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Conventional Chondrosarcoma, Central or Medullary

DEFINITION AND PATHOGENESIS

  • Primarily arising de novo from bone within the IM canal, either low (grade I) or intermediate (grade II)

IMPORTANCE

  • Distinction between enchondroma and low grade IM lesions radiographically and grossly impossible, and difficult with frozen section, so preoperative planning is imperative for appropriate tx
  • 2nd most common sarcoma of bone

CLINICAL FEATURES

  • Rarely seen in children, mean age 46 (5-82)
  • Mean age of 55 (28-93) in hand/foot lesions
  • 11-22% of all primary malignant bone tumors (1/2 as common as osteosarcoma)
  • 31% arise in the pelvis, 21% in the femur, ?6% in the spine (T>L>C)(usually stage IB lesions)
  • Local swelling, pain (81.4%), mass (33.1%), and tenderness; may grow very slowly
  • Pathological fx (8.1%)(15% in spinal lesions)
  • M:F = 1.3:1
  • ± adhesive capsulitis in proximal humeral location
  • Absence of pain does not exlude chondrosarcoma

RADIOLOGIC FEATURES

  • Metaphyseal, diaphyseal, rarely epiphyseal
  • Punctate, flocculent, or rings-and-arcs and popcorn-like calcifications (ossification around cartilage lobules)
  • Regions of the lesion don't retain geographic borders, esp in higher grade lesions
  • Lucencies represent replacement of normal bone by uncalcified cartilage (and without calcifications represent areas of higher grade)
  • Lesion may be "bubbly" in appearance
  • Pathologic fx or stress fx can occur (more commonly in higher grade tumors)
  • Erosion of cortex with breakthrough and a soft tissue mass heralds sarcoma and Grade II status
  • Deep endosteal scalloping (>2/3 of cortical thIickness)
  • 9/12 hand/foot lesions have at least one of the following:
    • Cortical destruction (8/12)
    • Soft tissue extension (7/12)
    • Periosteal reaction (4/12)
  • CT for cortical extent and matrix delineation, and MRI for medullary extent and soft tissue mass or extension
  • T2-weighted images: tumor has bright signal intensity, calcifications have low signal intensity on all se-quences, contrast enhancement in a ring and arc septal pattern; heterogeneity of signal intensity correlates with higher grade, more cellular lesions
  • Bone scan reveals ? uptake, esp along the periphery of the lesion
  • Angiography useful in large pelvic lesions, or thigh lesions for preoperative planning
  • IVP helpful in large pelvic lesions (ureteral stint placement can be helpful prior to resection to palpate for location)
  • When occurring in the sternum, nearly all are malignant
  • When >6-10cm, lesions must be considered most likely malignant

GROSS PATHOLOGY

  • Extension through articular cartilage and through ligaments may occur
  • Soft tissue mass is often surrounded by periosteal new bone or fibrous pseudocapsule

HISTOLOGIC AND MOLECULAR FEATURES

  • If there is malignant osteoid, it is an osteosarcoma
  • Histologic grades "½"-I (60.9%) and II (35.3%), recently "grade 1/2" has been coined; rarely grade III (3.2%)
  • (Older pts tend to have higher grade tumors)
  • ? cellularity and cytological atypia most important in determining grade
  • Hyaline cartilage (may be myxoid) with atypical cells, varibly sized nuclei, and ? cellularity and clumping of cells (cloning), mitotic figures (8%)
  • Myxoid matrix (87%)
  • Trabecular trapping (67%)
  • Collagenase-3 (MMP-13) present in a reported 100% of chondrosarcomas and 25% of benign cartilage tumors by immunohistochemistry
  • von Hippel-Lindau protein significantly reduced in chondrosarcoma tissues
    • Positively correlated with Bax expression
    • Positively correlated with apoptosis index in chondrosarcoma
      • (Reduced expression with decreased apoptosis)
    • (Not independently predictive of survival)
    • von Hippel-Lindau protein a positive regulator of p53
      • (von Hippel-Lindau protein loss of function may lead to malignancy)
    • Impaired von Hippel-Lindau protein levels have increased concentrations of HIF-? and HIF target gene products
      • HIF-? plays a role in evasion of apoptosis by chondrosarcoma cells
        • Associated with elevated levels of anti-apoptotic protein Bcl-xL
  • Endothelin-1 (potent vasoconstrictor) expression
    • Increased migration and expression of MMP-13
      • Reduced by pretreatment with inhibitors:
        • Focal adhesion kinase
        • Phosphatidylinositol 3-kinase
        • AKT
        • Mammalian target of rapamycin (mTOR)
        • NF-?B inhibitor
        • I?B protease inhibitor
    • Endothelin-1 tx induced phosphorylation of:
      • FAK
      • PI3K
      • AKT
      • mTOR
    • Endothelin-1 tx resulted in increased activated FAK/PI3K/AKT/mTOR
      • In turn activated IKK?/? and NF-?B
        • Resulting in crased MMP-13 expression and migration in chondrosarcoma cells

