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Introduction: Conventional chondrosarcoma is the second most common primary malignant bone tumor and usually occurs at older adult ages. It is rare in childhood and adolescence., Case History: This case report presents the treatment course of a 13-year-old boy with a symptomatic chondrogenic tumor of the right distal femur. Histopathologically, an epiphyseal intermediate-grade chondrosarcoma (G2) was diagnosed., Discussion: Based on the following case, potential radiological and histopathological differential diagnoses, such as chondroblastoma or chondroblastic osteosarcoma, are discussed against the background of current standards in orthopedic oncology., (© 2021. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background:  Chondrogenic tumors are the most frequent primary bone tumors. Malignant chondrogenic tumors represent about one quarter of malignant bone tumors. Benign chondrogenic bone tumors are frequent incidental findings at imaging. Radiological parameters may be helpful for identification, characterization, and differential diagnosis., Methods:  Systematic PubMed literature research. Identification and review of studies analyzing and describing imaging characteristics of chondrogenic bone tumors., Results and Conclusions:  The 2020 World Health Organization (WHO) classification system differentiates between benign, intermediate (locally aggressive or rarely metastasizing), and malignant chondrogenic tumors. On imaging, typical findings of differentiated chondrogenic tumors are lobulated patterns with a high signal on T2-weighted magnetic resonance imaging (MRI) and ring- and arc-like calcifications on conventional radiography and computed tomography (CT). Depending on the entity, the prevalence of this chondrogenic pattern differs. While high grade tumors may be identified due to aggressive imaging patterns, the differentiation between benign and intermediate grade chondrogenic tumors is challenging, even in an interdisciplinary approach., Key Points:   · The WHO defines benign, intermediate, and malignant chondrogenic bone tumors. · Frequent benign tumors: osteochondroma and enchondroma; Frequent malignant tumor: conventional chondrosarcoma. · Differentiation between enchondroma versus low-grade chondrosarcoma is challenging for radiologists and pathologists. · Pain, deep scalloping, cortical destruction, bone expansion, soft tissue component: favor chondrosarcoma. · Potential malignant transformation of osteochondroma: progression after skeletal maturity, cartilage cap thickness (> 2 cm adult; > 3 cm child). · Potentially helpful advanced imaging methods: Dynamic MRI, texture analysis, FDG-PET/CT., Citation Format: · Engel H, Herget GW, Füllgraf H et al. Chondrogenic Bone Tumors: The Importance of Imaging Characteristics. Fortschr Röntgenstr 2021; 193: 262 - 274., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Background: Benign bone tumors are of special clinical importance because they might be confused with malignant bone tumors., Objectives: The aim of this article it to present the characteristics of benign bone tumors. The focus is orientated towards conventional x‑ray as the essential pillar for primary diagnosis. Consequently, the description of signal intensities of benign bone tumors in magnetic resonance images or less helpful clues like male-female ratios are deliberately omitted., Results: The classification of bone tumors introduced by Lodwick allows the identification of benign growth patterns. Growth patterns will not help, for example, in case of dedifferentiation of benign chondroid tumors towards chondrosarcomas. Therefore, each diagnosis has to incorporate the patient's clinical scenario. Furthermore, benign bone tumors might also cause aggressive growth patterns. Tumors classified as Lodwick Ic or higher should not be automatically regarded as malignant. Naturally, further clarification is mandatory for these tumors., Conclusions: Differentiation between definitely benign bone tumors and those which need further work up is a critical diagnostic step. In the majority of cases, this is possible based on the appearance in conventional x‑ray images. In case of possibly malignant lesions, both the patient's symptoms and the x‑ray morphology have to be considered by orthopedic surgeons, pathologists, and radiologists to determine the optimal diagnostic strategy.

