Updated: 6/21/2021

Periosteal Chondromas

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

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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?

QID: 559
FIGURES:
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 D

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