DIFFERENTIAL CLINICOPATHOLOGIC DIAGNOSIS

  • Enchondroma, atypical enchondroma
  • Chondroblastic osteosarcoma (or other histiocytic types)
  • Sheets of spindle cells, chondroid lobules and lace-like osteoid
  • Osteoblastoma
  • IM infarcts, osteonecrosis
  • Intraosseous (ossifying) lipoma
  • MFH
  • Fibrosarcoma
  • Metastatic disease or multiple myeloma

DISEASE COURSE AND TREATMENT

  • Wide resection in ³ grade II lesions (contaminated margins will allow local recurrence, low oxygen tension in hematoma will sustain malignant cartilage growth in surrounding soft tissue)
  • Uncontaminated, clear margins the goal in pelvic resections
  • Ray resection (or limited amputation in phalangeal location) in hand/foot lesions
  • Biopsy the soft tissue mass (to R/O a higher grade lesion), otherwise low grade lesions best treated without bx, but with careful preoperative planning because of characteristic radiographical findings and problems with misdiagnoses associated with sampling errors
  • Cryosurgery after curettage and burring for low grade ("1/2" to 1) lesions (without soft tissue mass)
  • Metastases occur in <15% of low grade lesions and 15-50% of intermediate (grade II) lesions (tumor grade most important prognostic factor)
  • Poorer prognosis in axial lesions (including pelvic location), and incompletely curetted or resected lesions
  • Aggressively resecting pelvic chondrosarcomas results in long term survival (the outcome is determined by the adequacy of the resection)
  • 94% 1 yr, 82% 5 yr, 80% 10 yr, 77% 15 yr survival for pelvic chondrosarcomas
  • Re-resection of pelvic LR may result in cure
  • 5-year survival of pts with condrosarcoma of the spine is 55%, median survival 6 yrs
  • Relatively avascular tumor allows mechanical transplantabiltiy from one site to another (esp with < wide resec-tions)
  • Complications
  • Recurrences usually herald a stepup in grade and ? metastases (and possibly under tx in the first place)(may not occur for >10 years after initial tx)
  • Progression may occur via intravenous extension or to adjacent vital structures
  • Chemotherapy or XRT not helpful in controlling local disease or metastases
  • XRT should be considered in vertebral lesions when surgical ablation is not obtainable
  • Fluoroquinolone toxic to immature chondrocytes and their use in chondrosarcoma under investigation (induces oxidative metabolism?impairment of proteoglycan and procollagen synthesis; interacts with topoisomerase II?? inhibits DNA replication?DNA strand breaks and apoptosis)
  • ? incidence of LR and metastases when p53 overexpression or alteration is present (38% of conventional chondrosarcomas), mitoses, a myxoid tumor matrix, necrosis, high-grade tumor, size >100cc, and a ploidic abnormality (aneuploidy/high mean DNA index)
  • MIB-1 expression associated with recurrence and death (more predictive than histologic grade)
    Low ratio of mRNA expression of matrix metalloproteinase-1 to the tissue inhibitor of metalloproteinase-1 low histological grade, and F gender predictors of better prognosis

SPECIAL CONSIDERATION

  • INTRACORTICAL CHONDROSARCOMA
    • Lucent lesion within the cortex
    • Intermediate grade chondrosarcoma which requires en bloc resection
  • MULTICENTRIC CHONDROSARCOMAS
    • May be monomelic (± skip lesions) or disseminated
    • Can be synchronous, metachronous, occasionally with Ollier's disease

