Images of Musculoskeletal Oncology
Chrondrosarcoma - Primary
A 53 year old female has a history of right buttock pain radiating to her knee for several months. Physical exam reveals a mild limp, pain on right hip motion, and tenderness posteriorally over her hip.
The routine AP pelvis radiograph reveals an osteolytic lesion in the right acetabular region. The change is subtle and can easily be overlooked.
The lesion is clearly seen on this CT scan, and its destructive nature can be appreciated. The cortices are markedly thinned. These findings suggest a serious lesion.
CT directed needle biopsy demonstrates a cellular cartilaginous neoplasm with some irregularity of nuclei, and probably some calcifications. The diagnosis of chondrosarcoma IIB was made.

Her treatment included a resection of the acetabular and superior pubic ramus as an internal hemipelvectomy reconstruction, including a total hip replacement with allografts. However, she developed infection and recurrent chondrosarcoma and eventually required a hindquarter amputation. She ultimately succumbed with widespread metastases.

Learning Issues:

1. The radiographic abnormalities from a chondrosarcoma of the pelvis can easily be overlooked. CT or MRI is often required to document these lesions.

2. The biologic behavior of cartilaginous neoplasms often cannot be predicted from the radiographic or histologic findings.

Images of Musculoskeletal Oncology
University at Buffalo Department of Orthopaedics