Background: Osteogenic tumors include malignant and benign tumors that produce tumor osteoid and/or bone tissue. Osteosarcoma is the most common malignant bone tumor, especially in children and young adults., Objectives: The entities with their characteristic morphological features are described to enable the reader to come to a diagnosis and differential diagnosis on the basis of patient age, history and predominant location of the tumor., Methods: For this review we selectively used mainly large published patient cohorts. Our own and externally published data on widely accepted tumor criteria were also compared., Results: Detection is the initial diagnostic step for an osseous lesion, and is determined by the sensitivity of the method applied. Plain X‑ray films in two planes and CT are the basics in the radiological toolkit for osteogenic tumors. For evaluation of local tumor extension and biopsy planning MRI or scintigraphy should be combined. MRI as a stand-alone diagnostic tool is insufficient. For malignant bone tumors staging should be performed, applying a variable combination of thoracic CT, MRI, scintigraphy, and positron emission tomography (PET). Osteosarcoma, along with Ewing sarcoma and chondrosarcoma, are the most common malignant bone tumors; all sub-entities are significantly rarer. Among benign bone tumors, osteoid osteomas have the highest incidence, presenting with typical pain, location, and age predilection., Conclusions: Diagnostics and treatment of malignant bone tumors should preferably be performed in specialized centers because of significant therapeutic implications for patients. In uncertain cases, a second opinion should always be obtained.

Primary cartilage-forming tumors of the bone are frequent entities in the daily work of skeletal radiologists. This article describes the correlation of pathology and radiology in cartilage-forming skeletal tumors, in particular, enchondroma, osteochondroma, periosteal chondromas, chondroblastoma and various forms of chondrosarcoma. After reading, the radiologist should be able to deduce the different patterns of cartilage tumors on radiographs, CT, and MRI from the pathological aspects. Differentiation of enchondroma and chondrosarcoma is a frequent diagnostic challenge. Some imaging parameters, e. g., deep cortical scalloping (more than two thirds of the cortical thickness), cortical destruction, or a soft-tissue mass, are features of a sarcoma. Osteochondromas are bony protrusions with a continuous extension of bone marrow from the parent bone, the host cortical bone runs continuously from the osseous surface of the tumor into the shaft of the osteochondroma and the osteochondroma has a cartilage cap. Chondromyxoid fibromas are well-defined lytic and eccentric lesions of the metaphysis of the long bones, with nonspecific MRI findings. Chondroblastomas have a strong predilection for the epiphysis of long tubular bones and develop an intense perifocal bone marrow edema. Dedifferentiated chondrosarcomas are bimorphic lesions with a low-grade chondrogenic component and a high-grade noncartilaginous component. Most chondrogenic tumors have a predilection with regard to site and age at manifestation.

On the basis of three patients with bone and soft tissue sarcoma,we would like to illustrate the necessity of a well working inter-disciplinary cooperation of radiologists, internal oncologists, radiation therapists, orthopaedic surgeons and plastic surgeons. Functional extremity preservation in sarcoma patients can be achieved by a good interdisciplinary management without im-pairing the total prognosis of the patients. Patients with sarcoma should be treated in centres in which all specialised divisions are experienced and well trained in the treatment of tumour patients. Only then can a promising approach be achieved.

A 39-year old man was referred for evaluation of a left sided tumor in the region of the third and fourth rib. Computed tomography revealed a slightly enhancing costal tumor with mainly intrathoracic expansion. Calcifications inside the tumor were present. Assuming a chondrogenic tumor of unknown dignity, en bloc tumor resection and reconstruction of the chest wall was performed. By means of the histopathological examination the diagnosis of a chondrosarcoma grade I was made.

