Epiphyses Of Long Bones Research Articles

Chondroblastoma of Bone in Children: A Study of 3 Cases

Chondroblastoma is a benign bone tumor arising most often in the epiphyses of long bones. Nearly 90% occurred in patients between the ages of 5 and 25 years, but tumors were found in later adulthood and even in old age. A few chondroblastomas were predominantly cystic, and some contained zones that were indistinguishable microscopically from aneurysmal bone cysts. Conservative surgical removal, nearly always effective, should be thorough so as to minimize the risk of the occasional troublesome recurrence. Late sarcomatous change has been reported in a few cases whether radiation therapy was employed or not. We report a series of 3 boys with chondroblastoma, with an average age of 12 years. All our patients underwent biopsy for confirmation and then surgical treatment consisting of curettage of the lesion followed by bone autograft filling. The aim is to discuss the anatomoclinical and evolutionary aspects of this rare tumour, to evaluate the results of surgical treatment and to identify the factors influencing the rate of recurrence after treatment.

On the question of diagnosis and treatment of osteochondritis dissecans of the knee joint

About 25% of the adult population suffers from pain in the knee joint, the number of requests for medical help in the world reaches 4 million per year. The causes of chronic pain, in addition to inflammatory arthropathy, pathologies of the capsular-ligamentous apparatus and degenerative-dystrophic changes, can be pathologies of hyaline cartilage and subchondral bones – osteochondropathy. Among osteochondropathy of the knee joint, osteochondritis dissecans is of greatest importance in clinical practice. Although osteochondritis dissecans has been known for a century and a half, its exact cause remains unclear. Osteochondritis dissecans is a form of osteonecrosis that affects the subchondral epiphyses of long bones. In 75%, the knee is affected – the condyles (Konig's disease): in 64% of cases – the medial condyle, in 32% – the lateral, less often the pathology is localized in the patella (Leven's disease), the femoral trochlea and the tibial plateau. Osteochondritis dissecans is typically unilateral, but 7% to 25% of patients have bilateral involvement. The gold standard for staging osteochondritis, assessing the stability of the lesion and determining treatment tactics is arthroscopy. It is recommended to begin radiological diagnosis of osteochondritis dissecans with plain radiographs to localize the lesion. The prognosis for osteochondritis dissecans of the knee joint depends on the patient’s age, location and stage of the disease. In general, the prognosis for children is more favorable than for adults.

Chondroblastoma of the femoral head-surgical management, outcomes and clinical perspectives: a case report

Chondroblastoma is a rare benign tumor predominantly affecting the epiphyses of long bones, often presenting in the second decade of life. It is known for its potential to recur and cause joint complications despite its benign histology. This report details the case of a 12-year-old boy diagnosed with chondroblastoma of the femoral head, who underwent surgical treatment involving curettage and the use of synthetic hydroxyapatite (HA) bone substitutes. The patient presented with groin pain and limping, with imaging studies revealing an osteolytic lesion in the femoral head. A core needle biopsy confirmed the diagnosis. To manage the lesion, an anterolateral approach was used to perform extensive curettage, and the defect was filled with HA blocks. Postoperatively, the patient was managed with gradual weight-bearing and regular follow-ups. At five years, the patient exhibited normal hip function with no evidence of tumor recurrence, collapse of the femoral head, or osteoarthritis. This case demonstrates that the use of synthetic HA as a bone substitute in the treatment of chondroblastoma can effectively preserve joint integrity and function, providing a viable alternative to traditional grafting methods. The approach was successful in maintaining articular congruence and preventing complications, highlighting the potential benefits of synthetic materials in managing subchondral bone lesions.

Malignant chondroblastoma: NCDB analysis of demographic and socioeconomic factors.

