Primary intraspinal dumbbell-shaped mesenchymal chondrosarcoma with massive calcifications: a case report and review of the literature

Abstract

Background: Mesenchymal chondrosarcoma is a rare malignant tumor arising from bone or soft tissues. Instraspinal dumbbell-shaped mesenchymal chondrosarcoma is even rarer; however, it should not be neglected by clinicians.

Case presentation: A 26-year-old female was referred to our hospital with a 1.5-month history of sciatic pain and numbness in the left leg. Computed tomography and magnetic resonance imaging scans revealed an intraspinal dumbbell-shaped mass which had distinguishing features of neurogenic tumors, surprisingly, with massive calcifications, and no tumor metastasis was found. Then the patient underwent a total resection of the tumor, and during the operation, we found that the right nerve root of the fifth lumbar almost disappeared. The tumor was diagnosed as mesenchymal chondrosarcoma by histopathological examination after operation. Adjuvant therapies were not performed. However, recurrence of the tumor occurred 5 months later, and she underwent a total resection again combined with radiotherapy after second surgery.

Conclusions: To the best of our knowledge, this case study presents the first report in literature about primary instraspinal dumbbell-shaped mesenchymal chondrosarcoma with massive calcifications, which may provide some evidence for clinical practice. As the clinical symptoms and radiographic findings of mesenchymal chondrosarcoma are usually not specific, clinicians should consider it as a possible case and diagnose it through careful histopathological examination. Sometimes, calcification could be seen in tumors, which may influence or reflect the growth of tumor and disease prognosis. Although prognosis in mesenchymal chondrosarcoma varies from person to person, generally, complete resection, adjuvant therapy, and regular examinations are recommended to perform for patients with mesenchymal chondrosarcoma.

Keywords: Calcification; Intraspinal; Mesenchymal chondrosarcoma; Spinal tumor; Surgery.

Fig. 1

Images of X-rays and CT and MRI scans before operation. a, b Images of preoperative X-rays show unclear edge of left vertebral pedicle and posterior vertebra body of L4. c–h Preoperative CT images find massive calcifications within the mass. Images of f–h represent the level of L3, L4, and L5, respectively. i–k Images of preoperative MRI. Sagittal T1WI (i), T2WI (j), Gd-enhanced T1WI (k), and axial T2-WI (l–n) reveal a dumbbell tumor at the L3-5 level

Fig. 2

Postoperative histopathological findings. The tumor showed primitive round or spindle-shaped undifferentiated cells alternating with zones of well-differentiated cartilage (a HE × 200, b HE × 400). c–f Histopathological examination of the specimen stained positive for S-100, Vimentin, NSE, and CD99, respectively

Fig. 3

The postoperative X-rays and CT and MRI scans. (a-b) Images of postoperative X-rays. Sagittal T2WI (c) and T1WI (d) of the postoperative MRI images show the mass has been completely resected. (e-h) Images of postoperative CT confirm that the mass has been removed. e shows the sagittal plain and f-h represent the level of L3, L4 and L5, respectively

Fig. 4

MRI images 5 months after the surgery. Sagittal T1WI (a), T2WI (b), and axial T2-WI (c) find a soft tissue mass at the L4 level of spinal canal, confirming tumor recurrence