title: Chondrosarcomas of the hands and feet: A case series and systematic review of the literature.
abstract: OBJECTIVE
  To review the imaging features of chondrosarcomas (CS) of the hands and feet, with pathologic correlation.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, USA. Electronic address: lfayad1@jhmi.edu.
authors.forename: Laura M
authors.initials: LM
authors.lastname: Fayad
authors.affiliation: The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Shivani
authors.initials: S
authors.lastname: Ahlawat
authors.affiliation: Khyber Medical College, Khyber Teaching Hospital, Peshawar, Pakistan.
authors.forename: Muhammed Shayan
authors.initials: MS
authors.lastname: Khan
authors.affiliation: Department of Pathology, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: McCarthy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001853:Bone Marrow / Q000473:pathology; D001859:Bone Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D002813:Chondrosarcoma / Q000175:diagnosis* / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging / Q000379:methods*; D004487:Edema / Q000473:pathology; D004838:Epiphyses / Q000473:pathology; D005260:Female; D050278:Finger Phalanges / Q000000981:diagnostic imaging / Q000473:pathology; D005529:Foot Bones / Q000000981:diagnostic imaging / Q000473:pathology*; D005598:Fractures, Spontaneous / Q000175:diagnosis; D050276:Hand Bones / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011859:Radiography; D011877:Radionuclide Imaging; D012189:Retrospective Studies
keywords: Chondrosarcoma; Feet; Hands; MRI; Nuclear scintigraphy; Radiography