e23500 Background: Malignant chondroblastomas are atypical forms of the rare benign chondroid-producing neoplasm known as a chondroblastoma. Chondroblastomas account for less than 1% of all bone tumors and arise in the epiphyses of long bones in young adults. Unlike conventional chondroblastoma, the majority of patients diagnosed with malignant chondroblastomas tend to be older and tumors present at atypical body sites. Therefore investigating trends in diagnosis may yield important insight into its epidemiology. The National Cancer Database (NCDB) was explored to analyze the demographic factors in patients diagnosed with malignant chondroblastoma. Methods: A retrospective cohort analysis utilizing the 2004–2020 National Cancer Database (NCDB) included 67 patients with a histologically-confirmed diagnosis of malignant chondroblastoma (ICD-O-3 Code 9230). Demographic factors (age, sex, race, Hispanic status, insurance status, facility type, distance from facility, and Charlson-Deyo score) were analyzed by descriptive statistics, and incidence trends were interpreted using regression analysis. Results: Between 2004 – 2020, the NCDB identified 67 patients with a confirmed malignant chondroblastoma diagnosis. There was a slightly increasing incidence of patients diagnosed per year (R² = 0.471). The most common primary site was the frontal lobe (60%). Males and females were affected equally (49% and 51%, respectively) with a mean age at diagnosis of 46.5 years (SD = 15.3, Range = 21 – 74 years). The majority of patients were White (90%), non-Hispanic (87%), lived in metropolitan areas (82%), and were privately insured (63%). Treatment facilities primarily consisted of academic programs (48%). Patients lived an average of 27 miles away from the facility (SD = 49, Range = 356.3 miles). Most individuals (76%) had Charlson-Deyo comorbidity scores of 0. Primary treatment methods involved administering radiation therapy (52%). 60 patients (90%) underwent surgical intervention. For valid data, post-surgery survival rates were 100% after 30 days and 93% after 90 days. About half of the patients (57%) survived 5 years after their initial diagnosis. Conclusions: Malignant chondroblastoma is locally aggressive and has metastatic potential. Surgical intervention was the most common treatment (90%), which is consistent with the previous literature. In this study, AJCC staging was not applicable to almost all of the patients (99%). To the best of our knowledge, this is the first NCDB analysis of malignant chondroblastoma patient demographic and socioeconomic factors which addresses a significant gap in knowledge. Most patients were White, non-Hispanic, lived in metropolitan areas and were privately insured. Additional investigation is required to enhance our understanding of how demographic and socioeconomic factors influence the diagnosis, staging, and treatment of individuals with malignant chondroblastoma.

Giant Cell Tumor of the Temporal Bone with Direct Invasion into the Middle Ear and Skull Base: A Case Report.

Giant cell tumor (GCT) of bone is a rare, benign, osteolytic neoplasm that most commonly occurs in early adulthood and often involves the long bones of the body. Although GCT largely affects the epiphyses of long bones, several reports of GCT involvement of the cranial and facial bones exist in the literature. In addition to reviewing other reported cases of GCT of the lateral skull base in the literature, the authors report here on the clinical presentation, radiographic findings, and management of a patient found to have a GCT of the squamous part of temporal bone invading the middle ear and infratemporal fossae, which was treated by en bloc resection of the lateral skull base.

MULTILAYER DUAL-POROSITY 3D-PRINTED SCAFFOLDS TO RECREATE THE ANISOTROPIC MICROENVIRONMENT OF THE CARTILAGE

Articular cartilage is a multi-zonal tissue that coats the epiphysis of long bones and avoids its wear during motion. An unusual friction could micro-fracture this connective membrane and progress into an osteochondral defect (OD), where the affected cartilage suffers inflammation, fibrillation, and forfeiture of its anisotropic structure.Clinical treatment for ODs has been focused on micro-fracture techniques, where the defect area is removed and small incisions are performed in the subchondral bone, which allows the exudation of mesenchymal stem cells (hMSCs) to the abraded zone. However, hMSCs represent less than 0.01% of the total cell population and are not able to self-organise coherently, so the treatments fail in the long term. To select, support and steer hMSCs from the bone marrow into a specific differentiation stage, and recreate the cartilage anisotropic microenvironment, multilayer dual-porosity 3D-printed scaffolds were developed.Dual-porosity scaffolds were printed using prepared inks, containing specific ratios of poly-(d,l)lactide-co-caprolactone copolymer and gelatine microspheres of different diameters, which acted as sacrificial micro-pore templates and were leached after printing. The cell adhesion capability was investigated showing an increased cell number in dual-porosity scaffolds as compared to non-porous ones. To mimic the stiffness of the three cartilage zones, several patterns were designed, printed, and checked by dynamic-mechanical analysis under compression at 37 ºC. Three patterns with specific formulations were chosen as candidates to recreate the mechanical properties of the cartilage layers. Differentiation studies in the selected scaffolds showed the formation of mature cartilage by gene expression, protein deposition and biomolecular analysis. Given the obtained results, designed scaffolds were able to guide hMSC behaviour.In conclusion, biocompatible, multilayer and dual-porosity scaffolds with cell entrapment capability were manufactured. These anisotropic scaffolds were able to recreate the physical microenvironment of the natural cartilage, which in turn stimulated cell differentiation and the formation of mature cartilage.Acknowledgments: This work was supported by the EMAKIKER grant.

