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Updated: Jun 24 2023

Chondroblastoma

4.4

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Images
https://upload.orthobullets.com/topic/8021/images/Case G - femur - T2 MRI - Parsons_moved.png
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/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
      • o
      • o
      • o
      • Giant Cell Tumor
      • o
      • o
      • o
      • Aneurysmal bone cyst
      • o
      • Osteoblastoma
      • o
      • Chondromyoid fibroma (CMF)
      • o
  • 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
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