Updated: 10/6/2016

Chondroblastoma

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Cases
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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/Histology B - Parsons_moved.png
https://upload.orthobullets.com/topic/8021/images/Case G - femur - T2 MRI - Parsons_moved.png
https://upload.orthobullets.com/topic/8021/images/Histology A_moved.png
Introduction
  • A rare, benign chondrogenic lesion (differs from giant cell tumor by its chondroid matrix 
  • Epidemiology
    • demographics
      • M:F = 2:1
      • 80% of patients under 25 years of age
    • body 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
  • 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)
  • Prognosis
    • local recurrence rate is 10-15% after treatment
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
    • 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
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
Differential Groups
 
Epiphyseal lesion
 Benign lesion that may metastasize to lung
Treatment is curretage and bone grafting (1) 
Chondroblastoma
 •
Giant Cell Tumor
 •
Aneurysmal bone cyst    
Osteoblastoma    
Chondromyoid fibroma (CMF)    
ASSUMPTIONS: (1) assuming no impending fracture
 
 
IBank
  Location
Xray
Xray
CT
B.Scan
MRI
MRI
Histo(1)
Case A tibia
 
 
Case B calcaneus
 
 
Case C pelvis
 
Case D femur
 
 
 
Case E tibia
 
 
 
Case F prox. humerus
 
 
Case G femur
 
 
 
 
Case H tibia
 
 
 
(1) - histology does not always correspond to case 


 

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Questions (11)
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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? Review Topic

QID: 3133
FIGURES:
1

Figure B

13%

(184/1457)

2

Figure C

28%

(411/1457)

3

Figure D

35%

(517/1457)

4

Figure E

6%

(81/1457)

5

Figure F

17%

(246/1457)

ML 5

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PREFERRED RESPONSE 2

(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? Review Topic

QID: 18
FIGURES:
1

Chondroblastoma

63%

(220/347)

2

UBC

3%

(11/347)

3

Giant Cell Tumor

24%

(85/347)

4

Osteoid Osteoma

6%

(21/347)

5

Non-ossifying fibroma

3%

(10/347)

ML 2

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PREFERRED RESPONSE 1

(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? Review Topic

QID: 3523
FIGURES:
1

Giant cell tumor

25%

(628/2518)

2

Clear cell chondrosarcoma

5%

(115/2518)

3

Chondroblastoma

61%

(1528/2518)

4

Brodie's abscess

9%

(231/2518)

5

Osteochondral defect

0%

(6/2518)

ML 3

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PREFERRED RESPONSE 3
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ARTICLES (11)
VIDEOS (1)
CASES (2)
Topic COMMENTS (9)
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