DOI: 10.1148/rg.235035134
From the Archives of the AFIP
Imaging of Primary Chondrosarcoma: Radiologic-Pathologic Correlation1
Mark D. Murphey, MD,
Eric A. Walker, MD,
Anthony J. Wilson, MB, ChB,
Mark J. Kransdorf, MD,
H. Thomas Temple, MD and
Francis H. Gannon, MD
1 From the Departments of Radiologic Pathology (M.D.M., E.A.W., A.J.W.) and Orthopedic Pathology (F.H.G.), Armed Forces Institute of Pathology, 6825 16th Street NW, Bldg 54, Rm M-133A, Washington, DC 20306; Departments of Radiology and Nuclear Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (M.D.M.); Department of Radiology, University of Maryland School of Medicine, Baltimore (M.D.M.); Department of Radiology, Harborview Medical Center, Seattle, Wash (A.J.W.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.J.K.); and Department of Orthopedic Surgery, University of Miami School of Medicine, Miami, Fla (H.T.T.). Received May 19, 2003; revision requested June 10 and received June 20; accepted June 23. Address correspondence to M.D.M. (e-mail: murphey@afip.osd.mil).
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Figure 1. Photograph of a coronally sectioned gross specimen of a conventional intramedullary chondrosarcoma of the femur demonstrates a multilobulated lesion replacing a long extent of the marrow space (C). Two foci of deep endosteal scalloping (greater than two-thirds of the normal cortical thickness) with expansile remodeling of bone (arrows) are seen. A biopsy site is noted at the superolateral diaphysis (B).
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Figure 2. Photograph of an axially sectioned whole-mounted specimen (hematoxylin-eosin stain) shows multiple cartilaginous lobules (*) replacing the femoral marrow with deep endosteal scalloping anteriorly, cortical penetration, and a small focus of soft-tissue extension (large arrows), findings that represent conventional intramedullary chondrosarcoma. Enchondral ossification at the periphery of the chondroid lobules causing a ring-and-arc appearance is also seen (small arrows).
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Figure 3. High-power photomicrograph (original magnification, x200; hematoxylin-eosin stain) shows a grade 2 conventional chondrosarcoma with cartilage lobules (C) entrapping osseous trabeculae (T) and cellular atypia represented by multinucleated cartilage cells (arrows).
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Figure 4. High-power photomicrograph (original magnification, x250; hematoxylin-eosin stain) shows large cells with abundant clear cytoplasm (*) secondary to high glycogen content and prominent nucleoli within the nucleus, findings typical of a clear cell chondrosarcoma. Areas of typical conventional chondrosarcoma were also seen (not shown).
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Figure 5. Photograph of an oblique longitudinally sectioned gross specimen from the left calf of a 37-year-old man with a juxtacortical chondrosarcoma shows typical lobular chondroid architecture (C) with extrinsic erosion of the fibula (arrows) and cortical thickening (P). The marrow canal is not involved (M). (For radiologic images see Fig 15.)
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Figure 6a. Myxoid chondrosarcomas in two different patients. (a) Photograph of a sagittally sectioned gross specimen of an amputated finger shows gelatinous consistency of the myxoid tissue (*) and small foci of cartilage (C). (b) Photomicrograph (original magnification, x175; hematoxylin-eosin stain) reveals a cartilage neoplasm with prominent myxoid changes and cordlike arrangement of cells surrounding osseous trabeculae (T).
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Figure 6b. Myxoid chondrosarcomas in two different patients. (a) Photograph of a sagittally sectioned gross specimen of an amputated finger shows gelatinous consistency of the myxoid tissue (*) and small foci of cartilage (C). (b) Photomicrograph (original magnification, x175; hematoxylin-eosin stain) reveals a cartilage neoplasm with prominent myxoid changes and cordlike arrangement of cells surrounding osseous trabeculae (T).
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Figure 7. Photomicrograph (original magnification, x150; hematoxylin-eosin stain) shows the typical bimorphic appearance of mesenchymal chondrosarcoma, with a malignant cartilaginous component on the right (C) and an abrupt transition to a more cellular vascular portion on the left (H) with hemangiopericytoma-like features. Arrows = vascular channels.
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Figure 8. Photomicrograph (original magnification, x200; hematoxylin-eosin stain) shows a "collision of two tumors" typical of a dedifferentiated chondrosarcoma, with low-grade chondrosarcoma on the right (C) adjacent to a high-grade fibrosarcoma component on the left (F) with an abrupt transition.
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Figure 9a. Conventional intramedullary chondrosarcoma of the humerus in a 21-year-old man with shoulder pain. (a) Anteroposterior shoulder radiograph shows a proximal humeral mixed lytic and sclerotic lesion with expansile remodeling. The sclerotic component represents typical chondroid ring-and-arc calcification (white arrows). Lytic focus seen inferolaterally (black arrow) demonstrates deep endosteal scalloping typical of chondrosarcoma. (b) Anterior bone scan shows that the lesion has radionuclide uptake greater than that in the anterior iliac spines. (c) Axial CT scan shows decreased attenuation of the nonmineralized component of the lesion and chondroid mineralization (arrows). (d, e) Axial T1-weighted fat saturation (repetition time msec/echo time msec = 600/20) MR images obtained before (d) and after (e) intravenous administration of gadolinium show signal intensity similar to that of muscle and mild peripheral and septal enhancement (arrows). (f) Coronal T2-weighted (3,000/57) MR image demonstrates lobular growth (large arrow) and a focus of deep endosteal scalloping with cortical penetration (small arrows) laterally. (g) Photograph of the coronally sectioned gross specimen shows a cartilage lesion with lobular growth (large arrow) and cortical destruction laterally (small arrows), identically correlating to imaging features.
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Figure 9b. Conventional intramedullary chondrosarcoma of the humerus in a 21-year-old man with shoulder pain. (a) Anteroposterior shoulder radiograph shows a proximal humeral mixed lytic and sclerotic lesion with expansile remodeling. The sclerotic component represents typical chondroid ring-and-arc calcification (white arrows). Lytic focus seen inferolaterally (black arrow) demonstrates deep endosteal scalloping typical of chondrosarcoma. (b) Anterior bone scan shows that the lesion has radionuclide uptake greater than that in the anterior iliac spines. (c) Axial CT scan shows decreased attenuation of the nonmineralized component of the lesion and chondroid mineralization (arrows). (d, e) Axial T1-weighted fat saturation (repetition time msec/echo time msec = 600/20) MR images obtained before (d) and after (e) intravenous administration of gadolinium show signal intensity similar to that of muscle and mild peripheral and septal enhancement (arrows). (f) Coronal T2-weighted (3,000/57) MR image demonstrates lobular growth (large arrow) and a focus of deep endosteal scalloping with cortical penetration (small arrows) laterally. (g) Photograph of the coronally sectioned gross specimen shows a cartilage lesion with lobular growth (large arrow) and cortical destruction laterally (small arrows), identically correlating to imaging features.
