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Chondroblastoma of Bone*
Abstract
Chondroblastoma of bone is a rare lesion, and few large series have been reported. The purpose of this paper is to report forty-seven cases treated by one group of surgeons and to identify factors associated with more aggressive tumor behavior.
Seventy-three patients with chondroblastoma of bone were treated between 1977 and 1998. We were able to obtain historical data, imaging studies, histological findings, and adequate personal or telephone follow-up to determine the outcome for forty-seven patients.
The lesions were distributed widely in the skeleton, but most were in the epiphyses or apophyses of the long bones, especially the proximal part of the tibia (eleven tumors) and the proximal part of the humerus (ten tumors). The principal presenting symptoms were pain and limitation of movement. The treatment consisted of a variety of procedures, but the majority of the patients had intralesional curettage and packing with allograft or autograft bone chips or polymethylmethacrylate. Most of the patients had an excellent functional result, although in three osteoarthritis developed in the adjacent joint. Seven patients (15 percent) had a local recurrence; three of them had a second recurrence and one, a third recurrence. One patient died of widespread metastases, and another who had metastases to multiple sites was alive and disease-free after aggressive treatment of the metastatic lesions.
While the size of the lesion, the age and gender of the patient, the status of the growth plate, and an aneurysmal-bone-cyst component to the tumor had no significant effect on the recurrence rate, lesions around the hip (the proximal part of the femur, the greater trochanter, and the pelvis) accounted for the majority (five) of the seven recurrent tumors and one of the two metastatic lesions.
... The clinical manifestations encompass joint stiffness, pain, and swelling [2]. The primary treatment for CB is surgery, with the most frequently mentioned procedures being curettage with or without local adjuvants, bone grafting/cement, or cryosurgery [3,4]. The local recurrence rate (LR) ranges from 0 to 39% after treatment. ...
... Aggressive curettage is essential, despite the potential harm it can cause to the growth plate. Performing a non-aggressive curettage procedure may reduce damage to the growth plate and lead to a higher likelihood of recurrence [3]. Of the patients in our series, 17 individuals (44.7%) had physical involvement. ...
... Benign lung metastasis is rare, as evidenced by the limited number of documented cases in the literature, with a frequency ranging from 0.4% to 3.3% [2,3,22]. In our study and in other studies [1,10,11,15], there were no reported cases of distant metastasis during the final follow-up. ...
Background: Chondroblastoma (CB), a rare benign bone tumor that produces chondrocytes, often develops in the epiphysis or apophysis of children and young adults. The treatment of these rare tumors is complex. The standard treatment protocol involves curettage with local adjuvants and bone graft or cement application. The authors examined 38 CBs to determine risk factors for local recurrence, complications, and functional outcomes following epiphyseal curettage. Methods: Twenty-two girls and sixteen boys aged 10 to 17 years with histologically confirmed chondroblastoma who arrived at our hospital between January 2000 and June 2021 were reviewed retrospectively. Clinical data, radiographic images, histological results, treatment, functional outcomes, and the local recurrence rate were examined—surgical treatment involved total tumor curettage, followed by bone grafting and adjuvant techniques. Local recurrences have also been reported. Results: The most frequently affected site was the proximal femur. Sites of involvement included the proximal femur in 10 (26.3%) cases, the proximal tibia in 8 (20.8%), the humerus in 5 cases (13.2%), the distal tibia in 4 cases (10.5%), the distal femur in 3 cases (7.9%), the supracetabular region in 3 cases (7.9%), the talus in 1 case (2.6%), the calcaneus in 1 case (2.6%), the scapula in 1 case (2.6%), the lumbar spine in 1 case (2.6%), and the iliac bone in 1 (2.6%) patient. The mean follow-up was 144.2 months (24 to 276). The local recurrence rate was 7.9%. The mean Musculoskeletal Tumor Society (MSTS) score was 28.3 points (17 to 30). The mean duration of symptoms at presentation was 5.8 (range, 1 to 28) months. Conclusion: Aggressive curettage and bone grafting resulted in local control and good outcomes in most pediatric patients. In a relatively small proportion of cases, long-term complications and recurrence can occur due to growth plate damage and late diagnosis. In patients admitted to the pediatric clinic with pain, which is often accompanied by localized edema and joint effusion, early detection via advanced radiological scans (X-ray, CT, or MRI) may prevent delays in diagnosis.
... Growth disorders and growth plate injuries related to tumor destruction and aggressive curettage with local adjuvants such as liquid nitrogen or phenol in patients with open physis are reported in literature [2,[8][9][10]. Moreover, secondary osteoarthritis after extensive epiphyseal curettage has been described [2,11,12]. ...
... This could be related to the difficult surgical access at the femoral head, particularly in young patients with an open growth plate, with epiphyseal CBL very close to the physis and articular cartilage. In our series, proximal femur was one of the most affected sites in accordance with the literature [2,3,7,11,15]. Several treatment options were reported for CBL in this site. ...
... Thus, we believe that growth plate injuries were caused by tumor destruction rather than surgery. Benign lung metastasis exceptionally occur but only a few series reported them, with an incidence ranging between 0.4% and 3.3% [3,5,11,32]. In our series, so as so in others [2,4,7,12], no distant metastasis were detected at last follow-up. ...
Background
Chondroblastoma (CBL) is a rare benign chondroid producing bone tumor that typically occurs in epiphysis or apophysis of growing children and young adults. Intralesional curettage is the treatment of choice, while resection is required in selected cases, even though the use of minimally invasive ablation techniques has been advocated. Authors reviewed a series of 75 CBLs with the aim of assess risk factors for local recurrence, the growth plate related complications after epiphyseal curettage and the risk of arthritis of the adjacent joint after epiphyseal curettage.
Methods
We retrospectively review 69 CBLs treated with intralesional curettage and 6 treated with resection from March 1995 to February 2020. The median age was 18.8 years (7 to 42, median 16). The site was proximal humerus in 18 cases, proximal tibia in 17, distal femur in 16, talus in 6, femur’s head in 4, calcaneus in 3, acromion in 3, trochanteric region in 2, distal tibia in 2, patella in 2, supracetabular region in 1 and distal humerus in 1 patient.
Results
Mean follow-up was 124.2 months (24 to 322, median 116). Among patients treated with curettage, 7.3% of local recurrence was observed and 12 (17.4%) patients developed osteoarthritis of the adjacent joint. Five patients (7.3%) presented limb length discrepancy of the operated limb ranging from 0.5 to 2 cm. Recurrence free survival rate was 94.2% at 5 and 91.6% at 10 years. A mean Musculoskeletal Tumor Society (MSTS) of 29.3 points (20 to 30, median 30) was observed.
Conclusion
More than 90% of CBLs were successfully treated with aggressive curettage but segmental resection is required in selected cases. In a relatively small proportion of cases long term complications can occur due to growth plate damage or osteoarthritis.
Trial Registration
Retrospectively registered.
... Alternatively, after a surgical curettage, a significant disruption in the anatomy at the operative site is expected, resulting in more complexity with surgical revision, most likely when the lesion is close to the articular surfaces or in patients with open physis. 4,14,25,26 Furthermore, the lesions could be difficult to treat surgically, especially when small and epiphyseal locations commonly require an intraarticular approach for appropriate visualization. ...
... 13,17,21 With surgery, the recurrence rates can vary between 10 and 35% reported in several surgical series, and some patients suffer from two to three recurrences. 4,14,17,25 Revision of surgery after recurrence is more difficult than RFA, and annual follow-up for a minimum of 5 years is recommended to monitor the recurrence. 4,25,26 Chondroblastoma could recur within 10 months of treatment; a larger study with a longer follow-up is required to assess the risk of recurrence following RFA. 25 The successful surgical treatment of a tumor could be validated histopathologically by the evidence of tumor-free margins of the removed sample. ...
... 4,14,17,25 Revision of surgery after recurrence is more difficult than RFA, and annual follow-up for a minimum of 5 years is recommended to monitor the recurrence. 4,25,26 Chondroblastoma could recur within 10 months of treatment; a larger study with a longer follow-up is required to assess the risk of recurrence following RFA. 25 The successful surgical treatment of a tumor could be validated histopathologically by the evidence of tumor-free margins of the removed sample. However, with RFA, there is a requirement to use certain imaging techniques to verify the completeness and the adequacy of the therapeutic response and early detection of residual pathology. ...