REFERENCES

Alho A, Connor JF, Mankin HJ, Schiller AL, Campbell CJ: Assessment of malignancy of cartilage tumors using flow cytometry. A preliminary report. J Bone Joint Surg 65:779-85,1983.
Antonescu CR, Argani P, Erlandson RA, Healey JH, Ladanyi M, Huvos AG: Skeletal and extraskeletal myxoid chondrosarcoma: a comparative clinicopathologic, ultrastructural, and molecular study. Cancer 83:1504-21,1998.
Aoki J, Moser RP Jr, Kransdorf MJ: Chondrosarcoma of the sternum: CT features. J Comput Assist Tomogr 13:806-10,1989.
Aoki J, Sone S, Fujioka F, Terayama K, Ishii K, Karakida O, Imai S, Sakai F, Imai Y: MR of enchondroma and chondrosarcoma: rigs and arcs of Gd-DTPA enhancement. J Comput Assist Tomogr 15:1011-6,1991.
Babinet A, de Pinieux G, Tomeno B, Forest M, Anbact P: Intracortical chondrosarcoma. A case report. J Bone Joint Surg 85A:533-5,2003.
Ball AB, Barr L, Westbury G: Chondrosarcoma of the pelvis: the role of palliative debulking surgery. Eur J Surg Oncol 17:135-8,1991.
Bansal R, Pai RR, Nayak R, Raghuveer CV: Metastatic chondrosarcoma in soft tissue diagnosed by fine needle aspiration (FNA) cytology. Cytopathology 7:70-2,1996.
Barnes R, Catto M: Chondrosarcoma of bone. J Bone Joint Surg 48B:729-64,1966.
Bauer HCF, Brosjö O, Kreicbergs A, Lindholm J: Low risk of recurrence of enchondroma and low-grade chondrosarcoma in extremities: 80 patients followed for 2-25 years. Acta Orthop Scand 66:283-8,1995.
Berend KR, Toth AP, Harrelson JM, Layfield SJ, Hey LA, Scully SP: Association between ratio of matrix metalloproteinase-1 to tissue inhibitor of metalloproteinase-1 and local recurrence, metastasis, and survival in human chondrosarcoma. J Bone Joint Surg 80A:11-7, 1998.
Björnsson J, McLeod RA, Unni KK, Ilstrup DM, Pritchard DJ: Primary chondrosarcoma of long bones and limb girdles. Cancer 83:2105-19,1998.
Briccoli A, Campanacci L, Biagini R, Rocca M, Malaguti C, Mercuri M: Chondrosarcoma of the ribs and sternum. Considerations on 20 cases treated. Chir Organi Mov 87:17-23,2002.
Briccoli A, De Paolis M, Campanacci L, Mercuri M, Bertoni F, Lari S, Balladelli A, Rocca M: Chondrosarcoma of the chest wall: a clinical analysis. Surg Today 32:291-6,2002.
Boriani S, De Iure F, Bandiera S, Campanacci L, Biagini R, Di Fiore M, Bandello L, Picci P, Bacchini P: Chondrosarcoma of the mobile spine: report on 22 cases. Spine 25:804-12,2000.
Buiski G, Ratliff AH, Watt I: Cartilage-cell-containing tumours of the pelvis: a radiological review of 40 patients. Br J Radiol 59:197-204,1986.
Campanacci M, Guernelli N, Leonessa C, : Chondrosarcoma: a study of 133 cases, 80 with long-term follow-up. Ital J Orthop Traumatol 1:387-414,1975.
Cash S, Habermann E: Chondrosarcoma of the small bones of the hand: case report and review of the literature. Orthopedic Review 17:365-9,1988.
Cawte TG, Steiner GC, Beltran J, Dorfman H: Chondrosarcoma of the short tumbular bones of the hands and feet. Skeletal Radiol 27:625-32,1998.