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Figure 9c. Conventional intramedullary chondrosarcoma of the humerus in a 21-year-old man with shoulder pain. (a) Anteroposterior shoulder radiograph shows a proximal humeral mixed lytic and sclerotic lesion with expansile remodeling. The sclerotic component represents typical chondroid ring-and-arc calcification (white arrows). Lytic focus seen inferolaterally (black arrow) demonstrates deep endosteal scalloping typical of chondrosarcoma. (b) Anterior bone scan shows that the lesion has radionuclide uptake greater than that in the anterior iliac spines. (c) Axial CT scan shows decreased attenuation of the nonmineralized component of the lesion and chondroid mineralization (arrows). (d, e) Axial T1-weighted fat saturation (repetition time msec/echo time msec = 600/20) MR images obtained before (d) and after (e) intravenous administration of gadolinium show signal intensity similar to that of muscle and mild peripheral and septal enhancement (arrows). (f) Coronal T2-weighted (3,000/57) MR image demonstrates lobular growth (large arrow) and a focus of deep endosteal scalloping with cortical penetration (small arrows) laterally. (g) Photograph of the coronally sectioned gross specimen shows a cartilage lesion with lobular growth (large arrow) and cortical destruction laterally (small arrows), identically correlating to imaging features.
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Figure 9d. Conventional intramedullary chondrosarcoma of the humerus in a 21-year-old man with shoulder pain. (a) Anteroposterior shoulder radiograph shows a proximal humeral mixed lytic and sclerotic lesion with expansile remodeling. The sclerotic component represents typical chondroid ring-and-arc calcification (white arrows). Lytic focus seen inferolaterally (black arrow) demonstrates deep endosteal scalloping typical of chondrosarcoma. (b) Anterior bone scan shows that the lesion has radionuclide uptake greater than that in the anterior iliac spines. (c) Axial CT scan shows decreased attenuation of the nonmineralized component of the lesion and chondroid mineralization (arrows). (d, e) Axial T1-weighted fat saturation (repetition time msec/echo time msec = 600/20) MR images obtained before (d) and after (e) intravenous administration of gadolinium show signal intensity similar to that of muscle and mild peripheral and septal enhancement (arrows). (f) Coronal T2-weighted (3,000/57) MR image demonstrates lobular growth (large arrow) and a focus of deep endosteal scalloping with cortical penetration (small arrows) laterally. (g) Photograph of the coronally sectioned gross specimen shows a cartilage lesion with lobular growth (large arrow) and cortical destruction laterally (small arrows), identically correlating to imaging features.
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Figure 9e. Conventional intramedullary chondrosarcoma of the humerus in a 21-year-old man with shoulder pain. (a) Anteroposterior shoulder radiograph shows a proximal humeral mixed lytic and sclerotic lesion with expansile remodeling. The sclerotic component represents typical chondroid ring-and-arc calcification (white arrows). Lytic focus seen inferolaterally (black arrow) demonstrates deep endosteal scalloping typical of chondrosarcoma. (b) Anterior bone scan shows that the lesion has radionuclide uptake greater than that in the anterior iliac spines. (c) Axial CT scan shows decreased attenuation of the nonmineralized component of the lesion and chondroid mineralization (arrows). (d, e) Axial T1-weighted fat saturation (repetition time msec/echo time msec = 600/20) MR images obtained before (d) and after (e) intravenous administration of gadolinium show signal intensity similar to that of muscle and mild peripheral and septal enhancement (arrows). (f) Coronal T2-weighted (3,000/57) MR image demonstrates lobular growth (large arrow) and a focus of deep endosteal scalloping with cortical penetration (small arrows) laterally. (g) Photograph of the coronally sectioned gross specimen shows a cartilage lesion with lobular growth (large arrow) and cortical destruction laterally (small arrows), identically correlating to imaging features.
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Figure 9f. Conventional intramedullary chondrosarcoma of the humerus in a 21-year-old man with shoulder pain. (a) Anteroposterior shoulder radiograph shows a proximal humeral mixed lytic and sclerotic lesion with expansile remodeling. The sclerotic component represents typical chondroid ring-and-arc calcification (white arrows). Lytic focus seen inferolaterally (black arrow) demonstrates deep endosteal scalloping typical of chondrosarcoma. (b) Anterior bone scan shows that the lesion has radionuclide uptake greater than that in the anterior iliac spines. (c) Axial CT scan shows decreased attenuation of the nonmineralized component of the lesion and chondroid mineralization (arrows). (d, e) Axial T1-weighted fat saturation (repetition time msec/echo time msec = 600/20) MR images obtained before (d) and after (e) intravenous administration of gadolinium show signal intensity similar to that of muscle and mild peripheral and septal enhancement (arrows). (f) Coronal T2-weighted (3,000/57) MR image demonstrates lobular growth (large arrow) and a focus of deep endosteal scalloping with cortical penetration (small arrows) laterally. (g) Photograph of the coronally sectioned gross specimen shows a cartilage lesion with lobular growth (large arrow) and cortical destruction laterally (small arrows), identically correlating to imaging features.
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Figure 9g. Conventional intramedullary chondrosarcoma of the humerus in a 21-year-old man with shoulder pain. (a) Anteroposterior shoulder radiograph shows a proximal humeral mixed lytic and sclerotic lesion with expansile remodeling. The sclerotic component represents typical chondroid ring-and-arc calcification (white arrows). Lytic focus seen inferolaterally (black arrow) demonstrates deep endosteal scalloping typical of chondrosarcoma. (b) Anterior bone scan shows that the lesion has radionuclide uptake greater than that in the anterior iliac spines. (c) Axial CT scan shows decreased attenuation of the nonmineralized component of the lesion and chondroid mineralization (arrows). (d, e) Axial T1-weighted fat saturation (repetition time msec/echo time msec = 600/20) MR images obtained before (d) and after (e) intravenous administration of gadolinium show signal intensity similar to that of muscle and mild peripheral and septal enhancement (arrows). (f) Coronal T2-weighted (3,000/57) MR image demonstrates lobular growth (large arrow) and a focus of deep endosteal scalloping with cortical penetration (small arrows) laterally. (g) Photograph of the coronally sectioned gross specimen shows a cartilage lesion with lobular growth (large arrow) and cortical destruction laterally (small arrows), identically correlating to imaging features.
