Chondrosarcomas of the hands and feet: A case series and systematic review of the literature

Laura M Fayad; Shivani Ahlawat; Muhammed Shayan Khan; Edward McCarthy

doi:10.1016/j.ejrad.2015.06.026

Chondrosarcomas of the hands and feet: A case series and systematic review of the literature

Eur J Radiol. 2015 Oct;84(10):2004-12. doi: 10.1016/j.ejrad.2015.06.026. Epub 2015 Jul 2.

Authors

Laura M Fayad¹, Shivani Ahlawat², Muhammed Shayan Khan³, Edward McCarthy⁴

Affiliations

¹ The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, USA. Electronic address: lfayad1@jhmi.edu.
² The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, USA.
³ Khyber Medical College, Khyber Teaching Hospital, Peshawar, Pakistan.
⁴ Department of Pathology, Johns Hopkins University, Baltimore, MD, USA.

PMID: 26189572
DOI: 10.1016/j.ejrad.2015.06.026

Abstract

Objective: To review the imaging features of chondrosarcomas (CS) of the hands and feet, with pathologic correlation.

Materials and methods: For 24 histologically-confirmed CS of the hands (n=14) and feet (n=10), 23 studies were retrospectively reviewed by two musculoskeletal radiologists in consensus. Radiographs (n=23), bone scintigrams (n=2), and magnetic resonance (MR) (n=7) images were evaluated for lesion location, cortical and medullary involvement, presence of perilesional signal abnormalities and soft tissue masses (STM). Pathologic specimens were reviewed for tumor grade (grade 1-3). Descriptive statistics were reported.

Results: CS occurred in adults (age range 32-92) and most were located in the digits (22/23 (95.6%)) rather than tarsal/carpal bones (1/23 (4.4%)). For digital CS, 21/22 (95.45%) involved the epiphysis in addition to the metadiaphysis, 22/23 (95.6%) exhibited >2/3 endosteal scalloping, and 16/23 (69.5%) were expansile (>50% of the bone width). Pathologic fractures (7/23 (30.4%)) and STMs (16/23 (69.6%)) were frequent. By MR, perilesional abnormalities were common (bone marrow edema in 6/7 (85%), soft tissue edema in 5/7 (71.4%), STM in 7/7 (100%)). Following contrast administration (n=6), there was solid (3/6 (50%)) or lobular (3/6 (50%)) enhancement. Bone scintigrams showed increased uptake on all phases (>anterior superior iliac spine (ASIS)). Pathology specimens revealed 17 grade 2 and 7 grade 3CS, with increased cellularity, necrosis and myxoid features.

Conclusion: CS of the hands and feet have common distinctive features, including involvement of the end-of-bone, significant endosteal scalloping, expansile appearance, a frequent STM, and intermediate to high grade histologic features. Additional aggressive imaging features are identified by MR (perilesional signal abnormalities) and bone scintigraphy (increased uptake>ASIS) that may be helpful clues to the diagnosis.

Keywords: Chondrosarcoma; Feet; Hands; MRI; Nuclear scintigraphy; Radiography.

Publication types

Comparative Study
Review
Systematic Review

MeSH terms

Adult
Aged
Aged, 80 and over
Bone Marrow / pathology
Bone Neoplasms / diagnosis*
Bone Neoplasms / diagnostic imaging
Chondrosarcoma / diagnosis*
Chondrosarcoma / diagnostic imaging
Diagnosis, Differential
Diagnostic Imaging / methods*
Edema / pathology
Epiphyses / pathology
Female
Finger Phalanges / diagnostic imaging
Finger Phalanges / pathology
Foot Bones / diagnostic imaging
Foot Bones / pathology*
Fractures, Spontaneous / diagnosis
Hand Bones / diagnostic imaging
Hand Bones / pathology*
Humans
Magnetic Resonance Imaging / methods
Male
Middle Aged
Neoplasm Grading
Radiography
Radionuclide Imaging
Retrospective Studies