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Periosteal Chondroid Tumors

Radiologic Evaluation with Pathologic Correlation

P. Robinson1,2, L. M. White1, M. Sundaram3,4, R. Kandel5, J. Wunder6, D. J. McDonald7, C. Janney8 and R. S. Bell6

1 Department of Medical Imaging, Mount Sinai Hospital and the University Health Network, University of Toronto, 600 University Ave., Toronto, Ontario, Canada M5G 1X5.
2 Present address: Department of Radiology, St. James University Hospital, Beckett St., Leeds LS9 7TF, United Kingdom.
3 Department of Radiology, St. Louis University School of Medicine, Health Sciences Center, St. Louis, MO 63110-0250.
4 Present address: Department of Radiology, Mayo Clinic, 200 First St., S.W., Rochester, MN 55905.
5 Department of Pathology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada M5G 1X5.
6 Department of Orthopedic Oncology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada M5G 1X5.
7 Department of Orthopedic Surgery, St. Louis University School of Medicine, Health Sciences Center, St. Louis, MO 63110-0250.
8 Department of Pathology, St. Louis University School of Medicine, Health Sciences Center, St. Louis, MO 63110-0250.



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  		Fig. 1A. —46-year-old man with pathologic diagnosis of periosteal chondrosarcoma. Axial unenhanced CT image of left tibia shows posterior periosteal-based lesion with cortical scalloping, internal chondroid matrix, and bone marrow invasion.

 


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  		Fig. 1B. —46-year-old man with pathologic diagnosis of periosteal chondrosarcoma. Axial T2-weighted conventional spin-echo MR image (TR/TE, 2200/90) shows multilobular, predominantly high-signal-intensity mass (4 cm) along posterior cortex of proximal tibia with bone marrow invasion (arrows). No adjacent soft-tissue edema is seen.

 


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  		Fig. 2A. —28-year-old man with pathologic diagnosis of periosteal chondroma. Lateral radiograph of right humerus shows periosteal-based lesion with extrinsic scalloping of posterolateral cortex of proximal humeral metaphysis with small amount of marginal periosteal new bone formation (arrows).

 


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  		Fig. 2B. —28-year-old man with pathologic diagnosis of periosteal chondroma. Axial unenhanced CT image shows periosteal-based mass causing extrinsic cortical scalloping with small amount of internal chondroid matrix (arrow).

 


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  		Fig. 2C. —28-year-old man with pathologic diagnosis of periosteal chondroma. Sagittal unenhanced T1-weighted conventional spin-echo MR image (TR/TE, 416/15) shows low-signal-intensity soft-tissue mass (3 cm) causing cortical scalloping (arrow) and displacement of adjacent deltoid muscle (D).

 


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  		Fig. 2D. —28-year-old man with pathologic diagnosis of periosteal chondroma. Sagittal T2-weighted fat-suppressed fast spin-echo MR image (3900/90; echo train length, 8) shows cortical-based periosteal mass that has heterogeneously increased T2-weighted signal. Area of adjacent bone marrow edema (arrow) is seen within underlying humerus.

 


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  		Fig. 3. —37-year-old man with pathologic diagnosis of periosteal chondrosarcoma. Axial T2-weighted fat-suppressed fast spin-echo MR image (TR/TE 3800/80, echo train length, 8) of left tibia shows 4-cm high-signal-intensity mass based on posterior periosteal surface of proximal tibial metaphysis (T) with bone marrow invasion (arrow), irregular peripheral margins, and extensive soft-tissue edema.

 


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  		Fig. 4A. —31-year-old man with pathologic diagnosis of periosteal chondroma. Axial unenhanced CT image of left upper humerus shows periosteal-based lesion involving anterolateral cortex. Note dense slightly irregular calcification in lesion with irregular peripheral margins (arrows).

 


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  		Fig. 4B. —31-year-old man with pathologic diagnosis of periosteal chondroma. Axial unenhanced T1-weighted conventional spinecho MR image (TR/TE, 416/11) shows low-signal-intensity soft-tissue mass (2.2 cm) along periosteal surface of humerus and no evidence of bone marrow invasion.

 


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  		Fig. 4C. —31-year-old man with pathologic diagnosis of periosteal chondroma. Axial T2-weighted fat-suppressed fast spin-echo MR image (4200/90; echo train length, 8) shows cortical-based periosteal mass with low signal intensity correlating to mineralization seen on CT and high T2-weighted signal constituting remainder of lesion (arrow).

 


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  		Fig. 5A. —64-year-old woman with pathologic diagnosis of periosteal chondrosarcoma. Anteroposterior radiograph of ankle shows well-defined extrinsic erosions of tibia and fibula at level of syndesmosis.

 


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  		Fig. 5B. —64-year-old woman with pathologic diagnosis of periosteal chondrosarcoma. Axial T1-weighted conventional spin-echo MR image (TR/TE, 416/11) shows low-signal-intensity soft-tissue mass (3 cm) (open arrow) causing erosion of tibia (solid arrows) and fibula at level of syndesmosis. No evidence of marrow invasion is seen.

 


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  		Fig. 5C. —64-year-old woman with pathologic diagnosis of periosteal chondrosarcoma. Coronal T2-weighted gradient-echo MR image (416/10; flip angle, 15°) shows high-signal-intensity soft-tissue mass causing erosion of tibia and fibula (arrow) with no evidence of marrow invasion.

 

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