Mesenchymal Chondrosarcoma

It is a particularly rare and deadly type of chondrosarcoma. Approximately ⅔ of cases occur in the bone. and ⅓ in the soft tissues. Can metastasize to lungs, liver, lymph nodes and other bones.

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What is a Mesenchymal Chondrosarcoma?

This is a rare cancerous tumor (sarcoma) that can spread (metastasize). It is a particularly rare type of chondrosarcoma. Approximately ⅔ of cases occur in the bone and ⅓ in the soft tissues. Can metastasize to lungs, liver, lymph nodes and other bones.

Signs and Symptoms
Signs and Symptoms
  • • Signs and symptoms include pain and swelling. 
  • • ⅓ of patients are symptomatic for more than one year.
Causes
Causes
  • • Can be due to the same chromosomal translocation as a Ewing's sarcoma which is a small round blue cell cancer. (t11;22 or EWS/FLI 1)
Who is usually affected?
Who is usually affected?
  • • Typically affects adolescents and young adults.
  • • Seen equally in both males and females. 
  • • Predominantly affects those ages 10 to 40 years.
  • • The peak age is in the third decade of life. 
  • • Very rare.
Common Bones Involved
Common Bones Involved
  • • Lower extremity
  • • Femur
  • • Ribs
  • • Jaw
  • • Pelvis
  • • Can metastasize to lungs, liver, lymph nodes and other bones.
Biological Behavior
Biological Behavior
  • • Are malignant (cancerous) cartilage tumors that destroy bone, adjacent joints and spread into the surrounding muscles. 
  • • It consists of cartilage tissue mixed with small round blue cells similar to a Ewing sarcoma.
  • • Rare and deadly form of chondrosarcoma.
  • • The five year survival rate is 55-65% and the ten year survival rate is 27%.

 

Diagnosis
Diagnosis
  • • The work-up often consists of a physical examination, X-rays, CT scans, MRI, and sometimes bone scans are required. CT scans can be used to check for subtle mineralization that may help with the diagnosis
  • • CT of the chest is necessary to check for pulmonary metastases. The lungs and other bones are the to most common sites for the tumor to spread.
  • • The diagnosis is often confirmed with a biopsy, which means taking a sample of tumor and having it analyzed under a microscope by a pathologist.

Risk to your limbs

Mesenchymal Chondrosarcomas are cancerous aggressive tumors that, if left unchecked, will grow and destroy your normal bone. As the tumor slowly grows, the bone is weakened and you are at an increased risk of breaking the bone due to the tumor (called a pathological fracture). They may also spread to your lungs or other bones.

Radiographic imaging is used to help form a diagnosis. These include X-Ray, MRI, CT and Bone Scans

An example of an Mesenchymal Chondrosarcoma MRI is shown.

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Treatment of

Mesenchymal Chondrosarcoma

Due to its rarity, there are no guidelines for its optimal treatment. Treatment should be aggressive and individualized. Treatment usually involves surgical removal and chemotherapy. Most patients are treated with a combination of surgery and chemotherapy. There are two kinds: round cell variation and hemangiopericytoma-like variation. Treatment for round cell variation includes a combination of chemotherapy, radiation and wide surgical resection. And for hemangiopericytoma-like variation includes chemotherapy and wide surgical resection only without radiation. 

Surgery
Surgery

Most common treatment is wide radical limb sparing surgery. Surgical treatment includes wide or radical resections to remove the complete tumor and additional margins. The removal of additional, surrounding margins ensures that the tumor is completely removed and decreases the chances of the tumor coming back.

I've seen many doctors and I can confidently attest Dr. Wittig is the preeminent orthopaedic specialist. He is genuinely kind and caring, as he demonstrated by completely addressing my concerns and compassionately relating to what I was dealing with. He clearly outlined the plan of attack, and recommended the two additional doctors who would become part of my 'team'. Dr. Wittig was so effective in allaying our fears and bringing us optimism. My surgery was significant, but I was up and walking the next day and back at the gym 5 weeks later. This is further testament to Dr. Wittig's skill. He saved my leg and my life, and I feel so very blessed to say he is my doctor. I have already recommended him to others, and I will continue to do so. I would trust him with my closest family and lifelong friends. BEST DOCTOR EVER.

S.G.

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Hey! I am Dr. Wittig.

Myself and my amazing team are dedicated to saving your life and your limb. Losing a limb because of a tumor can be a terrifying experience. But, it does not have to be the only option. I’ve spent 20+ years as a Board-Certified Orthopedic Surgeon and Orthopedic Oncologist.

I’ve devoted my career to helping children and adults afflicted with bone and soft tissue masses by performing complex limb saving surgeries. Most patients can have their limb saved, which may require innovative techniques.

Patients afflicted with musculoskeletal tumors have complex conditions that are best taken care of at large hospitals. I am the Chairman of Orthopedics and Chief of Orthopedic Oncology at Morristown Medical Center. My philosophy is a multidisciplinary team approach, working together to tailor treatment to individual patients. Education and research are essential to my practice, providing the best setting for extraordinary patient care. Because of this, we have some of the top results in the country.