Condroblastoma pélvico / Pelvic Chondroblastoma

Este artículo describe el caso de una mujer de 24 años de edad con un condroblastoma de localización pélvica, con una masa a la altura de la cresta iliaca derecha, de seis meses de evolución y crecimiento progresivo. Los rayos X mostraron una lesión osteolítica con densidad heterogénea y extensión hacia los tejidos blandos; el estudio histopatológico evidenció un condroblastoma. Los condroblastomas son tumores óseos benignos productores de cartílago que aparecen en las epífisis de los huesos largos de personas jóvenes. Alrededor del 75% de estos tumores afectan los huesos largos, principalmente el fémur, la tibia y el húmero; excepcionalmente se localizan en los huesos planos craneofaciales y en los huesos pélvicos. Los condroblastomas tienen características radiológicas e histopatológicas distintivas, y pese a su comportamiento biológico benigno, pueden causar una alta morbilidad para los pacientes, debido a su localización y a su tratamiento exclusivamente quirúrgico.

This article describes the case of a 24-year old woman with a pelvic chondroblastoma localized at the top of the right iliac crest, with six months of evolution and progressive growth. X-rays revealed an osteolytic lesion with heterogeneous density, extending toward soft tissue; the hisopathologic study provided evidence of chondroblastoma. Chondroblastomas are benign bone tumors producers of cartilage which appears in the long bone epiphysis of young people. Nearly 75% of such tumors affect the long bones, principally the femur, the tibia, and the humerus; exceptions include those in the flat craniofacial bones and the pelvis bones. Chondroblastomas have distinct radiological and histopathologic characteristics, and despite their benign biological behavior, can cause elevated morbidity among patients due to their localization and being treated exclusively with surgery.

Imagen fotopénica secundaria a derrame pleural masivo visualizada en la fase precoz de una gammagrafía ósea / Photon-deficient right hemithorax on blood pool images in a pleural effusion

Presentamos un paciente con derrame pleural maligno visualizado como una área fotopénica en la imagen precoz de una gammagrafía ósea en 2 fases.

We present a patient with chondrosarcoma. In the blood pool phase of a bone scintigraphy we saw a cold area in the right hemithorax. This image was secondary to a malignant pleural effusion.

Estudio radiológico simple en el diagnóstico de condroblastoma epifisiario benigno: correlación anatomo – radiológica / Radiographic study in benign epiphyseal chondroblastoma diagnosis: anatomoradiological correlation

Introduction: A chondroblastoma is a rare, usually benign, tumor of bone that accounts for approximately 1 percent of all bone tumors, which mainly affects the growing skeleton. Local pain is the most common presenting symptom, and for some patients it implies functional involvement due to its periarticular site. Chondroblastoma most commonly affects the epiphysis of long bones, specially occuring on the lower extremities. Usually, radiography is the first diagnostic imaging technique to be performed and its relatively characteristic findings may cause alarm or lead to misdiagnosis. Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) are complementary studies that best show the lesion, its extension, and soft tissue involvement. Objectives: To present the most frequent manifestations of chondroblastoma in radiographies, establishing the anatomoradiological correlation of lesions. Material and Methods: Thirty-six patients with histologically proven chondroblastoma, who were registered in the National Register of Bone Tumors, between 1959 and 2004, were retrospectively investigated under clinical and radiological viewpoints. Results: Thirty-six patients (26 male, 10 female) whose ages ranged from 5 to 19 years (mean age 14.5 years) were studied. In all cases, biopsy results confirmed the diagnosis of chondroblastoma. Bone lesions were sited as follows: long bones of lower extremities in 22 patients; long bones of upper extremities, 8 cases; feet bones, 3 patients; pelvis, 3 cases, and rib cage in 1 case. Lesions, which were unique in all cases and involved epiphyseal region, were predominantly osteolytic in 30 patients. Metaphyseal extension was found in 28 patients. Eccentric bone lesions were seen in 27 cases, while calcifications were present in 18 patients and 9 cases were found to have soft tissue extensions. Conclusions: Benign epiphyseal chondroblastoma is an unusual bone lesion occuring in young patients, with well-characterized and constant...