Radio frequency ablation (RFA) is a minimally invasive technique that has become recognized in clinical practice for treating chondroblastoma, although curettage with bone graft is the standard treatment. Chondroblastoma is a locally aggressive cartilaginous bone tumor, representing nearly 5% of benign bone tumors. Chondroblastoma shows a preference toward the epiphysis or apophysis of long bones, but it was also reported in vertebrae and flat bones. The management of chondroblastoma could be challenging due to the risk to injure the epiphyseal plate or difficult location. The aim of this study was to determine if RFA is a suitable alternative to curettage with bone graft for the treatment of chondroblastoma. Moreover, there will be an evaluation of RFA's effectiveness in terms of symptoms relief; we also define the proper size of the lesion to be treated with RFA, and discuss the complications after the procedure, including the recurrence rate. Furthermore, we review the best imaging method to evaluate the therapeutic response of RFA and for the detection of residual disease early after the ablation. A comprehensive PubMed and Google Scholar search followed the Preferred Reporting Items for Systematic Review and Meta-Analysis 2020 checklist guidelines. Ninety-seven patients were identified after reviewing the available full texts of nine articles. The results of the current review provide further evidence to support the use of RFA as an alternative option to surgery.
... Chondroblastomas are rare, benign, bone tumors that represent approximately 1-2% of all primary bone tumors and 4-9% of all benign bone tumors. Chondroblastomas usually arise at the epiphysis, and the majority of cases occur in the second decade of life [1][2][3]. The most common sites are the proximal humerus and the proximal tibia, followed by the distal femur, and proximal femur [1]. ...
... The surgical choices, therefore, have been recommended as follows: (1) curettage via a tunnel drilled along the femoral neck (CVFN) with potential damage to the epiphyseal Open Access *Correspondence: h.katagiri@scchr.jp Division of Orthopaedic Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka Prefecture 411-8777, Japan growth plate and high local recurrence rate [2][3][4], (2) an open approach with capsulotomy and making a cortical window for curettage at the femoral neck just below the femoral head [4], or (3) a trapdoor procedure, which is a direct approach through the articular surface of the femoral head after hip joint dislocation, which was first described by Iwai et al. in 2008 [5]. ...
... Chondroblastomas are benign but locally aggressive tumors that are usually treated with curettage of the lesion and reconstruction with allograft, autologous bone graft, or bone substitute packing. Local recurrence rates between 8 and 15% have been reported, suggesting that the tumor location can influence local recurrence [1][2][3][4]9]. The clinical utility of adjuvant treatments, such as cryotherapy or phenols, is controversial because of the potential for damage to the joint cartilage, especially within the femoral head. Chondroblastomas usually occur in the epiphysis, but lesions within the femoral head pose a therapeutic challenge because the epiphysis of the femoral head is completely intracapsular, and approaching the femoral head confers an inherent risk for AVN and iatrogenic femoral head deformity, which likely leads to osteoarthritic changes of the hip joint in adolescence. ...
Background
Chondroblastomas are rare, benign, locally aggressive lesions that appear in the epiphysis. Surgery for femoral head chondroblastoma (FHCB) is difficult. Conventional treatment with curettage via a drilled tunnel along the femoral neck can damage the growth plate and is associated with high local recurrence rates. The trapdoor procedure, which directly facilitates lesion access from the femoral head articular surface, can reduce local recurrence and avoid growth plate damage, although it requires surgical dislocation. Little is known about the long-term results of this direct articular surface approach, and there are no case reports on trapdoor procedures without dislocation.
Case presentation
We report two cases (patients aged 12 and 15 years) of FHCB presented with coxalgia treated using the trapdoor procedure without surgical dislocation. Both surgeries were performed with patients in the semi-lateral position. The hip joint was exposed via an anterior approach, and a capsulotomy was performed at the superior rim of the acetabulum, followed by the external rotation of the hip joint. With a fine osteotome, a rectangular flap (trapdoor) was opened on the cartilage surface in the lateral non-weight-bearing area, and curettage of the lesion followed by bone and/or bone substitute grafting was performed. Subsequently, the trapdoor was replaced in its original position. There has been no local recurrence or femoral head aseptic necrosis after more than 6 and 12 years for patients 1 and 2, respectively. Both patients had musculoskeletal tumor society scores of 100% at follow-up and are enjoying a normal active life.
Conclusions
This direct femoral head approach without dislocation may be a simple treatment alternative for FHCB.
... Recurrences also are a major concern. Metastasis of a histological benign chondroblastoma is rare [5,6]. Surgical management is the primary treatment of choice for chondroblastoma and it entails adequate intralesional curettage alone or in combination with adjuvants [7]. ...
... The subchondral articular cortex is thinned to <5 mm in slightly more than half of the cases. The cortex is normal in 41% and completely destroyed in at least one region in up to 5% of cases [5,12]. Penetration through the cortex into the soft tissues is seen only in a small percentage of cases [10]. ...
... Chondroblastoma can be treated by simple curettage, bone grafting, and cementation involving similar surgical techniques as for giant cell cancer. The reconstruction following intralesional curettage can also be filled with autogenous bone graft, allogeneic bone graft, or both [5,9]. Although radiofrequency ablation has been reported as one option for the treatment of chondroblastoma in the literature, the mainstay of treatment remains surgery. ...
Introduction:
Chondroblastoma is a rare benign cartilaginous neoplasm arising in the epiphysis of long bones in young patients. It is an uncommon benign but locally aggressive tumor, mostly located in the secondary centers of ossification. These tumors arise near a joint or growth plate and surgical excision is always challenging.
Case report:
A 13-year-old boy presented with intermittent knee pain, swelling, and limitation of movements for 1 year. On examination, magnetic resonance imaging revealed a hyperintense lesion in distal femoral epiphysis with superior transphyseal extension and inferior thinning of cortex with cartilage breach. Histopathological examination confirmed the diagnosis of chondroblastoma of distal femur. We report a novel technique of approach in a case of distal femoral chondroblastoma in a skeletally immature individual.
Conclusion:
The technique we incorporated had an adequate exposure to reach the lesion for a complete curettage and bone grafting. It also reduced further injury to cartilage and physeal plate.
... Chondroblastoma is a rare, cartilaginous primary bone tumor, which presents predominantly in children and young adults [1]. These tumors represent 1% of all primary bone tumors. ...
... They typically arise in the epiphysis or apophyses of long bones such as the distal femur and proximal tibia and are relatively slow growing. Patients tend to complain of progressive joint pain which usually aids in early diagnosis [1]. Unfortunately, limited health-care resources can prevent patients from accessing treatment in a timely manner. ...
... Tumors are typically described as "locally aggressive" when the lesions have significant extracortical invasion and soft-tissue destruction, often a result of late identification and limited intervention. Locally aggressive chondroblastomas are usually associated with local recurrence, which has an incidence of 10%-35% and typically is due to inadequate resection of the primary lesion [1]. Locally aggressive chondroblastomas are associated with higher rates of recurrence [4,5,6,7,8]. ...
Introduction:
Chondroblastoma is a rare, cartilaginous primary bone tumor, which presents predominantly in children and young adults. These tumors represent 1% of all primary bone tumors. Patients tend to complain of progressive joint pain which usually aids in early diagnosis. However, early diagnosis has made the understanding of the untreated, progressive course of chondroblastoma quite difficult. This case report highlights a patient who was first encountered with locally advanced chondroblastoma and discusses the challenges of diagnosis and treatment with a focus on the natural progression of this disease.
Case report:
We report the case of a 16-year-old male encountered during relief efforts after the 2010 Haiti earthquake, who was found to have a massive, expansile, and destructive mass of the proximal left tibia and fibula. Radiographic appearance was concerning for a malignant bone forming process. However, biopsy revealed features most consistent with chondroblastoma with secondary aneurysmal bone cyst formation. Marginal resection was considered, but the degree of soft tissue and neurovascular invasion made it impossible to salvage the leg and thus an above-the-knee amputation was performed.
Conclusion:
This report reviews the challenging diagnosis of a massive chondroblastoma with locally aggressive features which required ablative surgery. This may provide insight into the untreated, natural course of this pathology.
... The metastases remained confined to the bone and did not involve the lungs, representing a distinct pattern of metastatic spread in chondroblastoma [65]. A study on 495 chondroblastoma patients found that the femur, talus, and calcaneum were the most commonly affected bones [66]. Most patients were under 30 years old, and tumors, primarily located in the medulla, can exhibit recurrence and metastasis even when appearing benign [66]. ...
... A study on 495 chondroblastoma patients found that the femur, talus, and calcaneum were the most commonly affected bones [66]. Most patients were under 30 years old, and tumors, primarily located in the medulla, can exhibit recurrence and metastasis even when appearing benign [66]. Birch et al. [30] documented a case study where a primary chondroblastoma originating from the third rib metastasized to the skull, acetabulum, and scapula 23 years after initial diagnosis. ...
Simple Summary
Chondroblastoma is a rare benign aggressive primary bone tumor, with susceptibility to local recurrence and metastasis, mainly to the lungs. However, various metastatic locations have been described, such as bone, soft tissue, and liver. Metastatic chondroblastoma treatment involves various approaches including surgical resection, radiotherapy, chemotherapy, and palliative treatment. The expression of RANKL in chondroblastoma cells has opened new avenues for treatment with denosumab, which shows effectiveness in controlling both local and metastatic tumors. Hence, there is a greater need to enhance our understanding of this rare tumor’s biology and refine therapeutic approaches to improve patient outcomes, reduce recurrence rates, and better manage metastatic cases.
