Chondrosarcoma pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Shivali Marketkar, M.B.B.S. [2]

Overview

On gross pathology, Greyish-white lobulated mass, necrosis, calcification, mucoid degeneration are characteristic findings of chondrosarcoma. On microscopic histopathological analysis abnormal cartilage, increased cellularity, nuclear atypia are characteristic findings of chondrosarcoma. Chondrosarcoma may be divided into three grades based on cancer cells morphology under microscope and growth rate of tumor.

Pathophysiology

Gross Pathology

Characteristic features of chondrosarcoma on gross pathology are:

• Greyish-white lobulated mass
• Necrosis
• Calcification
• Mucoid degeneration

Microscopic Pathology

In general chondrosarcomas are multilobulated (due to hyaline cartilage nodules) with central high water content and peripheral enchondral ossification. Characteristic features on microscopic analysis are variable depending on the chondrosarcoma subtype:

Mesenchymal chondrosarcoma

Mesenchymal chondrosarcoma is a malignant tumor with a characteristic biphasic pattern:

• Poorly differentiated small round blue cells.
• Islands of well-differentiated hyaline cartilage.
  • Progressive maturation of cartilage towards the center.
  • Central calcification or bone formation.
• Can have a hemangiopericytomatous vascular pattern.

Islands of cartilage in a background of small blue cells

Myxoid chondrosarcoma

• Myxoid background.
• small cells with eosinophilic cytoplasm.

Anastomizing chords of small neoplastic cells surround mucin pools

Chords of neoplastic cells surround mucin pools

Clear cell chondrosarcoma

• Lobules of uniform to polymorphic densely-packed large cells.
• Well defined pushing borders.
• Clear to intensively acidophilic granular cytoplasm with vacuoles.
• Central nuclei with occasional prominent nucleoli.
• Low mitotic rate.
• Clear cell areas lack production of hyaline chondroid matrix.
• Areas with osteoclast-type giant cells mixed with small trabeculae of reactive bone.
• May contain conventional low-grade chondrosarcoma.
• May have secondary aneurysmal bone cyst changes.

High grade round cells with cytoplasmic clearing

The lesion also had areas of more conventional chondrosarcoma

Dedifferentiated chondrosarcoma

• Poorly differentiated (mesenchymal) malignancy.
• Well-differentiated cartilaginous component.

Grading

Physicians grade chondrosarcoma using several criteria. But, particularly based on how abnormal the cancerous cells appear under the microscope and the growth rate of the tumors themselves, both of which are directly linked to the propensity of the cancer to invade locally, and to spread widely to distant organs and sites in the body (called metastasis).

Grade 1

• Chondrosarcoma grows relatively slowly, has cells whose histological appearance is quite similar to cells of normal cartilage.
• Mostly chondroid matrix, little if any myxoid.
• Mild-to-moderate increase of cellularity +/- binucleated cells.
• Have much less aggressive invasive and metastatic properties.

Grade 1 - Somewhat cellular cartilage with binucleation

Grade 2

• Intermediate grade chondrosarcoma.
• Little chondroid matrix, Necrosis and more common prominent myxoid.

Grade 2 - Very cellular cartilage with obvious hyperchromasia and nuclear atypia

Grades 3

• Grade 3 chondrosarcoma is increasingly faster-growing cancer, with more varied and abnormal-looking cells.
• Characterized by myxoid stroma, nuclear pleomorphism and mitoses.
• Absent chondroid matrix.
• These are much more likely to infiltrate surrounding tissues, lymph nodes, and organs.

Grade 3 - Even more cellular neoplastic cartilage with high grade nuclear atypia

Grade 4

• Some, but not all, authorities and medical facilities assign a "Grade 4" to the most anaplastic, undifferentiated cartilage-derived tumors.

Video

Below is a video of Extraskeletal Myxoid chondrosarcoma {{#ev:youtube|DxljkFd9xew}}

References

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