Fig. 5

Examples of imaging, histology, hTERT promoter status, and follow-up in four patients with chondrosarcoma. The arrows indicate the chondrosarcoma lesions. Chondrosarcoma, grade 1 (a). Left: Frontal X-ray of the distal tibia demonstrating a 10 cm lucent lesion containing typical chondroid matrix calcification (popcorn calcification). There is endosteal scalloping of the cortices and no signs of periosteal reaction. The image is consistent with a low-grade cartilaginous tumor or an enchondroma. Right: Microphotograph showing a lobulated chondroid tumor with low cellularity, limited cytological atypia and bone permeation. The tumor had no detectable hTERT promoter mutation and did not develop any recurrence or metastasis. Chondrosarcoma, grade 2 (b). Left: T2-weighted sagittal MRI of the lumbosacral column demonstrating a lobulated lesion of the S1/S2 vertebra with a high signal intensity. Several areas of low signal intensity are seen; these correspond to focal areas of dense calcification typical of cartilaginous material. Middle: T1-weighted sagittal MRI of the pelvis demonstrating a low signal intensity of the S1/S2 lesion which is typical of a cartilaginous tumor. Right: Microphotograph showing a chondroid tumor with varying cellularity, focal necrosis, pronounced cytological atypia and bone permeation. The tumor harbored a C228T hTERT promoter mutation. The patient later developed local recurrence, lung metastasis and died of the disease. Chondrosarcoma, grade 2 (c). Left: Axial CT of the thorax demonstrating an expansive lesion of the fourth left rib measuring 5 × 4 × 3 cm with an associated soft-tissue mass containing foci of calcification. The image is consistent with at least an intermediate grade central chondrosarcoma. Right: Microphotograph showing a chondroid tumor with loss of lobulated architecture, increased cellularity, and varying cytological atypia. The tumor had no detectable hTERT promoter mutation. The patient later developed local recurrence, but no distant metastasis. Chondrosarcoma, grade 3 (d). Left: T2-weighted coronar MRI of the left humerus demonstrating a high signal tumor extending from the proximal humeral metaphysis 20 cm distally within the diaphysis. There is a massive soft tissue tumor component growing circumferentially around the humerus which measures 10 cm in diameter. The MRI image is indicative of a highly aggressive tumor. Right: Microphotograph showing a highly cellular chondroid tumor with severe nuclear atypia consistent with a high-grade chondrosarcoma. The tumor harbored a C228T hTERT promoter mutation. The patient had lung metastasis at the time of diagnosis and died of the disease