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Figure 10a. Conventional intramedullary chondrosarcoma of the tibia in a 60-year-old man. (a) Anteroposterior and lateral radiographs show an extensive diaphyseal tibial lesion that is predominantly lytic. Areas of chondroid matrix mineralization are seen superiorly (large arrow) and a focus of deep scalloping (small arrows), cortical remodeling, and periosteal reaction (arrowheads) anterolaterally. (b) Anterior bone scan reveals marked radionuclide uptake in the lesion greater than that in the anterior iliac spines. (c) Axial CT scan shows the deep endosteal scalloping, cortical breakthrough, soft-tissue extension (M), and central flocculent calcification (C). The nonmineralized component has low attenuation. (d) Axial gadolinium-enhanced T1-weighted (688/14) MR image with fat saturation reveals mild peripheral enhancement (arrows) with deep endosteal scalloping extending through the cortex with soft-tissue extension (M). (e) Coronal T2-weighted (3,426/60) fat saturation MR image shows lobular growth (arrows), cortical penetration with soft-tissue extension (M), and high signal intensity throughout the lesion. (f) Photograph of the coronally sectioned gross specimen reveals the deep endosteal scalloping (arrows) and soft-tissue extension (M), identically correlating to imaging features.
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Figure 10b. Conventional intramedullary chondrosarcoma of the tibia in a 60-year-old man. (a) Anteroposterior and lateral radiographs show an extensive diaphyseal tibial lesion that is predominantly lytic. Areas of chondroid matrix mineralization are seen superiorly (large arrow) and a focus of deep scalloping (small arrows), cortical remodeling, and periosteal reaction (arrowheads) anterolaterally. (b) Anterior bone scan reveals marked radionuclide uptake in the lesion greater than that in the anterior iliac spines. (c) Axial CT scan shows the deep endosteal scalloping, cortical breakthrough, soft-tissue extension (M), and central flocculent calcification (C). The nonmineralized component has low attenuation. (d) Axial gadolinium-enhanced T1-weighted (688/14) MR image with fat saturation reveals mild peripheral enhancement (arrows) with deep endosteal scalloping extending through the cortex with soft-tissue extension (M). (e) Coronal T2-weighted (3,426/60) fat saturation MR image shows lobular growth (arrows), cortical penetration with soft-tissue extension (M), and high signal intensity throughout the lesion. (f) Photograph of the coronally sectioned gross specimen reveals the deep endosteal scalloping (arrows) and soft-tissue extension (M), identically correlating to imaging features.
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Figure 10c. Conventional intramedullary chondrosarcoma of the tibia in a 60-year-old man. (a) Anteroposterior and lateral radiographs show an extensive diaphyseal tibial lesion that is predominantly lytic. Areas of chondroid matrix mineralization are seen superiorly (large arrow) and a focus of deep scalloping (small arrows), cortical remodeling, and periosteal reaction (arrowheads) anterolaterally. (b) Anterior bone scan reveals marked radionuclide uptake in the lesion greater than that in the anterior iliac spines. (c) Axial CT scan shows the deep endosteal scalloping, cortical breakthrough, soft-tissue extension (M), and central flocculent calcification (C). The nonmineralized component has low attenuation. (d) Axial gadolinium-enhanced T1-weighted (688/14) MR image with fat saturation reveals mild peripheral enhancement (arrows) with deep endosteal scalloping extending through the cortex with soft-tissue extension (M). (e) Coronal T2-weighted (3,426/60) fat saturation MR image shows lobular growth (arrows), cortical penetration with soft-tissue extension (M), and high signal intensity throughout the lesion. (f) Photograph of the coronally sectioned gross specimen reveals the deep endosteal scalloping (arrows) and soft-tissue extension (M), identically correlating to imaging features.
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Figure 10d. Conventional intramedullary chondrosarcoma of the tibia in a 60-year-old man. (a) Anteroposterior and lateral radiographs show an extensive diaphyseal tibial lesion that is predominantly lytic. Areas of chondroid matrix mineralization are seen superiorly (large arrow) and a focus of deep scalloping (small arrows), cortical remodeling, and periosteal reaction (arrowheads) anterolaterally. (b) Anterior bone scan reveals marked radionuclide uptake in the lesion greater than that in the anterior iliac spines. (c) Axial CT scan shows the deep endosteal scalloping, cortical breakthrough, soft-tissue extension (M), and central flocculent calcification (C). The nonmineralized component has low attenuation. (d) Axial gadolinium-enhanced T1-weighted (688/14) MR image with fat saturation reveals mild peripheral enhancement (arrows) with deep endosteal scalloping extending through the cortex with soft-tissue extension (M). (e) Coronal T2-weighted (3,426/60) fat saturation MR image shows lobular growth (arrows), cortical penetration with soft-tissue extension (M), and high signal intensity throughout the lesion. (f) Photograph of the coronally sectioned gross specimen reveals the deep endosteal scalloping (arrows) and soft-tissue extension (M), identically correlating to imaging features.
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Figure 10e. Conventional intramedullary chondrosarcoma of the tibia in a 60-year-old man. (a) Anteroposterior and lateral radiographs show an extensive diaphyseal tibial lesion that is predominantly lytic. Areas of chondroid matrix mineralization are seen superiorly (large arrow) and a focus of deep scalloping (small arrows), cortical remodeling, and periosteal reaction (arrowheads) anterolaterally. (b) Anterior bone scan reveals marked radionuclide uptake in the lesion greater than that in the anterior iliac spines. (c) Axial CT scan shows the deep endosteal scalloping, cortical breakthrough, soft-tissue extension (M), and central flocculent calcification (C). The nonmineralized component has low attenuation. (d) Axial gadolinium-enhanced T1-weighted (688/14) MR image with fat saturation reveals mild peripheral enhancement (arrows) with deep endosteal scalloping extending through the cortex with soft-tissue extension (M). (e) Coronal T2-weighted (3,426/60) fat saturation MR image shows lobular growth (arrows), cortical penetration with soft-tissue extension (M), and high signal intensity throughout the lesion. (f) Photograph of the coronally sectioned gross specimen reveals the deep endosteal scalloping (arrows) and soft-tissue extension (M), identically correlating to imaging features.
