대한흉부영상의학회 Weekly Chest Cases

Case No : 767 Date 2012-07-09

Courtesy of Dong Won Kim, Ki-Nam Lee, Eun-Ju Kang / Dong-A University Hospital
Age/Sex 22 / F
Chief ComplaintChest pain

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Diagnosis With Brief Discussion

Diagnosis: Extraskeletal mesenchymal chondrosarcoma, anterior mediastinum.
Radiologic Findings: Chest PA shows well defined lobulated anterior mediastinal mass and large amount of pleural effusion. Chest CT images show large irregular heterogeneous mass with chondroid mineralization and encasement of aorta and pulmonary artery. The mass show poorly defined inferior border. CT scans also show large amount of pleural effusion and atelectasis of left lung.
Brief Review: Extraskeletal chondrosarcomas are relatively rare neoplasms and are far less common than their intraosseous counterparts, representing approximately 2% of all soft-tissue sarcomas. The histologic types of lesions that account for extraskeletal chondrosarcoma are myxoid, mesenchymal, and very rarely low grade.
Extraskeletal mesenchymal chondrosarcoma typically affects young adults between 15 and 35 years of age, with a female predilection Although many of these lesions affect the head and neck (brain, orbit, and meninges), musculoskeletal lesions most commonly involve the lower extremity (particularly the thigh). Clinical symptoms chondrosarcomas are nonspecific, with the most common finding being a slowly enlarging painless soft-tissue mass.
Radiographs of these lesions often demonstrate a nonspecific soft-tissue mass. Areas of chondroid matrix mineralization may be apparent, The typical appearance of the mineralized chondroid matrix is a ring- and arc-like pattern of calcification. On CT and MR images, both myxoid and mesenchymal chondrosarcomas have features similar to those described for tumors of these histologic types located in bone. Extraskeletal myxoid chondrosarcoma, reflective of its extremely high water content, appears with low attenuation on CT scans and very high signal intensity on T2-weighted MR images, with only mild peripheral to septal enhancement after contrast material administration. Extraskeletal mesenchymal chondrosarcoma, which has lower water content caused by the intermixture of small cells and more limited cartilaginous tissue, has attenuation similar to that of muscle on CT scans and typically has intermediate signal intensity on T2-weighted MR images.
References: 1. Murphey MD, Walker EA, Wilson AJ, Kransdorf MJ, Temple HT, Gannon FH. From the archives of the AFIP: imaging of primary chondrosarcoma: radiologic-pathologic correlation. Radiographics 2003; 23:1245-1278.
2. Taori K, Patil P, Attarde V, Chandanshive S, Rangankar V, Rewatkar N. Primary retroperitoneal extraskeletal mesenchymal chondrosarcoma: a computed tomography diagnosis. Br J Radiol 2007; 80:e268-270.
Keywords: mediastinum, malignant tumor,

No. of Applicants : 91

▶ Correct Answer : 6/91, 6.6%

- UWO , Canada S Lee
- Himeji St.Mary Hospital , Japan Yuichiro Kanie
- Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
- Onomichi Municipal Hospital , Japan Yoshihisa Masaoka
- Private sector , Greece Vasilios Tzilas
- All India Institute of medical sciences , India Justin Moses

▶ Correct Answer as Differential Diagnosis : 7/91, 7.7%

- Toyama University Hospital, Laboratory of Pathology , Japan TOMONORI TANAKA
- China Medical University , Chia-Yi Christian Hospital ,Taiwan, R.O.C. , Taiwan Jun Jun Yeh
- clinique de SAVOIE , France, Metropolitan gay-depassier philippe
- XiangYa hospital , China Xia Yu
- IRSA La Rochelle France , France Denis Chabassiere
- Radnet Teleradiology Istanbul , Turkey Armagan Sarac
- IRCCS Istituto Oncologico - Bari , Italy Carlo Florio

▶ Semi-Correct Answer : 11/91, 12.1%

- University of British Columbia , Canada Amr Ajlan
- McGill University Health Center , Canada Alexandre Semionov
- Hanam sungshim hospital , Korea (South) CHANG IL KIM
- Kyungpook National University Hospital , Korea (South) Jaekwang Lim
- Chonnam National University Hospital , Korea (South) So yeon Ki
- Onomichi municipal hospital , Japan Hirofumi Mifune
- James Paget Hospital , U.K , United Kingdom nabil mahmood
- chp st martin , France Mariotte benoit
- CHRU Lille , France Paul Lebert
- Heart Center Pontica , Bulgaria VLADISLAV RUSINOV
- Beaulieu clinic Geneva , Switzerland gilles GENIN

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 767 Date 2012-07-09

Discussion

No. of Applicants : 91