Condroblastoma de presentación atípica en concomitancia a osteomielitis crónica operado con cirugía radical: caso clínico / Chondroblastoma of atypical presentation in conjunction with chronic osteomyelitis operated through radical surgery: clinical case

INTRODUCCIÓN: El condroblastoma es un tumor óseo benigno representando menos del 1 por ciento del total de tumores óseos; se presenta principalmente en jóvenes. De etiología controversial, se desarrolla habitualmente en centros secundarios de osificación en huesos largos. No hay casos que describan su existencia junto a osteomielitis ni su tratamiento quirúrgico. CASO CLÍNICO: Mujer de 15 años con antecedente de osteomielitis de inicio reciente, diagnosticada con cintigrafía y biopsia en escápula izquierda; a pesar de tratamiento médico antibiótico con cloxacilina persiste dolor, eritema, impotencia funcional y aumento de volumen progresivo. Cintigrafía de control confirma nula respuesta a tratamiento inicial. Tomografía computada (TC) informa probable proceso tumoral osteolítico cortical con reacción de partes blandas en casi la totalidad de la escápula incluyendo cavidad glenoidea. Biopsia quirúrgica informa condroblastoma sospecha de variante agresiva resolviéndose con escapulectomía total con resección de cabeza humeral y posterior pexia clavículo-humeral. Biopsia definitiva de pieza quirúrgica informa osteomielitis crónica y condroblastoma agresivo. Evolución favorable en controles posteriores sin signos de recidiva local ni a distancia. DISCUSIÓN: La nula respuesta clínica al tratamiento inicial y su progresión hizo sospechar un proceso tumoral no diagnosticado inicialmente debido a que la biopsia no incluyó focos del condroblastoma. El manejo clásico del condroblastoma consiste en curetaje y relleno con autoinjerto; pero debido a la localización atípica, posibilidad de malignización y coexistencia con proceso osteomielítico crónico se optó por cirugía innovadora que consistió en resección total y posterior pexiaclavículo-humeral

INTRODUCTION: A Chondroblastoma is a benign bone tumor, corresponding to less than 1 percent of all bone tumors, and affecting mainly young people. Commonly developing in secondary centers of ossification in large bones, there are no cases describing its existence along with osteomyelitis, nor its surgical treatment. CLINICAL CASE: Woman (15 Y/O) with a history of osteomyelitis onset caused by a recent fall is diagnosed through scintigraphy and biopsy in the left scapule. Despite treatment with cloxacillin, pain persisted, erythema developed, with a progressive increase of volume and functional impotence. Control scintigraphy confirms no response to initial treatment. Computed Tomography (CT) informs of a probable cortical osteolysis tumoral process with soft tissue reactions in almost the entire scapule including glenoid cavity. Surgical biopsy shows chondroblastoma and, suspecting an agressive variant, it is resolved to perform a total scapulectomy with resection of scapule head and subsequent humerus-claviclepexia. Definitive biopsy of surgical piece shows chronic osteomyelitis and agressive chondroblastoma. The evolution of the patient is normal on follow-up controls, not presenting any signs of local neither distant relapse. DISCUSSION: The non-existence of a response to the initial treatment and its progression made us suspect of a natural process that was not diagnosed initially because the biopsy didn't include chondroblastoma focus. The usual chondroblastoma treatment consists of curetting and autograft filling; but due to the atypical location, and the possibility of coexistence with malignant and chronic osteomyelitic process we chose to apply an innovative surgery that consisted of total resection and subsequent pexia.

Chondroblastoma: a clinico-pathological analysis

To determine the clinico-pathological and histological features of Chondroblastoma [CB]. Case series. The Aga Khan University Hospital, Karachi, from 2000 to 2013. The histological slides of all reported cases of CB were retrieved and reviewed for morphological features. Clinical features were noted from surgical pathology reports. Frequency of features was noted. Sixty one cases of CB were identified. Pain was the most common presenting symptom. The age ranged from 10 to 38 years [mean 20 +/- 1.98 years; M: F 2.5:1] with 61% patients in the second decade of life. Forty six cases occurred in long tubular bones; distal femur being most common site. Metaphysis, clavicle, temporal bone and metacarpal were also involved. Histologically, all CBs were composed of round to polygonal cells and scattered osteoclast-type multinucleated giant cells and majority had hemosiderin pigment. Chicken-wire calcifications and coarse calcifications were seen in 85% and 26% of cases respectively. A spindle cell component was seen in 54% of cases. ABC-like areas were seen in 10 cases. Mitosis ranged from 1 to 6/10 HPFs. Recurrence was seen in 2 cases. Recurrent tumor showed similar morphology when compared with the initial tumor. CB is a benign tumor but has potential for recurrence. Males are more affected, second decade is more common and distal femur is most common site. Metaphysis, clavicle, temporal bone and metacarpal were the rare sites of CB. Histological features predictive of recurrence were not separately identified

