0:01

This was a 40 year old who had posterior neck pain.

0:05

We were doing the study for degenerative disc disease and the

0:08

neck pain was more on the left side than the right side.

0:11

Looking at the spine,

0:13

we really thought that there was very little in the way of

0:16

degenerative changes and we're about to report this out as

0:20

unremarkable evaluation for age. Fortunately, the fellow said,

0:25

well, what about this? And as we go out to the left side,

0:29

we come into this very large mass that

0:31

we would have otherwise missed.

0:33

And it is quite heterogeneous in its signal intensity.

0:37

It has very dark areas on T1-weighted scan as well as brighter

0:41

areas on T1-weighted scan, and it's quite heterogeneous

0:44

on both the T2, as well as the STIR sequence.

0:48

Despite its relatively large size,

0:50

you notice that there is very little adjacent edema in the

0:54

musculature nearby. That's sort of a giveaway that

0:57

this is thus likely to be a high grade malignancy.

1:01

The axial scans show the lesion as being multicompartmental with

1:06

areas of very heterogeneous signal intensity and there was

1:10

some scalloping of the bone and extension into the

1:14

neural foramen. Because this was done for DJD,

1:17

post-gadolinium enhanced scans were not performed.

1:20

The next thing that was performed, however,

1:21

was a CT scan to better characterize the lesion.

1:25

On the sagittal CT scan through the midline,

1:28

once again, no evidence of degenerative changes.

1:30

However, as we got out into the left lateral parasagittal location,

1:36

we see this lesion that has heterogeneous matrix to it

1:40

in these soft tissues. You can see that it has an element

1:43

of destruction of the pedicle on the left side at T1,

1:49

but in addition has kind of a matrix within the soft tissue of

1:54

the lesion that is seen probably more readily on the soft tissue

1:58

windows. You can see there are low density areas.

2:01

This matrix within the lesion would put it

2:05

into one of the chondro-osseous tumors.

2:09

This would be very unusual for a metastasis and

2:13

it would be highly unlikely for a plasmacytoma.

2:17

And therefore we're into primary bone tumors that have matrix

2:22

associated with it, either in the osteosarcoma or

2:26

chondrosarcoma family. With gadolinium administration,

2:30

we saw that the lesion does show enhancement but it doesn't

2:34

enhance into the adjacent musculature

2:37

and remains within the tumor,

2:39

which suggested that perhaps this was not

2:41

as aggressive as a typical osteosarcoma.

2:45

Based on the matrix and the absence of aggressive features

2:48

on post-gadolinium and T2-weighted imaging,

2:52

we suggested that this was a chondrosarcoma.

2:55

Chondrosarcomas are tumors that can vary widely as far as their

2:59

aggressiveness, particularly in the head-neck region,

3:02

they are usually low-grade lesions. In the spine,

3:05

they may be high or low grade.

3:07

In this case, intermediate grade chondrosarcoma.