Mesenchymal chondrosarcoma - a therapeutic challenge

Mesenchymal chondrosarcoma is an aggressive subtype of chondrosarcoma that accounts for less than 1% of all sarcomas. Although it appears in all age groups, it is more frequent in younger patients. In view of its low incidence, there is no consensus about its optimal treatment. The aim of this presentation is to share our experience of treating a patient suffering from mesenchymal chondrosarcoma. A 46-year-old female patient suffered for several years from health problems in the form of undefined pain and pressure in the right occipital region and later in the form of right-sided deafness. Magnetic resonance imaging showed an extracranial tumor mass spreading through the occipital bone into the neighboring brain tissue. An operation was performed and the tumor was removed. Histopathologic examination demonstrated mesenchymal chondrosarcoma. Follow up MRI revealed tumor relapse and a second operation was performed. Histopathology confirmed mesenchymal chondrosarcoma. As adjuvant therapy, 3D-CRT treatment using a tumor dose of 56 Gy in 28 fractions was administered. Afterwards, the patient was regularly followed up. Postoperative follow up using positron emission tomography/computed tomography (PET/CT) disclosed pathologic accumulation of fluorine-18-deoxyglucose (FDG) in the neck lymph nodes and lung parenchymal tissue. Ultrasound guided fine needle aspiration of the suspect neck lymph nodes was performed but only inflammatory cells and no tumor cells were found. With regard to the suspect FDG accumulation in the lung tissue, a thoracic surgeon was consulted. He suggested regular follow up of the patient. Mesenchymal chondrosarcoma is a relatively rare tumor with a high tendency towards local aggressive growth and distant metastases. As regards the presented case, adjuvant radiotherapy with regular follow up appointments seems to be an advisable and rational option. The question that remains is: which chemotherapy option should be administered and when in the treatment of this rare type of tumor?

Keywords: CHONDROSARCOMA, MESENCHYMAL – complications, diagnosis, radiotherapy, surgery; ADULT
Category: Case report
Volume: Vol. 57, No 1, january - march 2013
Authors: L.Galunić Bilić, Z. Krajina, A. Juretić, V. Dekleva, K. Lončar, L. Jajac Bručić, A. Mišir Krpan, F. Šantek, M. Bašić-Koretić
Reference work: Paediatr Croat. 2013;57:49-52

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