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Figure 10f. Conventional intramedullary chondrosarcoma of the tibia in a 60-year-old man. (a) Anteroposterior and lateral radiographs show an extensive diaphyseal tibial lesion that is predominantly lytic. Areas of chondroid matrix mineralization are seen superiorly (large arrow) and a focus of deep scalloping (small arrows), cortical remodeling, and periosteal reaction (arrowheads) anterolaterally. (b) Anterior bone scan reveals marked radionuclide uptake in the lesion greater than that in the anterior iliac spines. (c) Axial CT scan shows the deep endosteal scalloping, cortical breakthrough, soft-tissue extension (M), and central flocculent calcification (C). The nonmineralized component has low attenuation. (d) Axial gadolinium-enhanced T1-weighted (688/14) MR image with fat saturation reveals mild peripheral enhancement (arrows) with deep endosteal scalloping extending through the cortex with soft-tissue extension (M). (e) Coronal T2-weighted (3,426/60) fat saturation MR image shows lobular growth (arrows), cortical penetration with soft-tissue extension (M), and high signal intensity throughout the lesion. (f) Photograph of the coronally sectioned gross specimen reveals the deep endosteal scalloping (arrows) and soft-tissue extension (M), identically correlating to imaging features.
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Figure 11a. Conventional intramedullary chondrosarcoma of the acetabulum in a 52-year-old woman with a 2-year history of right hip and leg pain. (a) Anteroposterior hip radiograph shows subtle sclerosis caused by chondroid matrix mineralization and bone destruction of the ilium and iliopectoneal line cortex lesion center at the previous site of the triradiate cartilage (arrows). (b) Axial CT scan reveals an extensive low-attenuation soft-tissue mass (M) about the hip and faint intraosseous matrix mineralization (arrow). (c) Axial gadolinium-enhanced T1-weighted (666/10) MR image with fat saturation demonstrates peripheral and septal enhancement of both the soft-tissue and intraosseous components of the tumor (arrows) with hip joint invasion (arrowhead). (d) Coronal T2-weighted (3,300/102) MR image demonstrates soft-tissue extension (M) and high signal intensity similar to that of the bladder (B). (e) Photograph of the sagittally sectioned gross specimen demonstrates extensive marrow involvement (C), the soft-tissue mass (M), and joint invasion inferiorly (arrow).
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Figure 11b. Conventional intramedullary chondrosarcoma of the acetabulum in a 52-year-old woman with a 2-year history of right hip and leg pain. (a) Anteroposterior hip radiograph shows subtle sclerosis caused by chondroid matrix mineralization and bone destruction of the ilium and iliopectoneal line cortex lesion center at the previous site of the triradiate cartilage (arrows). (b) Axial CT scan reveals an extensive low-attenuation soft-tissue mass (M) about the hip and faint intraosseous matrix mineralization (arrow). (c) Axial gadolinium-enhanced T1-weighted (666/10) MR image with fat saturation demonstrates peripheral and septal enhancement of both the soft-tissue and intraosseous components of the tumor (arrows) with hip joint invasion (arrowhead). (d) Coronal T2-weighted (3,300/102) MR image demonstrates soft-tissue extension (M) and high signal intensity similar to that of the bladder (B). (e) Photograph of the sagittally sectioned gross specimen demonstrates extensive marrow involvement (C), the soft-tissue mass (M), and joint invasion inferiorly (arrow).
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Figure 11c. Conventional intramedullary chondrosarcoma of the acetabulum in a 52-year-old woman with a 2-year history of right hip and leg pain. (a) Anteroposterior hip radiograph shows subtle sclerosis caused by chondroid matrix mineralization and bone destruction of the ilium and iliopectoneal line cortex lesion center at the previous site of the triradiate cartilage (arrows). (b) Axial CT scan reveals an extensive low-attenuation soft-tissue mass (M) about the hip and faint intraosseous matrix mineralization (arrow). (c) Axial gadolinium-enhanced T1-weighted (666/10) MR image with fat saturation demonstrates peripheral and septal enhancement of both the soft-tissue and intraosseous components of the tumor (arrows) with hip joint invasion (arrowhead). (d) Coronal T2-weighted (3,300/102) MR image demonstrates soft-tissue extension (M) and high signal intensity similar to that of the bladder (B). (e) Photograph of the sagittally sectioned gross specimen demonstrates extensive marrow involvement (C), the soft-tissue mass (M), and joint invasion inferiorly (arrow).
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Figure 11d. Conventional intramedullary chondrosarcoma of the acetabulum in a 52-year-old woman with a 2-year history of right hip and leg pain. (a) Anteroposterior hip radiograph shows subtle sclerosis caused by chondroid matrix mineralization and bone destruction of the ilium and iliopectoneal line cortex lesion center at the previous site of the triradiate cartilage (arrows). (b) Axial CT scan reveals an extensive low-attenuation soft-tissue mass (M) about the hip and faint intraosseous matrix mineralization (arrow). (c) Axial gadolinium-enhanced T1-weighted (666/10) MR image with fat saturation demonstrates peripheral and septal enhancement of both the soft-tissue and intraosseous components of the tumor (arrows) with hip joint invasion (arrowhead). (d) Coronal T2-weighted (3,300/102) MR image demonstrates soft-tissue extension (M) and high signal intensity similar to that of the bladder (B). (e) Photograph of the sagittally sectioned gross specimen demonstrates extensive marrow involvement (C), the soft-tissue mass (M), and joint invasion inferiorly (arrow).
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Figure 11e. Conventional intramedullary chondrosarcoma of the acetabulum in a 52-year-old woman with a 2-year history of right hip and leg pain. (a) Anteroposterior hip radiograph shows subtle sclerosis caused by chondroid matrix mineralization and bone destruction of the ilium and iliopectoneal line cortex lesion center at the previous site of the triradiate cartilage (arrows). (b) Axial CT scan reveals an extensive low-attenuation soft-tissue mass (M) about the hip and faint intraosseous matrix mineralization (arrow). (c) Axial gadolinium-enhanced T1-weighted (666/10) MR image with fat saturation demonstrates peripheral and septal enhancement of both the soft-tissue and intraosseous components of the tumor (arrows) with hip joint invasion (arrowhead). (d) Coronal T2-weighted (3,300/102) MR image demonstrates soft-tissue extension (M) and high signal intensity similar to that of the bladder (B). (e) Photograph of the sagittally sectioned gross specimen demonstrates extensive marrow involvement (C), the soft-tissue mass (M), and joint invasion inferiorly (arrow).
