Benign Cartilaginous Tumors Research Articles

Revisiting the Imaging Characteristics of Chondroblastoma with Special Emphasis on Prognosis and Radiological Predictors of Local Tumor Recurrence

Background Chondroblastoma is an uncommon benign cartilaginous tumor of young adults and adolescents, accounting for 1% of all bone tumors. We aim to analyze the imaging characteristics of pathologically proven chondroblastoma, measure the incidence rate of local recurrence of this tumor, and identify factors that may influence its local recurrence. Materials and methods The details of a total of 44 patients with pathologically proven chondroblastoma who underwent surgery and followed up by cross-sectional imaging between January 2006 and March 2021 at the KFSHRC in Riyadh were retrieved from our archive. All available modalities, including plain radiography, CT, and magnetic resonance imaging (MRI), performed at baseline and on follow-up were reviewed and correlated with the histopathological diagnosis. Recurrence was calculated from the date of surgery to the date of recurrence or the date of being lost to follow-up depending on the date of recurrence. The statistical software STATA was used to analyze the data. Results The tumor recurrence rate was 4.55% (n = 2). Similarly, the residual tumor rate was 4.55% (n = 2). No metastases were documented. The recurrence-free survival was 93.8% at the 722-day follow-up. More than 95% of lesions demonstrated typical imaging features including: a well-defined lobulated margin, intermediate-to-low signal on T2-weighted images, and perilesional edema. Conclusions This study emphasizes the imaging findings of chondroblastoma, which classically affects skeletally immature patients. Although imaging findings cannot be used to predict recurrence or survival, we obtained excellent prognosis following surgical treatment at our institution.

Endoscopic Resection of Nasal Septal Chondroma.

Chondromas are benign cartilaginous tumors and rarely develop in the nasal septum. Although it causes different symptoms depending on the location and size of the tumor, the most common complaints are nasal obstruction and epistaxis. A submucosal mass narrowing the nasal passage can be seen in the septum by an endoscope. Computed tomography gives information about the localization and size of the mass. A definitive diagnosis is made by histopathologic examination. Treatment is surgical excision. Endoscopic surgery provides a less invasive and successful treatment. This case series aims to share that 2 cases with a diagnosis of nasal septal chondroma were successfully treated with endoscopic surgery.

Research

The April 2024 Research Roundup360 looks at: Prevalence and characteristics of benign cartilaginous tumours of the shoulder joint; Is total-body MRI useful as a screening tool to rule out malignant progression in patients with multiple osteochondromas?; Effects of vancomycin and tobramycin on compressive and tensile strengths of antibiotic bone cement: a biomechanical study; Biomarkers for early detection of Charcot arthropathy; Strong association between growth hormone therapy and proximal tibial physeal avulsion fractures in children and adolescents; UK pregnancy in orthopaedics (UK-POP): a cross-sectional study of UK female trauma and orthopaedic surgeons and their experiences of pregnancy; Does preoperative weight loss change the risk of adverse outcomes in total knee arthroplasty by initial BMI classification?.

Enchondroma of acromion: case report of an unusual tumor location

Enchondroma is a benign cartilaginous tumor and is rarely located on the shoulder girdle. The lesion that affects the subacromial area can cause rotator cuff impingement’s clinical signs. Our aim is to present this patient who has shoulder pain and was finally diagnosed with an acromial enchondroma. A 62-year-old female patient had an insidious left shoulder pain in the last 2 years. At the physical examination of the left shoulder, subacromial impingement syndrome’s sign was noticed. Plain radiographs didn’t have any typical features and magnetic resonance imaging (MRI) images were used for diagnosis. Well-circumscribed hypointense content on T1-weighted images was observed, and the lesion was seen as hyperintense on T2-weighted images. At the same time, subacromial effusion was noticed. Because of enchondroma’s small size, the patient was followed up with medical treatment and radiographical features. At one year follow-up, there was no change in the size of the lesion and no increased complaint about her left shoulder. Physicians should keep in mind that enchondroma may occur rarely in acromion and this condition may cause subacromial impingement. Therewithal, this diagnosis which is a rare reason for subacromial impingement syndrome should be considered in the differential diagnosis of shoulder pain.

