Central Chondrosarcoma
What is Central Chondrosarcoma?
Central chondrosarcoma is a sarcoma, the cells tend to divide to the cartilage. Divided into: central chondrosarcoma; peripheral chondrosarcoma; periosteal chondrosarcoma. Treatment is only surgical treatment, there are very high cure rate, radiotherapy and chemotherapy for chondrosarcoma invalid. Chondrosarcoma as a result of slow growth, in primary tumors may occur more than 10 years after local recurrence and metastasis.
1) Ⅰ grade central chondrosarcoma of about 20%. Well-differentiated cartilage, very few areas containing mucus. Chondroma from Cytological signs have the following: ① larger nuclear; ② nuclear large and small, usually circular; ③ common dual-core cells, never to see the mitotic phase (cell proliferation by direct split mode) ; ④ cells and more than chondroma.
2) Ⅱ grade central chondrosarcoma is the most common form, accounting for about 60%. Cartilage tissue showed marked atypia, nucleus, and the characteristic depth of staining, often dual-core cells, the three rare mononuclear cells, a number of the nucleus 4 to 5 times the normal nuclear and / or a strange shape.
3) Ⅲ grade central chondrosarcoma accounts for about 20%. Well-differentiated cartilage, cartilage lobules around a thick halo of cells, stained by the intensive deep into the cartilage cells, undifferentiated mesenchymal component. Chondrocyte atypia Obviously, the number of the rich to markedly pleomorphic nuclei, chromatin is characterized by too deep. Huge volume of regular cell, 5 ~ 10 times the normal cells, there are three or more nuclear, or have a lot of weird cell nucleus.
Chondrosarcoma in the center of the histopathology, the more difficult question is the centrality of the distinction between grade Ⅰ and chondroma chondrosarcoma.
What are symptoms of Central Chondrosarcoma?
Central Chondrosarcoma is slow development of symptoms. The main symptom is pain in the deep, non-violent, non-sustainability. Tumor has not been inflated as a result of the soft tissue often can not touch bone mass, and only a slight increase of bone; in advanced tumors, could be the formation of large spherical bone mass.
There are obviously a good site, followed by femur, pelvis, proximal humerus, scapula, proximal tibia. Occurred in less soft body parts are the other bones, radius, ulna, foot and hand.
Long bones in the center of the origin of chondrosarcoma is usually one end or in the backbone of the metaphysis, epiphyseal end of the tumor often violated, sometimes invading the joints; originated in the center of the backbone of the middle rare chondrosarcoma; pelvic chondrosarcoma of the Center for a good hair the surrounding region in the acetabulum (iliac, ischium or pubis); scapular chondrosarcoma of the center occurred in Coracoid - glenohumeral joint region. The center of the pelvic and scapular chondrosarcoma of bone can also be the majority of violations.
If chondrosarcoma Center is located in the spine, sacrum, ribs or pelvis parts can be compression of neural stem, causing intense pain, sometimes pain radioactive. Some cases of central chondrosarcoma of rapid growth, invasive, and can damage the early cortical bone, soft tissue invasion, the formation of large soft tissue mass.
How is diagnosis for Central Chondrosarcoma?
Central Chondrosarcoma is mainly diagnosed by X-ray examination. Showed the osteolytic bone disease, can have calcium deposition. Central chondrosarcoma can be expressed as fuzzy borders of osteolysis, with or without interruption of cortical bone, as a result of calcification and ossification of cartilage inclined, the tumor may appear impenetrable X-ray area, frequent calcification in the cartilage around the lobule, with no fixed structure, characterized by irregular mist particles, nodules or non-through X-ray ring.
The center of well-differentiated chondrosarcoma calcification, while the Center Ⅲ grade chondrosarcoma and anti-differentiation of central chondrosarcoma less calcification and more mucus zone.
Cortical bone can be very thin, scallop-shaped internal were, in some regions can be interrupted. Sometimes slow due to tumor expansion, the occurrence of cortical bone hyperplasia, thickening may appear. This thickening of cortical bone fairly typical performance that it has been the infiltration of the tumor.
Central chondrosarcoma less inclined to place the expansion of resistance, such as the backbone of the medullary cavity. Stronger in the invasive cases, the central chondrosarcoma to a wide range of early cortical disruption, the larger soft tissue mass, invasion of soft tissue calcification in the tumor size was not obvious.
Other diagnosis for Central Chondrosarcoma is bone scan, CT and MRI.
How is treatment for Central Chondrosarcoma?
Central Chondrosarcoma is treated by surgery. Surgical excision has a high cure rate, and is frequently used limb salvage. Regardless of central chondrosarcoma of the histological grade, the curettage are not available. Lesion resection for chondroma with only grade Ⅰ central chondrosarcoma of the border between the cases, there is the possibility of cure, but extensive resection of lesion and the use of local auxiliaries, such as phenol, bone cement and liquid nitrogen.
Central chondrosarcoma resection margin must be extensive or radical resection. After marginal resection, the risk of tumor recurrence is high, with the histological grade increased. Amputation for soft tissue tumor great central chondrosarcoma, especially in grade Ⅲ and chondrosarcoma central chondrosarcoma of the anti-differentiation. When the central chondrosarcoma in soft tissue after removal of relapse, often there is no certain limits, generally can not be en bloc resection, the need for surgery cut line. Located in the center of the trunk bone chondrosarcoma, surgical resection is very difficult. Central chondrosarcoma is the radioactive anti-tumor efficacy of radiotherapy is very low, and even the effect of pain relief is also poor. Poor efficacy of chemotherapy for the same, only some of the anti-differentiation in the use of chondrosarcoma. If lung metastases, it should be removed.
How is Prognosis of Central Chondrosarcoma
Ⅰ grade central chondrosarcoma of the transfer does not occur normally, such as surgical resection is not wide enough, the tumor can be local recurrence. Such as grade Ⅰ central chondrosarcoma violations or spinal visceral chamber can be fatal.
Despite the slow course of disease, histology can be no significant performance characteristics of the malignant, Ⅱ grade central chondrosarcoma of the transfer can occur early, after the possibility of local recurrence. Such as timely and adequate surgical treatment, the proportion of cured about 60%.
Ⅲ grade central chondrosarcoma of the poor prognosis, the survival rate of about 40%.
Prognosis of Central Chondrosarcoma is basically dependent on two factors: the histological grade and the correct operation of the program (extensive or radical resection, can not be contaminated).