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Figure 12a. Conventional chondrosarcoma of the rib in a 70-year-old man who presented with a painless anterior chest wall mass. (a) Lateral chest radiograph shows a mass (white arrows) overlying an anterior rib. Faint calcific opacity is seen (black arrow). (b) Axial CT scan demonstrates prominent chondroid matrix mineralization (arrows) to much better advantage and involvement of the costosternal junction. (c) Photograph of the axially sectioned gross specimen reveals the lesion clearly arising from the anterior rib and costal junction (R, arrows) and the lobular growth architecture (C) typical of hyaline cartilage neoplasms.
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Figure 12b. Conventional chondrosarcoma of the rib in a 70-year-old man who presented with a painless anterior chest wall mass. (a) Lateral chest radiograph shows a mass (white arrows) overlying an anterior rib. Faint calcific opacity is seen (black arrow). (b) Axial CT scan demonstrates prominent chondroid matrix mineralization (arrows) to much better advantage and involvement of the costosternal junction. (c) Photograph of the axially sectioned gross specimen reveals the lesion clearly arising from the anterior rib and costal junction (R, arrows) and the lobular growth architecture (C) typical of hyaline cartilage neoplasms.
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Figure 12c. Conventional chondrosarcoma of the rib in a 70-year-old man who presented with a painless anterior chest wall mass. (a) Lateral chest radiograph shows a mass (white arrows) overlying an anterior rib. Faint calcific opacity is seen (black arrow). (b) Axial CT scan demonstrates prominent chondroid matrix mineralization (arrows) to much better advantage and involvement of the costosternal junction. (c) Photograph of the axially sectioned gross specimen reveals the lesion clearly arising from the anterior rib and costal junction (R, arrows) and the lobular growth architecture (C) typical of hyaline cartilage neoplasms.
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Figure 13a. Craniofacial conventional chondrosarcoma in a 26-year-old man with nasal symptoms. (a) Coronal CT reformatted image reveals a low-attenuation mass (M) replacing nasal bones and displacing the nasal septum with small subtle chondroid matrix mineralization (arrows). (b, c) Sagittal T1-weighted (570/15) MR image obtained without (b) and coronal T1-weighted MR image (570/15) obtained with (c) gadolinium show the low-signal-intensity mass (M) with mild peripheral and septal enhancement (arrows) replacing the area of the cribriform plate in the anterior cranial skull base and extending into the nasal region. Severe sinus disease is seen. (d) Axial T2-weighted fat saturation (2,200/80) MR image shows that the mass (M) erodes the medial wall of the right maxillary sinus and left maxillary sinus with marked high signal intensity similar to that of mucosal thickening and fluid in both sinuses. Matrix mineralization cannot be seen. (e) Photograph of the gross specimen show portions of the cribriform plate superiorly, maxillary sinus, and lobules of cartilage growth (*).
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Figure 13b. Craniofacial conventional chondrosarcoma in a 26-year-old man with nasal symptoms. (a) Coronal CT reformatted image reveals a low-attenuation mass (M) replacing nasal bones and displacing the nasal septum with small subtle chondroid matrix mineralization (arrows). (b, c) Sagittal T1-weighted (570/15) MR image obtained without (b) and coronal T1-weighted MR image (570/15) obtained with (c) gadolinium show the low-signal-intensity mass (M) with mild peripheral and septal enhancement (arrows) replacing the area of the cribriform plate in the anterior cranial skull base and extending into the nasal region. Severe sinus disease is seen. (d) Axial T2-weighted fat saturation (2,200/80) MR image shows that the mass (M) erodes the medial wall of the right maxillary sinus and left maxillary sinus with marked high signal intensity similar to that of mucosal thickening and fluid in both sinuses. Matrix mineralization cannot be seen. (e) Photograph of the gross specimen show portions of the cribriform plate superiorly, maxillary sinus, and lobules of cartilage growth (*).
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Figure 13c. Craniofacial conventional chondrosarcoma in a 26-year-old man with nasal symptoms. (a) Coronal CT reformatted image reveals a low-attenuation mass (M) replacing nasal bones and displacing the nasal septum with small subtle chondroid matrix mineralization (arrows). (b, c) Sagittal T1-weighted (570/15) MR image obtained without (b) and coronal T1-weighted MR image (570/15) obtained with (c) gadolinium show the low-signal-intensity mass (M) with mild peripheral and septal enhancement (arrows) replacing the area of the cribriform plate in the anterior cranial skull base and extending into the nasal region. Severe sinus disease is seen. (d) Axial T2-weighted fat saturation (2,200/80) MR image shows that the mass (M) erodes the medial wall of the right maxillary sinus and left maxillary sinus with marked high signal intensity similar to that of mucosal thickening and fluid in both sinuses. Matrix mineralization cannot be seen. (e) Photograph of the gross specimen show portions of the cribriform plate superiorly, maxillary sinus, and lobules of cartilage growth (*).
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Figure 13d. Craniofacial conventional chondrosarcoma in a 26-year-old man with nasal symptoms. (a) Coronal CT reformatted image reveals a low-attenuation mass (M) replacing nasal bones and displacing the nasal septum with small subtle chondroid matrix mineralization (arrows). (b, c) Sagittal T1-weighted (570/15) MR image obtained without (b) and coronal T1-weighted MR image (570/15) obtained with (c) gadolinium show the low-signal-intensity mass (M) with mild peripheral and septal enhancement (arrows) replacing the area of the cribriform plate in the anterior cranial skull base and extending into the nasal region. Severe sinus disease is seen. (d) Axial T2-weighted fat saturation (2,200/80) MR image shows that the mass (M) erodes the medial wall of the right maxillary sinus and left maxillary sinus with marked high signal intensity similar to that of mucosal thickening and fluid in both sinuses. Matrix mineralization cannot be seen. (e) Photograph of the gross specimen show portions of the cribriform plate superiorly, maxillary sinus, and lobules of cartilage growth (*).