Abstract
Chondroblastoma metastasis, though rare, represents a clinically significant and notably important aspect of bone tumors. Understanding its epidemiological characteristics, pathological features, and treatment modalities, despite its infrequency, is imperative for comprehensive patient management. This review aims to elucidate the epidemiology, molecular mechanisms, diagnostic challenges, and therapeutic strategies associated with chondroblastoma metastasis. The patterns, prognostic factors, and treatment outcomes were explored through an analysis of case studies and clinical reports. Notably, we highlighted emerging therapeutic perspectives aimed at improving patient outcomes. To the best of our knowledge, there has been no previous review addressing these matters cumulatively, highlighting a significant gap in the existing scholarly literature. By shedding light on the nuances of chondroblastoma metastasis, this review contributes to the advancement of knowledge in this field and informs clinical decision-making for improved patient care.
... Local recurrence rates vary between 10 and 35%. [12] It is recommended that phenol or liquid nitrogen be used as an adjuvant to reduce the possibility of recurrence. [13][14][15][16] In case of recurrence, curettage and grafting are required again. ...
... Local recurrence rates after curettage and grafting have been reported to be between 10 and 35%. [12,27,28] Due to the concerns of surgeons that aggressive curettage can damage the growth plate in the pediatric population, it is thought that recurrence is probably caused by insufficient curettage. [8,29] This refers to that local adjuvants are more critical for the total eradication of the tumor. ...
Objectives:
This study aims to investigate the effect of adjuvant cryotherapy added to well-performed high-speed burr curettage on the long-term surgical outcomes of chondroblastoma cases.
Patients and methods:
Between January 2004 and December 2020, a total of 30 chondroblastoma cases (19 males, 11 females; median age: 18.6 years; range, 9 to 53 years) who were surgically treated were retrospectively analyzed. The pressurized-spray technique was performed using liquid nitrogen. Data including age, sex, radiological appearance, treatment modality, duration of follow-up, skin problems, and recurrence were recorded. All patients received adjuvant liquid nitrogen cryotherapy after extended intralesional curettage with high-speed burr. The bone cavity was filled with an autologous iliac crest bone graft, allograft, or polymethylmethacrylate (PMMA).
Results:
The median follow-up was 54 (range, 19 to 120) months. The lesion was located around the knee in 16 (53.3%), in the shoulder in seven (23.3%), around the hip in five (16.6%), and in the ankle in two (6.6%) cases. The defect was filled with an autologous iliac crest bone graft in 28 (93.3%), an additional allograft in eight (26.7%), and PMMA in two (6.7%) cases. Local recurrence was observed in only two (6.7%) patients during follow-up. Two (6.7%) patients developed physeal growth arrest. Osteoarthritic changes were observed in two (6.7%) patients (one knee and one hip) due to the periarticular location of the tumor. Three (10%) patients had skin complications. None of the cases had a pathological fracture.
Conclusion:
A well-performed extended intralesional curettage with high-speed burr is the first and essential step in treating chondroblastoma. Adding adjuvant liquid nitrogen cryotherapy with high-speed burr can improve treatment outcomes and significantly reduce the recurrence rate of this disease.
... Predictive factors, researched in other studies, include tumour localization (31), the occurrence of another bone tumour simultaneously with a giant cell tumour of bone (32), usage of different surgical adjuvants (bone cement (33,34), phenol (35)), occurrence of pathological fractures (36) and microscopic characteristics of surrounding tissue (37). Other histological diagnoses to be more frequently found in similar studies are chondroblastoma (38)(39)(40)(41), aneurismal bone cyst (42), osteoblastoma (43), and enchondroma (44). Predictive factors of recurrence included biological aggressiveness of a tumour (39), patient gender (40,41), tumour size (42), and the usage of phenol as a surgical adjuvant (43), to name a few. ...
... Other histological diagnoses to be more frequently found in similar studies are chondroblastoma (38)(39)(40)(41), aneurismal bone cyst (42), osteoblastoma (43), and enchondroma (44). Predictive factors of recurrence included biological aggressiveness of a tumour (39), patient gender (40,41), tumour size (42), and the usage of phenol as a surgical adjuvant (43), to name a few. ...
Background: Most aggressive benign bone tumours are treated surgically by an intralesional excision and bone defect filling. The primary aim of our study was to evaluate prognostic factors of recurrence after an intralesional excision of a benign bone tumour in the peripheral skeleton. We asked whether patient age and gender, maximal tumour diameter, histological diagnosis, and the tumour’s location statistically significantly impact postoperative tumour recurrences. The secondary aim was to evaluate preoperative differences between different histopathological groups of benign bone tumours and the impact of age and gender, maximal tumour diameter, histological diagnosis, and the tumour location on the number of diagnostic biopsies and curative surgical procedures.
Methods: Retrospective analysis of prospectively collected data included a cohort of patients operated on at a single tertiary tumour centre between 2010 and 2020 with at least one-year follow-up. Ordinal logistic regression was used to assess the influence of input variables on the number of diagnostic/curative surgical procedures and postoperative recurrences.
Results: The cohort analysis included 261 patients with 61 local recurrences. The risk of tumour recurrence was significantly lower with higher patient age (p = 0.001) and tumour location in the distal femur (p = 0.033). Higher number of diagnostical procedures correlated with higher patient age (p = 0.028), larger maximal tumour diameter (p = 0.035) and connective tissue tumour diagnosis (p = 0.027). Higher number of curative procedures correlated with larger maximal tumour diameter (p = 0.008) and lower patient age (p = 0.001).
Conclusions: Preoperative features of benign bone tumours significant impact the number of surgical procedures needed to treat the tumour and the risk of postoperative recurrence. Although most of these factors are nonmodifiable, they represent an incentive to create evidence-based guidelines for biopsy indications, surgical techniques and consistent postoperative follow-up.
... There are also reports about the use of radiofrequency ablation or radiation with or without combined surgical treatment [8]. Reported local recurrence rates vary between less than 10% and more than 30% [5,6,9,10]. In this study we analyze the efficacy of intralesional curettage with or without the use of bone substitute, autologous bone graft or bone cement for defect reconstruction and the additional use of hydrogen peroxide as adjuvant. ...
... However, patients of this subgroup treated with hydrogen peroxide showed a significantly lower recurrence rate of 11.8% (p < 0,05). Under the treatment of intralesional curettage and subsequent defect-filling with bone substitute and use of hydrogen peroxide as adjuvant our recurrence rates fall within the previously in literature reported range between less than 10% and more than 30% [5,6,9,10]. Thus, this study confirms the positive effect of hydrogen peroxide on the recurrence rate of chondroblastoma after initial curettage. ...
Background
Chondroblastoma is a rare benign cartilaginous bone tumor that represents 1–2% of all primary bone tumors. It is characterized by aggressive growth, possible recurrence after surgical treatment and, in rare cases, metastasis. Surgical management is the primary treatment and includes intralesional curettage with or without adjuvants. Local recurrence rates vary between less than 10% up to more than 30%.
Methods
In this retrospective study between 2009 and 2020 we analysed 38 cases of chondroblastoma with a mean follow-up of 27.9 months who underwent a surgical treatment in our institution. Epidemiological data, radiographic and histological examinations, different surgical techniques, complications and local recurrence were evaluated to comment on the question if curettage with or without adjuvants is a sufficient way of therapy.
Results
The study includes 25 male (65.8%) and 13 female (34.2%) patients with a mean age of 17.2 (11–51) years. The most common location of manifestation was the proximal epiphyseal humerus (34.2%), followed by the proximal tibia (26.3%) and the distal femur (15.8%). Joint involvement occurred in 28 patients (73.7%). In all cases intralesional curettage was performed; in 25 cases (65.8%) the resulting cavity was filled with bone substitute, in 7.9% (3 cases) with bone cement and in 10.5% (4 cases) with autogenous bone graft. Adjuvant hydrogen peroxide was used in 64.9% of the cases. The overall recurrence rate was 39.5% (15 cases). The following subgroup analysis showed a recurrence rate of 100% (4/4 cases) after curettage and defect reconstruction with autogenous bone. In the case of intralesional curettage and filling of the cavity with bone substitute but without use of adjuvant the recurrence rate was 50% (4/8 cases). A low recurrence rate of 11.8% (2 cases) was observed in the case of intralesional curettage, using hydrogen peroxide as adjuvant (17 cases) and bone substitute for defect reconstruction.
Conclusions
Chondroblastoma represents a rare pathology. Therapeutically an aggressive intralesional curettage with use of hydrogen peroxide as adjuvant and filling up the defect with bone substitute leads to low recurrence rates.
... The therapeutic management of chondroblastoma is surgical in the vast majority of cases [6,7,8]. The gold standard in the surgical treatment of this benign lesion is complete and meticulous curettage, often associated with filling with an auto / allograft [8]. ...