Introducción: El condroblastoma es una lesión ósea benigna poco frecuente (1 por ciento - 4.7 por ciento de los tumores óseos primarios), que afecta principalmente al esqueleto en crecimiento. Se manifiesta por dolor local de larga evolución y en algunos pacientes, compromiso funcional por su localización periarticular. Tiene predilección por las epífisis de los huesos largos o su equivalente epifisiarío, especialmente en extremidades inferiores. La radiografía simple es generalmente el primer examen y los hallazgos son relativamente característicos, pudiendo alarmar e inducir a error. Tomografía computada (TC) y resonancia magnética (RM) son complementarias y muestran mejor la lesión, extensión dentro del hueso y compromiso de partes blandas. Objetivos: Mostrarlas manifestaciones más frecuentes del condroblastoma en radiografías, estableciendo correlación anátomo-radiológica de las lesiones. Material y Métodos. Se analizaron retrospectivamente las características clínicas y radiológicas de 36 pacientes con condroblastoma confirmado por histología, incluidos en Registro Nacional de Tumores Óseos (RENATO), entre los años 1959 y 2004. Resultados. Se estudiaron 36 pacientes, 26 varones y 10 niñas, de 5 a 19 años (promedio = 14.5 años). Biopsia compatible con condroblastoma en todos los pacientes y su localización: huesos largos de extremidades inferiores(22), huesos largos de extremidades superiores(8), huesos del pie(3), pelvis(3) y parrilla costal(1). Las lesiones fueron únicas en todos los casos, predominantemente osteolíticas(30). La totalidad comprometía la epífisis; se observó extensión hacia la metáfisis(28), lesión ósea excéntrica(27), calcificaciones(W) y extensión hacia partes blandas(9). Conclusión. El condroblastoma epifisiario benigno es una lesión poco frecuente, de pacientes jóvenes, con manifestaciones radiológicas relativamente constantes y características, lo que puede permitir al radiólogo sospechar el diagnóstico en la radiografía simple ini...

Transphyseal spread of benign tumors and infections in pediatric patients: a series of six cases.

Epiphyseal extension of benign pathology is regarded as an infrequent occurrence. This observation has been attributed to anatomical and biochemical phenomenon unique to physeal cartilage. We report a retrospective series of six patients over a period of 4 years, diagnosed with benign pathologies that showed crossing of an open physeal plate by the disease. Four of these cases were infections and two were benign tumors. The patients were aged between 5 and 11 years, all of them were treated at a tertiary referral centre and followed up for a minimum period of 6 months to evaluate the progress of disease. The findings are more than just a pathological curiosity as they alter the management and surgical procedure that needs to be performed for these conditions. The recognition of the fact that benign tumors may occasionally present with transphyseal spread will prevent unjustified radical procedures that are best reserved for aggressive malignant conditions.

Chondroblastoma of bone--not a " benign disease": clinico-pathologic observations on sixty cases.

Chondroblastomas (CBL) account for less than 1% of all bone tumors. A 46 year review (1955-2000) of bone tumors yielded 60 cases of CBL. This paper reviews their histology, radiology, clinical presentation and emphasizes that this seemingly benign lesion is capable of aggressive behaviour. Histopathology slides and radiographs of sixty patients were studied and clinical details and follow-up were obtained. There were 44 males and 16 females, aged between 10 to 30 years. Long bones were involved in 81.4% of the cases, tibia being the commonest site. Symptoms comprised pain (60%), local swelling (25%) and joint symptoms (5%) or a combination of these. Radiologically, an oval sharply demarcated lytic lesion predominantly in the epiphysis was noted in 50% of the cases. On microscopy all lesions revealed chondroblasts having irregular grooved nuclei and osteoclasts with 80% of the tumors showing chondroid differentiation and calcification. Treatment comprised curetting (34 cases), wide excision (21 cases), radical excision (1 case) and was unknown in 4 cases. Follow-up ranging from 2 to 26 years was available in 83.3% of the patients; six (10%) had local recurrence (at 6 months, 8 months, 1 year, 2 years, 3 years and 5 years), two (3.3%) developed lung metastasis (synchronous in one and at 18 months in the other) and spontaneous malignant transformation occurred in one (1.4%) patient after 9 years; subsequent to three local recurrences. CBL, though seemingly benign, can behave in an aggressive manner. Since there are no reliable histological features to predict biologic behaviour, regular long term follow-up is recommended.

