MRI-histopathological correlation in paediatric conventional central chondrosarcoma: a report of 17 cases
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SCIENTIFIC ARTICLE
MRI-histopathological correlation in paediatric conventional central chondrosarcoma: a report of 17 cases Amir Ardakani 1 & Panagiotis Gikas 1 & Michael Khoo 2 & Paul O’Donnell 2,3 & Roberto Tirabosco 4 & Asif Saifuddin 2 Received: 23 June 2020 / Revised: 30 August 2020 / Accepted: 16 September 2020 # ISS 2020
Abstract Objective To describe the MRI features of paediatric conventional central chondrosarcoma (CC-CS) and correlate with histological grade. Materials and methods A retrospective review of children/adolescents with histologically confirmed CC-CS. Data collected included age, sex, skeletal location, and histology from needle biopsy or resection, which was classified as atypical cartilaginous tumours/grade 1 CS (ACT/Gd 1 CS), high-grade chondrosarcoma (HGCS), and dedifferentiated chondrosarcoma (DD-CS). MRI studies were reviewed independently by 2 radiologists blinded to the histology grade, who graded the tumours as ACT/Gd 1 CS, HGCS, and DD-CS based on MRI features. Results The study included 7 males and 10 females with mean age 13.9 years (range 6–18 years). Tumours were located in the femur (n = 6), humerus (n = 3), tibia, ilium, scapula, and ulna (n = 1 each), and the small bones of the hands or feet (n = 4). Final histology grade was ACT/Gd 1 CS in 15 cases and HGCS in 2 (both grade 1 CS with focal transition to grade 2), 15 based on surgical specimens, 1 based on open biopsy, and 1 on needle biopsy alone. Predicted MRI grade for the 2 readers was ACT/Gd 1 CS in 11 cases each and HGCS in 6 cases each, indicating a mismatch between predicted MRI grade and histological grade in 8 (47%) cases (4 cases with one reader mismatch and 4 cases with both). Conclusions MRI findings in paediatric CC-CS may be misleading, showing features suggestive of HGCS 7 of 17 (41.2%) of cases. This should be taken into consideration when planning surgical treatment. Keywords Chondrosarcoma . Neoplasms . Connective and soft tissue . Musculoskeletal diseases . Children . MRI
Introduction Conventional central chondrosarcoma (CC-CS) typically presents in patients aged 40–60 years old and accounts for ~ 70% of all CS [1, 2]. Histologically, low-grade CS is sub-classified into atypical cartilaginous tumour (ACT) when involving the appendicular skeleton or grade 1 CS (Gd 1 CS) when * Michael Khoo [email protected] 1
Department of Orthopaedic Oncology, Royal National Orthopaedic Hospital, Stanmore, UK
2
Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK
3
Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK
4
Department of Histopathology, Royal National Orthopaedic Hospital, Stanmore, UK
involving the flat bones and axial skeleton, high-grade chondrosarcoma (HGCS; grades 2 and 3 CS), and dedifferentiated chondrosarcoma (DD-CS) [3]. CC-CS of the long bones in the paediatric population is rare, accounting for ~ 5% of all cases [4], and the literature to date describes only a few case series, the data from
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