Chondrosarcoma of proximal femur with pathologic fracture
The present case appears in Healio. The patient is an otherwise healthy 63-year-old woman who had months of low-back and right lower extremity pain that was diagnosed as sciatica by her primary care physician. Despite her failure to respond to treatment and evidence of worsening symptoms, no imaging of the lower extremity was obtained, which likely would have demonstrated the cortical changes evident in the metaphysis at the time of her pathologic fracture.

At present her course was significantly complicated by pathologic fracture and contamination of all compartments of the right thigh along the entire length of the femur due to fracture hematoma. Given the involvement of multiple compartments, as well as the high-grade nature of her sarcoma, it was felt that limb salvage could not be safely performed nor negative margins obtained.

Following completion of her work-up, a lengthy and frank discussion was held with the patient regarding her diagnosis and treatment options; a shared decision was made to proceed with radical resection via hip disarticulation. Hip disarticulation was performed, and surgical margins were negative (Figure 4).

Final surgical pathology revealed areas of well-demarcated differentiated chondrosarcoma at the periphery of the patient’s lesion in addition to the high-grade spindle cell sarcoma morphology and extensive tumor necrosis seen on prior CT-guided needle biopsy and open biopsy. The final diagnosis was revised to dedifferentiated chondrosarcoma.

Postoperatively, after consultation, given the patient’s apparent lack of metastatic disease on presentation and aggressive, high-grade pathologic diagnosis, the decision was made to treat her with adjuvant chemotherapy (adriamycin/cisplatin) to maximize disease control in an attempt to reduce the risk of recurrence/metastasis.

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