James C. Wittig, MD
Sarcoma Surgeon
Orthopedic Oncologist
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
Plain X-ray: Periosteal Chondrosarcoma of Distal Femur
 |
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