Condroblastoma do osso esfenóide / Chondroblastoma of the sphenoid bone

Introdução: Condroblastoma é uma rara neoplasia benigna cartilaginosa, altamente destrutiva, que caracteristicamente surge na epífise de ossos longos em pacientes jovens. Sua ocorrência é extremamente rara na base do crânio, normalmente ocorrendo no osso temporal. Objetivo: Descrever um raro caso de um paciente apresentando um condroblastoma de osso esfenóide que invadia a fossa média, submetido a ressecção cirúrgica com sucesso, sem recorrência após 2 anos. Relato do Caso: W.J.S., 37 anos, masculino, encaminhado ao ambulatório de otorrinolaringologia com otalgia persistente e de forte intensidade há 3 meses. Apresentava otoscopia normal e sem tumorações visíveis. Tomografia computadorizada evidenciou massa tumoral em fossa infra-temporal à esquerda, invadindo fossa cerebral média. Biópsia sugeria tumor de células gigantes. Realizada ressecção ampla por abordagem anterior via osteotomia orbito-zigomática. Durante a cirurgia, confirmando achados tomográficos, não foi encontrado envolvimento do osso temporal. Exame histopatológico evidenciou condroblastoma. Após 18 meses da cirurgia, não apresenta queixas, sem déficits motores, sensitivos ou de nervos cranianos e sem sinais tomográficos de recorrência. Conclusão: Destaca-se a importância do diagnóstico diferencial do condroblastoma nas lesões da base do crânio e sua abordagem terapêutica, cujo objetivo sempre deve ser a maior ressecção possível com a máxima preservação de função.

Introduction: Chondroblastoma is an uncommon cartilaginous benign neoplasm, highly destructive, which specifically appears in the epiphysis of long bones in young patients. Its occurrence is extremely rare in the cranial base, normally occurring in the temporal bone. Objective: To describe a rare case in a patient presenting with a sphenoid bone chondroblastoma that invaded the middle cranial cavity, submitted to a successful surgical resection, without recurrence after 2 years. Case Report: W.J.S, 37 years old, male, forwarded to the otorhinolaryngology service with persistent and strong otalgia for 3 months. He had normal otoscopy and without visible tumorations. The computerized tomography confirmed tumor mass in the left infra-temporal cavity, invading the middle cranial cavity. The biopsy suggested giant cells tumor. After wide resection by frontal approach via orbitozygomatic osteotomy. During the surgery, we confirmed tomographic statements and didn't find temporal bone involvement. The histopathological exam confirmed chondroblastoma. After 18 months after the surgery, he doesn't present with complaints, without motor, sensitive deficits or of cranial nerves and without recurrence tomographic signals. Conclusion: The importance of differential diagnosis of chondroblastoma is remarkable in the cranial base lesions and its therapeutic approach, whose objective must always be the major possible resection with the maximum function conservation.

Recurrent and aggressive chondroblastoma: a case report.

Recurrent chondroblastoma with pulmonary and palatal metastasis is a rare occurrence. We report the cytological and histological findings of such a case in a 33 years old male, where the primary diagnosis of metastatic chondroblastoma was made on FNAC, which was later confirmed on histopathology. The present case highlights that, some chondroblastomas do exist, that are capable of pursuing a malignant course.

Ventana oncologica 11 / Window 11 oncological

En este caso se practicó una biopsia por aguja que confirmo el diagnóstico: Condroblastoma del Talo Izquierdo. En este caso, se practicó, una osteotomía del maléolo interno, con prefresado de tornillos esponjosos se expuso la lesión respetando el cartílago, se usó luego fresado de alta velocidad, y fenolización al 30%, luego se reconstruyó el talo con un auto injerto de cresta iliaca; la paciente tiene 7 años de tratada, sin recurrencia local, y sin necrosis avascular del talo.

Fine needle aspiration cytology of chondroblastoma--a case report.

Chondroblastoma accounts for less than one percent of osseous neoplasms, and is one fifth as common as giant cell tumor, a lesion with which it is very frequently confused. It has a marked predilection for the epiphysis of long bones. Radiologically, these are lytic lesions with a thin margin of increased density. A majority of chondroblastomas have an entirely benign course and are successfully treated by curettage and bony chip grafts. Clinically, chondroblastomas may be confused with other neoplasms, both benign and malignant. Fine needle aspiration is fast gaining acceptance as an accurate and rapid technique for diagnosing osseous neoplasms. The cytological features of chondroblastoma like individually lying chondroblasts, nuclear grooves, chodroid matrix and chicken-wire calcification are diagnostic of this neoplasm and may allow fine needle aspiration to become a valuable pre-operative technique in the management of these patients.