... The therapeutic management of chondroblastoma is surgical in the vast majority of cases [6,7,8]. The gold standard in the surgical treatment of this benign lesion is complete and meticulous curettage, often associated with filling with an auto / allograft [8]. ...
Chondroblastoma is a primary bone tumor in children, adolescents and young adults, which accounts for 1% of all bone tumors. Epiphyseal or epiphysometaphyseal localization, this lesion usually develops from secondary ossification centers close to the knee, shoulder and hip. Although chondroblastoma is a nonaggressive benign tumor, it can very rarely show a locally aggressive character or a malignant transformation or even metastases. We describe a histologically proven case of an aggressive, primary chondroblastoma of the tibia invading soft tissue in a 22-year-old girl.
... Codman reported these lesions in the proximal humerus 1931 and classified them as a chondromatous variety of giant cell tumors. 9 Ten years later, to highlight the lesion's chondroblastic origins and set it apart from the traditional giant cell tumor of the bone, Jaffe and Lichtenstein termed the Codman tumor as a benign CB. 10 While the precise cause of CB is still unknown, a wealth of information is available regarding the condition's presentation, appropriate assessment, and management of affected individuals. ...
Chondroblastoma (CB) is a rare primary benign bone tumor, usually affecting men in their 15-20-year age range. The most common location of this tumor is the proximal femur, humerus, and tibia's long bone epiphyses. The fibula is an uncommon site. A secondary aneurysmal bone cyst (ABC) can develop within a CB and can lead to misdiagnosing other benign or malignant bone tumors. Since CB with secondary ABC shares characteristics with several distinct benign and malignant bone tumors, it can be a challenging diagnosis, both pathologically and radiologically. Appropriate diagnosis is essential for optimal management. We present the case of a 15-year-old girl who developed a secondary aneurysmal bone cyst in addition to chondroblastoma. We also briefly review the limited literature on secondary ABC development in CB, including differential diagnosis, clinical and radiographic features, pathological features, management, and prognosis.
... The histology of the lesion is characterized by chondroblasts and osteoclastic-like giant cells, while the pathology of this malignancy is believed to originate in the osteoclast-like giant cells via the RANK/ RANK-L pathway. The current treatment paradigm for chondroblastoma is surgical resection and occasional radiotherapy [33][34][35][36][37][38]. ...
... MRI demonstrates prominent bone marrow and soft tissue associated edema, which is almost always present (Fig 8). 24,25 Most cases are successfully treated by curettage. Recurrence rates range from 5% to 14% and the reported rate of metastases is <1%. ...
Chondrogenic tumors are typically well recognized on radiographs, but differentiation between benign and malignant cartilaginous lesions can be difficult both for the radiologist and for the pathologist. Diagnosis is based on a combination of clinical, radiological and histological findings. While treatment of benign lesions does not require surgery, the only curative treatment for chondrosarcoma is resection. This article (1) emphasizes the update of the WHO classification and its diagnostic and clinical effects; (2) describes the imaging features of the various types of cartilaginous tumors, highlighting findings that can help differentiate benign from malignant lesions; (3) presents differential diagnoses; and (4) provides pathologic correlation. We attempt to offer valuable clues in the approach to this vast entity.
... 76 Surgical treatment is often wide resection or, if necessary for adequate control, amputation 38 Chondroblastoma Occurring most specifically within the epiphysis of long bones, chondroblastoma is a rare benign primary bone tumor with a frequently aggressive nature. 77,78 It is most often diagnosed in the second or third decade of life due to pain and often has associated joint symptoms due to its periarticular location. Radiographically, these are seen as well-circumscribed, lytic lesions in the epiphysis. ...
Development of malignancy is a multifactorial process, and there are multitude of conditions of bone that may predispose patients to malignancy. Etiologies of malignancy include benign osseous conditions, genetic predisposition, and extrinsic conditions. New-onset pain or growth in a previously stable lesion is that should concern for malignant change and should prompt a diagnostic workup for malignancy.
... Thus, careful preoperative planning that leads to appropriate access to the lesions and thus performing an adequate curettage of the entire tumor are very important 26 . Simple curettage has been associated with higher recurrence rates 27 . Some authors recommend a combination of curettage and high-speed burr to reduce the rate of recurrence 5,6,9 . ...
Objective
To review the outcomes of surgical management in the pediatric patients with extremity chondroblastoma. Especially the risk factors of recurrence and growth disorder. And discuss a potential method to decrease the rate of growth disorder by preventing the premature physeal closure.
Methods
Fifteen girls and twenty-seven boys aged from two to 14 years (mean, 11 years) with histologically proven chondroblastoma, who presented from January 2011 to June 2018 at our Hospital, were retrospectively reviewed. Clinical data, radiographic images, histological findings, treatment, functional outcomes, and local recurrence rate were analyzed. Surgical treatment included complete curettage of the tumor and the walls of the lesion followed by bone grafting, No adjuvant methods were used. Recurrence was defined as a return of symptoms and an expansion radiolucency at the operated site. It was confirmed by the histopathological analysis. When recurrence was diagnosed, the medical data were analyzed to detect the effect of different factors on local recurrence. Functional outcome was measured according to Sailhan's functional criteria, designed to provide a standardized method of assessing pediatric chondroblastoma patient postoperatively.
Results
The proximal part of the femur was the most frequently involved site. All the patients had at least 24 months of follow-up; mean duration was 30 months (range, 24–60 months). The local recurrence rate was 9.5%. Three resolved after repeat surgeries without further recurrence, one had a second recurrence and received another more aggressive curettage. Local recurrence of chondroblastoma was associated with age (P < 0.05), while not associated with sex, tumor location, the radiological character of the lesion or the grafting method (P > 0.05). No pulmonary metastasis was noted at latest follow-up. Five patients suffered from premature closure of physis due to physis injury. Thirty-one patients (73.8%) had a good outcome, and all returned to normal unrestricted activities. Six patients (14.3%) had a fair outcome due to occasional pain, asymmetric range of motion, or radiographic joint changes without arthritis. And five patients (11.9%) had a poor outcome because of chronic pain, loss of joint motion impairing normal life activities, or a limb-length discrepancy and limp.
Conclusions
Aggressive curettage and bone grafting resulted in local control and good outcomes in most pediatric patients. Being less than 12 years of age was the risk factor for recurrence. For those growing patients, premature physeal closure was observed after the curettage, interpositional technique with PMMA would be a good choice for prevention.
... A cortical window is created over the tumor, usually reaching the peripheral edge of the tumor so that it is wide enough to visualize the tumor cavity for tumor clearance. Inadequate tumor removal accounts for the high rate of recurrence that was reported to be between 10-35% in Chondroblastoma [3] and 18-53% in giant cell tumor of bones [4,5]. Also, the bigger the cortical window is made, the weaker is the weight-bearing and juxta-articular bone of the knee joint. ...
We describe a novel technique, Navigation and Endoscopic Assisted Tumor (NEAT) surgery in patients with benign bone tumors. The technique combines the advantages of both bone endoscopy and navigation guidance. It enables surgeons to perform intra-lesional tumor curettage in selected benign bone tumors in minimal access with less surgical trauma. The curettage procedure and the tumor cavity not only can be visualized with an endoscope but also can be assessed for tumor clearance with real-time feedback of navigation information on the preoperative CT images. It is particularly useful in benign bone tumors at difficultly accessed locations or tumors with irregular bone cavity and internal septae. The technique may avoid excessive bone removal to minimize the risk of fracture while preserving normal bone for better limb function. An initial learning curve, the facilities required, and a lack of long-term clinical results are some obstacles to its widespread use.
... C hondroblastoma is a benign-aggressive tumor, that similar to GCT, occurs in periarticular epiphyseal locations and harbors osteoclast-like giant cells that cause severe osteolysis mediated by the RANK/RANK-L signaling pathway. Treatment usually involves aggressive intralesional curettage, and local recurrence rates are reported at 10% to 20%, with slightly higher risk in pelvic locations [15][16][17][18][19][20] . Given the significant morbidity associated with wide resection, this is often reserved for multiply recurrent cases. ...
Case:
A 15-year-old boy with chondroblastoma of the right hemipelvis presented with significant periacetabular bone destruction. Neoadjuvant denosumab treatment facilitated initial joint preserving surgery. Unfortunately, he experienced 2 local recurrences and underwent wide surgical resection 2 years after his initial diagnosis.
Conclusion:
Inhibition of the receptor activator of NF-κB (RANK)/RANK ligand (RANK-L) pathway with denosumab has been used neoadjuvantly for the treatment of giant cell tumor of bone, but its role in the treatment of chondroblastoma is less understood. This patient's clinical response and effect on cellular RANK/RANK-L activity support the consideration of denosumab in the treatment algorithm for other osteolytic bone tumors such as chondroblastoma.