Chen C, Zhou H, Liu X, Liu Z, Ma Q. Reduced expression of von hippel-lindau protein correlates with decreased apoptosis and high chondrosarcoma grade. J Bone Joint Surg Am. 2011 Oct 5;93(19):1833-40.
Cohen EK, Kressel HY, Frank TS, Fallow M, Burk DL Jr, Dalinka MK, Schiebler ML: Hyaline cartilage-origin bone and soft tissue neoplasms: MR appearance and histologic correlation. Radiology 167:477-81,1988.
Coughlan B, Feliz A, Ishida T, : p53 expression and DNA ploidy of cartilage lesions. Hum Pathol 26:620-4,1995.
Dahlin DC, Henderson ED: Chondrosarcoma, a surgical and pathological problem: review of two hundred and twelve cases. J Bone Joint Surg 38A:1025-38,1956.
Damron TA, Sim FH, Unni KK: Multicentric chondrosarcomas. Clin Orthop 328:211-9,1996.
De Beuckeleer LHL, De Schepper AMA, Ramon F: Magnetic resonance imaging in cartilaginous tumors: is it usefull or necessary? Skeletal Radiol 25:137-41,1996.
De Beuckeleer LH, De Schepper AM, Ramon F, Somville J: Magnetic resonance imaging of cartilaginous tumors: a retrospective study of 79 patients. Eur J Radiol 21:34-40,1995.
Dijkhuizen T, van den Berg E, Molenaar WM, : Cytogenetics as a tool in the histologic subclassification of chondrosarcomas. Cancer Genet Cytogenet 76:100-5,1994.
Dobashi Y, Sugimura H, Sato A, : Possible association of p53 overexpression and mutation with high-grade chondrosarcoma. Diagn Mol Pathol 2:257-63,1993.
Eriksson AI, Schiller A, Mankin HJ: The management of chondrosarcoma of bone. Clin Orthop 153:44-66,1980.
Erikson U, Hjelmstedt A: Limb-saving radical resection of chondrosarcoma of the pelvis. J Bone Joint Surg 58:568-70,1976.

Erlandson RA, Huvos AG: Chondrosarcoma: a light and electron microscopic study. Cancer 34:1642-52,1974.
Evans HL, Ayala AG, Romsdahl MM: Prognostic factors in chondrosarcoma of bone: a clinicopathologic analysis with emphasis on histologic grading. Cancer 40:818-31,1977.
Exner GU, Dumont CE, Malinin TI, von Hochstetter AR: Recurrent aggressive chondrosarcoma of the middle phalanx of the index finger: excision and reconstruction with an osteocartilaginous allograft. Arch Orthop Trauma Surg 123:425-8,2003.
Forest M: Chondrosarcoma: variants. In Forest M, Tomeno B, Vanel D (eds) Orthopaedic Surgical Pathology. Diagnosis of Tumors and Peudotumoral Lesions of Bone and Joints. New York: Churchill Livingstone; 1998, 261-92.
Geirnaerdt MJ, Hermans J, Bloem JL, Kroon HM, Pope TL, Taminiau AH, Hogendoom PC: Usefulness of radiography in differentiating enchondroma from central grade I chondrosarcoma. Am J Roentgenol 169:1097-1104,1997.
Geirnaerdt MJ, Hogendoom PC, Bloem JL, Taminiau AH, van der Woude HJ: Cartilaginous tumors: fast contrast enhanced MR imaging. Radiology 214:539-46,2000.
Gibbs CP Jr, Weber K, Scarborough MT: Malignant bone tumors. J Bone Joint Surg 83A:1728-45,2001.
Gitelis S, Bertoni F, Picci P, Campanacci M: Chondrosarcoma of bone: the experience at the Instituto Orthopedico Rizzoli. J Bone Joint Surg 63A:1248-57,1981.
Grabias S, Mankin HJ: Chondrosarcoma arising in histologically proved unicameral bone cyst. A case report. J Bone Joint Surg 56:1501-9,1974.
Greenspan A: Tumors of cartilage origin. Orthop Clin North Am 20:347-66,1989.
Gruber HE, Marshall GJ, Kirchen ME, Menendez LR, Schwinn CP: Bone remodelling in the presence of chondrosarcoma: histomorphometry. Acta Anat 148:1-7,1993.
Harwood AR, Krajbich JI, Fornasier VI: Radiotherapy of chondrosarcoma of bone. Cancer 45:2769-2777,1980.
Healey JH, Lane JM: Chondrosarcoma. Clin Orthop 204:119-29,1986.
Helio H, Karaharju E, Bohling T, Kivioja A, Nordling S: Chondrosarcoma of bone: a clinical and DNA flow cytometric study. Eur J Surg Oncol 21:408-13,1995.
Henderson ED, Dahlin DC: Chondrosarcoma of bone: a study of two hundred and eighty-eight cases. J Bone Joint Surg 45A:1450-8,1963.
Hudson TH, Chew FS, Manaster BJ: Radionuclide bone scanning of medullary chondrosarcoma. AJR 139:1071-7,1982.
Hudson TM, Manaster BJ, Springfield DS, Spanier SS, Enneking WF, Hawkins IF, Jr: Radiology of medullary chondrosarcoma: preoperative treatment planning. Skeletal Radiol 10:69-78,1983.
Huvos A, Marcove R: Chondrosarcoma in the young: a clinicopathologic analysis of 79 patients younger than 21 years of age. Am J Surg Path 11:930-42,1987.
Janzen L, Logan PM, O'Connell JX, Connell DG, Munk PL: Intramedullary chondroid tumors of bone: correlation of abnormal peritumoral marrow and soft-tissue MRI signal with tumor type. Skeletal Radiol 26:100-6,1997.
Juntis E, Dart RC: Chondrosarcoma of the hand with metastasis: a review of the literature and case report. J Hand Surg 8:320-4,1983.
Kaufman JH, Douglass HO Jr, Blake W, Moore R, Rao UN: The importance of initial presentation and treatment upon the survival of patients with chondrosarcoma. Surg Gynecol Obstet 145:357-63,1977.
Kawai A, Healey JH, Boland PJ, Lin PP, Huvos AG, Meyers PA: Prognostic factors for patients with sarcomas of the pelvic bones. Cancer 82:851-9,1998.
Kreicbergs A, Boquist L, Borgssen B, Larsson SE: Prognostic factors in chondrosarcoma: a comparative study of cellular DNA content and clinicopathologic features. Cancer 50:577-83,1982.
Krochak R, Harwood AR, Cummings BJ, Quirt IC: Results of radical radiation experience with chondrosarcoma of bone. Radiother Oncol 1:109-115,1983.
Lagergren C, Linbom A, Soderberg G: The blood vessels of chondrosarcomas. Acta Radiol 55:321-8,1961.
Lee FY, Mankin HJ, Fondren G, Gebhardt MC, Springfield DS, Rosenberg AE, Jennings LC: Chondrosarcoma of bone: an assessment of outcome. J Bone Joint Surg 81A:326-38,1999.

