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| RADIOLOGY QUIZ |
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| Year : 2012 | Volume
: 29
| Issue : 1 | Page : 85-86 |
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"Ring and arc'' calcification in a rib mass
Robert James1, Akashdeep Singh2, Rupinder Kaur1
1 Department of Medicine, Christian, Medical College and Hospital, Ludhiana, Punjab, India
2 Department of Pulmonary Medicine, Christian, Medical College and Hospital, Ludhiana, Punjab, India
| Date of Web Publication | 28-Jan-2012 |
Correspondence Address:
Akashdeep Singh
Department of Pulmonary Medicine, Christian Medical College and Hospital, Ludhiana-141008, Punjab
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0970-2113.92375
How to cite this article:
James R, Singh A, Kaur R. "Ring and arc'' calcification in a rib mass. Lung India 2012;29:85-6 |
A 42-year-old female presented with complaints of progressively increasing right shoulder pain of 6 months duration along with low-grade fever. She was evaluated at another center, and based on radiology (chest X-ray), she was started on anti-tubercular treatment with which she had no response.
Physical and neurologic examinations were normal. Chest radiography revealed a partially calcified mass in the right upper zone area [Figure 1]. Routine hematological investigations and repeated bacteriological examinations of the sputum were normal.
A computed tomography (CT) scan of the chest revealed a 4 cm × 5 cm lobulated mass arising from the right second posterior rib [Figure 2]. The mass revealed scattered calcification(ring and arc pattern). There were no other bony lesions or enlarged lymph nodes so as to suggest a metastatic disease. The tumor was excised along with the second rib. | Figure 2: Non-contrast computed tomography of chest revealing a mass lesion with ring and arc calcification
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Q1. What is your diagnosis?
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 Answer | |  |
Chondrosarcoma of 2 nd rib | Discussion | | |
Histopathological examination revealed myxoid chondroid matrix, increased cellularity, and chondrocytes consistent with diagnosis of chondrosarcoma [Figure 3].  | Figure 3: Histopathology showing myxoid chondroid matrix and increased cellularity
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Chondrosarcoma is a rare malignant tumor of bone that produces cartilage matrix. The estimated annual incidence has been reported as 1 in 200,000. [1] Chondrosarcomas often arise in the pelvis or bones of the trunk, but primary chest wall chondrosarcomas are relatively rare. [2] Chondrosarcomas are typically located anteriorly within the chest wall, arising from the sternum or costochondral arches, [3] but in this case it originated from the right second rib posteriorly which is an unusual site. Radiographs of chondrosarcoma typically reveal a mixed lytic and sclerotic appearance. The sclerotic areas represent chondroid matrix mineralization and are seen in 60-78% of lesions. The characteristic appearance of mineralized chondroid matrix is a ring and arc pattern of calcification. This characteristic chondroid calcification usually allows confident radiologic diagnosis of a cartilaginous lesion. [4] The index case had a classic "ring and arc" calcification within a well-circumscribed rib mass, highly suggestive of chondrosarcoma.
| References | | |
| 1. | Giuffrida AY, Burgueno JE, Koniaris LG, Gutierrez JC, Duncan R, Scully SP. Chondrosarcoma in the United States (1973 to 2003): An analysis of 2890 cases from the SEER database. J Bone Joint Surg Am 2009;91:1063-72. 
[PUBMED] [FULLTEXT] |
| 2. | Kitada M, Ozawa K, Sato K, Hayashi S, Sasajima T. Resection of a chondrosarcoma arising in the right first rib: A case report. Ann Thorac Cardiovasc Surg 2010;16:118-21.
[PUBMED] [FULLTEXT] |
| 3. | Somers J, Faber LP. Chondroma and chondrosarcoma. Semin Thorac Cardiovasc Surg 1999;11:270-7.
[PUBMED] |
| 4. | Murphey MD, Walker EA, Wilson AJ, Kransdorf MJ, Temple HT, Gannon FH. From the archives of the AFIP: Imaging of Primary Chondrosarcoma: Radiologic-Pathologic Correlation. Radiographics 2003;23:1245-78.
[PUBMED] [FULLTEXT] |
[Figure 1], [Figure 2], [Figure 3]
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