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Periosteal chondromas

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Topic updated on 03/03/14 3:49pm
  
Introduction
  • A rare type of chondroma (benign chondrogenic lesion) which occur on surface of long bones  
  • Epidemiology
    • demographics
      • occur in 10-20 year-olds
    • locationsurface of long bones (under periosteum) in distal femur, proximal humerus, and proximal femur
      • 59% of lesions in proximal humerus
      • other locations in the hand (metacarpal or phalanges)
Presentation
  • Symptoms
    • many are painful secondary to irritation of tendons
Imaging
  • Radiographs
    • well-demarcated, shallow cortical defect
    • punctate mineralization (calcification) in 1/3.
    • saucerization of underlying bone 
    • radiographs important to differentiate from chondrosarcoma (histology may be similar)
Studies
  • Histology
    • similar to enchondroma except for increased cellularity and more malignant looking cells (can look like chondrosarcoma)
      • bland hyaline cartilage 
      • small chondroid cells in lacunar spaces 
Treatment
  • Operative
    • marginal excision including underlying cortex
      • indications
        • severe symptoms interferring with function
      • technique
      • lesion will recur if cartilage is left behind
      • bone graft any large defects
Differentials & Groups
 
Surface Lesion
 
May have similar chondrogenic histology
 
Treated with marginl excison (2)
   
Periosteal chondroma
 
 
   
Osteochondroma / MHE
           
Parosteal osteosarcoma
           
Periosteal osteosarcoma
           
Enchondroma / Olliers / Marfuccis    
       
Osteochondroma (MHE)    
       
Chondrosarcoma    
       
Neurilemoma (soft tissue)        
   
Nodular fasciitis (soft tissue)        
   
Epidermal inclusion cyst        
   
Glomus tumor        
   
 ASSUMPTIONS: (2) assuming no impending fracture
 
IBank
  Location
Xray
Xray
CT
Bone scan
MRI
MRI
Case A prox. humerus          
Case B prox. humerus      
Case C prox. humerus          
Case D wrist        
Case E prox. tibia        

 

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(OBQ08.173) A 19-year-old male presents with 2 months of night pain in the right shoulder. A radiograph is shown in Figure A and axial CT scan images are found in Figure B and C. A needle biopsy is performed and the representative histology slide is shown in Figure D. What is the most appropriate treatment for this tumor? Topic Review Topic
FIGURES: A   B   C   D    

1. Observation with serial radiographs
2. Irradiation treatment course with maximum dosage of 60 grays
3. Marginal excision including the underlying cortex
4. Wide surgical excision
5. Neoadjuvant chemotherapy, surgical excision, followed by adjuvant chemotherapy

PREFERRED RESPONSE ▶




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