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Presented by Edward McCarthy, M.D. and prepared by Greg Seidel, M.D.
Case 3: A 35 year old man year old man had pain in his hip for 3 months.
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1. Question
Week 120: Case 3
A 35 year old man year old man had pain in his hip for 3 months. A radiograph demonstrated a poorly defined lytic lesion in the proximal femur. The lytic area was admixed with stippled radiodensity.images/0113033a.jpg
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images/0113033e.jpgCorrect
Answer: Clear cell chondrosarcoma
Histology: Clear cell chondrosarcoma is a variant of chondrosarcoma that favors the epiphyseal end of long bones. 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.
Incorrect
Answer: Clear cell chondrosarcoma
Histology: Clear cell chondrosarcoma is a variant of chondrosarcoma that favors the epiphyseal end of long bones. 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.