Coexisting chondroblastoma and osteochondroma: a case report.

The coexistence of two different types of benign cartilaginous tumours of bone in the same patient has not been reported in literature. We report a case in which a sixteen-year-old male had a benign chondroblastoma of the proximal left humerus and an osteochondroma of the distal left femur. Both originated at the same time and had a progressive increase in size with growth.

Comportamiento del condroblastoma de astrágalo en un basquetbolista: reporte de un caso y revisión de la literatura / Behavior of talus chondroblastoma in a basketball player: case report

La presencia de este tipo de tumores en el pie es extremadamente raro y sólo algunos han sido reportados. La forma de presentarse en este deportista y su evolución totalmente benigna a pesar de su aspecto, estimula al cirujano ortopedista a una resección quirúrgica amplia en estos casos

Chondroblastoma of the temporal bone: a clinicopathologic study of five cases

Chondroblastoma is a rare benign bone tumor. It commonly affects the epiphysis of long bones during the second and third decades of life. Chondroblastoma of the temporal bone is extremely rare. We reviewed five cases of chondroblastoma arising in the temporal bone. Four cases were female and one was male. The ages ranged from 41 to 60 years (mean, 53.6 years). All cases involved the temporal bone. Three involved the left side and two the right. Chief complaints were long-standing localized pain and hearing difficulty. A sharply demarcated lobulated mass was the main radiological finding. Microscopic findings were those of chondroblastoma of usual locations. Two cases showed aneurysmal bone cyst-like areas. Immunohistochemical studies for CD34, CD99, S-100 protein and cytokeratin were performed. Tumor cells were diffusely positive for S-100 protein in three cases and weakly positive for cytokeratin in one case. CD34 and CD99 were negative in all cases. In summary, chondroblastoma of the temporal bone is rare and occurs in older age group than reported cases of chondroblastoma of the usual location in the literature.

Punción biopsia ósea percutánea guiada bajo TC / TC guided percutaneous biopsy of the bone lesions

Se evaluaron los beneficios de la biopsia percutánea por TC en distintas lesiones óseas. Las indicaciones se establecieron por protocolos de acuerdo a si la lesión era inflamatoria, benigna o maligna, respetando las contraindicaciones del método. Del total de biopsias realizadas entre enero de 1995 y septiembre de 1996, se extrajeron 76 por disponerse del estudio por TC y del resultado anatomopatológico. Las muestras extraídas correspondieron a: vértebra, 33; fémur, 17; tibia, 6; costillas, 6; ilíaco, 4; esternón, 4; sacro, 2; rama isquiopubiana, 2; cuboides, 1 y escafoides, 1. Se concluye que la biopsia percutánea guiada bajo TC es la técnica de elección para determinar la etiología de las lesiones del sistema musculoesquelético, cuando está indicada una biopsia guiada por imágenes. El método tiene muy baja morbilidad y es bien tolerado por el paciente

Tumores óseos primarios en pediatría / Diagnostic imaging of the primary bone tumors in pediatry

Los tumores óseos primarios (TOP) no son frecuentes, sin embargo, en proporción frente a otros tumores ocupan un lugar significativo en la población pediátrica. Su tratamiento ha variado sustancialmente en los últimos años. La cirugía trata en lo posible de ser menos mutilante conservando la anatomía y de ser posible la función. La quimioterapia (adyuvante y neoadyuvante) y la radioterapia juegan un importante rol. La aplicación de estos métodos ha producido una gran demanda del Diagnóstico por Imágenes. En la actualidad la sistemática de estudios de los TOP incluye Radiología Convencional, Medicina Nuclear, Tomografía Computada, Resonancia Magnética y, a veces, Angiografía. Con el objeto de analizar las ventajas y desventajas de cada método y las características de los principales tumores se presentan 126 pacientes con TOP (todos confirmados por biopsia percutánea o cirugía). Nuestras conclusiones son: 1) La MN es inespecífica pero un aliado eficaz para buscar, frente a un probable TOP, otras localizaciones óseas. 2) La radiología convencional es el método mejor para determinar las características histológicas de los TOP. 3) La TC y la RNM son indispensables para determinar las conductas terapéuticas, para planear la cirugía y la radioterapia y para evaluar los tratamientos instituidos

Condroblastoma benigno: consideraçöes a respeito de um caso

Relata um caso de condroblastoma benigno, comenta as características clínicas, anátomo patológicas, terapêuticas e prognóstico da lesäo, baseado em informaçöes da literatura

Condroblastoma con invasión articular y sinovitis tumoral: reporte de dos casos / Condroblastoma with articular invasión and tumor synovitis

Se reportan dos casos de condroblastoma con invasión articular, haciendo énfasis en radiología, clínica y tratamiento