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Figure 13e. Craniofacial conventional chondrosarcoma in a 26-year-old man with nasal symptoms. (a) Coronal CT reformatted image reveals a low-attenuation mass (M) replacing nasal bones and displacing the nasal septum with small subtle chondroid matrix mineralization (arrows). (b, c) Sagittal T1-weighted (570/15) MR image obtained without (b) and coronal T1-weighted MR image (570/15) obtained with (c) gadolinium show the low-signal-intensity mass (M) with mild peripheral and septal enhancement (arrows) replacing the area of the cribriform plate in the anterior cranial skull base and extending into the nasal region. Severe sinus disease is seen. (d) Axial T2-weighted fat saturation (2,200/80) MR image shows that the mass (M) erodes the medial wall of the right maxillary sinus and left maxillary sinus with marked high signal intensity similar to that of mucosal thickening and fluid in both sinuses. Matrix mineralization cannot be seen. (e) Photograph of the gross specimen show portions of the cribriform plate superiorly, maxillary sinus, and lobules of cartilage growth (*).
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Figure 14a. Clear cell chondrosarcoma in the left proximal femur of a 30-year-old man with hip pain. (a) Anteroposterior hip radiograph demonstrates a lytic lesion of the left proximal femoral metaepiphysis with a medial sclerotic margin (black arrows) and a small area of sclerosis (white arrow) that could represent matrix mineralization. (b) Axial CT scan clearly demonstrates central flocculent calcification (white arrow) and sclerotic margin (black arrows). (c, d) Axial T1-weighted (500/25) (c) and coronal T2-weighted (2,500/90) (d) MR images show marrow replacement (*), which has high signal intensity on the long repetition time image (* in d) and a central area of low signal intensity corresponding to central calcification (arrow). No edema is noted surrounding the lesion. (e) Photograph of the coronally sectioned gross specimen shows the medullary lesion with prominent areas of hemorrhage (H).
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Figure 14b. Clear cell chondrosarcoma in the left proximal femur of a 30-year-old man with hip pain. (a) Anteroposterior hip radiograph demonstrates a lytic lesion of the left proximal femoral metaepiphysis with a medial sclerotic margin (black arrows) and a small area of sclerosis (white arrow) that could represent matrix mineralization. (b) Axial CT scan clearly demonstrates central flocculent calcification (white arrow) and sclerotic margin (black arrows). (c, d) Axial T1-weighted (500/25) (c) and coronal T2-weighted (2,500/90) (d) MR images show marrow replacement (*), which has high signal intensity on the long repetition time image (* in d) and a central area of low signal intensity corresponding to central calcification (arrow). No edema is noted surrounding the lesion. (e) Photograph of the coronally sectioned gross specimen shows the medullary lesion with prominent areas of hemorrhage (H).
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Figure 14c. Clear cell chondrosarcoma in the left proximal femur of a 30-year-old man with hip pain. (a) Anteroposterior hip radiograph demonstrates a lytic lesion of the left proximal femoral metaepiphysis with a medial sclerotic margin (black arrows) and a small area of sclerosis (white arrow) that could represent matrix mineralization. (b) Axial CT scan clearly demonstrates central flocculent calcification (white arrow) and sclerotic margin (black arrows). (c, d) Axial T1-weighted (500/25) (c) and coronal T2-weighted (2,500/90) (d) MR images show marrow replacement (*), which has high signal intensity on the long repetition time image (* in d) and a central area of low signal intensity corresponding to central calcification (arrow). No edema is noted surrounding the lesion. (e) Photograph of the coronally sectioned gross specimen shows the medullary lesion with prominent areas of hemorrhage (H).
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Figure 14d. Clear cell chondrosarcoma in the left proximal femur of a 30-year-old man with hip pain. (a) Anteroposterior hip radiograph demonstrates a lytic lesion of the left proximal femoral metaepiphysis with a medial sclerotic margin (black arrows) and a small area of sclerosis (white arrow) that could represent matrix mineralization. (b) Axial CT scan clearly demonstrates central flocculent calcification (white arrow) and sclerotic margin (black arrows). (c, d) Axial T1-weighted (500/25) (c) and coronal T2-weighted (2,500/90) (d) MR images show marrow replacement (*), which has high signal intensity on the long repetition time image (* in d) and a central area of low signal intensity corresponding to central calcification (arrow). No edema is noted surrounding the lesion. (e) Photograph of the coronally sectioned gross specimen shows the medullary lesion with prominent areas of hemorrhage (H).
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Figure 14e. Clear cell chondrosarcoma in the left proximal femur of a 30-year-old man with hip pain. (a) Anteroposterior hip radiograph demonstrates a lytic lesion of the left proximal femoral metaepiphysis with a medial sclerotic margin (black arrows) and a small area of sclerosis (white arrow) that could represent matrix mineralization. (b) Axial CT scan clearly demonstrates central flocculent calcification (white arrow) and sclerotic margin (black arrows). (c, d) Axial T1-weighted (500/25) (c) and coronal T2-weighted (2,500/90) (d) MR images show marrow replacement (*), which has high signal intensity on the long repetition time image (* in d) and a central area of low signal intensity corresponding to central calcification (arrow). No edema is noted surrounding the lesion. (e) Photograph of the coronally sectioned gross specimen shows the medullary lesion with prominent areas of hemorrhage (H).
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Figure 15a. Juxtacortical chondrosarcoma of the fibula in a 37-year-old man who had a painful lump in his right lower leg for 1 year. (a) Anteroposterior radiograph shows a soft-tissue mass with osteoid and chondroid mineralization between the tibia and fibula at the proximal diaphysis and extrinsic erosion of the fibula (arrows). (b) Axial CT scan reveals a mass with prominent mineralized matrix, low attenuation in the nonmineralized portion of the lesion (*) typical of cartilaginous neoplasms, and extrinsic erosion of the fibula (arrow) but no involvement of the marrow. (c) Axial T1-weighted (600/12) MR image demonstrates the low-signal-intensity juxtacortical lesion (M) adjacent to the proximal fibular diaphysis with extrinsic erosion (arrow) but no marrow involvement. (d) Sagittal T2-weighted (2,000/80) MR image demonstrates marked high signal intensity in the mass (M) and lobular margins (arrows) (see Fig 5).
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Figure 15b. Juxtacortical chondrosarcoma of the fibula in a 37-year-old man who had a painful lump in his right lower leg for 1 year. (a) Anteroposterior radiograph shows a soft-tissue mass with osteoid and chondroid mineralization between the tibia and fibula at the proximal diaphysis and extrinsic erosion of the fibula (arrows). (b) Axial CT scan reveals a mass with prominent mineralized matrix, low attenuation in the nonmineralized portion of the lesion (*) typical of cartilaginous neoplasms, and extrinsic erosion of the fibula (arrow) but no involvement of the marrow. (c) Axial T1-weighted (600/12) MR image demonstrates the low-signal-intensity juxtacortical lesion (M) adjacent to the proximal fibular diaphysis with extrinsic erosion (arrow) but no marrow involvement. (d) Sagittal T2-weighted (2,000/80) MR image demonstrates marked high signal intensity in the mass (M) and lobular margins (arrows) (see Fig 5).
