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
QUESTIONS 1 of 1 1 Previous Next (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? Review Topic QID: 559 FIGURES: A B C D 1 Observation with serial radiographs 9% (108/1268) 2 Irradiation treatment course with maximum dosage of 60 grays 2% (23/1268) 3 Marginal excision including the underlying cortex 32% (411/1268) 4 Wide surgical excision 28% (359/1268) 5 Neoadjuvant chemotherapy, surgical excision, followed by adjuvant chemotherapy 28% (358/1268) Select Answer to see Preferred Response PREFERRED RESPONSE 3