CHONDROSARCOMA (Greek chondros a cartilage + sarcoma) — a malignant tumor of a bone.
It is allocated from group of osteosarcomas by Keyller (V. H. Keiller, 1925) and Phemister (D. Century of Phemi-ster, 1930).
There are separate instructions on pathogenetic communication of a chondrosarcoma with an inborn enkhondromatoz (see the Bone, dysplastic diseases) and with disturbances of a skeletogeny as osteoarticular exostoses.
Among patients with a chondrosarcoma apprx. 2/3 men aged from 30 up to 60 years make. Most often femoral and humeral bones are surprised (preferential their proximal ends); then on the frequency of defeat pelvic bones, a shovel, edges, a backbone, a breast follow. Very seldom the chondrosarcoma develops in ossicles of a brush and foot. Also cases of primary emergence of a chondrosarcoma in soft tissues are possible.
Distinguish so-called central, preferential intra bone, the chondrosarcoma arising in a bone, and peripheral, preferential extra bone, developing from a cartilaginous component of osteoarticular exostoses (see the X ondrodisplaziya). The chondrosarcoma developing in not changed bone call primary, and arising against the background of various patol. processes, damages, etc. — secondary.
The chondrosarcoma macroscopically represents bluish be-luyu, sometimes the translucent fabric forming the segments of the different sizes and forms divided by connective tissue layers. In a tumor sites various
Fig. 1 meet. The roentgenogram of a hip joint at a chondrosarcoma in a neck of a femur with preferential intra bone type of defeat (a direct projection): the heterogeneous site of destruction of a bone tissue with indistinct contours (it is specified by an arrow).
Fig. 2. The roentgenogram of a hip joint and proximal part of a diaphysis of a femur at a chondrosarcoma with preferential extra bone type of defeat (a direct projection): the affected bone is surrounded with consolidation of soft tissues, extensive with vague borders.
consistences — from dense, due to calcification and secondary enchondral bone formation (see the Bone), to liquid, in connection with formation of the cystous cavities containing mucous masses. Usually central chondrosarcoma destroys compact substance of a bone and infiltrirut surrounding soft tissues. Gis-tol. the structure of a tumor is various — from corresponding to typical cartilaginous tissue (see) to obviously malignant aiaplazirovanny with a large number of sharply atypical polymorphic cells. The quantity and character of interstitial substance in a chondrosarcoma vary.
On degree of a maturity of fabric of a tumor allocate malodifferentsirovan - the ny, moderately differentiated and high-differentiated chondrosarcomas. According to Shayovich (F. Schajowicz, 1981), apprx. 60% of chondrosarcomas are characterized by a high and moderate maturity, i.e. are rather well differentiated, grow slowly, gradually extending to adjacent fabrics, metastasises give seldom (usually — in lungs, is more rare — in a brain, a liver, kidneys, limf, nodes, other bones) and in late terms.
A wedge, manifestations depend on features gistol. structures of a tumor.
The anamnesis with small expressiveness of symptoms is characteristic of the high-differentiated tumors long (4 — 5 years). The general condition of the patient a long time remains good, moderate,
non-constant pains are noted. During the progressing of process pain amplifies, especially at night. Slow, but permanently coming to an end with progressing, development of a disease is observed at patients aged 30 years are more senior. At low-differentiated a chondrosarcoma x, the anamnesis of a disease short is more often at persons of young age (
1 — 3 month). Rapid, steady development of symptoms (pain, a tumor, dysfunction of an extremity) is noted. In the first 6 — 8 months of a disease hematogenous metastasises in lungs appear.
In recognition of a chondrosarcoma the important role belongs рентге^ Nol. to a research — to data of a X-ray analysis (see), tomographies (see) and an angiography (see). Important rentgenol. a sign of a chondrosarcoma is increase available or emergence new patol. changes at repeated rentgenol. researches. Preferential vnut-rikostny chondrosarcoma is characterized by destruction of a bone tissue, the zone a cut occupies the most part or all marrowy channel of the affected bone (fig. 1). The tumor has indistinct borders that is especially noticeable in the field of the marrowy channel. Structure of the site of defeat, as a rule, heterogeneous due to numerous inclusions of salts of calcium in the form of «specks», islands or conglomerates. Cortical substance of a bone at the level of defeat is sharply thinned, is destroyed by places, sometimes has the needle or layered drawing that is caused by a periostitis (see).
For preferential out of a bone oh of a chondrosarcoma consolidation of soft tissues, extensive with vague borders, to-rye or segmentarno is characteristic, or on all perimeter' shroud the affected bone (fig. 2). The numerous friable or merging in a dense conglomerate sites of calcification are defined on the foyer of consolidation. The condition of an adjacent bone depends on a form of a tumor and extent of damage of a bone tissue. More often cortical substance has as if corroded external contours, sharp thinning or final fracture of cortical substance of a bone can be observed.
The final diagnosis can be established only with the help gistol. researches. However the biopsy is accompanied by risk of implantation of a tumor in adjacent soft tissues.
Treatment preferential operational. The volume of an operative measure (a resection, amputation or an exarticulation of an extremity) is defined by degree of a zlokachestvennost of a tumor, its localization and a distributional pattern of process.
The forecast depends hl. obr. from degree of a differentiation of fabric of a tumor. Five-year survival of patients with the low-differentiated, moderately differentiated and high-differentiated chondrosarcoma makes, according to Evans (H. L. Evans, 1977) and sotr., respectively 29, 81 and 90%. Remote forecast adverse.
Prevention of secondary chondrosarcomas consists in timely removal of the centers of an enkhondromatoz (see the Chondromatosis of bones) or kostnokhryashchevy exostoses (see the Chondrodysplasia).
Bibliography: Vinogradova T. P. Tumors of bones, page 135, M., 1973; JI and at N the island and I. G. Tumors of a skeleton, M., 1962; Pathoanatomical diagnosis of tumors of the person, under the editorship of N. A. Krayevsky, etc., page 409, M., 1982; Rabinovich Yu. Ya. Chondrosarcomas and osteochondrosarcomas of bones, Surgery, No. I, page 78, 1959; Sh and y about in and the p F, etc. Histologic classification of bone tumors, page 37, Geneva, WHO, 1974; FreyschmidtJ. Knochenerkrankungen im Erwachsenenal-ter, V. u. a., 1980; LichtensteinL. Bone tumors, St Louis, 1977; Schajo-w i z with F. Tumors and tumorlike lesions of bone and joints, p. 160, N. Y. a. o.,
BB. H. Nightingales; I. P. Korolyuk (rents.).