Clear-Cell Chondrosarcoma of the Lumbar Spine: Case Report and Review of the Literature

Department of Neurosurgery, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
Neurosurgery (Impact Factor: 3.62). 04/2011; 68(4):E1160-4; discussion 1164. DOI: 10.1227/NEU.0b013e31820ccf90
Source: PubMed


Clear-cell chondrosarcoma is a rare subtype of chondrosarcoma. These osseous tumors are most commonly found in the end of long bones. We report a rare case of clear-cell chondrosarcoma of the osseous spine.
A 52-year-old man presented to another institution with a pathologic L1 compression fracture. Intraoperatively, this fracture was discovered to be secondary to a chondrosarcoma involving T12, L1, and L2. He was then referred to our institution for further evaluation and treatment. A 2-stage operation was performed with successful en bloc resection of residual chondrosarcoma with negative margins. The first stage using a posterior approach resulted in placement of pedicle screws from T9 to L4, laminectomies from T12 to L2, and placement of Tomita saws between the thecal sac and the vertebral body at both the T11-12 and L2-3 disc levels. The second stage of the procedure involved a transthoracic, retroperitoneal approach to the thoracolumbar spine. Osteotomies between T11-12 and L2-3 were completed, and the vertebral bodies of T12, L1, and L2 were delivered as an en bloc specimen. The final pathology of the specimen was clear-cell chondrosarcoma with negative margins.
This report discusses a rare occurrence of clear-cell chondrosarcoma in the osseous spine. Aggressive surgical intervention with the goal of en bloc resection of tumor is recommended to promote tumor-free survival.

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    • "Clear cell chondrosarcoma is most commonly localized in the epiphyseal region of long bones, particularly femur and humerus. Presentation as a primary tumor of the osseous spine is rare, with only a few cases reported in the literature [4] [5] [6] [7] [8] [9] [10] [11]. "
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    ABSTRACT: Chondrosarcoma is the third most common primary malignant bone tumor after osteosarcoma and Ewing's sarcoma. Clear cell chondrosarcoma is a rare subtype variant of chondrosarcoma, most commonly encountered in the proximal part of the femur or humerus. Vertebral involvement is exceedingly rare and shows a predilection for the thoracic spine. We report the case of a woman with clear cell chondrosarcoma of the thoracic spine, which has been surgically excised, and review the pertinent literature (PubMed). Although it has a reasonably benign biological behavior, clear cell chondrosarcoma needs to be treated as a malignancy. The best treatment for spinal chondrosarcoma is surgery. It should be promptly and adequately resected. Gross-total resection should be the ultimate surgical goal. Radiation therapy should also be considered, especially in the case of subtotal resection or inoperable lesions. In conclusion, it is important to keep in mind this entity in the differential diagnosis of spinal tumors, in order to optimize treatment planning. With adequate treatment, local recurrence rates as low as 20% can be achieved.
    Case Reports in Oncological Medicine 10/2012; 2012(6):693137. DOI:10.1155/2012/693137
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    • "Lesions may recur even after two decades of first surgical treatment. Lung, brain, and skeleton are the most probable metastatic locations [3]. A summary of clinical data for this rare entity is provided in Table 1. "
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    ABSTRACT: Clear cell chondrosarcoma is a rare variant of chondrosarcoma that mostly involves the end of long bones. However, nine cases have been reported in the head and neck: four in larynx, two in nasal septum, two in maxilla and one in the skull. These cases form the basis of this review. Head and neck cases accounts for less than 5% of Clear cell chondrosarcomas in the whole body and the larynx is the most common place. The histological findings of head and neck cases are consistent with general features of this entity in the whole body and nearly all tumors in this case series had a component of conventional chondrosarcoma. Clear cell chondrosarcoma is an intracompartmental tumor and retains "Grenz zone" just beneath the epithelium. Therefore, the overlying mucosa remained intact in all laryngeal cases. Nasal tumor caused ballooning of the septum and the maxillary lesion did not involve the oral mucosa. This tumor presents various radiographic features in the head and neck area. Chondroblastoma, chondroma, osteoblastoma, osteosarcoma and metastatic renal cell carcinoma are included in the histologic differential diagnoses. Differentiation from chondroblastic osteosarcoma is important in the maxilla. A wide resection is adequate in most cases. However, some laryngeal cases show tendency to recur. Clear cell chondrosarcoma is a slow growing tumor and this necessitates a long time follow-up of patients. Due to the extreme rarity in the head and neck, diagnosis of Clear cell chondrosarcoma in this area, must be confirmed by histochemical and immunohistochemical studies.
    Head & Neck Oncology 04/2012; 4(1):13. DOI:10.1186/1758-3284-4-13 · 3.14 Impact Factor
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    ABSTRACT: Clear cell chondrosarcoma is a rare cartilaginous tumour of low-grade malignancy. Although it has a characteristic histological appearance, its radiological features and clinical presentation often mimic a benign lesion. Herein, we describe the case of a patient with a clear cell chondrosarcoma of the right proximal femur that had an atypical appearance of chronic avascular necrosis on initial plain radiographs, which made preoperative diagnosis a challenge. In addition, the tumour also had extensive areas of aneurysmal bone cyst-like changes, which is not only a rare histologic phenomenon in clear cell chondrosarcoma, but also a confounding factor in the interpretation of the radiologic findings.
    Singapore medical journal 03/2014; 55(3):e49-51. DOI:10.11622/smedj.2014038 · 0.60 Impact Factor
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