have different degrees of differentiation and need to be carefully examined.
Clinical manifestations
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Primary chondrosarcoma, the age of onset is usually under 30 years old, more men than women, preferably in the long bones of the limbs, especially in the lower end of the femur, the upper end of the tibia, and the upper end of the humerus metaphysis is most common. Other bones such as ribs, ilium, scapula or sternum may also develop. Occurrence in the short bones is rare. The main symptom is a dull ache. It can be intermittent to persistent, and affects the neighboring joints so that the movement is limited. Sometimes a localized lump is detected, but there is no obvious pressure pain, and the surrounding skin may be congested and red hot phenomenon.
Secondary chondrosarcoma is usually found in adults over 30 years of age and is more common in men. It occurs in the pelvis, followed by the scapula, femur and humerus. The main manifestation of chondrosarcoma is lumps, the course of disease is slow, the pain is not obvious, and there is no redness or heat in the surrounding skin. When it is close to the joints, it can cause swelling of the joints and limitation of the activities, and if it stimulates and presses on the nerves, it can cause radiating pain and numbness. Tumors located in the chest cavity and pelvis are usually difficult to be detected until the tumor compresses the internal organs and produces corresponding symptoms.
X-ray manifestations
(1) Central type is more common than peripheral type, and primary type is more common. In primary cases, the tumor occurs in the medullary cavity of the metaphysis, showing a large unicompartmental or multicompartmental translucent area with irregular margins, which is interspersed with irregular calcified spots and bone fragments. Sometimes a large number of flocculated calcifications and ossified plaques can be seen covering the bony area, forming a dense shadow. Tumor expansion and growth can make the bone cortex thin, once the tumor breaks through the bone cortex or complicates pathological fracture, the tumor will soon invade into the surrounding soft tissues, forming a soft tissue mass, in which scattered calcified spots can be seen. Due to the stimulation of the tumor, there is often multilayered new bone formation under the periosteum, so that the bone cortex is thickened or the tumor breaks through the new bone and the "cuff" sign appears. The X-ray of secondary tumors shows that the osteolytic translucent shadow of the tumor increases in size, the edge is blurred, the number of calcified points increases, the collection of visible calcified shadows dissolves and disappears, and finally the tumor breaks through the cortex and develops in the soft tissues and forms calcified shadows.
(2) Peripheral type Soft central type is rare. Of these, secondary is more common than primary. The malignant transformation of osteochondroma often shows that the cartilage cap increases in size and thickens on the basis of primary osteochondroma, forming a cartilage mass with blurred boundaries, and there are a lot of scattered speckled or flocculent irregular calcifications in the tumor and its surrounding soft tissues, and sometimes there can be a thick and long new bone formation, and the bone part can show trabecular disorders and signs of damage. The malignant transformation of chondrosarcoma not only shows rapid growth, but also disappears the original typical chondrosarcoma manifestations due to the destruction of the tumor. In a few cases, cuff-like periosteal reaction may occur.
Differential diagnosis:
Differential diagnosis
(1) Chondroma has scattered sand-like calcified spots in the tumor, but they are smaller and fewer in number than those of chondroma, and the bone cortex is intact without periosteal reaction.
(2) Osteosarcoma This consists of sarcomatous connective tissue evolving into neoplastic osteoid and bone tissue. Osteosarcoma contains characteristic tumor bone.
(iii) Chondrofibrosarcoma Benign damage in terms of tissue arrangement with a low recurrence rate.
Treatment and prevention:
The most effective method is surgical resection. After a clear diagnosis is made, a localized lumpectomy with segmental amputation or amputation is considered according to the specific situation. Surgery for most chondrosarcomas should strive for localized complete resection as the main, for recurrent or primary malignant degree of high, fast-developing cases begin to amputation or joint disarticulation, for the low-grade, moderate and severe malignant chondrosarcoma of 5-year survival rate of 78%, 53% and 22%, respectively.
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