Ayurvedic Management of Avascular Necrosis of head of Femur: A Case Report

Avascular Necrosis (AVN) is a pathological condition characterised by a reduction in the blood supply to the subchondral bone, leading to the degenerative condition of the bone, marked by the death of cellular components of the bone. It is also known as osteonecrosis. The epiphysis of long bones at weight-bearing joints is typically affected. All of these conditions have a poor prognosis. In Ayurveda, it corresponds to Asthivahastrotodushtivikara (musculoskeletal disorder) as there is kshaya (necrosis) of asthi (bone) and Majja (bone marrow) dhatu (major structural components of the body). In modern medicine, AVN is managed by the use of corticosteroids and many surgical procedures such as drilling, insertion of prosthetics, or bone grafts. Therefore, Ayurveda provides a conservative line of treatment based on the principle of Asthi-majjagatkashaya (decalcification of bone) caused by abhighatajanyavataprakopa (trauma). A case of AVN with the right femoral head was treated with shaman (oral medications), Sodhana (bio-purification), and bruhmana (rejuvenation) procedures. The therapy provided significant improvements in pain and range of movement of the hip joint, based on the patient’s signs and symptoms before and after treatment. Conservative treatment can give outstanding results, improve the quality of life, halt disease progression, and help manage AVN by tissue regeneration without harmful effects.

Unusual sites of giant cell tumor of bone

Giant cell tumor (GCT), a benign but regionally aggressive and destructive tumor, is most frequently found at the epiphysis of long bones. The distal femur, proximal tibia, and distal radius are the three most typical locations. The pelvis, proximal femur, proximal humerus, distal tibia, and sacrum are uncommon locations. About 18– 23% of benign bone neoplasms are GCT. They often manifest in early adulthood because they happen after the growth plate has closed, with the majority of instances being documented between the ages of 20 and 50. GCT is a primarily benign bone tumor that exhibits local recurrence, has metastasis potential, and may show malignant change. Depending on the site, complications such as hemorrhage or pathological fracture, GCTs can have varied appearances. Rarely, ribs, vertebral bodies, and bones of the hand and foot may be affected. Other than the long bones, the radiographic characteristics of GCT are non-specific and resemble those of other osteolytic diseases. This review shows GCT imaging features from both typical and unusual locales.

Giant cell tumour of proximal radius – A rare case report of treatment, with resection & custom- made radial head prosthesis

Giant cell tumour is locally aggressive benign lesion arising from epiphysis of long bones, common in 2 and 3 decade of life. The most commonest sites being, lower end radius, upper end tibia, and lower end femur. Treatment depends upon stage of disease Presenting here with a case of 36-yrs old male presented with pain and swelling at rt elbow. Patient having GCT arising from upper end radius, was treated with excision of lesion and reconstruction of 4-cm defect with custom-made radial head prosthesis. A literature review of GCT upper end radius is very scanty, hardly any reports available, however for a lesion involving head and around 3-cm of neck with pathological #, treatment remains excision of tumour and reconstruction with prosthetic radial head.

A CLINICOPATHOLOGICAL STUDY OF LESIONS OF BONE

Objective: The objective is to study the clinico-pathological diagnosis of bone lesions. Methods: The present study was a prospective and observational (non-interventional) type of study. A total of 100 patients from March 2012 to April 2013 were recruited. All excised bone specimens received in the Department of Pathology, SBKS MI and RC, Pipariya, constituted the study material. The specimens were subjected to a detailed histopathological examination. In each case, the pathological reaction pattern was studied carefully and documented. Results: The total number of cases studied was one hundred, of which 63 were males and 37 were females in the age group of 3 years–65 years. The most common presenting symptoms were pain and swelling in all bone lesions. Out of 100 cases, non-neoplastic cases were 54% and neoplastic cases were 46%. Among 46% of neoplastic lesions, we found that 30% were benign and 16% were malignant. Among non-neoplastic lesions, 14% were tumor-like lesions, 13% were non-specific osteomyelitis, 12% were tuberculosis inflammation, and 15% were avascular necrosis. The most common benign lesion was a giant cell tumor (17%). The most common malignant lesion was osteosarcoma (6%). The most common tumor-like lesion was fibrous dysplasia (9%). The majority of bone tumors were located in the epiphysis of long bones. Conclusion: Light microscopy or histopathological examination is the gold standard in the diagnosis of bone lesions and is invariably accurate when correlated with clinico-radiological features.