Leerapun T, Hugate RR, Inwards CY, Scully SP, Sim FH: Surgical management of conventional grade I chondrosarcoma of long bones. Clin Orthop 463:166-72,2007.

Li MC, Guo HC, Chen G, Kong F, Zhang QH. Meningitis caused by Enterococcus casseliflavus with refractory cerebrospinal fluid leakage following endoscopic endonasal removal of skull base chondrosarcoma. Chin Med J (Engl). 2011 Oct;124(20):3440.

Lichtenstein L, Jaffe HL: Chondrosarcoma of bone. Am J Pathol 19:553-74,1943.
Lindbom A, Soderberg G, Spjut HJ: Primary chondrosarcoma of bone. Acta Radiol 55:81-96,1961.
Mankin HJ: Chondrosarcomas of digits: are they really malignant? Cancer 86:1635-7,1999.
Mankin HJ, Cantley KP, Lippiello, Schiller AL, Campbell CJ: The biology of human chondrosarcoma. I. Description of the cases, grading, and biochemical analyses. J Bone Joint Surg 62A:`60-76,1980.
Mankin HJ, Cantley KP, Schiller AL, Lippiello L: The biology of human chondrosarcoma: II. Variation in chemical composition among types and subtypes of benign and malignant cartilage tumors. J Bone Joint Surg 62A:176-88,1980.
Marco RAW, Gitelis S, Brebach GT, Healey JH: Cartilage tumors: evaluation and treatment. J Am Acad Orthop Surg 8:292-304,2000.
Marcove RC, Huvos AG: Cartilaginous tumors of the ribs. Cancer 76:618-25,1971.
Marcove RC, Mike V, Hutter RV, Huvos AG, Shoji H, Miller TR, Kosloff R: Chondrosarcoma of the pelvis and upper end of the femur. J Bone Joint Surg 54A:561-72,1972.
Marcove RC, Stovell PB, Huvos AG, Bullough PG: The use of cryosurgery in the treatment of low and medium grade chondrosarcoma: a preliminary report. Clin Orthop 122:147-56,1977.
Masi L, Malentacchi C, Campanacci D, Franchi A: Transforming growth factor-beta isoform and receptor expression in chondrosarcoma of bone. Virchows Arch 440:491-7,2002.
Miller DR, Mankin HJ: A comparison of collagen synthesis by different categories of human chondrosarcoma in organ culture. Clin Orthop 168:252-7,1982.
Miller DR, Treadwell BV, Mankin HJ: De novo protein synthesis by human chondrosarcoma in cell and organ culture: evidence of unusually high collagen production by a neoplastic tissue. Connect Tissue Res 8:9-20,1980.
Mirra JM, Gold R, Downs J, Eckardt JJ: A new histologic approach to the differentiation of enchondroma and chondrosarcoma of the bones. A clinicopathologic analysis of 51 cases. Clin Orthop 201:214-37,1985.
Mirra JM, Picci P, and Gold RH. Intramedullary cartilage- and chondroid-producing tumors. In Bone Tumors. Clinical, radiologic and pathologic correlations. Lea & Febiger. Philadelphia, 1989, pp 439-690.
Moser RP, Jr:: Cartilaginous Tumors of the Skeleton. AFIP Atlas of Radiologic-Pathologic Correlations. Fascicle II. Davidson AJ (Ed). Mosby-Year Book, St. Louis, 1990.