Case of Chondroma in Prepubic Space: A Rare Occurrence

The pelvic bone can be affected by a various diseases, including tumours. Cartilaginous tumours may develop in this area because it contains hyaline and fibrocartilage. The pelvis is known to host malignant tumours like chondrosarcoma. On the other hand, chondroma, a benign cartilaginous tumour, is occasional. Chondroma is known to occur in different osseous and extraosseous locations. Extraskeletal/soft-tissue chondroma, though rare, is known for its occurrence in various anatomical locations. Hereby, the authors present a case report of a chondroma in the prepubic space that manifested with urinary symptoms. A 58-year-old female, known to be diabetic, came with acute urinary retention. She experienced a recent onset of burning micturition and abdominal pain. Radiological and cytological findings were non diagnostic. During pelvic exploration, a solid mass of 3×3 cm was noted in the prepubic space without a connection to the urinary bladder or underlying bone. Excisional biopsy of the mass showed benign mature chondrocytes in a background of chondroid matrix, suggesting a benign cartilaginous tumour (chondroma). The patient is now free of her symptoms and is doing well during the follow-up at three months. Authors could not find any case reports of chondroma in the prepubic space in the literature. The present case of extraskeletal chondroma in the prepubic space is an infrequent entity at an unusual site.

Chondromyxoid Fibroma In Skull: An Unusual Site

Chondromyxoid fibroma are the rarest of the benign cartilaginous neoplasms. Mostly it involves metaphysis of long bones, however, rarely can be found in calvarium / skull base. We report a case of a 30 year-old female who was referred to the Radiology Department at Shifa International Hospital, Islamabad with history of progression and gradual loss of vision in unilateral eye. The patient had contrast enhanced MRI of brain which showed a heterogeneously enhancing mass lesion abutting the clivus, CP angle and brain stem with internal areas of necrosis. Differentials of chordoma, meningioma and chondrosarcoma were given. The patient then underwent surgery which confirmed the mass to be chondromyxoid fibroma

A rare location of the rare tumour-chondromyxoid fibroma of calcaneum

Chondromyxoid fibroma (CMF) primary location is the long tubular bones of the lower extremity followed by foot and knee. This benign cartilaginous tumor of bone is the rarest reported neoplasm of cartilaginous origin. This mass can mimic other benign and malignant bone tumors owing to its variable histologic features. We report a case of CMF of the calcaneum with varying presentations. Pathologic examination is difficult but can be used to differentiate this lesion from more serious conditions. A quick and accurate diagnosis of CMF can prevent unnecessary treatment that could be harmful to the patient.

A Case of Chondromyxoid Fibroma Observed in the Nasal Cavity

Chondromyxoid fibroma (CMF) is an extremely rare, benign cartilaginous tumor found in the craniofacial region. It is often misdiagnosed due to its rare occurrence in the nasal and paranasal sinus; moreover, it has similarities with other cartilaginous tumors, showing the same radiologic and histopathologic features. A 62-year-old female consulted our clinic with the chief complaint of a left nasolabial mass of one-month history. The mass was located in the nasal cavity: from there it extended anteriorly to the anterior nasal spine, posteriorly to the end of the hard palate, and laterally to the maxillary sinus. The nasal septum was deviated to the right side due to the mass effect. Complete removal of the mass was conducted via the modified endoscopic Denker’s approach, and the diagnosis of CMF was established. During the 36-month follow-up, no recurrence was observed.

Ollier Disease: A Case Report and Literature Review

Ollier's disease is a non-hereditary disease whose manifestations most often begin in the first decade of life. It is characterized by the growth of benign cartilaginous tumors called enchondromas and is associated with bone deformities and shortenings. We report the case of a 3-year-old patient with Ollier disease, suspected on clinical findings and confirmed by standard radiographs and biopsy. Diagnosis of Ollier disease is based on specific clinical manifestations and radiographic findings. Histological analysis has a limited role and is mainly used in cases of suspected sarcomatous transformation. Treatment of Ollier disease is generally conservative, except in the case of complications. No drug treatment is currently available. Surgery is performed in cases of deformity, pathological fracture, deviation, limb inequality and malignant sarcomatous transformation. The prognosis and course of the disease are influenced by orthopedic complications and the high risk of sarcomatous degeneration.