Giant cell tumor of the clivus misdiagnosed as calcifying fibrous tumor

Abstract Introduction/Objective Giant cell tumors of bone (GCTs) are generally benign, locally aggressive lesions accounting for approximately 4% of primary bone tumors. GCTs of the skull are rare and constitute <1% of all reported GCTs as they typically occur in the epiphysis of long bones. Specifically, in the clivus location, these tumors are exceedingly rare with fewer than 10 articles in English literature. The purpose of this report is to describe a case of GCT in this unusual location that was misdiagnosed as giant cell reparative granuloma on biopsy and subsequently calcifying fibrous tumor on resection. Methods/Case Report A 34-year-old male presented with history of headache, visual disturbance, epistaxis, and nausea. MRI demonstrated a large soft tissue mass eroding the clivus. A biopsy was interpreted at an outside institution as giant cell reparative granuloma. The patient was treated with denosumab and subsequently underwent resection of the mass due to worsening symptoms. Post-treatment pathology was interpreted as calcifying fibrous tumor. The patient presented to our institution for further management and outside pathology was reviewed. Histologically, the initial tumor was composed of a bland spindle cell proliferation with admixed osteoclast-type giant cells. In this location, the differential diagnosis includes Brown tumor, giant cell reparative granuloma, and, rarely, GCT. HG34W immunostain was positive in the tumor cells confirming the diagnosis of GCT. The post-therapy specimen showed abundant woven bone formation and a lack of giant cells. Post-denosumab GCT are known to show these features. Follow up imaging showed a slow growing moderately enhancing mass at the resection site. Patient is alive with disease 36 months after initial diagnosis. Results (if a Case Study enter NA) NA Conclusion With rare exceptions, bone tumors frequently follow generalized patterns of involvement. Pathologists need to be aware of these exceptions. Appropriate panel of immunohistochemical stains help clinching the right diagnosis, especially in unusual clinical settings.

Influence of growth plate morphology on bone trabecular groups, a framework computational approach.

The morpholog of the growth plate undergoes various transformations during each stage of development, affecting its shape, width, density, and other characteristics. This significantly impacts the distribution of stress in the epiphysis of long bones. To the best of our knowledge, this study represents the first attempt to examine the relationship between growth plate morphology and trabecular bone patterns. Our analysis was conducted using a finite element model and we analyzed two medical cases: trabecular patterns in the femoral epiphysis and the calcaneus bone. Our findings revealed a correlation between the formation of main trabecular groups and growth plate morphology. We investigated how an increased density in high-shear stress zones, which are typically located at the periphery of the growth plate, may occur to prevent failure by shear. This is evident in cases such as slipped capital femoral epiphysis or sever's disease, different simulations align with the clinical data available in the literature from a qualitative and quantitative point of view. Our results suggest that further research should focus on understanding the impact of growth plate morphology on bone remodeling and exploring potential preventive measures for different bone disorders.

Giant Cell Tumor of the Sphenoid with Clivus Extension in a Pediatric Patient

We present a case of giant cell tumor of the clivus in a pediatric patient. The case is very interesting because this benign tumor is generally located in the epiphysis of long bones, and only 1% is found in the cranial vault and the base of skull. The sphenoid bone and the petrous portion of the temporal bone are the most commonly affected cranial locations, probably due to their endochondral ossification.

Osteopoikilosis: a rare case with interesting imaging

Background: Osteopoikilosis (OPK) is a rare osteosclerotic dysplasia. It is usually asymptomatic and diagnosis is made incidentally by radiographic findings. It has a unique radiographic presentation with multiple small, well-defined, circular, or ovoid radiodensities which are distributed symmetrically in the epiphysis and metaphysis of long bones. Aim of the work: In this case report, a 38-year-old man with mild joint discomfort was diagnosed with OPK according to his radiographic findings and literature review. Conclusion: It is important to diagnose OPK and to distinguish it from other medical conditions to calm the patient and to reduce unnecessary investigation.

