AJR:179, October 2002 1077 Mesenchymal Chondrosarcoma of the Maxilla A 31-year-old man reported experiencing si- nus pressure that recently had become worse. He initially attributed the pain to his long-stand- ing history of allergic rhinitis. After repeated ep- isodes of sinus infections requiring multiple courses of antibiotic therapy, the patient under- went CT of the sinuses (not shown), which re- vealed a large mass that was expanding the left maxillary sinus. The patient subsequently pre- sented to our institution and underwent MR im- aging (Fig. 1), which showed a large soft-tissue mass in the maxillary sinus with extension into the left nasal cavity, left ethmoid sinus, and left inferior sphenoid and frontoethmoid recesses. Surgical excision was promptly performed, with histologic findings consistent with a mes- enchymal chondrosarcoma. Conventional chondrosarcomas are rare malignant cartilagenous tumors that most fre- quently occur in the ends of long bones and the pelvis and less frequently in the ribs [1]. These tumors can be classified according to both ra- diographic (central, peripheral, or juxtacorti- cal) and microscopic (clear cell, mesenchymal, or dedifferentiated) features [2]. The mesen- chymal variant accounts for approximately 2% of all cases [3] and can occur in the ribs, verte- brae, pelvis, or mandible. MR imaging shows a mesenchymal chon- drosarcoma as a large, irregular, and aggres- sive-appearing mass originating in the maxilla. The mass is predominantly hypointense, slightly more so than the cerebral parenchyma, on axial T1-weighted MR imaging. On T2- weighted MR imaging, this lesion is markedly hyperintense aside from a few areas of mild hypointensity seen medially. Gadolinium-en- On the AJR Viewbox C Fig. 1.—31-year-old man with maxillary sinus mass. A, Axial T1-weighted MR image obtained at level of pons shows large, lobular, and expansile mass that originates in left maxillary sinus, which is completely infiltrated by this soft-tissue mass, obliterating nasal septum. B, Coronal T2-weighted MR image with frequency-selective fat suppression reveals markedly hyperintense lobular mass, which is confirmed as originating in left maxillary sinus. Mass extends across midline into right maxillary sinus. C, Coronal contrast-enhanced T1-weighted MR image with frequency-selective fat suppression shows heteroge- neously enhancing mass that contains enhancing invaginations resembling gyri. D, Photomicrograph of histopathologic specimen reveals cartilagenous lobule containing abnormal neoplastic chondrocytes. (H and E, ×10) B A D Downloaded from www.ajronline.org by 171.243.67.90 on 05/28/23 from IP address 171.243.67.90. Copyright ARRS. For personal use only; all rights reserved
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