Prevalence and characteristics of benign cartilaginous tumours of the shoulder joint. An MRI-based study

ObjectiveEnchondromas (EC) of the shoulder joint are benign intraosseous cartilage neoplasms, with atypical cartilaginous tumours (ACT) representing their intermediate counterpart. They are usually found incidentally on clinical imaging performed for other reasons. Thus far the prevalence of ECs of the shoulder has been analysed in only one study reaching a figure of 2.1%.Materials and methodsThe aim of the current study was to validate this number via retrospective analysis of a 45 times larger, uniform cohort consisting of 21.550 patients who had received an MRI of the shoulder at a single radiologic centre over a time span of 13.2 years.ResultsNinety-three of 21.550 patients presented with at least one cartilaginous tumour. Four patients showed two lesions at the same time resulting in a total number of 97 cartilage tumours (89 ECs [91.8%], 8 ACTs [8.2%]). Based on the 93 patients, the overall prevalence was 0.39% for ECs and 0.04% for ACTs. Mean size of the 97 ECs/ACTs was 2.3 ± 1.5 cm; most neoplasms were located in the proximal humerus (96.9%), in the metaphysis (60.8%) and peripherally (56.7%). Of all lesions, 94 tumours (96.9%) were located in the humerus and 3 (3.1%) in the scapula.ConclusionFrequency of EC/ACT of the shoulder joint appears to have been overestimated, with the current study revealing a prevalence of 0.43%.

A rare presentation of osteochondroma at the spinous process of the cervical spine: a case report.

Osteochondroma is a benign cartilaginous tumor that usually arises from the growth plate of the long bones. Its presentation in flat bones is uncommon. Spinal osteochondroma is a rare case, with only a 4% incidence compared to all spinal neoplasms. We report an unusual case of osteochondroma at the spinous process of the C4 spine of a 15-year-old patient with the chief complaint of neck discomfort on movement. The patient has previously been diagnosed and treated for multiple hereditary exostoses of other bones. The patient underwent surgery for the current lesion with complete excision to the base of the lesion. Histopathology revealed a benign osteochondroma with a thin layer of cartilaginous cap. The patient was healed uneventfully and had no recurrence of the lesion on the same site at the 1-year follow-up. Surgical resection remains the mainstay treatment of osteochondroma and has proved to the low recurrence. In the case of cervical osteochondroma, surgery is advisable, particularly in symptomatic patients, to prevent complications.

Prevalence and characteristics of benign cartilaginous tumours of the knee joint as identified on MRI scans

BackgroundEnchondromas (EC) and atypical cartilaginous tumours (ACT) of the knee joint represent benign/intermediate chondromatous neoplasms of the bone that are most commonly discovered incidentally. Based on small to intermediate-sized cohorts, the prevalence of cartilaginous tumours of the knee as visible in MRI is estimated at 0.2–2.9%. This study aimed at verifying/challenging these numbers via retrospective examination of a larger, uniform patient cohort.MethodsBetween 01.01.2007 and 01.03.2020, 44,762 patients had received an MRI of the knee for any indication at a radiologic centre. Of these, 697 patients presented with MRI reports positive for cartilaginous lesions. In a three-step workflow, 46 patients were excluded by a trained co-author, a radiologist and an orthopaedic oncologist, as wrongly being diagnosed for a cartilage tumour.ResultsOf 44,762 patients, 651 presented with at least one EC/ACT indicating a prevalence of 1.45% for benign/intermediate cartilaginous tumours of the knee joint (EC: 1.4%; ACTs: 0.05%). As 21 patients showed 2 chondromatous lesions, altogether 672 tumours (650 ECs [96.7%] and 22 ACTs [3.3%]) could be analysed in terms of tumour characteristics: With a mean size of 1.6 ± 1.1 cm, most lesions were located in the distal femur (72.9%), in the metaphysis of the respective bone (58.9%) and centrally in the medullary canal (57.4%).ConclusionsThis study revealed an overall prevalence of 1.45% for cartilage lesions around the knee joint. Whilst a constant increase in prevalence was found for ECs over 13.2 years, prevalence remained constant for ACTs.

Outcome of surgical interventions for solitary enchondromas of the hand : Controversial issues.

