Chondrosarcomas of the hands and feet: A case series and systematic review of the literature

Objective To review the imaging features of chondrosarcomas (CS) of the hands and feet, with pathologic correlation. Materials and methods For 24 histologically-confirmed CS of the hands (n = 14) and feet (n = 10), 23 studies were retrospectively reviewed by two musculoskeletal radiologists in consensus. Radiographs (n = 23), bone scintigrams (n = 2), and magnetic resonance (MR) (n = 7) images were evaluated for lesion location, cortical and medullary involvement, presence of perilesional signal abnormalities and soft tissue masses (STM). Pathologic specimens were reviewed for tumor grade (grade 1-3). Descriptive statistics were reported. Results CS occurred in adults (age range 32-92) and most were located in the digits (22/23 (95.6%)) rather than tarsal/carpal bones (1/23 (4.4%)). For digital CS, 21/22 (95.45%) involved the epiphysis in addition to the metadiaphysis, 22/23 (95.6%) exhibited >2/3 endosteal scalloping, and 16/23 (69.5%) were expansile (>50% of the bone width). Pathologic fractures (7/23 (30.4%)) and STMs (16/23 (69.6%)) were frequent. By MR, perilesional abnormalities were common (bone marrow edema in 6/7 (85%), soft tissue edema in 5/7 (71.4%), STM in 7/7 (100%)). Following contrast administration (n = 6), there was solid (3/6 (50%)) or lobular (3/6 (50%)) enhancement. Bone scintigrams showed increased uptake on all phases (>anterior superior iliac spine (ASIS)). Pathology specimens revealed 17 grade 2 and 7 grade 3CS, with increased cellularity, necrosis and myxoid features. Conclusion CS of the hands and feet have common distinctive features, including involvement of the end-of-bone, significant endosteal scalloping, expansile appearance, a frequent STM, and intermediate to high grade histologic features. Additional aggressive imaging features are identified by MR (perilesional signal abnormalities) and bone scintigraphy (increased uptake > ASIS) that may be helpful clues to the diagnosis.