... Sie sind meist epiphysär im proximalen Humerus, in der proximalen Tibia sowie im proximalen und distalen Femur lokalisiert [3,7]. Lokale Rezidivraten variieren in der Literatur von 3-30 % [3,6,9]. Ebeid et al. konnten zeigen, dass durch intraläsionale Kürettage und Auffüllen des Defektes mittels Knochenzement oder -graft eine gute lokale Tumorkontrolle erreicht werden kann [3]. ...
Zusammenfassung
Wir präsentieren den Fall einer 22-jährigen Patientin mit einem histopathologisch gesicherten Chondroblastom des rechten Humeruskopfes. Um bei der jungen und funktionell anspruchsvollen Patientin eine möglichst schonende und anatomische Rekonstruktion der humeralen Gelenkfläche zu erzielen, ohne dabei auf einen totalendoprothetischen Gelenkersatz zurückzugreifen, implantierten wir nach intraläsionaler Kürettage des Chondroblastoms eine HemiCAP®. Die sehr guten funktionellen Kurzzeitergebnisse zeigen, dass dieser Therapieansatz eine sehr gute Behandlungsoption darstellen kann.
Benign and malignant bone and soft tissue tumors of the hip, while only accounting for a relatively small proportion of neoplasms overall, are not uncommonly identified during imaging of the hip. It is important for the radiologist to have a sound understanding of these neoplastic lesions and their imaging features, both incidental and suspected, as imaging plays a crucial role in their diagnosis and investigation and guiding appropriate management. Moreover, certain non-neoplastic conditions may mimic tumors which can serve as potential pitfalls, and correct identification of these entities is critical in order to avoid unnecessary investigations which may cause harm and distress to patients. A wide range of bone and soft tissue tumors have been identified and classified according to the most recent World Health Organization (WHO) classification of tumors published in 2020. Due to the wide range of conditions described so far, it is not possible to provide an all-encompassing review of the bone and soft tissue neoplasms that may affect the hip. This chapter delves into the commonly seen tumors and tumor-like lesions affecting the hip, providing an overview of the commonly encountered lesions. Particular attention is given to the imaging characteristics of the various lesions, which can aid in the differential diagnosis. Real-world examples of images have been included to illustrate key points and salient imaging features.
The cartilage tumours can be benign or malignant. Differentiating benign and malignant chondroid tumours by histology alone is difficult. Clinical and radiological correlation is very essential. Other cartilage lesions which mimic tumours are fracture callus, costochondral junction and intervertebral disc. This chapter describes how to diagnose different chondroid lesions/tumours such as enchondroma, osteochondroma,chondroblastoma, chondromyxoid fibroma, chondrosarcoma, subungual exostosis and BPOP.
Aims:
The epiphyseal approach to a chondroblastoma of the intercondylar notch of a child's distal femur does not provide adequate exposure, thereby necessitating the removal of a substantial amount of unaffected bone to expose the lesion. In this study, we compared the functional outcomes, local recurrence, and surgical complications of treating a chondroblastoma of the distal femoral epiphysis by either an intercondylar or an epiphyseal approach.
Methods:
A total of 30 children with a chondroblastoma of the distal femur who had been treated by intraregional curettage and bone grafting were retrospectively reviewed. An intercondylar approach was used in 16 patients (group A) and an epiphyseal approach in 14 (group B). Limb function was assessed using the Musculoskeletal Tumor Society (MSTS) scoring system and Sailhan's functional criteria.
Results:
At final follow-up, the mean MSTS score was 29.1 (SD 0.9) in group A and 26.7 (SD 1.5) in group B (p = 0.006). According to Sailhan's criteria, the knee function was good and fair in 14 (87.5%) and two (12.5%) patients of group A, and eight (57.1%) and six (42.9%) patients of group B, respectively (p = 0.062). The lesion had recurred in one patient (6.2%) in group A and four patients (28.6%) in group B. Limb shortening > 1 cm was recorded in one patient (6.2%) from group A and six patients (42.8%) from group B. Joint degeneration was noted in one patient from group A and three patients from group B.
Conclusion:
An intercondylar approach to a chondroblastoma of the middle two-quarters of the distal femoral epiphysis results in better outcomes than a medial or lateral epiphyseal approach: specifically, better limb function, a lower rate of recurrence, and a lower rate of physeal damage and joint degeneration.
Objective:
Chondroblastoma (CB) is a benign cartilaginous bone neoplasm which commonly occurs in long bones of adolescents. CB can uncommonly involve foot. Its mimics include both benign and malignant lesions. H3K36M immunohistochemical (IHC) stain is a helpful tool for establishing the diagnosis of CB in such challenging situations. In addition, H3G34W IHC stain helps to rule out giant cell tumor which is the closest differential of CB. Our objective was to describe the clinicopathological features and frequencies of H3K36M, H3G34W and SATB2 IHC stains in CB of foot.
Materials and methods:
We reviewed H&E slides and blocks of 29 cases diagnosed as "chondroblastoma" of foot at our institutions.
Results:
Patient's age ranged from 6 to 69 (mean: 23.3 and median: 23) years. Males were almost 5 times more commonly affected than females. Talus and calcaneum were involved in 13 (44.8 %) cases each. Microscopically, tumors were composed of polygonal mononuclear cells and multinucleated giant cells and chondroid matrix. Other histological features included aneurysmal bone cyst-like (ABC-like) change (44.8 %), osteoid matrix (31 %), chicken-wire calcification (20.7 %), and necrosis (10.3 %). H3K36M was expressed in 100 % and SATB2 in 91.7 % cases. H3G34W was negative in all cases, where performed. One out of 11 patients with follow up information developed local recurrence after 48 months.
Conclusion:
CB in foot occur at an elder age and show more frequent ABC-like changes as compared to long bones. Males are affected ~5:1 as compared to 2:1 in long bones. H3K36M are H3G34W are extremely useful diagnostic markers for CB, especially elderly (aged or higher) patients and we report the largest series of foot CB cases confirmed by immunohistochemistry.
Talar chondroblastoma, which is a benign tumor of immature cartilage cells, is an uncommon but easily missed diagnosis of foot pain. Arthroscopic treatment for this condition is a safe, powerful, and promising technique with definitive advantages of visualization and minimal invasion. Here, we report a case of a talar chondroblastoma treated by posterior ankle arthroscopic curettage, allograft bone graft, and platelet-rich plasma-fibrin glue (PRP-FG) application.
Level of evidence
Case Report. Level IV.
Silverberg's Principles and Practice of Surgical Pathology and Cytopathology is one of the most durable reference texts in pathology. Thoroughly revised and updated, this state-of-the-art new edition encompasses the entire fields of surgical pathology and cytopathology in a single source. Its practice-oriented format uniquely integrates these disciplines to present all the relevant features of a particular lesion, side by side. Over 4000 color images depict clinical features, morphological attributes, histochemical and immunohistochemical findings, and molecular characteristics of all lesions included. This edition features new highly experienced and academically accomplished editors, while chapters are written by the leading experts in the field (several new to this edition, bringing a fresh approach). Dr Steven Silverberg's practical approach to problem solving has been carefully preserved. The print book is packaged with access to a secure, electronic copy of the book, providing quick and easy access to its wealth of text and images.
Musculoskeletal neoplasms in the foot and ankle are overall infrequent clinical conditions. This being said, lesions in this area tend to cause symptoms early during their presentation, thus causing patients to seek medical attention. As in other locations of the body, most bone and soft tissue tumors within the foot and ankle will be benign; however, even in non-malignant disease, local management of active or aggressive lesions can be challenging given the segment’s complexity and the size and proximity of different structures. Similarly, malignant tumors (sarcomas or metastatic disease) can cause rapid bone and soft tissue destruction, making reconstruction alternatives scarce. In order to achieve adequate outcomes, it is crucial for every specialist involved in these patients’ care to be familiar with the general principles of the diagnosis and management of musculoskeletal tumors within the foot and ankle. This chapter gives emphasis on the most common histologies and their management, with particular attention to clinical presentation, evaluation, early referral, and initial treatment.
Introduction: Chondroblastoma has a wide range of differential diagnosis encompassing various benign and malignant entities. The closest differential diagnosis is giant cell tumor of the bone due to overlapping radiological and histomorphological features. Extensive aneurysmal bone cyst like changes and lack of adequately sampled chondroid matrix often masquerades the primary bone lesion and amplifies the diagnostic difficulty in small biopsies with limited tissue. Immunohistochemistry is helpful in such instances to resolve the diagnostic dilemma. Objectives: To analyze the immunohistochemical expression of anti-histone H3F3K36M antibody inchondroblastoma and validate its utility in differentiating chondroblastomafrom its histological mimics. Material and methods: Immunohistochemistry was performed using anti-histone antibody H3.3K36M in 44 histologically diagnosed chondroblastoma and 92 other histological mimickers. All chondroblastoma and giant cell tumor of the bone included in the study were also tested for anti-histone H3.3 G34W antibody. Of the 33 giant cell tumors of bone with classic morphology and imaging findings, 24 H3.3 G34W positive and 9 negative tumors were included intentionally to rule out the possibility of chondroblastoma. The sensitivity, specificity, positive and negative predictive value of marker with regard to chondroblastoma was calculated. Results: Immunohistochemistry revealed unequivocal nuclear positivity for H3.3K36M in the mononuclear cells in all the 44 Chondroblastoma tested, denoting a sensitivity of 100% cases. Allthesetumors tested simultaneously for anti-histone H3.3G34W were negative. None of the histological mimickers were positive H3.3K36M indicating a specificity of 100%. The positive and negative predictive value was 100%. Conclusion: H3.3K36M mutant antibody is highly sensitive and specific IHC marker and can be used as a valuable adjunct to distinguish chondroblastomafrom its histological mimics especially on small biopsies.