Enchondromas are the most common primary bone tumors of the hand and are benign cartilaginous tumors. This study evaluated the clinical and radiologic results of patients who underwent surgical interventions for isolated hand enchondromas with aminimum follow-up of 1 year and focused on controversial issues. Aretrospective study included 66patients with solitary hand enchondromas with follow-up >12months who underwent surgical interventions between January 2014 and July 2020. Patients with multiple enchondromas, low-grade chondrosarcoma, or who missed follow-up were excluded. All patients underwent thorough curettage with or without filling. Follow-up visits were done at 6 weeks, 3months, 6months, and annually. Demographic characteristics, clinical presentation, surgical details, final histologic examination, rehabilitation program, complications, and recurrences were recorded. The range of movement of the affected hand was compared to the contralateral one. Radiological evaluation of defect filling using the modified Neer classification was done. Of the patients 25were male and 41were female (38right hand affection, 28left hand affection), the mean age was 30.4 ± 11.9years. Indications for surgery were local pain, swelling, and pathological fractures. The mean follow-up period was 28.8 ± 12.9months (range 12-67months). The mean MSTS score was 28.73 ± 1.6 (range 24-30). The middle finger was most frequently affected (18cases, 27.3%) and the proximal phalanx was the most common location (37cases, 56.1%). The mean length of lesions was 18.9 ± 6.67 mm and the mean width was 12.3 ± 4.1 mm. According to the modified Neer classification, 50cases were classified as grade1(healed), 16cases as grade2 (healed with defects), and no case presented as persistent or recurrent lesions. Solitary hand enchondroma can be effectively treated with adequate curettage, with or without autologous bone grafting, with positive functional and radiological outcomes. When compared to grafting from the iliac crest, harvesting bone from the distal radius provides ashorter hospital stay and reduced complication rates.

Benign cartilaginous tumors of the hand, a five-year retrospective study.

Benign and malignant cartilaginous bone tumors of the hand are rare findings, however representing a particular pathology due to the capacity to induce significant functional impairment. Even though a large proportion of tumors of the hand and wrist are benign, these may present destructive characteristics, deforming adjacent structures until compromising function. The most appropriate surgical approach for most benign tumors is intralesional lesion resection. Malignant tumors often require wide excision, up to segment amputation to obtain tumor control. A five-year retrospective study was performed on patients admitted in our Clinic with benign cartilaginous tumors of the hand, in which 15 patients were admitted within this period, 10 presenting with enchondroma, four presenting with osteochondroma, and lastly one with chondromatosis. After clinical and imaging evaluation, all the aforementioned tumors were surgically removed. Definitive diagnosis for all bone tumors, either benign or malignant, was established by tissue biopsy and histopathological examination, dictating therapeutic strategy.

Subungual Osteochondromas of the Toe: Two Case Reports for Diagnosis and Treatment.

Benign cartilaginous tumors, known as chondrogenic tumors, show cartilage components in the microscopic diagnosis. We present two clinical cases with cartilaginous tumors of the toes showing distinctive clinical manifestations. Two juvenile patients visited our outpatient clinic due to tumors with toenail deformities. A 10-year-old girl presented with a palpable mass with a nail deformity on the left third toe. The initial pathology report was soft tissue chondroma until complete resection. Another 15-year-old male patient visited the dermatology department with a toenail deformity and underwent a punch biopsy. The pathology report was fibrosis with myxoid degeneration. Excisional biopsies were performed for both patients. In the operative field, we observed exophytic tumors connected to the distal phalangeal bones. The final pathology reports were subungual osteochondroma on both patients. The specimen exhibited mature bone trabeculae with a focal cartilaginous cap. Benign cartilaginous tumors have a slow, progressive course and do not show significant symptoms. However, tumors in subungual areas are accompanied by toenail deformities and they can cause pain. Their clinical characteristics lead to a delayed diagnosis. Surgeons can be confused between soft tissue and chondrogenic tumors. When they conduct physical examinations, these categories should be considered in the differential diagnosis.

Treatment of a pediatric pathological fracture of the proximal phalanx due to enchondroma using plate and screw: a case report

Introduction: The most typical primary bone tumour of the hand is an enchondroma. A pathologic fracture is a common presentation of this benign cartilaginous tumour. It is common for asymptomatic solitary enchondromas to be discovered during regular x-rays. However, in nearly half of the cases, acute pain, swelling, and deformity indicate a pathologic fracture. For symptomatic lesions, surgical therapy with curettage and bone graft is the norm. Case Presentation: A 15-year-old girl with chief complain of pain on her right little finger and history of trauma after playing basketball 5 days before admission. At inspection, the fifth finger was painful during movement, with a discrete residual hematoma around the proximal phalanx. The x-rays showed a minimally displaced fracture at the shaft of the proximal phalanx of the 5th finger of the right hand, and lytic lesion occupying the whole middle third of the phalanx. We assessed the patient with pathological fracture suggestive of an enchondroma. A 1-stage surgical treatment was decided: a curettage followed by open reduction internal fixation using miniplate titanium matrix, and bone graft to fill the defect. Postoperative x-rays showed complete healing of the fracture at 4 weeks. Conclusion: Enchondromas pose the risk of pathological fracture, recurrence and, to a lesser extent, malign transformation. We describe an option of surgical management which is simple and results in good and excellent short-term results. Successful treatment of these lesions is dependent on the complete removal of the tumour bed followed by stabilization.

