An Unusual Cause of Precordial Chest Pain

Extraskeletal chondrosarcoma in anterior mediastinum is very rare. A 45-year-old male patient was admitted to the hospital with precordial chest pain. A large and well-shaped mass in the anterior mediastinum was seen radiologically, and there was a clearly compression of the heart by the mass. The lesion was totally resected, and extraskeletal mediastinal chondrosarcoma was histopathologically diagnosed. We aimed to present and discuss the radiologic, clinic, and histopathologic features of unusual presentation of extraskeletal chondrosarcoma in a case.


Background
Chondrosarcoma is a malignant mesenchymal tumor arising from cartilage-forming tissues involving the bones (bone chondrosarcoma) or the so tissues (extraskeletal chondrosarcoma). Bone chondrosarcoma usually affects middleaged to elderly adults, and the pelvic bones, ribs, shoulder girdle, and long bones are the most common locations. Extraskeletal chondrosarcoma usually affects the deep so tissues of the extremities and the region of head and neck [1,2]. Extraskeletal chondrosarcoma in anterior mediastinum is very rare. We present a patient with extraskeletal chondrosarcoma in anterior mediastinum, which was located on the heart.

Case Presentation
A 45-year-old, nonsmoker male was admitted to the hospital with precordial chest pain. Blood tests results were normal. Chest roentgenogram was initially thought to be normal. But a masslike opacity was seen on the heart (Figure 1). orax computed tomography (CT) and magnetic resonance (MR) imaging demonstrated a large and well-shaped mass in the anterior mediastinum and clearly compression of the heart by the mass (Figure 2).
Pulmonary function tests revealed normal spirometric values. e �beroptic bronchoscopy was performed, and it was normal. Whole-body PET-CT with low-dose CT protocol was performed before the surgery, and there was no F1�-�uorodeoxyglucose (FDG) uptake in lesion or any part of body. e surgical excision was planned. ere was no relationship between the mass and adjacent structures. An encapsulated mass was totally removed. Pathological examination revealed a well-differentiated chondrosarcoma with chondrocyte atypias and neoplastic chondrocytes ( Figures  3 and 4). No recurrence was seen in the 2-year followup. e approval of patient and institution were taken to use their records for our study. Written informed consent was obtained from the patient for publication of this case report and accompanying images.

Conclusions
Chondrosarcomas are presumably derived from primitive precartilaginous mesenchymal cells [3]. It may occur in extraskeletal locations and mainly in the so tissues of the orbit, the cranial and spinal meningeal coverings,  and lower limbs [4]. Primary chondrosarcoma of the anterior mediastinum without any continuity with cartilagecontaining organs are extremely rare. In the present case, chondrosarcoma was located on anterior mediastinum and extraskeletal.
Chondrosarcoma is more frequently found in patients from the fourth to seventh decades, with a male predominance [2,5]. Local pain is the most frequent presenting symptom of patients with this neoplasm [1,6,7]. Precordial chest pain was main symptom in our case. Also, the mass lesion was marked compressing on the heart. Chest radiography, thorax CT, and MRI depicts lobulated, well-shaped so tissue mass, as in our case. Mediastinal chondrosarcomas also shares imaging �ndings with other skeletal and so-tissue tumors. Brenner et al. reported that the combination of pSUV on PET imaging and histopathologic tumor grading in chondrosarcoma might be helpful for determining a more accurate diagnosis [8]. Histopathologic examination shows chondrocyte atypias and neoplastic chondrocytes, as seen in our case.
e wide local excision is recommended for treatment. In the present case, mediastinal chondrosarcoma was totally resected. e patient did not receive radiotherapy because all the surgical margins were tumor-free. According to reported one article, the primary chondrosarcomas of anterior mediastinum may have a less aggressive clinical course than previously recognized [3]. ere is no recurrence during two years aer surgery. Burt et al. reported that the 47 primary sarcomas of the mediastinum and mediastinal chondrosarcoma was seen in only one patient. Also, factors signi�cantly affecting survival were tumor grade and radicality of resection [9].
In conclusion, the extraskeletal chondrosarcoma in anterior mediastinum is very rare and usually overlooked on chest radiography. e complete surgical excision is enough for treatment, and prognosis is better than other chondrosarcomas.

Consent
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.