Frequency, presentation and postintervention prognosis of chondroblastoma

To evaluate the frequency of clinico-radiological presentation and the prognosis after treatment of chondroblastoma. Design: A descriptive, observational study. Place and Duration of Study :The study was carried out at the Department of Orthopaedic Surgery, JPMC, Karachi over the period of 16 years, January 1986 to June 2002. Methodology: Patients in teenage, presenting with signs and symptoms of a primary bone tumours, were included by retrospectively reviewing the tumour registry record. Detailed scrutiny of clinical record was carried out to analyze the clinico radiological presentation and posttreatment prognosis criteria of healing was symptom-free centripetal and homogenous ossification. Seven [1.24%] out of 563 primary bone tumour cases were chondroblastoma. The clinico-radiological presentation in the 2 out of 7 [28.57%] cases was classical, 2 simulated osteomyelitis and other 3 as chondromyxoid fibroma, aneurysmal bone cyst and giant cell tumour. Lesions were treated with curettage and bone grafting. One patient [14.28%] developed recurrence within 2 years after curettage and healed after re-curettage and bone grafting. Five out of 7 [71,42%] tumours showed good response and 2 out of 7[28.57%] showed satisfactory response. Chondroblastoma is very rare benign primary bone tumour with high local recurrence rate. The lesions confined to epiphysis of weight-bearing bone present early with symptoms of mild arthritis. Lesions in non-weight -bearing bones often present late and simulates epiphysio-metaphyseal tumours. Lesions heals with centripetal healing and need more than 2 years follow-up to achieve recurrence-free healing

Condroblastoma benigno do osso occipital: relato de caso / Benign chondroblastoma of the occipital bone: a case report

Condroblastoma benigno é tumor ósseo raro, tendo como origem células cartilagíneas. Classicamente este tumor acomete regioes epifisárias de ossos longos, sendo incomum o envolvimento de ossos do crânio, principalmente o osso occipital. Relatamos o caso de uma paciente com 16 anos de idade, com diagnóstico de condroblastoma benigno do osso occipital e discutimos os principais aspectos deste tumor.

Fibroma condromixóide da coluna torácica: relato de caso e revisäo da literatura / Chondromyxoid fibroma of the spinal cord: a case report and review of the literature

Os autores relatam o caso de compressao medular torácica da quinta articulaçao costovertebral à direita. O diagnóstico pré-operatório, com mielotomografia, foi de processo expansivo intrarraquidiano extradural ao nível de T5. Feita a abordagem cirúrgica por laminectomia, com ressecçao apenas da lesao intrarraquidiana. O diagnóstico de fibroma condromixóide somente foi definido com o estudo histopatológico. A paciente teve importante melhora neurológica. Decidiu-se pelo acompanhamento clínico e radiológico. Após dois anos houve recidiva do processo para dentro do canal raquidiano. Desta vez, foi realizada abordagem posterolateral à direita, por costotransversectomia e retirada da lesao. O diagnóstico histopatológico foi o mesmo. A paciente evoluiu com melhora neurológica e está sendo feito o seguimento há dois anos. Chamamos a atençao para a raridade do caso e discutimos a conduta.

Chondromyxoid fibroma of the femur: a case report with intra-cortical location

Chondromyxoid fibroma (CMF) is the least common benign cartilaginous tumor, comprising less than 0.5 to 1% of all skeletal neoplasms. This subject was a 16-year-old female with a three-year history of pain involving the distal femoral metaphysis. This case showed an unusual feature: it was intracortical in location. Radiologic differential diagnosis included metaphyseal fibrous defect, periosteal chondroma, simple or aneurysmal bone cyst, and cortical abscess. On operation, the lesion filled the intracortical defect with whitish myxoid soft tissue, bulging into the adjacent soft tissue. Microscopically, it showed typical features of chondromyxoid fibroma composed of mainly myxoid nodules and peripheral fibrous elements with focal chondroid differentiation.