Pijm. Wuisman et al., SECONDARY CHONDROSARCOMA IN OSTEOCHONDROMAS - MEDULLARY EXTENSION IN 15 OF 45 CASES, Acta orthopaedica Scandinavica, 68(4), 1997, pp. 396-400
We reviewed 45 secondary chondrosarcomas: 16 arising in solitary osteo
chondromas and 29 in 27 patients with multiple osteochondromas. Less t
han radical or wide primary surgery resulted in local recurrence in 8
of 14 lesions: 2 of 2 intralesional excisions, 5 of 11 marginal excisi
ons, and in one case with radiotherapy alone. No local recurrence was
found after a primary wide surgical procedure in 30 lesions and a radi
cal procedure in 1 lesion after a mean of 8 (0.2-22) years' follow-up.
5 patients had died: 3 of pulmonary metastases (2 stage in, 1 stage I
IB), and 2 of local tumor invasion, both in the spine. Medullary invas
ion occurred in 15 of 45 lesions, this was oftener than reported in se
condary chondrosarcoma. Medullary invasion was not always detected pre
operatively, even when MR or CT examinations had been performed. There
fore, we recommend that a secondary chondrosarcoma should be removed w
ith a wide surgical resection, including a part of the underlying bone
, to keep the local recurrence risk low. There were no clinical or pro
gnostic differences between tumors that had arisen from solitary or fr
om multiple osteochondromas.