Purpose: To evaluate the role of projectional radiography in the detection of primary and potentially malignant bone neoplasms., Materials and Methods: We retrospectively reviewed the images and medical records of 80 patients (42 male, 38 female; range: 6 to 73 years; mean: 33 years) with pathologically proven primary or indeterminate bone tumors., Results: The most common symptom was local pain (84 %). In 69 of 80 patients (86 %), projectional radiography was the first imaging modality, which correctly identified the malignant character of the bone lesion in 60 of these 69 patients (87 %). In 2 patients, bone neoplasms were overlooked due to diagnostically inadequte image quality. The false-diagnosis rate was not significantly different between board-certified radiologists working in hospitals and radiologists in outpatient facilities (p > 0.05). Bone tumors predominantly affecting adults, such as chondrosarcomas, needed a longer time for the diagnosis than bone tumors mainly found in childhood, such as osteosarcomas. The median age of patients with delayed imaging work-up because of attempted conservative therapy (45 years +/- 20 years) was significant higher than the median age of patients with immediate radiographic work-up (27 years +/- 16 years)., Conclusion: Projectional radiography is the most common initial imaging method for bone pain and continues to play an important role to reduce the time gap between first onset of symptoms and definitive treatment. In unremitting focal bone pain, bone neoplasms should be taken into consideration not only in children but also in patients beyond adolescence.

The resection of primary malignancies in the pelvis is technically demanding as organs and structures are to be preserved and reconstruction of the defect as well as the postoperative function and rehabilitation are dependent on an optimal prosthesis. We present two patients with a sarcoma of the pelvis where for the first time a structured concept of technology integration led to a press-fit implantation of a hemipelvic prosthesis. This concept includes the design and production of a "custom-made" prosthesis as a hemipelvic substitute and the coating of this prosthesis with Bonit, a second-generation calcium phosphate, and gentamycin in watery solution. The tumor resection was done with computer-assisted surgery based on computed tomographies (CT) of the pelvis model done by rapid prototyping rather than on the CT of the patients' pelvis. With this procedure the presurgically simulated resection could be executed precisely with complete resection of the tumors and an accuracy which allowed an exact implantation of the prosthesis. The course was uneventful with primary healing and no sign of an infection or loosening after 6 months.

To assess the efficiency of plain radiographs for the detection of primary and potentially malignant bone tumors a retrospective study in 70 patients with histologically proven bone sarcomas was performed. Plain radiographs were the first imaging modality in most cases and for many patients the basic step leading to further diagnostic investigations. With young patients suffering from bone pain imaging work-up was obtained immediately, whereas older patients showed significant delay until radiographs were performed. The findings of this study suggest that radiography is an effective tool for the diagnosis of primary and potentially malignant bone tumors and that physicians should think of bone tumors also when patients beyond the adolescence have focal bone pain.

Clear-cell chondrosarcoma is a rare, low-malignant bone tumor. The lesion most commonly occurs in adults, generally in the 3rd or 4th decade. Clear-cell chondrosarcoma has a predilection for the epiphyses of long tubular bones, particularly the femoral head. Radiologically, it is a sharply defined radiolucent lesion. Histologically, it is characterized by large tumor cells with distinct boundaries and a clear cytoplasm. In addition to areas of conventional chondrosarcoma, there are partially mineralized trabecular osteoid formations. On the basis of 16 cases of clear-cell chondrosarcoma, we present the observations of the Hamburg Bone Tumor Register. The cases were examined according to age distribution, location, and radiological and pathomorphological criteria. The proximal femur was the most frequent location; rare manifestations in the rib, os ilium, and distal phalanx of the hand were also present. In 50% of the cases high-malignant osteosarcoma or conventional chondrosarcoma was considered. In addition to the epiphysis of the proximal femur, clear-cell chondrosarcoma can also involve other, rather unusual sites in the skeleton. Knowledge of the histomorphology of this tumor is therefore of crucial importance for the diagnosis.

Background: Radiobiological and physical examinations suggest clinical advantages of heavy ion irradiation. We report the results of 23 women and 22 men (median age 48 years) with skull base tumors irradiated with carbon ion beams at the Gesellschaft für Schwerionenforschung (GSI), Darmstadt, from December 1997 until September 1999., Patients and Methods: The study included patients with chordomas (17), chondrosarcomas (10) and other skull base tumors (Table 1). It is the first time that the intensity-controlled rasterscan-technique and the application of positron-emission tomography (PET) for quality assurance was used. All patients had computed tomography for three-dimensional-treatment planning (Figure 1). Patients with chordomas and chondrosarcomas underwent fractionated carbon ion irradiation in 20 consecutive days (median total dose 60 GyE). Other histologies were treated with a carbon ion boost of 15 to 18 GyE delivered to the macroscopic tumor after fractionated stereotactic radiotherapy (median total dose 63 GyE)., Results: Mean follow-up was 9 months. Irradiation was well tolerated by all patients. Partial tumor remission was seen in 7 patients (15.5%) (Figure 2). One-year local control rate was 94%. One patient (2.2%) deceased. No severe toxicity and no local recurrence within the treated volume were observed., Conclusion: Clinical effectiveness and technical feasibility of this therapy modality could clearly be demonstrated in our study. To evaluate the clinical relevance of the different beam modalities studies with larger patient numbers are necessary. To continue our project a new heavy ion accelerator exclusively for clinical use is planned to be constructed in Heidelberg.

