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CHONDROBLASTOMA
General Information
Benign neoplasm of immature cartilage cell (chondroblast) proliferation
Ewing 1928
Clinical Data
Location:
Metaphysis only 4%
Epiphyseal Lesions
Differential Diagnosis of Lesions that tend to involve the epiphysis:
Chondroblastoma
Clear cell chondrosarcoma
Infection
Osteoid Osteoma
Osteoblastoma
Clinical Presentation
Signs/Symptoms:
Age:
Range 3 - 72 years
95% of cases occur between the ages 5 and 25
Sites:
Trochanter 7%
Radiographic Presentation
Usually radiolucent
Calcifications are often better detected with a CT scan but are not uniformly present
Lesions may expand the bone and new periosteal bone may form
Plain X-rays:
MRI:
High signal on T2 mixed with low signal areas (low signal areas proposed to be
secondary to lysosomal content of highly cellular areas)
CT scan:
Most useful for detecting subtle mineralization that is not apparent on X-rays
Useful for identifying intact periosteum around any expansile soft tissue component
that appears as a surrounding thin reactive shell of bone/mineralization (Egg Shell
Rim of Calcification). This helps place the tumor in a benign category.
Can help evaluate bony quality, extent of bone and cortical destruction and whether
the subchondral plate of bone adjacent to the joint cartilage has been destroyed or is
intact.
Bone Scan:
Gross Pathology
Lesion may be fully cystic with solid foci of tumor tissue at periphery
Microscopic Pathology
The tumor is composed of chondroblasts that have a distinct, thick cell membrane.
The thick cell membrane gives it a "Chicken Wire Fence Appearance" especially
when the cell membranes are calcified. "Chicken Wire Calcifications"
Calcification is an important diagnostic sign and deposits itself along cell membranes.
This gives a pattern referred to as a "Chicken Wire pattern of Calcification" because
the appearance is similar to a chicken wire fence.
Biological Behavior
Chondroblastomas are benign aggressive tumors. They grow aggressively and destroy
the bone.
Chondroblastomas can destroy the cortex and grow into the soft tissues. They are
contained by the periosteum (this differs from a malignant tumor that destroys the
cortex)
There are extremely rare cases where chondroblastomas metastasize to the lungs and
may not appear for 30 years
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Treatment
Intralesional curettage resection and bone grafting is the most common treatment. Cement
and internal fixation may also be used to fill the defect after removal for selected patients.
Rarely chondroblastomas that have grown out of control have required amputations
for treatment because they have completely destroyed the bone and/or adjacent joint.
In patients who are skeletally immature (still growing) there is always a risk of growth
plate failure from the chondroblastoma since it usually grows adjacent to the growth
plate and may damage it.
Prognosis
Chondroblastomas are benign aggressive tumors that grow and destroy the bone and
joint as it grows.
Most patients are cured with the first surgery
Radiofrequency has been successful in the treatment of very selected small tumors.
Pulmonary metastases have extremely rarely been reported to develop 30 years after
initial treatment.