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|Year : 2021 | Volume
| Issue : 2 | Page : 534-535
Thoracic Chondrosarcoma with a Polka-dot Appearance
Manish K Kasliwal, Aparna Harbhajanka, Marta Couce
Department of Neurosurgery and Pathology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
|Date of Submission||26-Jun-2017|
|Date of Decision||03-Aug-2019|
|Date of Acceptance||08-Aug-2019|
|Date of Web Publication||24-Apr-2021|
Dr. Manish K Kasliwal
Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kasliwal MK, Harbhajanka A, Couce M. Thoracic Chondrosarcoma with a Polka-dot Appearance. Neurol India 2021;69:534-5
A 54-year-old woman presented with complaints of back pain for few weeks. The medical history was insignificant. Her neurological exam was well preserved except for the presence of hyper-reflexia involving the bilateral knee and ankle reflexes with a mild increase in lower extremity muscle tone. A computed tomography (CT) of the spine showed an intrinsic lesion involving the thoracic vertebral body demonstrating prominent trabeculae with characteristic polka dot appearance on axial images [Figure 1]. MRI of the spine with contrast was obtained to further characterize the lesion that revealed the presence of an intrinsic vertebral body lesion hyperintense on T1W MRI, iso to hyperintense on T2W MRI, and contrast enhancement with soft tissue extension into the epidural space and pedicle with mild spinal cord compression [Figure 1]. Whole-body FDG-PET scan did not show any increased uptake in the lesion, and a CT scan of the chest abdomen and pelvis did not show any evidence of any systemic malignancy. Various possible primary spinal tumors were considered in the differential diagnosis, and a biopsy obtained showed the presence of vertebral chondrosarcoma [Figure 2].
|Figure 1: Sagittal (a) and axial (b) images of the thoracic spine computed tomography (CT) of demonstrating a vertebral body lesion with prominent trabeculae (a) and characteristic polka dot appearance on axial images. (c) Sagittal T1W (c), T2W (d), and axial post-contrast (e) MRI of the thoracic spine showing the vertebral body lesion with minimal epidural spread and involvement of the pedicle|
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|Figure 2: Histopathological photograph demonstrating a grade 3 chondrosarcoma with intermediate cellularity and partly myxoid matrix appearance, nuclear atypia, and prominent nucleoli. Hematoxylin and eosin stain, ×200 (a); ×400(b)|
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Primary spine tumors are rare compared to a metastatic lesion involving the vertebral column and are associated with significant challenges associated with their clinical management. Obtaining a tissue diagnosis remains the crux in formulating an appropriate treatment strategy. The importance of CT guided diagnostic biopsy cannot be overemphasized and every attempt should be made to obtain a diagnosis using well-planned, CT-guided trocar biopsy. An open biopsy is not synonymous and in some studies have been correlated with an increased risk of local recurrence and should preferably be avoided. Characteristic radiological appearances such as polka dot appearance for hemangioma and soap bubble appearance in cases of giant cell tumor should not be considered as a proxy for pathological diagnosis before embarking on any form of conservative or active intervention. The outcomes of surgery for certain primary tumors that are well contained within the vertebral body such as chondrosarcoma or chordoma mandates an entirely different surgical approach, often an en-bloc resection if feasible but can have unusual imaging features as was seen in the case described here where an atypical vertebral hemangioma was considered a likely diagnosis with a possibility of direct radio surgical treatment if there was absence of an associated soft tissue component but histopathology showed presence of a grade III chondrosarcoma.An inappropriately performed biopsy with contamination of the tract can preclude further management in such circumstances, and hence, the temptation to work up and plan treatment for suspected primary tumors from radiological appearances should be avoided. While a number of treatment options are available for patients with spinal tumors both primary and secondary with an ever-increasing role of spinal radiosurgery; well-planned biopsy still remains at the helm as the single most important step to direct the most appropriate treatment and help avoid diagnostic and therapeutic pitfalls.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]