Periosteal Chondroma

Abstract

In october 1952 and May 1953, we had the opportunity of making a preoperative diagnosis of periosteal chondroma, an entity which was described in detail by Lichtenstein and Hall (1) in July 1952. Inasmuch as their account of 6 cases involving the hands, long bones, and feet provided the only complete clinical, radiologic, surgical, and pathologic description of the condition, it was felt that a further report might be useful. As Lichtenstein pointed out, Mason (2) used the term periosteal chondroma in a paper on tumors of the hand in 1937. Schinz, Baensch, Friedl, and Uehlinger (3) briefly refer to “parosteal” chondromas, which may be the soft-tissue phase of the same entity or perhaps a form of extraperiosteal chondroma. Periosteal chondromas are small, slow growing, cartilaginous tumors developing within and beneath the periosteum as lobulated masses of hyaline cartilage. Histologically, they are more cellular than ordinary osteochondromas or enchondromas. Lichtenstein notes that the plump cartilage cell nuclei tend to indicate active growth, a finding not borne out by the clinical course. The lesion shows no predilection for either sex or any age group. A slow-growing soft-tissue mass is the usual presenting symptom. Occasionally, localized pain in the absence of a history of trauma is the primary complaint. By definition, periosteal chondroma must arise from the periosteum and result in pressure changes in the adjacent cortex. Roentgenograms reveal a small soft-tissue mass and an associated cortical excavation with a sclerotic border. If calcium flecks are deposited in the lesion, its cartilaginous origin becomes obvious. Roentgen visualization in two planes is imperative in order to avoid false localization of the cortical defect. Treatment consists in simple excision of the cartilage lobule and curettement of the sclerotic cortical base, or block excision of the involved area. Osteochondroma, solitary enchondroma, and extraperiosteal chondromas are the more common conditions to be differentiated from periosteal chondroma. Neurofibroma and simple fibroma must also be considered. In the vicinity of joints, bone erosion caused by synovioma, although infrequently seen (4), must be kept in mind in differential diagnosis. Glomus tumor of the phalanges is another remote possibility. Case Reports The following cases fulfill the criteria listed above: CASE I: A 27-year-old white male was seen on Oct. 9, 1952, with an eight–year history of intermittent painful swelling, without heat or redness, localized at the superior margin of the left calcaneus at its posterior border. During his first illness, in 1944, he had obtained symptomatic relief by means of simple soaks and heat. Late in 1949, the swelling recurred and spread posteriorly to the Achilles tendon. This region remained firm and thickened to palpation.