Gastrointestinal stromal tumors (GIST) represent an extremely rare group of tumors, which are mostly of smooth muscle origin like leiomyomas, leiomyosarcomas and leiomyoblastomas. With the introduction of immunohistochemical analysis an epithelioid and an autonomic nerve variant can be distinguished. The purpose of this review is to demonstrate the image morphological appearance of these rare tumors together with the pathology based upon a retrospective analysis of five of our own cases since 1997. There are no pathognomonic imaging findings for characterizing a gastrointestinal stromal tumor; however, it should be included in the differential diagnosis if one or multiple large, round or oval, well-delineated gastrointestinal tumors occur in combination with central necrosis. Carney's syndrome is characterized by the syndromal association of a gastrointestinal stromal tumor (originally: gastric leiomyosarcoma) with an extra-adrenal paraganglioma and a pulmonary chondroma. In this rare syndrome, the radiological approach is important to diagnose or rule out the--simultaneous or consecutive--appearance of at least two of the three tumor entities (GIST, extra-adrenal paraganglioma, pulmonary chondroma).

This is a report on two patients in their eighth decade suffering from a chondrosarcoma in the proximal femur and in the big toe. The resection of 22 cm of the proximal femur and the replacement with a modular tumour prosthesis proved successful. The other patient had a tumour in the proximal phalanx of the big toe and wide resection of the first ray was performed. No patient gave evidence of local recurrence or distant metastasis.

Malignant cartilaginous tumors (chondrosarcomas) are, with a relative frequency of 20%, the second most common malignant tumors of bone after osteosarcoma. The diagnosis of chondrosarcoma can usually be made confidently based on combination of clinical information, radiographs, Gd-enhanced MR imaging, and histologic examination of a biopsy sample. The combination of these parameters is important because accuracy of histologic diagnosis is adversely affected by unrepresentative sampling of these usually large tumors. The prognosis of patients with chondrosarcoma becomes poorer with more axial location, higher histologic grade, larger tumor size and inadequate resection. By careful analysis of radiographs and Gd-enhanced MR imaging the radiologist has the ability to improve the management of patients with chondrosarcoma.

Diagnosis, concepts of therapy and prognosis of primary malignant bone tumors require intensive cooperation between orthopedic surgeons, radiologists and pathologists with special knowledge in oncology. The present paper demonstrates relevant topics of diagnosis, radiological appearance and therapy of the osteosarcoma, Ewing's sarcoma, chondrosarcoma and malignant fibrous histiocytoma based on the material of the Vienna Bone Tumor Registry and more than 35 years of cooperation between the Institute of Pathology and Anatomy and the Department of Orthopedics at the University of Vienna.

