dr james c wittig, orthopedic oncologist, new york, new jersey
About Dr. Wittig
Juxtacortical (Periosteal) Chondrosarcoma

General Information

Juxtacortical/Periosteal
  • Similar to juxtacortical chondroma
  • Periosteal lesion - cortical erosion
  • Chondroid matrix calcification
  • Similar to periosteal ogs (no hair on end periosteal reaction)
  • Larger soft tissue mass/size (>3-4cm)
  • Intramedullary canal spared
Juxtacortical Chondrosarcoma

Definition:

  • A malignant, subperiosteal cartilaginous tumor that lacks osteoid production and erodes the underlying cortical bone (periosteal chondrosarcoma)
  • <2% of chondrosarcomas

Age:

  • 15-63 (80% are >20 years old vs periosteal osteosarcoma and periosteal chondroma)
  • No sex predilection

Clinical:

  • Painless, mass or swelling; 1/3 of patients have pain (pain rarely exceeds swelling)
  • Most Common Locations:
    • Femur
    • Humerus
    • Pelvis
    • Rib or foot

Radiographic Presentation

Radiology:

  • Metaphyseal
  • Cortical erosion with sclerotic underlying cortex (saucer shaped defect)
  • Matrix calcification
  • Triangular sclerotic spur at margin of tumor
  • >5cm in diameter; average size: 11 cm (vs periosteal chondroma that is usually <5cm)
  • No hair on end periosteal reaction (vs. chondroblastic osteosarcoma)
  • Intramedullary canal is spared
Roll over the images for more information
Cortical Thickening at Periphery of Lesion, Erosion of Outer Cortex Juxtacortical Chondrosarcoma

Differential Diagnosis

  • Periosteal Chondroma
  • Periosteal Osteosarcoma

Gross Pathology

  • Grossly lobulated, gray-white, translucent
  • Calcification is common
  • Underlying cortex eroded with irregular sclerotic reaction

Microscopic Pathology

  • Lobulated
  • Well differentiated, low grade, hyaline cartilage
  • Focally myxoid stroma
  • No osteoid production
  • Almost always grade 1 or 2
  • Rarely grade 3

Juxtacortical Chondrosarcoma

Prognosis
  • Low rate of Mets
    • Metastisizes most commonly to the lungs
      • Most are low to intermediate grade tumors
    • 80-90% long term survival

Treatment

  • Wide Limb Sparing Resection whenever feasible
    • Amputation may be indicated for very large, unresectable or recurrent tumors
  • Chemotherapy and radiation are generally not used in treatment of periosteal chondrosarcoma
    • Chemotherapy may be considered for Grade 3 tumors
    • Postoperative radiation may be considered for large tumors that can not be removed with a wide margin
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