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Primary extraskeletal mesenchymal chondrosarcoma arising from the pancreas.

Oh BG, Han YH, Lee BH, Kim SY, Hwang YJ, Seo JW, Kim YH, Cha SJ, Hur G, Joo M - Korean J Radiol (2007 Nov-Dec)

Bottom Line: A 41-year-old man was evaluated by CT to find the cause of his abdominal pain.The CT scans showed a heterogeneously enhancing necrotic mass with numerous areas of coarse calcification, and this was located in the left side of the retroperitoneal space and involved the body and tail of the pancreas.Following excision of the mass, it was pathologically confirmed to be primary extraskeletal mesenchymal chondrosarcoma that arose from the pancreas.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Ilsan Paik Hospital, Inje University, School of Medicine, Goyang-si, Gyeonggi-do, Korea.

ABSTRACT
We report here on a case of primary extraskeletal mesenchymal chondrosarcoma that arose from the pancreas. A 41-year-old man was evaluated by CT to find the cause of his abdominal pain. The CT scans showed a heterogeneously enhancing necrotic mass with numerous areas of coarse calcification, and this was located in the left side of the retroperitoneal space and involved the body and tail of the pancreas. Portal venography via the celiac axis also showed invasion of the splenic vein. Following excision of the mass, it was pathologically confirmed to be primary extraskeletal mesenchymal chondrosarcoma that arose from the pancreas.

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A. Unenhanced transverse CT scan reveals an ill defined, lobulated mass (arrowheads) of heterogeneously low attenuation that contains numerous areas of coarse calcification (arrows) in the left side of the retroperitoneum.B. On the contrast-enhanced transverse CT scan obtained during the portal venous phase, subtle enhancement is only noted in the periphery of the mass (arrows), and most of the mass remains without enhancement.C. The contrast-enhanced coronal reformatted image shows the ill defined necrotic low attenuated mass (arrowheads) and obliteration of the splenic vein by the mass (thick arrow) with the development of multiple collateral veins (thin arrows).D. Portal venography via the celiac axis also shows obliteration of the splenic vein (thick arrow) by the mass and the development of multiple collateral veins (thin arrows).E. A large multilobulated mass (arrowheads) is located in the body and tail of the pancreas with attachment to the spleen (asterisk) and transverse colon (arrows).F. Light microscopic image shows the typical bimorphic pattern of chondrosarcoma. The chondroid zone (A) is surrounded by a proliferation of undifferentiated cells (B) with abrupt transition. (Hematoxylin & Eosin staining, ×100)
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Figure 1: A. Unenhanced transverse CT scan reveals an ill defined, lobulated mass (arrowheads) of heterogeneously low attenuation that contains numerous areas of coarse calcification (arrows) in the left side of the retroperitoneum.B. On the contrast-enhanced transverse CT scan obtained during the portal venous phase, subtle enhancement is only noted in the periphery of the mass (arrows), and most of the mass remains without enhancement.C. The contrast-enhanced coronal reformatted image shows the ill defined necrotic low attenuated mass (arrowheads) and obliteration of the splenic vein by the mass (thick arrow) with the development of multiple collateral veins (thin arrows).D. Portal venography via the celiac axis also shows obliteration of the splenic vein (thick arrow) by the mass and the development of multiple collateral veins (thin arrows).E. A large multilobulated mass (arrowheads) is located in the body and tail of the pancreas with attachment to the spleen (asterisk) and transverse colon (arrows).F. Light microscopic image shows the typical bimorphic pattern of chondrosarcoma. The chondroid zone (A) is surrounded by a proliferation of undifferentiated cells (B) with abrupt transition. (Hematoxylin & Eosin staining, ×100)

Mentions: A 41-year-old man presented with a 1-month history of abdominal pain. His previous medical and familial histories were unremarkable. Unenhanced transverse CT scan of the abdomen revealed an ill defined, lobulated mass that measured about 13 × 12 × 7 cm in size and it appeared as a heterogeneously low attenuated mass with numerous areas of coarse calcification. It was located in the left side of the retroperitoneal space and involved the body and tail of the pancreas (Fig. 1A). Contrast-enhanced CT was performed after mechanical injection of 130 cc of nonionic iopromide (300 mg/ml of iodine) into the antecubital vein at a rate of 2.65 ml/sec. After initiating infusion of contrast material, we used scanning delays of 30 seconds before starting to obtain the arterial phase images. Imaging in the portal venous phase was performed after a scanning delay of 70 seconds from the initiation of infusion of contrast material. On the contrast-enhanced transverse CT scan obtained during the portal venous phase, subtle enhancement was noted in only the periphery of the mass and most of the mass remained without enhancement (Fig. 1B). The contrast-enhanced coronal reformatted image showed the ill defined necrotic low attenuated mass with obliteration of the splenic vein by the mass, and there was the development of multiple collateral veins (Fig. 1C). Portal venography via the celiac axis also showed tumor invasion to the splenic vein (Fig. 1D). The patient underwent exploratory laparotomy and mass excision was done. The specimen was revealed to be a large, firm, fixed hypervascular mass arising from the pancreas, and it occupied the left upper quadrant of the abdomen. A large multilobulated mass that measured 15 cm in maximum diameter was located in the body and tail of the pancreas, and it was attached to the spleen and transverse colon (Fig. 1E). Microscopically, the chondroid zone was surrounded by proliferation of undifferentiated cells with abrupt transition (Fig. 1F). The pathological diagnosis was extraskeletal mesenchymal chondrosarcoma arising from the pancreas with invasion to the splenic vein.


