Cervical Chondrosarcoma

History
The patient is a 39-year-old gentleman with a history of Maffucci's syndrome who presents with a painless neck mass he has had for the past several months. The patient noticed the mass has enlarged and denies any neurovascular deficits.

Examination
On physical examination, patient has an obvious deformity of his right neck. A 5 x 5-cm mass is located just below and posterior to the right ear. The mass is firm, non-mobile, and non-tender. He has full active range of motion and is neurovascularly intact.

Prior Treatment
No treatments or imaging has been performed on this mass.

Past Surgical Treatments
Multiple orthopedic surgeries but, of note, a large right-shoulder resection due to chondrosarcoma and left below elbow amputation for chondrosarcoma as well.

Images
Radiographs demonstrate multiple enchondromas and subcutanenous lesions consistent with hemangiomas. The right lateral neck mass is seen. Specifically, the AP radiograph (Figure 1A) demonstrates a chondroid matrix mass. The lateral radiograph (Figure 1B) demonstrates a lytic lesion as well.

Figure 1A

Figure 1B

Magnetic resonance imaging demonstrates an exophytic, lobulated bony mass extending from the right aspect of the C2 vertebral body posteriorly measuring 7.1 x 5.0-cm (Figure 2A). The lesion has a heterogenous signal and demonstrates extensive displacement of the surrounding soft tissues (Figure 2B).

Figure 2A

Figure 2B

Computerized tomography demonstrates a right-sided upper neck mass with mixed bone and soft tissue showing rim enhancement. The mass has a chondroid matrix appearance. (Figures 3A, 3B)

Figure 3A

Figure 3B

Preoperative angiography revealed that at the level of the mass, the right vertebral artery was non-patent. The majority of the mass was avascular as well. The brain stem was supplied by collaterals and the left vertebral artery.