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Chondroblastoma
Chondroblastoma is a rare benign tumor that develops from cartilage germ cells, most commonly affecting the epiphysis of long bones in teenagers before growth plate closure. It appears lytic with punctate calcification on x-ray and shows clear borders and surrounding edema on MRI. Microscopically it contains islands of chondroblasts with chicken wire calcification and multinucleated giant cells. Treatment involves curettage with bone grafting, and it has a low recurrence rate with marginal excision but high recurrence with intra-capsular curettage.
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Chondroblastoma
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- 2. Synonyms and relatedkeywords: ď‚—Codman tumor, ď‚—Cartilage-containing giant cell tumor, calcified giant cell tumor, epiphyseal chondromatous giant cell tumor, ď‚—Epiphyseal tumors, ď‚—Benign cartilaginous neoplasms, chondroclasts
- 3. Rare benign tumor. Epiphysis. CODMAN’STUMOR – first described by Codman 1931. <1% of all primary bone tumors. Develops from – Cartilage germ cells. Reticulohistiocytes – according to Valls.
- 4. Age: Active epiphysial plategrowth Range: 3-73 yrs. Teenagers – before obliteration of growth plates. 90% in 5 – 25 yrs. of age. Sex Male : Female 2 : 1
- 5. Site: EPIPHYSIAL region oflong bones and occasionally to adjacent metaphysis. Common occurrence: Lower extremity (72% of cases), in which 50% of the chondroblastomas occur around the knee. Prox. Humerus 18% > Prox. Tibia 17% > Distal femur 16% > Prox. Femur 16% > Ankle bones 9% Size: 1- 6 cm.
- 6. Clinical features: Non-specific andvague. Pain & swelling – several months. May be referred to nearest joint Some loss of joint function & muscle wasting. Joint effusion esp. around knee. Pathological fractures – rare.
- 7. Mortality/Morbidity: Without surgical excision,the tumor may extend into the adjacent soft tissues or synovium and metastasize to distant organs. Metastasis, when it occurs, most frequently involves the lungs and tends to occur at the time of primary tumor recurrence. Widespread metastases and death have been reported.
- 8. Radiological features: X –RAYS: Lytic area – Oval or round < ½ of epiphysial area. Thin rim of sclerosis Punctate or streaky calcification.
- 9. Usually open growthplates. In metaphysial extension, crossing growth plate results in – Eccentric location & bulging expansion of cortex.
- 10. C. T. Scan: ď‚—Showsclearer exact evaluation and extent.
- 11. M.R.I. Scan: ď‚—Better extentof involvement.
- 12. 16 yr oldgirl ď‚—Pathological # - rare
- 13. ď‚—14-year-old boy. ď‚—Well-circumscribed, thin, scleroticmargins. ď‚— Chondroblastomas may have sclerotic, nonsclerotic, or incompletely sclerotic borders.
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- 15. MRI T2 image ď‚—Thelesion is confined to the epiphysis. ď‚—The presence of surrounding edema is best depicted with MRI.
- 16. ď‚—Pedicle and transverse processof a lumbar vertebra. ď‚—Diagnosis of chondroblastoma was confirmed at pathologic examination
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- 18. ď‚—17-year-old boy. ď‚—A subtle,solid, adjacent metaphyseal periosteal reaction is present medially. ď‚—A metaphyseal periosteal reaction occurs in 15-30% of chondroblastomas.
- 19. ď‚—Fluid-fluid levels are occasionallyseen on images of chondroblastomas, ď‚—Can simulate aneurysmal bone cysts.
- 20. Uptake of thebone-seeking agent may be due to – regional hyperemia of the tumor.
- 21. Pathology: Gross: Usually well demarcatedlesions. Capsule – thin, easily disruptable Soft, reddish –purple, friable, focally fritty tissue. Cystic spaces and haemorrhages may be seen.
- 22. Microscopic: Islands of chondroblastswithin uniform polyhedral closely packed cells. Background of fibrous stroma cells within the islands – PAVING STONE APPEARANCE.
- 23. Cells – round,plump and active. Pericellular lattice-like fine calcification – “CHICKEN WIRE” or “PICKET FENCE” pattern. Small granular purplish areas of micro calcification. Multinucleated Giant cells – scattered in stroma. Often prominent, dilated blood vessels at centre & periphery.
- 24. Differential diagnosis: ď‚—Enchondroma ď‚—Hand, diaphysial. ď‚—G.C.T. ď‚—Eccentrical,soap bubble or trabecular pattern ď‚—No calcifications ď‚—Often after closure of growth plate. ď‚—Central chondrosarcoma ď‚—Slow growth, severe pain & margins not demarcated.
- 25. ď‚—Chondromyxoid fibroma ď‚—Metadiaphysis (Characteristic). ď‚—Septate. ď‚—Monostoticfibrous dysplasia. ď‚—Ground glass appearance. ď‚—No calcifications.
- 26. Treatment & prognosis: Curettageand autologous bone grafting – high recurrence rate (10 – 35%). Close follow up & observation till skeletal maturity – when potential growth remaining & lesion abuts epiphysial plate. Marginal extra capsular excision – when growth plate not at all at risk, low recurrence rate. Defect – Autologous bone grft.
- 27. Methacrylate adjunct –when excision impractical & intra capsular curettage is of high risk of recurrence due to surgical inaccessibility. Curettage followed by cryosurgery: In case of recurrence or when associated with ABC. Yields consistent good results with a high cure rate when entire tumor is adequately frozen by liquid nitrogen.
- 28. Radiosensitivity: Radiosensitive tumor Not usedfor uncomplicated cases – potential hazards of irradiation induced malignant transformation. Even more favorable results with other modes.