Updated: 6/21/2021

Chondroblastoma

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https://upload.orthobullets.com/topic/8021/images/Case H- tibia- xray - Parsons_moved.jpg
https://upload.orthobullets.com/topic/8021/images/Case H - tibia MRI - parsons_moved.gif
https://upload.orthobullets.com/topic/8021/images/Case G - femur - T2 MRI - Parsons_moved.png
https://upload.orthobullets.com/topic/8021/images/Histology B - Parsons_moved.png
https://upload.orthobullets.com/topic/8021/images/Histology A_moved.png
  • summary
    • Chondroblastomas are rare, benign chondrogenic lesions that are most commonly found in the epiphysis of the proximal tibia and distal femur.
    • Patients typically present between the ages of 10 and 20 years with regional pain.
    • Diagnosis is made with biopsy showing chondroblasts arranged in "cobblestone" or "chickenwire" pattern with focal areas of chondroid matrix.
    • Treatment is usually extended intralesional curettage and bone grafting.
  • Epidemiology
    • Demographics
      • M:F = 2:1
      • 80% of patients under 25 years of age
    • Anatomic location
      • epiphyseal lesion in young patients (usually around 12 years of age)
      • common locations include distal femur and proximal tibia >>> proximal humerus, proximal femur, calcaneus, flat bones and apophysis or triradiate cartilage of the pelvis
      • typically epiphyseal but may occasionally cross the physis
  • Etiology
    • Pathophysiology
      • thought to arise from cartilaginous epiphyseal plate
      • categorized as cartilage tumor due to its areas of chondroid matrix, but type II collagen is not expressed by tumor cells
    • Genetics
      • mutations
        • may have genetic abnormalities on chromosome 5 and 8
    • Associated Conditions
      • medical conditions & comorbidities
        • < 1% develop benign pulmonary metastasis (similar to giant cell tumor)
  • Presentation
    • Symptoms
      • progressive pain at tumor site
      • limping
    • Physical examination
      • inspection
        • muscle atrophy
        • tenderness over affected bone
      • motion
        • decreased ROM
  • Imaging
    • Radiographs
      • recommended views
        • AP, lateral, and oblique of involved area
      • findings
        • well-circumscribed epiphyseal lytic lesion with thin rim of sclerotic bone that is sharply demarcated from normal medullary cavity
        • lesions often cross physis into metaphysis
        • stippled calcifications within the lesion may or may not be present (25%-45%)
        • cortical expansion may be present
        • soft tissue expansion rare
      • chest radiographs
        • evaluate for possible metastatic lesions
      • differential with radiographs
        • giant cell tumor
        • osteomyelitis
        • clear cell chondrosarcoma
    • CT
      • indications
        • not required
        • defines bony extent of lesion
    • MRI
      • findings
        • extensive edema surrounding lesion
  • Studies
    • Histology
      • findings
        • chondroblasts arranged in "cobblestone" or "chickenwire" pattern may be present
        • scattered multinucleated giant cells with focal areas of chondroid matrix
        • occasional multinucleated giant cells may be present
        • mononuclear stromal cells are distinct, S100+ cells with large central nuclei
          • nuclei have longitudinal groove resembling coffee bean
        • 1/3 of chonroblastomas have areas of secondary ABC
  • Differential 
    • Chondroblastoma differential 
      Epiphyseal lesion
      Benign lesion that may metastasize to lung
      Treatment is curettage and bone grafting
      Chondroblastoma
      Giant Cell Tumor
      Aneurysmal bone cyst
      Osteoblastoma
      Chondromyoid fibroma (CMF)
  • Treatment
    • Operative
      • extended intralesional curettage and bone grafting
        • indications
          • standard of treatment in symptomatic individuals
        • technique
          • may do local adjuvant treatment with phenol or cryotherapy to decrease local recurrence
      • surgical resection
        • indications
          • pulmonary metastasis
  • Prognosis
    • Local recurrence rate is 10-15% after treatment
Flashcards (4)
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Questions (12)
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(OBQ18.130) A 14-year-old male presents with longstanding knee pain. Which of the following benign bone lesions may require a chest radiograph as part of the initial screening?

QID: 213026
1

Chondroblastoma

83%

(1167/1409)

2

Enchondroma

3%

(48/1409)

3

Non-ossifying fibroma

4%

(52/1409)

4

Osteochondroma

7%

(101/1409)

5

Unicameral bone cyst

2%

(22/1409)

L 2 A

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(OBQ13.60) An 18-year-old male presents with pain and swelling of his right shoulder. Figures A-C are the radiographs, CT scans and biopsy specimens of this patient. What is the most likely diagnosis?

QID: 4695
FIGURES:
1

Enchondroma

4%

(153/3914)

2

Ewing sarcoma

16%

(637/3914)

3

Chondroblastoma

46%

(1801/3914)

4

Osteosarcoma

23%

(903/3914)

5

Osteoblastoma

10%

(400/3914)

L 4 C

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(OBQ11.100) A 14-year-old boy presents with 6 months of knee pain and swelling. Clinical photo, radiograph, CT scan, MRI scans, and histologic slide are shown in Figures A through F. What is the most likely diagnosis?

QID: 3523
FIGURES:
1

Giant cell tumor

25%

(873/3504)

2

Clear cell chondrosarcoma

5%

(174/3504)

3

Chondroblastoma

61%

(2136/3504)

4

Brodie's abscess

9%

(299/3504)

5

Osteochondral defect

0%

(10/3504)

L 3 B

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(OBQ10.45) A 15-year-old boy sustains a left knee injury while playing soccer. A radiograph and CT is shown in Figure A. Upon further questioning of the boy's mom, she reports he's been complaining of some left knee pain at bedtime for the past 3 months. Which of the following histology slides (Figures B-F) most likely represents this boy's biopsy specimen?

QID: 3133
FIGURES:
1

Figure B

13%

(295/2291)

2

Figure C

31%

(718/2291)

3

Figure D

34%

(783/2291)

4

Figure E

6%

(130/2291)

5

Figure F

15%

(343/2291)

L 5 C

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(OBQ06.7) A 13-year-old boy presents with 3 months of increasing knee pain, particularly at night. A radiograph and histology are shown in Figure A and B. What is the most likely diagnosis?

QID: 18
FIGURES:
1

Chondroblastoma

65%

(491/750)

2

UBC

3%

(23/750)

3

Giant Cell Tumor

21%

(158/750)

4

Osteoid Osteoma

8%

(57/750)

5

Non-ossifying fibroma

3%

(21/750)

L 2 C

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