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Figure 15c. Juxtacortical chondrosarcoma of the fibula in a 37-year-old man who had a painful lump in his right lower leg for 1 year. (a) Anteroposterior radiograph shows a soft-tissue mass with osteoid and chondroid mineralization between the tibia and fibula at the proximal diaphysis and extrinsic erosion of the fibula (arrows). (b) Axial CT scan reveals a mass with prominent mineralized matrix, low attenuation in the nonmineralized portion of the lesion (*) typical of cartilaginous neoplasms, and extrinsic erosion of the fibula (arrow) but no involvement of the marrow. (c) Axial T1-weighted (600/12) MR image demonstrates the low-signal-intensity juxtacortical lesion (M) adjacent to the proximal fibular diaphysis with extrinsic erosion (arrow) but no marrow involvement. (d) Sagittal T2-weighted (2,000/80) MR image demonstrates marked high signal intensity in the mass (M) and lobular margins (arrows) (see Fig 5).
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Figure 15d. Juxtacortical chondrosarcoma of the fibula in a 37-year-old man who had a painful lump in his right lower leg for 1 year. (a) Anteroposterior radiograph shows a soft-tissue mass with osteoid and chondroid mineralization between the tibia and fibula at the proximal diaphysis and extrinsic erosion of the fibula (arrows). (b) Axial CT scan reveals a mass with prominent mineralized matrix, low attenuation in the nonmineralized portion of the lesion (*) typical of cartilaginous neoplasms, and extrinsic erosion of the fibula (arrow) but no involvement of the marrow. (c) Axial T1-weighted (600/12) MR image demonstrates the low-signal-intensity juxtacortical lesion (M) adjacent to the proximal fibular diaphysis with extrinsic erosion (arrow) but no marrow involvement. (d) Sagittal T2-weighted (2,000/80) MR image demonstrates marked high signal intensity in the mass (M) and lobular margins (arrows) (see Fig 5).
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Figure 16a. Myxoid chondrosarcoma of bone in a 50-year-old woman with a gluteal mass. (a) Anteroposterior hip radiograph shows lytic destruction of the greater trochanter with faint sclerosis. (b) Axial CT scan shows aggressive bone destruction, subtle chondroid matrix mineralization in the intraosseous and extraosseous components (arrows), and marked low attenuation of a soft-tissue mass (M). (c) Coronal T1-weighted (500/25) MR image reveals the low-signal-intensity mass (M) arising from the greater trochanter with a hemorrhagic focus superiorly (H). (d) Axial T2-weighted (3,000/80) MR image reveals the marked high signal intensity of the mass (M). Matrix mineralization cannot be seen on the MR images. (e) Photograph of the axially sectioned gross specimen corresponds well with the imaging features, as it demonstrates high-water-content myxoid and cartilaginous nodules (M), hemorrhage (H), and chondroid mineralization (arrows) in the mass extending out of the greater trochanter.
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Figure 16b. Myxoid chondrosarcoma of bone in a 50-year-old woman with a gluteal mass. (a) Anteroposterior hip radiograph shows lytic destruction of the greater trochanter with faint sclerosis. (b) Axial CT scan shows aggressive bone destruction, subtle chondroid matrix mineralization in the intraosseous and extraosseous components (arrows), and marked low attenuation of a soft-tissue mass (M). (c) Coronal T1-weighted (500/25) MR image reveals the low-signal-intensity mass (M) arising from the greater trochanter with a hemorrhagic focus superiorly (H). (d) Axial T2-weighted (3,000/80) MR image reveals the marked high signal intensity of the mass (M). Matrix mineralization cannot be seen on the MR images. (e) Photograph of the axially sectioned gross specimen corresponds well with the imaging features, as it demonstrates high-water-content myxoid and cartilaginous nodules (M), hemorrhage (H), and chondroid mineralization (arrows) in the mass extending out of the greater trochanter.
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Figure 16c. Myxoid chondrosarcoma of bone in a 50-year-old woman with a gluteal mass. (a) Anteroposterior hip radiograph shows lytic destruction of the greater trochanter with faint sclerosis. (b) Axial CT scan shows aggressive bone destruction, subtle chondroid matrix mineralization in the intraosseous and extraosseous components (arrows), and marked low attenuation of a soft-tissue mass (M). (c) Coronal T1-weighted (500/25) MR image reveals the low-signal-intensity mass (M) arising from the greater trochanter with a hemorrhagic focus superiorly (H). (d) Axial T2-weighted (3,000/80) MR image reveals the marked high signal intensity of the mass (M). Matrix mineralization cannot be seen on the MR images. (e) Photograph of the axially sectioned gross specimen corresponds well with the imaging features, as it demonstrates high-water-content myxoid and cartilaginous nodules (M), hemorrhage (H), and chondroid mineralization (arrows) in the mass extending out of the greater trochanter.
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Figure 16d. Myxoid chondrosarcoma of bone in a 50-year-old woman with a gluteal mass. (a) Anteroposterior hip radiograph shows lytic destruction of the greater trochanter with faint sclerosis. (b) Axial CT scan shows aggressive bone destruction, subtle chondroid matrix mineralization in the intraosseous and extraosseous components (arrows), and marked low attenuation of a soft-tissue mass (M). (c) Coronal T1-weighted (500/25) MR image reveals the low-signal-intensity mass (M) arising from the greater trochanter with a hemorrhagic focus superiorly (H). (d) Axial T2-weighted (3,000/80) MR image reveals the marked high signal intensity of the mass (M). Matrix mineralization cannot be seen on the MR images. (e) Photograph of the axially sectioned gross specimen corresponds well with the imaging features, as it demonstrates high-water-content myxoid and cartilaginous nodules (M), hemorrhage (H), and chondroid mineralization (arrows) in the mass extending out of the greater trochanter.
