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Presented by Edward McCarthy, M.D. and prepared by Shien Micchelli, M.D.
Case 6: A 35-year-old woman had hip pain for a year.
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1. Question
Week 278: Case 6
A 35-year-old woman had hip pain for a year. Imaging studies showed a lytic lesion in her femeral head.images/8_7_06_6a.jpg
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images/8_7_06_6e.jpgCorrect
Answer: Clear cell chondrosarcoma
Histology: Clear cell chondrosarcoma is a very variant of chondrosarcoma that favors the epiphyseal end of long bones as in this case. The lesions are radiolytic with stippled radiodensities of cartilage. Histologically, there are sheets of round cells with clear cytoplasm admixed with multinucleated giant cells and, in areas, a chondroid-like stromal. Also, there are zones of cells which look like the cells of chondroblastoma. Often in clear cell chondrosarcoma, areas of conventional chondrosarcoma are present.
Discussion: The lesion is not a conventional chondrosarcoma because of the sheets of clear cells. These clear cells define this lesion as a clear cell chondrosarcoma.
Although the lesion has many zones with cells reminiscent of chondroblastoma, the aggressive growth pattern (as apparent on the radiograph) and the presence of conventional chondrosarcoma-like areas excludes the diagnosis of chondroblastoma.
Although the sheets of clear cell may lead one to suspect a diagnosis of metastatic renal cell carcinoma, the chondroid areas and multinucleated giant cells are typical of clear cell chondrosarcoma.
Incorrect
Answer: Clear cell chondrosarcoma
Histology: Clear cell chondrosarcoma is a very variant of chondrosarcoma that favors the epiphyseal end of long bones as in this case. The lesions are radiolytic with stippled radiodensities of cartilage. Histologically, there are sheets of round cells with clear cytoplasm admixed with multinucleated giant cells and, in areas, a chondroid-like stromal. Also, there are zones of cells which look like the cells of chondroblastoma. Often in clear cell chondrosarcoma, areas of conventional chondrosarcoma are present.
Discussion: The lesion is not a conventional chondrosarcoma because of the sheets of clear cells. These clear cells define this lesion as a clear cell chondrosarcoma.
Although the lesion has many zones with cells reminiscent of chondroblastoma, the aggressive growth pattern (as apparent on the radiograph) and the presence of conventional chondrosarcoma-like areas excludes the diagnosis of chondroblastoma.
Although the sheets of clear cell may lead one to suspect a diagnosis of metastatic renal cell carcinoma, the chondroid areas and multinucleated giant cells are typical of clear cell chondrosarcoma.
