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http://upload.orthobullets.com/topic/8019/images/Case F - prox tibia - xray - Parsons_moved.png
http://upload.orthobullets.com/topic/8019/images/Case F - prox tibia - CT - Parsons_moved.png
http://upload.orthobullets.com/topic/8019/images/Histology A_moved.png
http://upload.orthobullets.com/topic/8019/images/Histology C_moved.jpg
http://upload.orthobullets.com/topic/8019/images/Case A - prox humerus - xray - Parsons_moved.png
http://upload.orthobullets.com/topic/8019/images/Case B - prox humerus - xray - Parsons_moved.png
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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