The diagnosis of primary malignant bone tumors, which only account for 1% of malignancies in humans, represents quite a challenge for the pathologist. Apart from the often overlapping morphology between different entities, heterogeneity within one and the same tumor has to be kept in mind. Furthermore, in most cases the diagnosis must be established based on small biopsy specimens and occasionally even on frozen sections. In this context detailed clinical information including the patient's age and exact localization of the tumor, as depicted by X-ray or MRI, are essential requirements for a correct diagnosis. In addition, multiple biopsies from different tumor sites may be of help. For example, 25% of osteogenic sarcomas (OSA) are chondroplastic. Others may contain areas similar to fibrosarcoma (FSA) or malignant fibrous histiocytoma (MFH). Since 90% of OSA occur in the second decade of life whereas chondrosarcomas, FSA and MFH usually manifest after the age of 40 years, a biopsy solely composed of malignant chondromatous tissue obtained from a tibial lesion of a 10-year-old child should most likely be considered as part of an OSA. In the differential diagnosis of the so-called small, round cell tumors, which include Ewing sarcoma, malignant lymphoma and small-cell OSA, immunohistochemical staining of the paraffin-embedded material and a molecular biological/genetic work-up of frozen material are most helpful. In this paper the histomorphological characteristics and criteria for differential diagnosis of the most common primary malignant bone tumors are discussed.

Rapid growth of a painful and often recurrent bone tumor of the hand, is suspicious of low malignant chondrosarcoma, even despite previous histological identification as an enchondroma. The difficulty of differential diagnosis of enchondroma and chondrosarcoma is demonstrated in two cases and discussed in a review of the literature.

On a 23-year-old patient with an unclear clinical picture the sonographic examination of bone and soft tissue enabled an early detection of a pathological process, thus helping to direct the further use of radiological diagnostics. Unfortunately, the patient could not be helped due to the rapid onset of the diseases. But the case underscores the useful intervention of sonographic examination in the diagnosis of tumors located in locomotor system.

89 central and 5 periosteal chondrosarcomas identified between 1974-1989 were reviewed in a retrospective study. The purpose of this study was to examine the morphological characteristics of different types of chondrosarcomas and to describe remarkable features of location, age distribution and male to female ratio. We distinguish four types of centrally located chondrosarcoma: classical chondrosarcomas, dedifferentiated chondrosarcomas, mesenchymal chondrosarcomas and clear cell chondrosarcomas. Five periosteal chondrosarcomas were represented. Classical chondrosarcomas as well as clear cell chondrosarcomas indicate a significant predominance of males; no sex predilection in dedifferentiated and mesenchymal chondrosarcomas was seen. Nearly 60% of classical and mesenchymal chondrosarcomas occur in the trunk. 85% of dedifferentiated chondrosarcomas are located in the long bones of the limbs. The most common location of clear cell chondrosarcoma is the proximal part of the femur. There is a marked predilection for mesenchymal chondrosarcomas in the second and third decades of life. The mean age of patients with classical chondrosarcomas was 54 years, but clear cell chondrosarcomas occur 10 years earlier and dedifferentiated chondrosarcomas 10 years later. Characteristically, classical chondrosarcomas produce a pure chondroid matrix with variable differentiation of tumour chondrocytes. The most important histological feature of the dedifferentiated chondrosarcoma is the close association of two different cellular components. One of these consists of cartilage, which is generally well differentiated. In most of our cases the second component showed features of osteosarcoma (50%). Mesenchymal chondrosarcoma is characterized by concentric infiltration of cartilage islands by small tumour cells.(ABSTRACT TRUNCATED AT 250 WORDS)

The value of CT for the differential diagnosis of primary malignant tumours in the pelvis was investigated in the case of three types of tumour: osteosarcomas, chondrosarcomas and Ewing's sarcomas. A total of 78 CT examinations in 29 patients was used. The results show that CT, using suitable techniques (high resolution etc.) constitutes a valuable diagnostic method for differentiating these bone tumours. This applies not only for the localisation of the tumour and for defining its extent, but also for showing the morphology of intra- and extra-osseous soft tissue components and their patterns of calcification. It is possible to recognise patterns of growth and of tissue destruction that are typical of individual tumours.

Based on 46 enosteal cartilaginous tumours of the long tubular bones (43 patients) the established radiological and Mirra's histopathological criteria of tumour status are assessed independently and compared retrospectively. In lesions of Lodwick's type I B (37 cases) with mineralisation of the cartilaginous matrix and facultatively cortical arrosion, lack of periosteal reaction, destruction of the corticalis and parosseal tumour extension none of Mirra's histopathological criteria of malignancy was found. It may be expected that biopsy and histopathological examination will not give valuable additional information in this radiological constellation, because there are no known definite histopathological criteria of benignity. Suspicious radiological findings should prompt complete resection of the lesion. Biopsy and histopathological classification are always crucial when matrix mineralisation is lacking and therefore the diagnosis of a cartilaginous tumour cannot be established radiologically.

