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Presented by Edward McCarthy, M.D. and prepared by Greg Seidel, M.D.
Case 5: A 40 year old man developed pain in his hip over the past four months.
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1. Question
Week 96: Case 5
A 40 year old man developed pain in his hip over the past four months. Radiographs demonstrated the poorly defined lytic lesion involving the greater trochanter and metaphyseal portion of the proximal femur. There were stippled radiodensities associated with this lesion./images/0729025a.jpg
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/images/0729025e.jpgCorrect
Answer: Clear cell chondrosarcoma
Histology: Clear cell chondrosarcoma is a rare variant of chondrosarcoma consisting of sheets of clear cells admixed with multinucleated giant cells, seams of new bone, and islands of mature hyaline cartilage. The clear cells have centrally located nuclei and abundant clear cytoplasm. The mixture of the cells with mature cartilage and multinucleated giant cells is the diagnostic feature of clear cell chondrosarcomas. Clear cell chondrosarcomas favor the ends of long bone and always include the epiphyseal zone. Some of the cells of clear cell chondrosarcomas resemble those present in chondroblastomas. The epiphyseal location of clear cell chondrosarcoma and these chondroblastoma-like cells suggest that clear cell chondrosarcoma may represent a malignant change in pre-existing chondroblastomas.
Discussion: The lesion is not a chondroblastoma because of the atypical clear cells. Multinucleated giant cells are present in chondroblastoma, but the admixture with clear cells is typical of clear cell chondrosarcoma.
The lesion is not a metastatic renal cell carcinoma. The admixture with mature hyaline cartilage and woven bone is typical of chondrosarcoma. However, should the clear cells be very predominant in such a lesion, a renal cell carcinoma should be ruled out with a CT scan.
The lesion is not an osteosarcoma. Although there are seams of neoplastic bone seemingly being synthesized by the neoplastic clear cells, this feature is very typical of clear cell chondrosarcoma.
Incorrect
Answer: Clear cell chondrosarcoma
Histology: Clear cell chondrosarcoma is a rare variant of chondrosarcoma consisting of sheets of clear cells admixed with multinucleated giant cells, seams of new bone, and islands of mature hyaline cartilage. The clear cells have centrally located nuclei and abundant clear cytoplasm. The mixture of the cells with mature cartilage and multinucleated giant cells is the diagnostic feature of clear cell chondrosarcomas. Clear cell chondrosarcomas favor the ends of long bone and always include the epiphyseal zone. Some of the cells of clear cell chondrosarcomas resemble those present in chondroblastomas. The epiphyseal location of clear cell chondrosarcoma and these chondroblastoma-like cells suggest that clear cell chondrosarcoma may represent a malignant change in pre-existing chondroblastomas.
Discussion: The lesion is not a chondroblastoma because of the atypical clear cells. Multinucleated giant cells are present in chondroblastoma, but the admixture with clear cells is typical of clear cell chondrosarcoma.
The lesion is not a metastatic renal cell carcinoma. The admixture with mature hyaline cartilage and woven bone is typical of chondrosarcoma. However, should the clear cells be very predominant in such a lesion, a renal cell carcinoma should be ruled out with a CT scan.
The lesion is not an osteosarcoma. Although there are seams of neoplastic bone seemingly being synthesized by the neoplastic clear cells, this feature is very typical of clear cell chondrosarcoma.