Introduction: The purpose of this study was to evaluate the outcomes of surgical management of chondroblastoma in appendicular skeleton treated with curettage and reconstruction. Materials and Methods: This retrospective study included 40 patients of chondroblastoma treated with intralesional curettage and filling of defect with bone graft or bone graft substitute or bone cement. The patients were prospectively followed to consolidation of bone graft or bone graft substitute. The mean age of presentation was 14 years (13–32 years). There were 24 were male and 16 were female patients. The mean follow-up was 11 years (4–17 years). Results: The location of chondroblastoma was proximal tibia in 12 patients, distal femur in 14 patients, proximal femur in 8 patients, and proximal humerus in six patients. The physis was found open (8), closing (12), and closed (20) patients. The tumour was of Enneking grade of tumour was 1 in 22, II in 14 and III in 4 patients. The mean union time in bone graft group and bone graft substitute group 3 months and 4 months, respectively. There was local recurrence in six patients (3 in bone graft group and 2 in bone graft substitute group, 1 in bone cement group). The other complications were surgical site infection (two cases). The mean Musculoskeletal Tumor Society score in both groups was 27. Conclusion: Intralesional curettage provides excellent functional outcomes with preservation of adjacent joint mobility. The methods of reconstruction with bone graft, bone graft substitute, and bone cement provide optimal results, and the outcomes were comparable in all these groups.
Primary bone sarcomas and aggressive benign bone tumors are relatively rare. It is essential to recognize features that are concerning for these aggressive tumors based on a patient's history, physical exam, and radiographs. Physicians and other health care providers should have a high suspicion for these tumors and promptly refer these patients to orthopaedic oncologists. A multidisciplinary, team-based approach is required to obtain an accurate diagnosis and provide comprehensive care. This review discussed the appropriate work-up, biopsy principles, relevant peri-operative medical management, and surgical treatment options for patients with aggressive primary bone tumors around the knee. Primary bone sarcomas (osteosarcoma and chondrosarcoma) and aggressive benign bone tumors (giant cell tumor, chondroblastoma, and chondromyxoid fibroma) that have a predilection to the distal femur and proximal tibia are the focus of this review.
PurposeFemoral head chondroblastoma poses a surgical challenge. Anatomical limitations may lead to increased risk of local recurrence, damage to the articular cartilage, growth disturbances, and/or avascular necrosis (AVN). We are presenting our results with surgical hip dislocation approach with the aim to evaluate its efficacy in preventing recurrence and its safety, preserving a functional hip joint and avoiding complications.Patients and methodsTen patients were managed using surgical hip dislocation with direct access to femoral head lesions, extended curettage through a modified trapdoor approach, and cement reconstruction. These were six males and four females, with a mean age of 17 ± 2.7 years (range: 14–20) and a mean follow-up of 34 ± 12 months (range: 17–57). The lesion extended into the neck in 60% of patients with the physis being either closed in seven or closing in three patients.ResultsWe had a single case (10%) of recurrence at the trochanters for which re-curettage was done. However, all patients had their hips preserved with good function at the latest follow-up, and no serious complications recorded. The Musculoskeletal Tumor Society score improved significantly from a pre-operative median of 23.5 (range: 16–28) to a post-operative median of 29 (range: 26–30) (P = 0.005).Conclusion
This report describes a safe reproducible approach to effectively manage these locally aggressive lesions with good short-term results. This is done while maintaining the integrity of the articular surface, growth plate, as well as preserving the femoral head blood supply.
Chondroblastoma is an uncommon osseous neoplasm that accounts for less than 1% of all bone tumors. Characteristically it arises in the epiphysis or apophysis of long bones in young patients and may extend into the metaphysis. A sixteen-year-old male presents with a 1-year history of left knee pain associated with joint stiffness and interfering with performing daily activities. Radiographic and contrast enhanced magnetic resonance imaging favored the diagnosis of chondroblastoma. This was then confirmed histologically. The clinical signs and symptoms of Chondroblastoma are usually nonspecific, pain is most often moderate and can be revealed as a result of a trauma. The definitive diagnosis is mainly pathological due to the lack of specificity of radiological findings consistent with the presented case.
Purpose:
To present our experience on the implementation of radiofrequency thermal ablation (RFA) for the treatment of chondroblastoma.
Materials and methods:
This case series includes 12 patients (10 males) with chondroblastoma using RFA under CT guidance. Tumours were located in the humeral head (3), femoral head (2), distal femoral epiphysis (4), tibial epiphysis (2) and calcaneus (1). Tumour size ranged from 12 to 60 mm (median: 33 mm). According to tumour size and location, monopolar electrode's active tip ranged from 1 to 3 cm. Dry and perfused ablation mode was used to treat smaller (6) and larger (6) lesions, respectively. Cementation was also made in 5 cases. Technical success was considered if the tumour was treated according to the protocol and complete ablation was achieved. Clinical success was assessed according to a visual analogue scale.
Results:
Technical success was achieved in 11 of 13 cases (83%) afters the first treatment. After a second treatment in the 2 failed cases, pain control was achieved in all cases eventually (100% of clinical success). Follow-up MRI demonstrated resolution of oedema in all cases, as well as a necrotic area extending beyond the outer edge of the lesion in all cases except one. Radiography or CT showed stability of the lesions, with increased sclerosis and no cortex collapse. In one case, a 4 cm shortening of the humerus was observed at the end of skeletal development (7 years after treatment). In another case, early hip osteoarthritis was developed (15 years after treatment). No other long-term complications were observed.
Conclusion:
Successful treatment of chondroblastoma can be achieved by RFA. Cementoplasty adds strength to the ablated bone in weight bearing areas. MRI hallmarks associated with clinical success were resolution of bone marrow edema, and area of necrosis extending beyond the tumour edge. Radiography and CT proved to be useful in demonstrating cortex integrity.
Background
Diagnosis of osteosarcoma in the proximal femur is challenging because of its atypical features. Hence, further characterization of the tumors of this location is necessary. In this study, we evaluated the characteristic features and outcomes of osteosarcoma in the proximal femur.
Methods
Fifteen patients with proximal femoral osteosarcoma proximal to the intertrochanteric region were evaluated. The demographic, clinical, and radiologic characteristics of the patients were investigated. A modified Lodwick-Madewell system was used for the classification of the osteolysis pattern.
Results
From a total of the 446 patients who had osteosarcoma, 24(5.4%) were identified in the proximal femur. The main clinical symptom was pain without mass. The osteolysis pattern was ill-defined in 10, “moth-eaten” in three, change of margin in one, and well-defined without sclerotic rim in one patient. Bone matrix mineralization was present in nine patients, which was in osteoid form in seven patients and in calcified form in two patients. Cortical destruction was seen in six patients. Peripheral edema and joint effusion were identified in nine and seven, respectively, out of 12 patients who had an MRI. Soft-tissue component and periosteal reaction were not seen in any patient. At a mean follow-up of 7.3 yr, four patients were deceased.
Conclusions
Osteosarcoma of the proximal femur generally presents without classical features. Most notably, the tumor almost never has an extraosseous tumor mass. Therefore, the absence of an extraosseous component does not preclude the diagnosis of osteosarcoma in the femoral neck.
Level of Evidence
Level IV.
Objective: To determine the clinico-pathological and histological features of Chondroblastoma (CB). Place of study : Department of Pathology associated with Orthopaedics Department, Darbhanga Medical College and Hospital, Laheriasarai, Bihar. Methodology: The histological slides of all reported cases of CB were retrieved and reviewed for morphological features. Clinical features were noted from surgical pathology reports. Frequency of features was noted. Results: Sixty one cases of CB were identified. Pain was the most common presenting symptom. The age ranged from 10 to 38 years (mean 20 ± 1.98 years; M: F 2.5:1) with 61% patients in the second decade of life. Forty six cases occurred in long tubular bones; distal femur being most common site. Metaphysis, clavicle, temporal bone and metacarpal were also involved. Histologically, all CBs were composed of round to polygonal cells and scattered osteoclast-type multinucleated giant cells and majority had hemosiderin pigment. Chicken-wire calcifications and coarse calcifications were seen in 85% and 26% of cases respectively. A spindle cell component was seen in 54% of cases. ABC-like areas were seen in 10 cases. Mitosis ranged from 1 to 6/10 HPFs. Recurrence was seen in 2 cases. Recurrent tumor showed similar morphology when compared with the initial tumor. Conclusion: CB is a benign tumor but has potential for recurrence. Males are more affected, second decade is more common and distal femur is most common site. Metaphysis, clavicle, temporal bone and metacarpal were the rare sites of CB. Histological features predictive of recurrence were not separately identified.
