Elsevier

World Neurosurgery

Volume 92, August 2016, Pages 588.e1-588.e5
World Neurosurgery

Case Report
Secondary Chondrosarcoma of the Upper Thoracic Costovertebral Junction with Neural Foraminal Extension and Compressing the Spinal Cord

https://doi.org/10.1016/j.wneu.2016.04.105Get rights and content

Background

Chondrosarcoma is a rare malignant tumor of bone. This family of tumors can be primary malignant tumors or a secondary malignant transformation of an underlying benign cartilage tumor. Secondary chondrosarcoma arising from a benign solitary costal osteochondroma is extremely rare. Data show that the reported incidence of costal osteochondroma is very low and they are usually found in the anterior region at the costochondral junction. To our knowledge, however, there have been no previous reports, in English literature, describing osteochondroma malignant transformation located in the thoracic costovertebral junction.

Case Description

We report the case of a man with chondrosarcoma arising from the malignant degeneration of an osteochondroma at the right first thoracic costovertebral junction with neural foraminal extension and compressing the spinal cord.

Conclusions

Although it is rare in solitary osteochondromas of rib, malignant transformation must always be considered.

Introduction

Chondrosarcoma is a malignant cartilage-forming bone neoplasm that accounts for 10% of all primary bone tumors with usually poor prognosis.1 Secondary chondrosarcoma arising from a benign solitary costal osteochondroma is extremely rare and has been reported to be 1% in patients.2 Osteochondromas represent 8% of rib tumors and they are usually found in the anterior region at the costochondral junction.3

Chondrosarcoma of the rib in the posterior mediastinum are very rare.4

The following study describes the first case, to our knowledge, of osteochondroma malignant transformation located at the upper thoracic costovertebral junction in a 61-year-old man.

The clinical manifestation, imaging, pathologic findings, management, and outcome associated with such lesion were discussed in this report.

Section snippets

Case report

A 55-year-old man was admitted in 2008 with progressive weakness in his lower limbs with right intercostal pain irradiated from the back. Two months before admission he started with gait difficulties and frequent falls, progressing to a severe paraparesis and inability to walk.

Neurological examination showed spastic paraparesis. Hypoesthesia with partial loss of pain and temperature and diminished proprioception and vibration were seen below the T4 level, in addition to severe spasticity.

Discussion

Osteochondroma is considered a developmental lesion and it is defined as an osteochondral exostosis with cortical and marrow continuity.5, 6

Osteochondroma can arise in any bone that develops from endochondral ossification,5 and the most common age at presentation is 11–20 years. There is no sex predilection in case of solitary osteochondromas.7

About 3% of solitary osteochondromas have costal origin and always involve the ribs in the region of the costochondral junction.8 Generally, posterior

Conclusion

Although it is rare in solitary osteochondromas of rib, malignant transformation must always be considered. Changes of clinical features and in radiologic appearance of an osteochondroma must be viewed with suspicion. The diagnosis is based on histopathologic examination.

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  • Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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