Multhaupt HAB, Alvarez JC, Rafferty PA, Warhol MJ, Lackman RD: Fluoroquinolone's effect on grwoth of human chondrocytes and chondrosarcomas. In vitro and in vivo correlation. J Bone Joint Surg 83B(suppl 2, part 1):56-61,2001.
Murphey MD, Andrews CL, Flemming DJ, Temple HT, Smith WS, Smirniotopoulos JG: From the archives of the AFIP: primary tumors of the spine--radiologic pathologic correlation. Radiographics 16:1131-58,1996.
Murphey MD, Flemming DJ, Boyea SR, Bojescul JS, Sweet DE, Temple HT: Enchondroma versus chondrosarcoma in the appendicular skeleton: differentiating features. Radiographics 18:1213-37,1998.
McNaney D, Lindberg RD, Ayala AG, Barkely HT Jr, Hussey DH: Fifteen year radiotherapy experience with chondrosarcoma of bone. Int J Radiat Nocol Biol Phys 8:187-90,1982.
Ogose A, Unni KK, Swee RG, May GK, Rowland CM, Sim FH: Chondrosarcoma of small bones of the hands and feet. Cancer 80:50-9,1997.
Oshiro Y, Chaturvedi V, Hayden D, Nazeer T, Johnson M, Johnson M, Johnston DA, Ordóñez NG, Ayala AG, Czerniak B: Altered p53 is associated with aggressive behavior of chondrosarcoma. A long term follow-up study. Cancer 83:2324-34, 1998.
Ozaki T, Hillmann A, Linder N, Blasius S, Winkelmann W: Chondrosarcoma of the pelvis. Clin Orthop 337:226-39,1997.
Ozaki T, Hillmann A, Lindner N, Blasius S, Winkelmann W: Metastasis of chondrosarcoma. J Cancer Res Clin Oncol 122:625-8,1996.
Ozaki T, Lindner N, Hillmann A, Rodl R, Blasius S, Winkelmann W: Influence of intralesional surgery on treatment outcome of chondrosarcoma. Cancer 77:1292-7,1996.
Palmieri TJ: Chondrosarcoma of the hand. J Hand Surg 9A:332-8,1984.
Park Y-K: Unusual types of chondrosarcoma. Pathol Case Rev 5:307-13,2000.
Patel M, Pearlman H, Engle J, Wollowick B: Chondrosarcoma of the proximal phalanx of the finger. J Bone Joint Surg 59A:401-3,1977.
Peh WCG: Primary central chondrosarcoma. Am J Orthop 31:155,2002.
Pring ME, Weber KL, Unni K, Sim FH: Chondrosarcoma of the pelvis. A review of sixty-four cases. J Bone Joint Surg 83A:1630-42,2001.
Pritchard DJ, Lunke RJ, Taylor WF, Dahlin DC, Medley BE: Chondrosarcoma: a clinicopathologic and statistical analysis. Cancer 45:149-57,1980.
Rizzo M, Ghert MA, Harrelson JM, Scully SP: Chondrosarcoma of bone. Clin Orthop 391:224-33,2001.
Rosenthal DI, Schiller AL, Mankin HJ: Chondrosarcoma: correlation of radiological and histological grade. Radiology 150:21-6,1984.
Rosier RN, O'Keefe RJ, Teot LA, Fox EJ, Nester TA, Puzaz JE, Reynolds PR, Hicks DG: P-glycoprotein expression in cartilaginous tumors. J Surg Oncol 65:95-105,1997.
Sanerkin NG: The diagnosis and grading of chondrosarcoma of bone: a combined cytologic and histologic approach. Cancer 45:582-94,1980.
Sanerkin NG, Gallagher P: A review of the behavior of chondrosarcoma of bone. J Bone Joint Surg 61B:395-400,1979.

