J Korean Neurosurg Soc.  2013 Jan;53(1):46-48. 10.3340/jkns.2013.53.1.46.

Chondrosarcoma Apoplexy in Thoracic Spine

Affiliations
  • 1Department of Neurosurgery, College of Medicine, Yeungnam University, Daegu, Korea. sw902@ynu.ac.kr

Abstract

Chondrosarcoma is a very uncommon malignant primary bone tumor, especially, it occurs extremely rare in the spine. A 52-year-old man was admitted to the emergency room with sudden paraplegia. Twelve hours prior to a paraplegic event, he visited an outpatient clinic with discomfort and tenderness around the medial border of the right scapular, and his neurologic status was absolutely intact. Magnetic resonance imaging showed a lobulated soft tissue mass from T3 to T5, which extended to the epidural space. Computed tomography scans showed soft tissue mass on the spinal posterior arch and osteolytic change of the adjacent bony structures. Emergent surgery was performed and the lesion was removed. Dark reddish blood and gel-like material were encountered around the dura and posterior arch during the operation. Multiple pulmonary nodules were found on a chest CT scan and a biopsy of one of them had been proven to be a metastasis of chondrosarcoma. The histologic examination showed dedifferentiated chondrosarcoma. The patient's neurologic deficit was improved slowly from ASIA A to ASIA D. Chondrosarcoma in the spine is extremely rare, even more with acute hemorrhage and sudden expansion into the epidural space. We named it chondrosarcoma apoplexy. We should consider the possibility of a hemorrhagic event when the patient's neurologic deficit worsens suddenly with spinal bone tumor.

Keyword

Chondrosarcoma; Spine; Paraplegia; Hemorrhage; Pulmonary metastasis

MeSH Terms

Ambulatory Care Facilities
Asia
Biopsy
Chondrosarcoma
Emergencies
Epidural Space
Hemorrhage
Magnetic Resonance Imaging
Multiple Pulmonary Nodules
Neoplasm Metastasis
Neurologic Manifestations
Paraplegia
Spine
Stroke
Thorax

Figure

  • Fig. 1 MR imagings show a lobulated soft tissue mass from T3 to T5 which extended to the epidural space. There are destructive changes around adjacent bony structures by this mass (A : T2 weighted image, B : T1 weighted image, C and D : Gd-enhanced image).

  • Fig. 2 Computed tomography scans show soft tissue mass on the spinal posterior arch and osteolytic change of the adjacent bony structures.

  • Fig. 3 A : Gross finding. The resected specimen shows lobulated grayish-white cartilaginous mass with myxoid and cystic change. B : Microscopic finding. The tumor shows bimorphic pattern consisting of low grade chondrosarcoma (on the right) juxataposed of high-grade spindle cell sarcoma (on the left) (hematoxylin eosin stain, ×200).


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