BACKGROUND AND IMPORTANCE: Clear-cell chondrosarcoma is a rare subtype of chondrosarcoma. These osseous tumors are most commonly found in the end of long bones. We report a rare case of clear-cell chondrosarcoma of the osseous spine. CLINICAL PRESENTATION: A 52-year-old man presented to another institution with a pathologic L1 compression fracture. Intraoperatively, this fracture was discovered to be secondary to a chondrosarcoma involving T12, L1, and L2. He was then referred to our institution for further evaluation and treatment. A 2-stage operation was performed with successful en bloc resection of residual chondrosarcoma with negative margins. The first stage using a posterior approach resulted in placement of pedicle screws from T9 to L4, laminectomies from T12 to L2, and placement of Tomita saws between the thecal sac and the vertebral body at both the T11-12 and L2-3 disc levels. The second stage of the procedure involved a transthoracic, retroperitoneal approach to the thoracolumbar spine. Osteotomies between T11-12 and L2-3 were completed, and the vertebral bodies of T12, L1, and L2 were delivered as an en bloc specimen. The final pathology of the specimen was clear-cell chondrosarcoma with negative margins. CONCLUSION: This report discusses a rare occurrence of clear-cell chondrosarcoma in the osseous spine. Aggressive surgical intervention with the goal of en bloc resection of tumor is recommended to promote tumor-free survival.
BACKGROUND AND IMPORTANCE: Clear-cell chondrosarcoma is a rare subtype of chondrosarcoma. These osseous tumors are most commonly found in the end of long bones. We report a rare case of clear-cell chondrosarcoma of the osseous spine. CLINICAL PRESENTATION: A 52-year-old man presented to another institution with a pathologic L1 compression fracture. Intraoperatively, this fracture was discovered to be secondary to a chondrosarcoma involving T12, L1, and L2. He was then referred to our institution for further evaluation and treatment. A 2-stage operation was performed with successful en bloc resection of residual chondrosarcoma with negative margins. The first stage using a posterior approach resulted in placement of pedicle screws from T9 to L4, laminectomies from T12 to L2, and placement of Tomita saws between the thecal sac and the vertebral body at both the T11-12 and L2-3 disc levels. The second stage of the procedure involved a transthoracic, retroperitoneal approach to the thoracolumbar spine. Osteotomies between T11-12 and L2-3 were completed, and the vertebral bodies of T12, L1, and L2 were delivered as an en bloc specimen. The final pathology of the specimen was clear-cell chondrosarcoma with negative margins. CONCLUSION: This report discusses a rare occurrence of clear-cell chondrosarcoma in the osseous spine. Aggressive surgical intervention with the goal of en bloc resection of tumor is recommended to promote tumor-free survival.
Authors: Alexander Klein; Felix Tauscher; Christof Birkenmaier; Andrea Baur-Melnyk; Thomas Knösel; Volkmar Jansson; Hans Roland Dürr Journal: J Bone Oncol Date: 2019-10-31 Impact factor: 4.072