Primary extraskeletal mesenchymal chondrosarcoma arising from the pancreas.

Oh BG, Han YH, Lee BH, Kim SY, Hwang YJ, Seo JW, Kim YH, Cha SJ, Hur G, Joo M - Korean J Radiol (2007 Nov-Dec)

A. Unenhanced transverse CT scan reveals an ill defined, lobulated mass (arrowheads) of heterogeneously low attenuation that contains numerous areas of coarse calcification (arrows) in the left side of the retroperitoneum.B. On the contrast-enhanced transverse CT scan obtained during the portal venous phase, subtle enhancement is only noted in the periphery of the mass (arrows), and most of the mass remains without enhancement.C. The contrast-enhanced coronal reformatted image shows the ill defined necrotic low attenuated mass (arrowheads) and obliteration of the splenic vein by the mass (thick arrow) with the development of multiple collateral veins (thin arrows).D. Portal venography via the celiac axis also shows obliteration of the splenic vein (thick arrow) by the mass and the development of multiple collateral veins (thin arrows).E. A large multilobulated mass (arrowheads) is located in the body and tail of the pancreas with attachment to the spleen (asterisk) and transverse colon (arrows).F. Light microscopic image shows the typical bimorphic pattern of chondrosarcoma. The chondroid zone (A) is surrounded by a proliferation of undifferentiated cells (B) with abrupt transition. (Hematoxylin & Eosin staining, ×100)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2627457&req=5

Figure 1: A. Unenhanced transverse CT scan reveals an ill defined, lobulated mass (arrowheads) of heterogeneously low attenuation that contains numerous areas of coarse calcification (arrows) in the left side of the retroperitoneum.B. On the contrast-enhanced transverse CT scan obtained during the portal venous phase, subtle enhancement is only noted in the periphery of the mass (arrows), and most of the mass remains without enhancement.C. The contrast-enhanced coronal reformatted image shows the ill defined necrotic low attenuated mass (arrowheads) and obliteration of the splenic vein by the mass (thick arrow) with the development of multiple collateral veins (thin arrows).D. Portal venography via the celiac axis also shows obliteration of the splenic vein (thick arrow) by the mass and the development of multiple collateral veins (thin arrows).E. A large multilobulated mass (arrowheads) is located in the body and tail of the pancreas with attachment to the spleen (asterisk) and transverse colon (arrows).F. Light microscopic image shows the typical bimorphic pattern of chondrosarcoma. The chondroid zone (A) is surrounded by a proliferation of undifferentiated cells (B) with abrupt transition. (Hematoxylin & Eosin staining, ×100)
Mentions: A 41-year-old man presented with a 1-month history of abdominal pain. His previous medical and familial histories were unremarkable. Unenhanced transverse CT scan of the abdomen revealed an ill defined, lobulated mass that measured about 13 × 12 × 7 cm in size and it appeared as a heterogeneously low attenuated mass with numerous areas of coarse calcification. It was located in the left side of the retroperitoneal space and involved the body and tail of the pancreas (Fig. 1A). Contrast-enhanced CT was performed after mechanical injection of 130 cc of nonionic iopromide (300 mg/ml of iodine) into the antecubital vein at a rate of 2.65 ml/sec. After initiating infusion of contrast material, we used scanning delays of 30 seconds before starting to obtain the arterial phase images. Imaging in the portal venous phase was performed after a scanning delay of 70 seconds from the initiation of infusion of contrast material. On the contrast-enhanced transverse CT scan obtained during the portal venous phase, subtle enhancement was noted in only the periphery of the mass and most of the mass remained without enhancement (Fig. 1B). The contrast-enhanced coronal reformatted image showed the ill defined necrotic low attenuated mass with obliteration of the splenic vein by the mass, and there was the development of multiple collateral veins (Fig. 1C). Portal venography via the celiac axis also showed tumor invasion to the splenic vein (Fig. 1D). The patient underwent exploratory laparotomy and mass excision was done. The specimen was revealed to be a large, firm, fixed hypervascular mass arising from the pancreas, and it occupied the left upper quadrant of the abdomen. A large multilobulated mass that measured 15 cm in maximum diameter was located in the body and tail of the pancreas, and it was attached to the spleen and transverse colon (Fig. 1E). Microscopically, the chondroid zone was surrounded by proliferation of undifferentiated cells with abrupt transition (Fig. 1F). The pathological diagnosis was extraskeletal mesenchymal chondrosarcoma arising from the pancreas with invasion to the splenic vein.

Bottom Line: A 41-year-old man was evaluated by CT to find the cause of his abdominal pain.The CT scans showed a heterogeneously enhancing necrotic mass with numerous areas of coarse calcification, and this was located in the left side of the retroperitoneal space and involved the body and tail of the pancreas.Following excision of the mass, it was pathologically confirmed to be primary extraskeletal mesenchymal chondrosarcoma that arose from the pancreas.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Ilsan Paik Hospital, Inje University, School of Medicine, Goyang-si, Gyeonggi-do, Korea.

ABSTRACT
We report here on a case of primary extraskeletal mesenchymal chondrosarcoma that arose from the pancreas. A 41-year-old man was evaluated by CT to find the cause of his abdominal pain. The CT scans showed a heterogeneously enhancing necrotic mass with numerous areas of coarse calcification, and this was located in the left side of the retroperitoneal space and involved the body and tail of the pancreas. Portal venography via the celiac axis also showed invasion of the splenic vein. Following excision of the mass, it was pathologically confirmed to be primary extraskeletal mesenchymal chondrosarcoma that arose from the pancreas.

Show MeSH
Related in: MedlinePlus