Answer for BIR CoW 21 Aug 2022
Sternal Chondrosarcoma
Findings
Plain Radiographs There is a lytic destructive lesion arising from body of sternum with ring and arc like calcifications. CT There is a large lytic destructive mass lesion arising from the body of sternum with ring and arc like calcifications and low density soft tissue components.
Discussion
Chondrosarcoma is the most common malignant tumour of the sternum. Usually presents in the 4t to 6th decades. It may arise either de novo or de-differentiate from pre-existing exostoses or enchondroma. Secondary chondrosarcomas can occur as a part of the spectrum of radiation-induced sarcomas after previous therapeutic irradiation for thoracic, mediastinal and chest wall malignancies. Clinically, it presents as a painless slow-growing, large, midline mass. The presence of a stippled or "rings and arcs" pattern of calcifications on radiographs indicates the presence of a chondroid matrix. On CT, the tumor can be intramedullary or juxta-cortical, resulting in cortical destruction and the presence of a large, lobulated soft tissue component with chondroid calcifications. Rapid enlargement and a large soft tissue component favor malignancy or malignant transformation of preexisting exostoses or enchondroma. On MRI, the tumor exhibits T2 hyperintense signal consistent with cartilage matrix.
Findings
Plain Radiographs There is a lytic destructive lesion arising from body of sternum with ring and arc like calcifications. CT There is a large lytic destructive mass lesion arising from the body of sternum with ring and arc like calcifications and low density soft tissue components.
Discussion
Chondrosarcoma is the most common malignant tumour of the sternum. Usually presents in the 4t to 6th decades. It may arise either de novo or de-differentiate from pre-existing exostoses or enchondroma. Secondary chondrosarcomas can occur as a part of the spectrum of radiation-induced sarcomas after previous therapeutic irradiation for thoracic, mediastinal and chest wall malignancies. Clinically, it presents as a painless slow-growing, large, midline mass. The presence of a stippled or "rings and arcs" pattern of calcifications on radiographs indicates the presence of a chondroid matrix. On CT, the tumor can be intramedullary or juxta-cortical, resulting in cortical destruction and the presence of a large, lobulated soft tissue component with chondroid calcifications. Rapid enlargement and a large soft tissue component favor malignancy or malignant transformation of preexisting exostoses or enchondroma. On MRI, the tumor exhibits T2 hyperintense signal consistent with cartilage matrix.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
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Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!