Lung India

RADIOLOGY QUIZ
Year
: 2012  |  Volume : 29  |  Issue : 1  |  Page : 85--86

"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

Correspondence Address:
Akashdeep Singh
Department of Pulmonary Medicine, Christian Medical College and Hospital, Ludhiana-141008, Punjab
India




How to cite this article:
James R, Singh A, Kaur R. "Ring and arc'' calcification in a rib mass.Lung India 2012;29:85-86


How to cite this URL:
James R, Singh A, Kaur R. "Ring and arc'' calcification in a rib mass. Lung India [serial online] 2012 [cited 2019 Oct 23 ];29:85-86
Available from: http://www.lungindia.com/text.asp?2012/29/1/85/92375


Full Text

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.{Figure 1}

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}

Q1. What is your diagnosis?

 View Answer

 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}

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

1Giuffrida 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.
2Kitada 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.
3Somers J, Faber LP. Chondroma and chondrosarcoma. Semin Thorac Cardiovasc Surg 1999;11:270-7.
4Murphey 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.