INTERESTING IMAGE Year : 2023  |  Volume : 38  |  Issue : 1  |  Page : 63-64  

Primary mesenchymal chondrosarcoma of the mediastinum with adrenal metastasis: A rare scenario

Nihit Mhatre1, Shantanu Pande2, Shashikant Patne3, Megha Bansal3
1 Department of Nuclear Medicine, Homi Bhabha Cancer Hospital and Mahamana Pandit Madan Mohan Malaviya Cancer Centre (Units of Tata Memorial Centre), Varanasi, Uttar Pradesh, India
2 Department of Nuclear Medicine, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
3 Department of Pathology, Homi Bhabha Cancer Hospital and Mahamana Pandit Madan Mohan Malaviya Cancer Centre (Units of Tata Memorial Centre), Varanasi, Uttar Pradesh, India

Date of Submission21-Nov-2021Date of Decision15-Jan-2022Date of Acceptance17-Jan-2022Date of Web Publication24-Feb-2023

Correspondence Address:
Dr. Nihit Mhatre
Department of Nuclear Medicine, MPMMCC/HBCH, Units of Tata Memorial Centre, Varanasi - 221 005, Uttar Pradesh
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/ijnm.ijnm_180_21

   Abstract 

Mesenchymal chondrosarcoma (MC) is a rare malignant tumor that represents <3% of all chondrosarcomas. Herein, we describe extraskeletal MC involving the mediastinum in a 24-year-old gentleman with a rare phenomenon of adrenal metastasis.

Keywords: Adrenal gland, cartilaginous tumor, F18-2-fluoro-2-deoxy-glucose positron-emission tomography/computed tomography

How to cite this article:
Mhatre N, Pande S, Patne S, Bansal M. Primary mesenchymal chondrosarcoma of the mediastinum with adrenal metastasis: A rare scenario. Indian J Nucl Med 2023;38:63-4
How to cite this URL:
Mhatre N, Pande S, Patne S, Bansal M. Primary mesenchymal chondrosarcoma of the mediastinum with adrenal metastasis: A rare scenario. Indian J Nucl Med [serial online] 2023 [cited 2023 Feb 25];38:63-4. Available from: https://www.ijnm.in/text.asp?2023/38/1/63/370432

A 24-year-old male complained of breathlessness, disturbed sleep, weight loss, and loss of appetite of 1-month duration. A contrast-enhanced computed tomography (CT) scan of the chest revealed a large mass in the mediastinum with calcific changes and filling defects in the superior vena cava and right atrium. A CT-guided biopsy from the mediastinal mass was done. H and E-stained photomicrographs show atypical cartilaginous tumor mixed with a mesenchymal area of malignant round cells [Figure 1]h and [Figure 1]i. Immunohistochemistry showed positive nuclear staining with S-100 protein in atypical cartilage [Figure 1]j and membranous positivity of CD99 in mesenchymal cells [Figure 1k], consistent with mesenchymal chondrosarcoma (MC).

Figure 1: F18-2-fluoro-2-deoxy-glucose (FDG) positron-emission tomography/computed tomography showed a large mediastinal soft tissue mass (a-g, white arrows) with extensive calcifications and increased peripheral FDG uptake. An FDG -avid soft tissue mass was noted in the right suprarenal region (a-g, blue arrows), also showing central calcification (d). H and E-stained photomicrographs show atypical cartilaginous tumor mixed with mesenchymal area of malignant round cells (h-i). Immunohistochemistry showed positive nuclear staining with S-100 protein in atypical cartilage (j) and m. Membranous positivity for CD99 in mesenchymal cells (k)

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F18-2-fluoro-2-deoxy-glucose (FDG) positron-emission tomography with CT (PET/CT) for staging was done. FDG PET/CT showed a large mediastinal soft tissue mass [Figure 1a-g, white arrows] measuring 14.3 cm × 17 cm with extensive calcifications and increased peripheral FDG uptake with a maximum standard uptake value (SUVmax) of 8.57. An FDG avid soft tissue mass was noted in the right suprarenal region [Figure 1a-g, blue arrows], also showing central calcification [Figure 1d], measuring 3.5 cm × 3.2 cm with SUVmax of 7.64. The right adrenal gland was not visualized separately.

MC is a rare malignant tumor that represents <3% of all chondrosarcomas.[1] Reports of metastasis of MC to unusual sites such as adrenal, pancreas, and thyroid are few in the published literature.[2],[3],[4],[5] Detection of adrenal metastasis on PET/CT in case of extraskeletal MC is however not reported. Histopathologic evidence of the adrenal metastasis was not achievable as the patient was lost to follow-up; however, the imaging features suggest this possibility given the overall scenario.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 

   References 
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    2.Paasch C, De Santo G, Boettge KR, Strik MW. Mesenchymal chondrosarcoma metastasising to the pancreas. BMJ Case Rep 2018;11:e226369.  
    3.Ortiz S, Tortosa F, Sobrinho Simões M. An extraordinary case of mesenchymal chondrosarcoma metastasis in the thyroid. Endocr Pathol 2015;26:33-6.  
    4.Sun J, Zhang W, He T, Wang H, Tian R. 18F-FDG PET/CT imaging of pancreatic and adrenal metastases in a patient with mesenchymal chondrosarcoma. Clin Nucl Med 2021;46:231-2.  
    5.Hunter K, Alexander A, Passerini S, Rovner A, Garg A. Extraskeletal mesenchymal chondrosarcoma arising in adductor magnus with metastatic foci. BJR Case Rep 2016;2:20150117.  
    
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