July 10th, 2020

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Long Bone Chondrosarcoma with Metastasis to the Ovary: A Case Report
Authors:  J. Stuart May, M.D., Corey Hamilton, M.D., Ali Raufi, M.D., Nadim Bou Zgheib, M.D., Yehuda Lebowicz, M.D., Doreen Griswold, M.D., Linda Brown, M.D., and Felix H. Cheung, M.D.
BACKGROUND: Chondrosarcomas are largely low grade with low potential for distant metastasis, but up to 10% of cases can be high grade, almost certainly involving distant metastatic lesions. When chondrosarcomas metastasize, typical sites include the lungs, soft tissues, and lymph nodes. Rarely, distant metastasis can involve the liver, kidney, brain, or heart.

CASE: A 43-year-old, white woman presented with left knee pain. Magnetic resonance imaging (MRI) of the knee revealed a diffuse abnormality of the proximal left tibia. Computerized tomography (CT)–guided biopsy revealed malignant cartilaginous neoplasm. CT scans showed bilateral lung nodules. The patient completed 11 weeks of chemotherapy, then underwent radical resection of the proximal tibia with replacement. Pathology showed high-grade chondrosarcoma. Two months post-treatment she developed a rapidly enlarging pelvic mass. At time of laparotomy a large midline abdominopelvic mass was encountered. Pathology returned positive for metastatic chondrosarcoma. The patient was managed expectantly thereafter due to stable disease in the chest and the slow-growing nature of chondrosarcoma. The risks related to toxicity were deemed to outweigh the benefits of chemotherapy.

CONCLUSION: Chondrosarcoma metastasis to the gynecological tract is exceedingly rare. Unique to this case is metastasis to the ovary from a primary chondrosarcoma not involving the axial skeleton. This is the only reported case of long bone chondrosarcoma metastasis to the ovary.
Keywords:  bone, chondrosarcoma, gynecologic cancer, mass, metastasis, ovary, pelvis
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