summary Periosteal Chondromas are rare, benign, chondrogenic tumors that occur on the surface of long bones, most commonly the proximal humerus. Patients typically present between the ages of 10 and 20 years of age with regional pain secondary to irritation of overlying tendons. Diagnosis is made with radiographs showing a well-demarcated, shallow cortical defect with saucerization of the underlying bone. Treatment is usually observation. Marginal surgical excision of the lesion, including the underlying cortex, is indicated in patients with severe and progressive pain. Epidemiology Demographics occur in 10-20 year-olds Anatomic location the surface 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 Differentials Differential of Periosteal Chondromas Surface Lesion May have similar chondrogenic histology Treated with marginal excision 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 • 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
QUESTIONS 1 of 2 1 2 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (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? QID: 559 FIGURES: A B C D Type & Select Correct Answer 1 Observation with serial radiographs 10% (218/2234) 2 Irradiation treatment course with maximum dosage of 60 grays 2% (48/2234) 3 Marginal excision including the underlying cortex 35% (772/2234) 4 Wide surgical excision 26% (587/2234) 5 Neoadjuvant chemotherapy, surgical excision, followed by adjuvant chemotherapy 27% (594/2234) L 5 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic