Three-month history of pain in the right hip.
The patient presented with a three-month history of pain in the right hip. X-ray images of the pelvis showed a well-defined lytic lesion in the right femoral head, with central matrix calcification (Fig. 1). A Computed Tomography scan demonstrated the lesion with sclerotic rim and central calcification (Fig. 2). Magnetic resonance (MR) imaging revealed a low signal intensity lesion on T1-weighted images (Fig. 3a), while on T2-weighted images the non-mineralised matrix had high signal intensity. There was no oedema surrounding the lesion (Fig. 3b). After intravenous gadolinium administration the lesion was enhanced in all but the areas of calcification (Fig. 3c).
With these findings, the differential diagnosis included chondroblastoma and clear-cell chondrosarcoma (CCCS). Because of the absence of oedema and inflammatory tissue, the size of the lesion, its extension to the metaphysis, and the age of the patient, the most probable diagnosis was CCCS. The histopathological examination confirmed this diagnosis.
The treatment included surgical resection with total hip arthroplasty (Fig. 4).
Clear-cell chondrosarcoma (CCCS) is a rare cartilaginous tumour of low-grade malignancy, representing about 2% of all chondrosarcomas. Its clinical, roentgenographic, and pathological characteristics separate it from conventional chondrosarcoma. The most common location of CCCS is the epiphysis of long bones, especially of the proximal femur and humerus. It affects adults in the third to fifth decades of life and males more frequently than females (1, 2).
The histological hallmarks of CCCS are the large tumour cells with distinct boundaries and clear cytoplasm. Areas of conventional chondrosarcoma may occur within the tumour (2).
Radiologically the tumour appears as a well-demarcated, often calcified lytic lesion at the epiphysis of a long bone. The lesion is usually slightly expansile with a sharp margin between the tumour and the adjacent normal bone and extends often to the metaphysis. The size of CCCS is usually 4-8cm in diameter (3).
MR imaging is useful for the assessment of the extent of the tumour. On T1-weighted images the lesion is most often demonstrated with low signal intensity. The absence of oedema around the lesion is characteristic of CCCS. After intravenous gadolinium administration the tumour is usually enhanced except for areas of calcification (4).
CCCS is often radiologically indistinguishable from chondroblastoma and therefore frequently presents diagnostic difficulties. Chondroblastoma occurs in younger patients, is smaller and more confined to the epiphysis. It also presents with bone marrow oedema and periosteal reaction, which are uncommon in CCCS. Histological examination is necessary for the final diagnosis (4).
The treatment of CCCS is "en bloc" recection. The prognosis is good with a 5-year survival rate of more than 80% (1, 5).
Clear-cell chondrosarcoma of the femoral head
Based on the provided X-ray, CT, and MRI images, a bony lesion is observed in the right hip region around the femoral head/proximal femur. The lesion is mostly located in the epiphyseal region under the distal articular surface (near the hip joint) and can extend to the proximal metaphysis. The lesion has relatively well-defined margins, showing areas of radiolucency and some calcification or calcium deposits around it. On CT, the lesion appears lytic with a clear boundary and punctate or nodular calcification inside. MRI shows overall low signal on T1 and moderate to slightly high signal on T2, suggesting abundant cartilaginous matrix within the lesion. There is minimal surrounding bone marrow edema, and no significant swelling or effusion in the adjacent soft tissue.
Given the patient’s age, the lesion’s location (near the joint surface), its well-defined margins, as well as the characteristic cartilaginous calcification and limited peripheral edema, clear cell chondrosarcoma is highly suspected. A pathological examination should be conducted to differentiate it from other cartilage-origin tumors.
Combining the clinical history of a 57-year-old patient with right hip pain for three months, the imaging findings (a well-defined lytic lesion in the epiphysis/proximal femoral head area with local calcification, minimal peripheral edema on MRI), and the results of surgical or biopsy pathology, the comprehensive assessment suggests a diagnosis of: Clear Cell Chondrosarcoma (CCCS).
Based on the surgical approach and individual patient factors, rehabilitation typically begins after the incision has healed to some extent. Following the FITT-VP principle (Frequency, Intensity, Time, Type, Progression, and individual Variation), rehabilitation can be divided into the following stages:
Throughout the rehabilitation process, careful observation of the surgical site and pain levels in the affected limb is vital. If significant pain or swelling occurs at any stage, prompt evaluation and follow-up are required. Some patients may need to extend or adjust the rehabilitation plan based on bone healing.
Disclaimer: This report is based on the provided imaging and clinical data for reference and cannot replace an in-person consultation with a qualified physician. Specific treatment and exercise programs should be tailored to the patient’s actual condition and the recommendations of the attending physician.
Clear-cell chondrosarcoma of the femoral head
