Updated: 10/15/2016

Chondromyxoid Fibroma

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https://upload.orthobullets.com/topic/8022/images/Case D - tibia - xray b -Parsons_moved.png
https://upload.orthobullets.com/topic/8022/images/mricmfcoronal.jpg
https://upload.orthobullets.com/topic/8022/images/Histology A - Stellate and giant cells - Parsons_moved.png
https://upload.orthobullets.com/topic/8022/images/mricmfaxial.jpg
https://upload.orthobullets.com/topic/8022/images/bonescancmf.jpg
Introduction
  • A rare and benign chondrogenic lesion characterized by variable amounts of chondroid, fibromatoid and myxoid elements
  • Epidemiology
    • demographics
      • more common in males
      • most common in second and third decades of life
        • may affect patients up to 75 years old
    • location
      • long bones (ie. tibia, distal femur)
        • often affects metaphyseal (proximal tibia) regions
      • pelvis
      • feet or hands 
  • Pathophysiology
    • may arise from physeal remnants
  • Genetics
    • mutations
      • a genetic rearrangement may affect chromosome 6 (postion q13)
  • Prognosis
    • natural history
      • recurrence in CMF is not uncommon 
        • may occur in 20-30% of cases 
    • negative prognostic variables
      • children
      • tumor is more lobulated with abundant myxoid material
    • metastasis
      • has not been reported
Presentation
  • History
    • long standing pain (months to years)
    • may be incidentally identified
  • Symptoms
    • pain and mild swelling 
Imaging
  • Radiographs 
    • findings
      • lytic, eccentric metaphyseal lesion 
        • sharply demarcated from adjacent bone
        • scalloped and sclerotic rim 
        • calcifications are rare
        • cortical expansion may be seen
        • lesion size may range from two to ten centimeters
  • MRI 
    • findings  
      • low signal on T1-weighted images
      • high signal on T2-weighted images 
  • Bone scan
    • findings
      • increased signal uptake will be seen 
Studies
  • Histology
    • findings
      • low-power  
        • biphasic appearance
          • hypercellular area with lobules of fibromyxoid tissue 
            • spindle-shaped cells or stellate-shaped cells
              • the cells contain hyperchromatic nuclei
              • multinucleated giant cells and fibrovascular tissue are located between lobules
          • hypocellular area with chondroid material
      • high power
        • myxoid stroma with stellate cells 
        • regions of pleiomorphic cells with bizarre nuclei may be seen
  • Diagnostic criteria 
    • histopathologic examination is mandatory for confirmation of the diagnosis
Differential
  • Radiographic
    • aneurysmal bone cyst (ABC) 
    • chondroblastoma 
    • non-ossifying fibroma  
  • Histologic
    • chondroblastoma 
    • enchondroma  
    • chondrosarcoma  
Treatment
  • Operative
    • intralesional curretage and bone grafting (or PMMA) 
      • indications
        • mainstay of treatment
Complications
  • Recurrence 
    • occurs in 25% of cases
Ibank
  Location
Xray
Xray
CT
B. Scan
MRI
MRI
Histo(1)
Case A foot
Case B tibia
Case C femur

Case D tibia             
    
(1) - histology does not always correspond to case 

 

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Questions (4)

(OBQ12.133) A 12-year-old female presents for evaluation of worsening right wrist pain. She denies any trauma and is otherwise healthy. A current radiograph is shown in Figures A and B. A biopsy is obtained and shown in Figure C. What is the most likely diagnosis? Review Topic

QID: 4493
FIGURES:
1

Chondrosarcoma

5%

(168/3424)

2

Osteosarcoma

2%

(75/3424)

3

Chondromyxoid fibroma

49%

(1670/3424)

4

Nonossifying fibroma

33%

(1139/3424)

5

Enchondroma

10%

(347/3424)

ML 4

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