Case:
This report describes a case of pediatric femoral head chondroblastoma, which was initially treated by minimally invasive curettage. At the 18-month follow-up, a subsequent osteochondral defect occurred, which was treated with a partial articular resurfacing system. At 5.5 years follow-up, he was symptom-free with minor degenerative x-ray changes.
Conclusion:
We describe a technique of focal anatomic hip resurfacing using the HemiCAP system in a pediatric chondroblastoma patient who presented with an osteochondral defect after primary curettage. This approach yielded good short-term to midterm results and is a potential alternative to total hip arthroplasty in young patients.
Background:
Pediatric Orthopaedic Oncology is a developing subspecialty within the field of Pediatric Orthopaedics. Traditionally, the field of Orthopaedic Oncology has been focused on the skeletally mature individual, and the research tends to be all encompassing rather than truly evaluating isolated populations. The purpose of this review is to summarize the most clinically relevant literature in the field of Pediatric Orthopaedic Oncology over the last 6 years.
Methods:
We evaluated the PubMed database utilizing keywords for pediatric orthopaedic oncology: sarcoma, osteosarcoma, Ewing sarcoma, bone cyst. In additionally, we further broadened our search by searching for relevant articles in the contents sections of major orthopaedic surgery journals that routinely publish both pediatric and orthopaedic oncology literature. In keeping with "What's New," we selected the most clinically relevant articles published in the last 6 years from January 1, 2014 through February 2020. Basic science and systemic therapies literature was widely reviewed and the research and clinical trials most relevant to pediatric sarcoma and neoplastic processes found in the pediatric population were included.
Results:
Our search yielded 60 articles that met general criteria, from which 14 were determined to be most relevant to the goals of this paper. Of the papers presented in this review, there were papers related to management of benign tumors/tumor-like conditions, bone cysts, limb salvage procedures, and amputation procedures. Ultimately included in the review were 5 studies related to limb salvage, 4 related to bone cysts, 1 related to multiple hereditary exostoses, 2 related to osteofibrous dysplasia, 1 related to chondroblastoma, and 1 discussing cementation in skeletally immature patients. They were level III, IV, and V studies. Basic science and systemic therapies literature was widely reviewed and the research and clinical trials most relevant to pediatric sarcoma and neoplastic processes found in the pediatric population were included. Our search of the basic science and systemic therapies literature yielded 19 sources were found to be pertinent to our aims and 18 of those sources were published between 2015 and 2020.
Conclusions:
There are many, varied, and creative procedures in the realm of limb salvage, though there remains a lack of high-level evidence to support some of the more novel procedures. In regards to benign bone tumors, despite a more solid base of literature, there still does not seem to be consensus as to the best treatment. In particular, there continue to be many schools of thought on the treatment of benign bone cysts. Research in the basic science arena and systemic therapies are advancing in exciting ways in regards to pediatric sarcoma. Orthopaedic oncologic research specific to the pediatric population overall continues to be impeded by low sample sizes and inadequate levels of evidence, which limits the ability of surgeons to draw definitive conclusions from the literature.
Several interventional treatments have recently been integrated into the therapeutic armamentarium available for the treatment of bone tumors. In some scenarios (e.g., osteoid osteoma), interventional treatments represent the sole and definitive applied treatment. Due to the absence of widely shared protocols and the complex multivariate scenarios underlying the clinical presentation of the remaining bone tumors including metastases, therapeutic strategies derived from a multidisciplinary tumor board are essential to provide effective treatments tailored to each patient. In the present review, we present the multidisciplinary therapeutic strategies commonly adopted for the most frequent bone tumors.
Case:
Two patients presenting to the clinic with midfoot pain were found to have pathologic fractures through chondroblastomas of the navicular bone. Patient 1 was a 15-year-old boy who experienced multiple recurrences despite more aggressive interventions. Patient 2 was a 13-year-old boy who experienced full recovery after lesion resection.
Conclusion:
Navicular chondroblastoma is a rare site of presentation, with only 3 documented cases. Given the potential aggressive nature of these lesions with significant cortical destruction and soft-tissue extension, the navicular represents a difficult anatomic location to manage.
Chondroblastoma is a rare benign chondrogenic tumor that occurs in skeletally immature patients between ages 10 and 20 years old. In literature are reported few cases of lung metastases, mainly occurred after surgery or local recurrences. There is no evidence on the pathogenesis of lung metastasis, as well as pulmonary disease course. Few treatments for metastases with aggressive behavior were based on chemotherapy regimen employed in other sarcoma with no results or not satisfying ones. Denosumab is approved for treatment of giant cell tumors and it is under investigation for other giant cell-rich bone tumors. Here, we report a case of a 16-year-old male chondroblastoma of the left humerus with bilateral lung metastases at presentation and progressing during follow-up, treated with denosumab for almost 2 years. We confirm that denosumab treatment can be effective in controlling chondroblastoma metastasis and it has been a safe procedure in an adolescent patient.
Purpose:
Chondroblastoma is a benign, but potentially locally aggressive, bone tumor with predilection for the epiphysis of long bones in growing children. Historically, there is a reported 2% risk of lung metastasis, however these cases are mostly in the form of isolated single reports and the vast majority in adults. The purpose of this study was to identify the "true" risk of lung metastases at presentation in skeletally immature patients with a benign chondroblastoma, and therefore revisit the need for routine chest staging.
Methods:
This was a multi-institution, international retrospective study of children and adolescents diagnosed and treated for a benign chondroblastoma. We focused on the screening and diagnosis of lung metastasis, type of staging utilized and the incidence of local recurrence. Detailed review of the available literature was also performed for comparison.
Results:
The final studied cohort included 130 children with an average age of 14.5 years (range: 6 to 18 y). There were 94 boys and 36 girls. Lesions more often involved the proximal humerus (32/130), proximal tibia (30/130), and proximal femur (28/130). At an average follow-up of 50 months, there were 15 local recurrences (11% rate) and no cases of lung metastasis. All patients underwent chest imaging at presentation. The overall reported lung metastases rate in the pulled literature review (larger series only) was 0.4% (7/1625), all patients were skeletally mature.
Conclusions:
This is the largest cohort of pediatric-exclusive chondroblastoma in the literature. Despite minor differences in management between the centers included, the recurrence rate was similar and there was no evidence of lung metastasis (0 in 130). The incidence of distant involvement in a true benign chondroblastoma in children is much lower than the 2% previously reported in the literature, and the need for routine chest staging should be revisited.
Level of evidence:
Level III.
Chondroblastoma is a benign bone tumor arising most often in the epiphyses of long bones. Nearly 90% occurred in patients between the ages of 5 and 25 years, but tumors were found in later adulthood and even in old age. A few chondroblastomas were predominantly cystic, and some contained zones that were indistinguishable microscopically from aneurysmal bone cysts. Conservative surgical removal, nearly always effective, should be thorough so as to minimize the risk of the occasional troublesome recurrence. Late sarcomatous change has been reported in a few cases whether radiation therapy was employed or not. Atypical sarcomas, especially chondrosarcomas, mimic chondroblastoma in rare instances, but there is no convincing evidence for a primarily malignant chondroblastoma. The one metastasizing benign chondroblastoma that was documented is a pathologic rarity. The tumor may respond favorably to radiation therapy, which should be employed only for surgically inaccessible tumors, and it may be curative.
A case of chondroblastoma associated with an aneurysmal bone cyst has been described. The radiographic appearance of the lesion understandably reflects the combined features of both tumors. Up to one-half of all cases of aneurysmal bone cysts are found in association with other tumors, benign or malignant, and up to 15% of chondroblastomas are combined with an aneurysmal bone cyst (4).
Chondroblastoma, a rare bone tumor usually found in the epiphyseal region of long bones, appeared in the rib of a 49-year-old man. Review of the literature reveals that the most common locations for this tumor are the knee and proximal humerus. The most common age group is the second decade. Eighteen cases of chondroblastoma of the rib have been reported in the literature; the patients were older than typical patients with epiphyseal chondroblastoma and had an excellent prognosis after resection of the tumor.
(C) Lippincott-Raven Publishers.
A boy with metastatic and fatal chondroblastoma is presented. Unlike previously published examples of metastatic chondroblastoma, these metastases developed before any operative manipulation of the primary tumor. The histologic characteristics of the primary, metastatic, and locally recurrent tumors were those of a conventional chondroblastoma. A review of published cases of atypical, aggressive, and malignant chondroblastoma is presented with current follow-up information. Although some metastatic chondroblastomas may result from operative manipulation of the primary tumor and are clinically benign, other histologically benign chondroblastomas exist that are capable of pursuing a malignant course. The authors designate these as malignant chondroblastomas. No histologic criteria exist for the separation of these tumors.