Schreuder HW, Pruszczynski M, Veth RP, Lemmens JA: Treatment of benign and low-grade malignant intramedullary chondroid tumours with curettage and cryosurgery. Eur J Surg Oncol 24:120-6,1998.
Scully SP, Berend KR, Toth A, Qi WN, Qi Z, Block JA: Marshal Urist Award. Interstitial collagenase gene expression correlates with in vitro invasion in human chondrosarcoma. Clin Orthop 376:291-303,2000.
Scully SP, Layfield LJ, Harrelson JM: Prognostic markers in chondrosarcoma: evaluation of cell proliferation and regulators of the cell cycle. Sarcoma 1:79-87,1997.
Sheth DS, Yasko AW, Johnson ME, Ayala AG, Murray JA, Romsdahl MM: Chondrosarcoma of the pelvis: prognostic factors for 67 patients treated with definitive surgery. Cancer 78:745-50,1996.
Shin KH, Rougraff BT, Simon MA: Oncologic outcomes of primary bone sarcomas of the pelvis. Clin Orthop 304:207-17,1994.
Shives TC, McLeod RA, Unni KK, Schray MF: Chondrosarcoma of the spine. J Bone Joint Surg 71A:1158-65, 1989.
Springfield DS, Gebhardt MC, McGuire MH: Chondrosarcoma: a review. J Bone Joint Surg. 78-A:141-149, 1996.
Springfield DS, Gebhardt MC, McGuire MH: Chondrosarcoma: a review. In Pritchard DJ (ed): Instructional Course Lectures 45. Rosemont, IL, American Academy of Arthopaedic Surgeons, 1996, pp417-424.
Toriyama M, Rosenberg AE, Mankin HJ, Fondren T, Treadwell BV, Towle CA: Matrix metalloproteinase digestion of aggrecan in human cartilage tumours. Eur J Cancer 34:1969-73,1996.
Tsuchiya H, Ueda Y, Morishita H, Nonomura A, Kawashima A, Fellinger EJ, Tomita K: Borderline chondrosarcoma of long and flat bones. J Cancer Res Clin Oncol 119:363-8,1993.
Tuns M, Ekinci C: Chondrosarcoma diagnosed by fine needle aspiration cytology. Acta Cytol 40:283-8,1996.
Unal O, Arslan H, Karaayvac M, Akpelat N: Subdiaphragmatic location of costal chondrosarcoma. Act Radiol 4:198-9,2000.
Uría JA, Balbín M, López JM, Alvarez J, Vizoso F, Takigaqa M, López-Otín C: Collagenase-3 (MMP-13) expression in chondrosarcoma cells and its regulation by basic fibroblast growth factor. Am J Pathol 153:91-101,1998.
Van Beerendonk HM, Rozeman LB, Taminiau AH, Sciot R, Bovee JV, Cleton-Jansen AM, Hogendoom PC: Molecular analysis of the INK4A/INK4A-ARF gene locus in conventional (central) chondrosarcomas and enchondromas: indication of an important gene for tumour progression. J Pathol 202:359-66,2004.
Vanderhooft JE, Conrad EU, Anderson PA, Richardson ML, Bruckner J: Intradural recurrence with chondrosarcoma of the spine: a case report and review of the literature. Clin Orthop 294:90-95,1993.
van Loon CJM, Veth RPH, Pruszczynski M, Webbes T, Lemmens JAM, van Horn J: Chondrosarcoma of bone: oncologic and functional results. J Surg Oncol 57:214-21,1994.

Wu MH, Lo JF, Kuo CH, Lin JA, Lin YM, Chen LM, Tsai FJ, Tsai CH, Huang CY, Tang CH. Endothelin-1 promotes MMP-13 production and migration in human chondrosarcoma cells through FAK/PI3K/Akt/mTOR pathways. J Cell Physiol. 2011 Sep 29. doi: 10.1002/jcp.23043.

Yaghmai I: Angiographic features of chondromas and chondrosarcomas. Skeletal Radiol 3:91-8,1978.
Young C, Sim F, Unni K, McLeod R: Chondrosarcoma of bone in children. Cancer 66:1641-8,1990.

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