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 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 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
QUESTIONS 1 of 12 1 2 3 4 5 6 7 8 9 10 11 12 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (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? Tested Concept QID: 4695 FIGURES: A B C Type & Select Correct Answer 1 Enchondroma 4% (143/3805) 2 Ewing sarcoma 17% (628/3805) 3 Chondroblastoma 46% (1747/3805) 4 Osteosarcoma 23% (876/3805) 5 Osteoblastoma 10% (392/3805) L 4 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review tested concept Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (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? Tested Concept QID: 3523 FIGURES: A B C D E F Type & Select Correct Answer 1 Giant cell tumor 25% (853/3437) 2 Clear cell chondrosarcoma 5% (168/3437) 3 Chondroblastoma 61% (2098/3437) 4 Brodie's abscess 9% (296/3437) 5 Osteochondral defect 0% (10/3437) L 3 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review tested concept (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? Tested Concept QID: 3133 FIGURES: A B C D E F Type & Select Correct Answer 1 Figure B 13% (290/2234) 2 Figure C 31% (693/2234) 3 Figure D 35% (771/2234) 4 Figure E 6% (127/2234) 5 Figure F 15% (332/2234) L 5 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review tested concept Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (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? Tested Concept QID: 18 FIGURES: A B Type & Select Correct Answer 1 Chondroblastoma 65% (444/681) 2 UBC 3% (23/681) 3 Giant Cell Tumor 21% (142/681) 4 Osteoid Osteoma 8% (53/681) 5 Non-ossifying fibroma 3% (19/681) L 2 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review tested concept
All Videos (1) Podcasts (1) Login to View Community Videos Login to View Community Videos Chondroblastoma Histopathology Michael Hughes Pathology - Chondroblastoma D 2/4/2012 1919 views 5.0 (7) Pathology⎪Chondroblastoma Orthobullets Team Pathology - Chondroblastoma Listen Now 9:39 min 6/4/2020 96 plays 0.0 (0)
Multiple Exostosis (C2141) mohamed amer Pathology - Chondroblastoma E 2/7/2015 188 1 1 Lytic Elbow Lesion (C1840) Pathology - Chondroblastoma E 3/24/2014 113 0 5