The importance of computed tomography is examined in malignant primary bone tumours using a strongly defined examination group of 13 Patients (six Ewing's-sarcomas, five osteosarcomas, one chondrosarcoma and one spindle-shaped cell sarcoma). Computed tomography is judged superior compared to plain radiographs in recognition of bone marrow infiltration and presentation of parosteal tumour parts as well as in analysis of tissue components of tumours, CT is especially suitable for therapy planning and evaluating response to therapy. CT does not provide sufficient diagnostic information to determine dignity and exact diagnosis of bone tumours.

The characteristic features of chondroma and chondrosarcoma of the larynx (less than 1% of laryngeal tumors) are discussed in a case report. Laryngoscopy (rounded, smooth tumor, covered by normal mucous membrane) and HR-CT of the larynx (swelling of the cartilages, calcifications in 80% of cases) give a characteristic view of the tumor, so that, by synopsis of both, a definite diagnostic statement concerning the kind of tumor is possible. However, carcinoma of the larynx with invasion of the cartilage, laryngeal manifestation of multiple chondromatosis and calcification after severe trauma have to be differentiated from cartilaginous tumors of the larynx. The adequate therapy of chondroma and low-grade chondrosarcoma consists of partial laryngectomy and reconstruction of the air passages. High-grade chondrosarcoma should be treated with radical laryngectomy.

The rare primary bone tumors of the chest wall have to be distinguished from metastatic or specific inflammatory bone diseases as well as from neoplasm of mediastinal or bronchogenic origin secondarily involving the chest wall. Their x-ray appearance may lead to confusion with pulmonary or mediastinal tumors. Since definite diagnosis by x-ray studies including computed tomography is not possible and many of these tumors are malignant or tend to recur locally, radical resection is mandatory. From 1970 to 1982 34 primary tumors of the bony chest wall were observed. A definite histological diagnosis was obtained in 28 cases. Ten tumors were malignant, chondrosarcoma being the most frequent ones. Tumor resections were carried out in 27 patients, the surgical procedures being single rib resection (17), multiple rib resection (6), partial sternum resection (2) and thoracotomy (2) for tumor enucleation. In 8 cases chest wall defects had to be covered with lyophilized Dura mater (2), with diaphragm (2), subscapular (1) and pectoral muscle flaps (3).

A primary malignant bone disease can generally be suspected on the basis of x-ray findings and may be even highly probable if several signs of malignancy are seen on one and the same film. Such changes include bone lesions larger than 6 cm on the first film with blurred outlines, showing patterns of destruction resembling moth-eaten textiles, the covering periosteum revealing spicula or Codman's triangles. Rapidly growing tumours can break cortex components from the continuous layer and shift them outwards. Roentgenological case controls are useless and must be replaced by a sample excision, since x-ray malignancy signs have no absolute value as decisive criteria in view of the fact that they are seen, inter alia, also in osteomyelitis, myositis ossificans and callus formations.

The computed tomography (CT) morphology of chondrogenic tumors and the utility of CT in their diagnostic work-up is presented on the basis of 19 cases. CT provided unique informations regarding definition of tumor extent and tumor relationship to adjacent structures particularly in the axial skeleton. CT has diminished the indications for angiography in chondrogenic tumors.

Computed tomography (CT) of the spine and spinal cord is gaining more and more importance as a valuable investigative method in neuroradiology. Performed as a noninvasive procedure, with or without intravenous contrast enhancement, it can be used to diagnose paravertebral soft tissue lesions, constrictive lesions of the bony spinal canal, structure changes of the vertebral column or of individual vertebrae, vascular intraspinal lesions, and intraspinal tumors with abnormally high or abnormally low attenuation values. Performed as an invasive procedure, after intrathecal introduction of metrizamide, spinal CT can in selected cases be used in conjunction with conventional metrizamide myelography as an additional procedure (secondary CT-myelography) or even as initial procedure ("primary" CT-myelography), taking advantage of its unique properties, namely to provide a transverse axial image of the spine and related soft tissue structures and to detect even small differences in density. Further improvement of spinal CT, particularly the routine non-invasive demonstration of the intraspinal soft tissues, is to be expected.