Periarticular soft tissue chondroma around the knee and shoulder joint – report of 2 cases

Soft tissue chondroma is a rare benign cartilaginous tumor with a typical localization in the hands and feet. The periarticular development of the tumor, combined with its non-specific radiographic manifestation, can lead to serious diagnostic difficulties. We present 2 clinical cases of periarticular soft tissue chondroma, diagnosed and treated in our clinic within the last 2 months.

Chondroblastoma of Thoracic Vertebrae: a Case Report and Review of the Literature.

Chondroblastoma is a rare benign cartilaginous bone tumor typically seen at the epiphysis of long axial bones. In this regard, there are rare findings about spinal chondroblastomas. We report a 29-year-old man with T1 vertebral chondroblastoma misdiagnosed with a traumatic fracture following an accident. The patient was admitted to our clinic with a chief complaint of axial back pain and kyphosis following posterior spinal fixation. We report his clinical and imaging data before his past operation and at this admission. Our patient underwent a two-stage operation. In the first stage, posterior spinal reconstruction and kyphosis correction was performed. In the second stage, mass resection was performed anteriorly in the T1 vertebral body as much as possible. The results confirmed the chondroblastoma diagnosis histologically. Our patient remained symptom-free with no growth in tumor remnant during 6months follow-up. Although vertebral chondroblastoma is a sporadic tumor, it should be considered in the differential diagnosis when facing a vertebral infiltrative osteolytic mass, even when mimicking a traumatic fracture after the accident. In addition, histological confirmation is necessary under such conditions. We also reviewed the literature's clinical presentations, imaging findings, and treatments of 34 case reports with vertebral chondroblastoma.

Case report on the approach to surgical management for a large chest wall chondrosarcoma.

Introduction and importancePrimary chest wall tumours are uncommon. Challenges arise in management due to delays in diagnosis and timing of treatment. The mainstay of treatment remains complete resection as adjuvant therapy has a limited role. Choice of repair and materials for chest wall reconstruction vary depending on the size and location of the defect. There are no published reports on management of chondrosarcomas arising from the rib in the Caribbean.Case presentationA 61-year-old female was referred from a rural clinic with a 10-month history of a progressively enlarging, painless right anterior chest wall lump. Computed Tomography (CT) shows features of a conventional chondrosarcoma arising from the ribs and including surrounding soft tissue, muscle and pleura. Surgical specimen confirms a grade 2 chondrosarcoma.Clinical discussionThis case illustrates the importance of a multidisciplinary team discussion. Differentiating a chondrosarcoma from a benign cartilaginous tumour requires consideration of clinical features, radiological characteristics and histological features. Chest wall reconstruction aims to preserve functional and structural integrity with adequate soft tissue coverage. The patient had good cosmesis as well as pulmonary function postoperatively and no recurrence at the 3 year follow up.ConclusionThis case highlights that the MDT is essential to a good outcome for the surgical management of a chest wall chondrosarcoma. Wide en-bloc resection followed by reconstruction using polypropylene mesh and a latissimus dorsi flap as a one-stage procedure can be successful.

두개저에 발생한 연골점액유사섬유종 1예

Chondromyxoid fibroma (CMF) is a rare benign cartilaginous tumor that usually arises from metaphysis of the long bone of the lower extremities. Only 1%-5% of CMF occurs in the head and neck and few cases of sinonasal CMF have been reported. Because sinonasal CMF and chondrosarcoma have common radiologic and pathologic feature, it is difficult to distinguish from chondrosarcoma. However fast and accurate diagnosis is important because mortality of chondrosarcoma is nearly 50%. This report describes one case of skullbase CMF attached to posterior septum and rostrum of sphenoid bone, mimicking chondrosarcoma in radiologic findings. We tried to share diagnostic and therapeutic process of skullbase CMF which occurred in unusual location, and elaborate differentiating points of cartilage neoplasms in the nasal cavity which have completely different prognosis.