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Figure 16e. Myxoid chondrosarcoma of bone in a 50-year-old woman with a gluteal mass. (a) Anteroposterior hip radiograph shows lytic destruction of the greater trochanter with faint sclerosis. (b) Axial CT scan shows aggressive bone destruction, subtle chondroid matrix mineralization in the intraosseous and extraosseous components (arrows), and marked low attenuation of a soft-tissue mass (M). (c) Coronal T1-weighted (500/25) MR image reveals the low-signal-intensity mass (M) arising from the greater trochanter with a hemorrhagic focus superiorly (H). (d) Axial T2-weighted (3,000/80) MR image reveals the marked high signal intensity of the mass (M). Matrix mineralization cannot be seen on the MR images. (e) Photograph of the axially sectioned gross specimen corresponds well with the imaging features, as it demonstrates high-water-content myxoid and cartilaginous nodules (M), hemorrhage (H), and chondroid mineralization (arrows) in the mass extending out of the greater trochanter.
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Figure 17a. Mesenchymal chondrosarcoma of the acromion in a 30-year-old man with right shoulder pain for 1 year. (a) Anteroposterior shoulder radiograph shows a lesion with expansile remodeling of the acromion and relatively subtle chondroid calcifications (arrows). (b) Axial CT scan reveals abundant chondroid matrix that replaces the acromion. (c-e) Coronal T1-weighted (500/17) MR images before (c) and after (d) intravenous gadolinium administration demonstrate an intraosseous and extraosseous mass (M) with intermediate signal intensity and moderate diffuse enhancement (E). Prominent serpentine vascular structures (arrows) with high flow and feeding vessels (arrows) are seen on the contrast material-enhanced image (d) and the coronal T2-weighted (3,116/16) MR image with fat saturation (e). Lesion shows heterogeneous intermediate signal intensity on the long repetition image. (f) Photograph of the gross specimen also shows the large scapular lesion arising from the acromion with several vascular channels identified (arrows).
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Figure 17b. Mesenchymal chondrosarcoma of the acromion in a 30-year-old man with right shoulder pain for 1 year. (a) Anteroposterior shoulder radiograph shows a lesion with expansile remodeling of the acromion and relatively subtle chondroid calcifications (arrows). (b) Axial CT scan reveals abundant chondroid matrix that replaces the acromion. (c-e) Coronal T1-weighted (500/17) MR images before (c) and after (d) intravenous gadolinium administration demonstrate an intraosseous and extraosseous mass (M) with intermediate signal intensity and moderate diffuse enhancement (E). Prominent serpentine vascular structures (arrows) with high flow and feeding vessels (arrows) are seen on the contrast material-enhanced image (d) and the coronal T2-weighted (3,116/16) MR image with fat saturation (e). Lesion shows heterogeneous intermediate signal intensity on the long repetition image. (f) Photograph of the gross specimen also shows the large scapular lesion arising from the acromion with several vascular channels identified (arrows).
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Figure 17c. Mesenchymal chondrosarcoma of the acromion in a 30-year-old man with right shoulder pain for 1 year. (a) Anteroposterior shoulder radiograph shows a lesion with expansile remodeling of the acromion and relatively subtle chondroid calcifications (arrows). (b) Axial CT scan reveals abundant chondroid matrix that replaces the acromion. (c-e) Coronal T1-weighted (500/17) MR images before (c) and after (d) intravenous gadolinium administration demonstrate an intraosseous and extraosseous mass (M) with intermediate signal intensity and moderate diffuse enhancement (E). Prominent serpentine vascular structures (arrows) with high flow and feeding vessels (arrows) are seen on the contrast material-enhanced image (d) and the coronal T2-weighted (3,116/16) MR image with fat saturation (e). Lesion shows heterogeneous intermediate signal intensity on the long repetition image. (f) Photograph of the gross specimen also shows the large scapular lesion arising from the acromion with several vascular channels identified (arrows).
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Figure 17d. Mesenchymal chondrosarcoma of the acromion in a 30-year-old man with right shoulder pain for 1 year. (a) Anteroposterior shoulder radiograph shows a lesion with expansile remodeling of the acromion and relatively subtle chondroid calcifications (arrows). (b) Axial CT scan reveals abundant chondroid matrix that replaces the acromion. (c-e) Coronal T1-weighted (500/17) MR images before (c) and after (d) intravenous gadolinium administration demonstrate an intraosseous and extraosseous mass (M) with intermediate signal intensity and moderate diffuse enhancement (E). Prominent serpentine vascular structures (arrows) with high flow and feeding vessels (arrows) are seen on the contrast material-enhanced image (d) and the coronal T2-weighted (3,116/16) MR image with fat saturation (e). Lesion shows heterogeneous intermediate signal intensity on the long repetition image. (f) Photograph of the gross specimen also shows the large scapular lesion arising from the acromion with several vascular channels identified (arrows).
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Figure 17e. Mesenchymal chondrosarcoma of the acromion in a 30-year-old man with right shoulder pain for 1 year. (a) Anteroposterior shoulder radiograph shows a lesion with expansile remodeling of the acromion and relatively subtle chondroid calcifications (arrows). (b) Axial CT scan reveals abundant chondroid matrix that replaces the acromion. (c-e) Coronal T1-weighted (500/17) MR images before (c) and after (d) intravenous gadolinium administration demonstrate an intraosseous and extraosseous mass (M) with intermediate signal intensity and moderate diffuse enhancement (E). Prominent serpentine vascular structures (arrows) with high flow and feeding vessels (arrows) are seen on the contrast material-enhanced image (d) and the coronal T2-weighted (3,116/16) MR image with fat saturation (e). Lesion shows heterogeneous intermediate signal intensity on the long repetition image. (f) Photograph of the gross specimen also shows the large scapular lesion arising from the acromion with several vascular channels identified (arrows).
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Figure 17f. Mesenchymal chondrosarcoma of the acromion in a 30-year-old man with right shoulder pain for 1 year. (a) Anteroposterior shoulder radiograph shows a lesion with expansile remodeling of the acromion and relatively subtle chondroid calcifications (arrows). (b) Axial CT scan reveals abundant chondroid matrix that replaces the acromion. (c-e) Coronal T1-weighted (500/17) MR images before (c) and after (d) intravenous gadolinium administration demonstrate an intraosseous and extraosseous mass (M) with intermediate signal intensity and moderate diffuse enhancement (E). Prominent serpentine vascular structures (arrows) with high flow and feeding vessels (arrows) are seen on the contrast material-enhanced image (d) and the coronal T2-weighted (3,116/16) MR image with fat saturation (e). Lesion shows heterogeneous intermediate signal intensity on the long repetition image. (f) Photograph of the gross specimen also shows the large scapular lesion arising from the acromion with several vascular channels identified (arrows).
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