Report of an investigative study concerning 33 patients suffering from tumors and inflammatory lesions of the pelvis examined by computed tomography. These findings have been compared with the results of conventional radiologic techniques. For many reasons CT of the pelvis shows considerable advantages to all other diagnostic radiologic methods. Therefore CT evaluation is now a standard method before and after surgery.

Analysis of 374 cases of enchondroma, 42% of which were localized in the short bones of the hand. The findings in radiology and pathology are presented and discussed, with special attention to the difficulty of classifying these tumors histologically and distinguishing them from chondrosarcoma. The recurrence rate in the short bones of the hand was 9%, and 19% in the long tubular bones. It was especially high after mere currettage of the tumor.

A retrospective study of 50 exostotic chondrosarcomas of the trunk reveals statistically significant correlations of histological grading and growth pattern as well as bone destruction pattern as general hallmarks of the degree of malignancy. No correlation between presence and type of matrix mineralisations was found. A radiomorphological classification derived from the CT appearance of mineralisations allows a distinction of 5 types that are important for diagnostic specificity and recurrence detection. MRI provides sensitive detection of early local recurrences due to high-contrast display of chondroid tissue irrespective of mineralisations. However, the specificity is low.

The radiographic and histological morphology of 38 tumors lesions of the scapula are analyzed. Osteochondromas (n = 12), chondrosarcomas (n = 7), plasmacytomas (n = 4) and Ewing's sarcomas (n = 3) were the most frequent neoplasms. The radiographically determined growth rates allowed an estimate of the dignity in all cases. Benign lesions were only observed in the first five decades of life, and were mostly located in the scapular blade. Most tumors found in the acromion and in the glenoid region and all lesions diagnosed in the 6th to the 8th decades of life were malignant. In 63.2% of cases correct diagnosis of the type of lesion present was possible on radiographic examination.

The radiological appearance of chondrosarcoma, especially in their less common skeletal sites, is described. Variations in the radiographic manifestations are mentioned and the difficulties of differential diagnosis, especially in the long bones, ribs and hands, are stressed.

Over 20 years 5 patients with dyschondroplasia (Ollier) have been seen in the department for Orthopedics and Traumatology at Cluj-Napoca (Romania). Three were male, two female. 4 came from large families. First signs appeared gradually in 3, in 2 spontaneous fractures drew the attention to the disease. Radiographycally there were the typical chondromas with a strong tendency towards ossification in the adult. Shortening and deformity is proportional to the growth of the chondromas. The cause is unknown. In one case a chondroma became sarcomatous. One arm had to be exarticulated. This patient had no recurrence after 14 years.

Computer tomographic findings in 25 patients with destructive lesions of the sternum have been analysed. In 14 cases there was, in addition to bone destruction, extensive or ill-defined soft tissue infiltration. With two exceptions. CT demonstrated the bone changes more clearly than conventional tomography. The value of CT lies in its ability to demonstrate the exact extent of the bone destruction with simultaneous demonstration, or exclusion, of soft tissue infiltration. This is of value when resection or radiotherapy is planned.

Chondroma as a cartilage forming tumor ist localized in up to 50% of the cases in the small bones of the hands and feet, where it is considered a benign tumor. The closer the localization is towards the trunk, the more probable is potential malignancy. The problem is discussed describing two cases with chondroma of the pelvis, which developed into chondrosarcoma. As there could not be achieved any therapeutical success with radiation and chemotherapy, therapy must consist in excochleation, i.e. en-bloc-resection, special alloarthroplasty or hemipelvectomy. The more radical and the sooner the operation is performed, the higher is the chance of survival.