We reviewed the cases of seventy patients with chondroblastoma who were treated at the Istituto Ortopedico Rizzoli between 1949 and 1983 and found that the proximal end of the humerus was the most common location (eighteen), with the proximal end of the femur (fifteen), distal end of the femur (fifteen), and proximal end of the tibia (twelve) being the other frequently involved sites. Sixty-three of the patients were between eleven and thirty years old. Fifty-eight patients sought medical attention because of an aching pain, usually referred to the adjacent joint. Fifty patients were followed for two years or longer after treatment. Seven patients had a local recurrence: four were successfully treated with a repeat curettage and one, by two subsequent marginal excisions; one was advised to have a repeat curettage; and the seventh was advised to have a resection and arthrodesis of the knee. The final functional results were considered to be excellent in forty-seven of the fifty patients who were followed for two years or more.
The 4 major series of chondroblastomas reported include 258 cases, of which only 5 were in the metaphysis of long bones. Two other metaphyseal lesions were recorded in a smaller group of chondroblastomas reported. No clinical details were given in 2 cases, but the other 5 cases, with the addition of the one reported here (girl of 13), provide some information to compare with epiphyseal chondroblastomas. The bones most often involved by epiphyseal chondroblastomas are the femur, tibia, and humerus. Therefore, except for the humerus, the distribution of metaphyseal tumors roughly parallels the most common locations of epiphyseal chondroblastomas. The age distribution is also comparable, but the number of cases is too few for a meaningful statement on this point. The long duration of symptoms from metaphyseal chondroblastomas is similar to that for epiphyseal chondroblastomas. Recurrence, after primary curettage, occasionally sufficiently massive to require ablation of an extremity, has been reported in a few epiphyseal chondroblastomas. The one aggressive metaphyseal lesion does not as yet warrant viewing metaphyseal lesions as being more frequently aggressive, since the majority were controlled by the initial curettage.
Benign chondroblastoma of bone is a rare benign tumor occurring almost invariably in the epiphyses of long bones, adjacent to the epiphyseal cartilage plate and sometimes extending into the adjacent metaphysis. The vast majority of these lesions occur in the second decade of life with a 2:1 male to female ratio. The lesion is characterized by a low recurrence rate of up to 24%, but when associated with aneurysmal bone cyst results in a significantly higher recurrence rate. Malignant metastasizing chondroblastomas, in the absence of previous irradiation therapy, are exceedingly rare. The most successful treatment is curettage with bone graft or curettage with cryosurgery.
Benign chondroblastoma often prsents with a typical roentgenographic appearance. When the radiologist encounters this lesion in the tubular bones, he will be able to suggest the correct diagnosis in most cases. Unfortunately, when the lesion arises in flat bones (as with many bone tumors), the diagnosis is considerably more difficult. Even in this situation, the radiologist occasionally may be able to suggest the diagnosis of chondroblastoma. The present study revealed the following: This benign cartilaginous tumor has an excellent prognosis and should be treated with conservative surgical measures. 60% of the lesions occur in patients who are in the second decade, and another 20% occur in those in the third decade. Approx. two thirds of the lesions occur in males. About three fourths of the lesions occur in the hip, knee, and shoulder regions. Nearly all lesions are located within the epiphysis or have a significant epiphyseal component. More than 90% are oval lesions with well defined margins. 60% of the lesions have a thin rim of surrounding sclerosis. Approx. three fourths of the cortical expansion that is frequently extensive. The metaphyseal portion of the tumor may not show the characteristic sclerotic rim and sharp margin seen in the epiphysis. Features that definitely occur but are relatively uncommon include pathologic fracture, trabeculation, cortical absence, and slcerosis beyond the confines of the tumor.
1. A case of chondroblastoma occurring in the upper tibial epiphysis of the right leg of a girl aged fourteen is reported.
2. Because the tumour recurred the leg was amputated.
3. Pulmonary metastases appeared two years after amputation.
1. A clinical, radiological and pathological study of sixty-nine cases of epiphysial chondroblastoma has been made.
2. The nature of the tumour is discussed and its clinical and radiographic features are described. A special type is described, for which the name "cystic chondroblastoma" is suggested.
3. The results of treatment are described and the generally benign behaviourof the lesion is noted.
4. The occurrence of malignant change is noted and discussed.
A chondroblastoma of the proximal humerus in a 15-year-old boy was removed en bloc due to its very large size and locally destructive, aggressive character. This case is reported because of the rarity of chondroblastomas excised en bloc; specimens were examined in detail by correlated roentgenographic, gross inspection, histologic and electron-microscopic methods.
Chondroblastoma is a rare, benign primary bone tumor usually involving secondary centers of enchondral ossification. The consistent epiphyseal location in the great majority of chondroblastomas signifies that the tumor may arise from an aberrant germ cell of the physeal plate. This case report describes a chondroblastoma located in a atypical nonphyseal location, namely in the right fourth metatarsal base. Cases such as these imply that the cell of origin may not exclusively be derived form the physeal plate. The clinical-radiographic significance is that historically chondroblastoma is considered an epiphyseal lesion, but rare cases such as the one reported here and those of the skull demonstrate that this is not always a characteristic of these tumors. The implication from a histogenetic standpoint is that chondroblastoma may, on rare occasions, occur in an area of an enchondrally formed bone other than adjacent to the physeal plate. We are presently investigating the histogenetic relationship of the chondroblastoma (CB) of bone to CB of soft tissue, giant-cell tumor of tendon sheath (GCT-TS), pigmented villonodular synovitis (PVNS) and chondroma of tendon sheath (chondroma of soft parts). We now have collected about 15 cases of GCT-TS and PVNS with extensive areas of chondroid and/or cartilage differentiation that cannot be distinguished from CB of bone by histologic or electron microscopic features alone. From these interesting observations we are developing the histogenetic concept that all of these lesions are interrelated to multipotential mesenchymal and/or synovial cells of the tendon sheath.(ABSTRACT TRUNCATED AT 250 WORDS)
To define the characteristics of chondroblastoma at magnetic resonance (MR) imaging and the combination of findings that are diagnostic for chondroblastoma.
From January 1987 through December 1992, 22 patients with histologically confirmed chondroblastoma and prior MR imaging examinations were seen. Patients included 16 men and six women, aged 10-58 years (median, 17 years). Retrospective analysis of findings at MR imaging, plain radiography, computed tomography, and bone scanning was performed.
Low to intermediate heterogeneous signal intensity, lobular internal architecture, and fine lobular margins were well defined with high-resolution T2-weighted (repetition time > or = 1,500 msec, echo time > or = 70 msec) MR imaging. Adjacent bone-marrow and soft-tissue edema and periosteal reactions were more dramatically demonstrated on MR images than on radiographs. Bone marrow edema was prominent in all but five cases. Obvious periosteal reaction and adjacent soft-tissue edema were visible in 17 cases.
Knowledge of the MR imaging findings of chondroblastoma will allow accurate diagnosis and help avoid confusion with infection and aggressive neoplasms.
A case of malignant chondroblastoma with metastases is reported. The patient initially presented with a lytic lesion in his left pubic ramus. He was treated with curettage, but the lesion recurred 3 years later. After repeated curettage, radiation therapy, and the late development of multiple bone and soft-tissue metastases, he succumbed to his disease 13 years after diagnosis. The surgical pathology from each of his several procedures was reviewed. Although no definite malignant transformation was apparent, a metastatic deposit curetted 3 months prior to death showed some increase in mitotic activity. Flow cytometry of specimens from the patient's first local recurrence and a late distant metastasis was performed and revealed the interval development of a minor aneuploid peak between the two samples. This fatal chondroblastoma is the only one in our series of 80 patients treated over the past 25 years.
A total of 322 cases of chondroblastoma were referred to the Armed Forces Institute of Pathology between 1960 and 1990. Ten additional cases of chondroblastoma were treated at Walter Reed Army Medical Center between 1985 and 1993. Forty-two of these involved the foot, two of which were treated at Walter Reed Army Medical Center. Patients with chondroblastoma of the foot were male in 35 (81%) cases, with a mean age of 25.5 years, which was significantly different from the mean age of 17.3 years in patients with chondroblastoma of the long bones (P < 0.0001). Chondroblastoma of the foot is most commonly found in the posterior subchondral areas of the talus and calcaneus as well as in the calcaneal apophysis. Radiographically, the lesion was associated with an articular surface or apophyseal area in all cases and appeared radiolucent, with little to no matrix production. The margins were generally well defined. Cystic features were noted grossly and histologically in 24 (57%) specimens, a feature seen in only 21% of all chondroblastomas overall. Treatment consists of thorough curetting and bone grafting with good oncologic and functional results.
- Kyriakos