Chondroblastoma- a rare sinonasal tumor: case report and review of literature

Chondroblastoma is a benign primary bone tumor that typically develops in the epiphyses of long bones. Chondroblastoma of the craniofacial skeleton is extremely rare, with most cases occurring in the squamosal portion of the temporal bone. In this report, we describe a case of chondroblastoma of the nasal cavity presenting with a left sided nasal mass which was excised with open approach. We review the literature on craniofacial chondroblastomas with particular emphasis on sinonasal lesions.

Chondroblastoma: Cytomorphologic Analysis of 10 Cases with Review of the Literature

Introduction: Chondroblastoma (CB) is a rare, benign cartilage-producing tumor, typically affecting the epiphysis of long bones in skeletally immature individuals. There have been only limited case reports describing the cytomorphologic features of this tumor, and thus the cytopathologic diagnostic criteria are controversial. Herein, we report the cytologic findings of 10 CB cases, discuss the diagnostic criteria and critical differential diagnosis, along with a comprehensive review of the literature. Methods: We performed a retrospective search of our cytopathology and surgical pathology databases for cases diagnosed as CB that had corresponding cytology specimens from four large medical institutions. All available cytopathology specimens were retrieved and reviewed. Clinicopathologic and radiologic data were recorded. Results: Ten cases were retrieved from 8 patients aged 15–42 years (mean, 24 years), five of whom were males. Eight cases represented primary tumors while 2 cases were recurrences. Three cases occurred in the femur, two cases occurred in the humerus, while 1 case occurred in each of the glenoid, talus, and proximal phalanx of the 3rd toe. The cytologic diagnosis of CB was achieved in 7 cases. The neoplastic mononuclear cells were present in all cases and their cytologic features were similar. These cells displayed round to oval eccentric nuclei, evenly distributed chromatin, and inconspicuous nucleoli; few of which had nuclear indentations. Multinucleated giant cells were present in 9 cases (90%). Fragments of chondromyxoid matrix were present in 4 cases on cytologic preparations (40%). Cell blocks were available in 8 cases. Mononuclear and multinucleated giant cells were present in all adequate cell blocks and their cytologic features were identical to those seen in the smears. The chondroid matrix was present in only three of the adequate cell blocks (43%). Conclusion: We concluded that with the appropriate clinical and radiologic setting, the diagnosis of CB can be achieved on cytology if characteristic chondroblasts are present. The presence of chondromyxoid matrix is a helpful clue but is not necessary for the diagnosis. As in surgical pathology, cytologic evaluation of bone tumors should be interpreted in conjunction with clinical and radiologic findings.

Chondroblastoma in a Distal Phalanx of the Great Toe – A Rare Case Report

Chondroblastoma is a rare benign appearing lesion arising in the epiphysis of long bones in skeletally immature individuals. It is a cartilage-producing neoplasm constituting < 1% of all bone tumors. A 16 years old girl presented to orthopedic OPD of tertiary care hospital with swelling of her left great toe for 3 years. The swelling was insidious at onset and gradually progressed to the present size of 3.5x2.5x2 cm. Radiographic examination shows an osteolytic lesion and coarse trabeculation

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.

Radio Frequency Ablation for the Treatment of Appendicular Skeleton Chondroblastoma: Is It an Excellent Alternative? Systematic Review and Meta-Analysis.

Radio frequency ablation (RFA) is a minimally invasive technique that has become recognized in clinical practice for treating chondroblastoma, although curettage with bone graft is the standard treatment. Chondroblastoma is a locally aggressive cartilaginous bone tumor, representing nearly 5% of benign bone tumors. Chondroblastoma shows a preference toward the epiphysis or apophysis of long bones, but it was also reported in vertebrae and flat bones. The management of chondroblastoma could be challenging due to the risk to injure the epiphyseal plate or difficult location. The aim of this study was to determine if RFA is a suitable alternative to curettage with bone graft for the treatment of chondroblastoma. Moreover, there will be an evaluation of RFA's effectiveness in terms of symptoms relief; we also define the proper size of the lesion to be treated with RFA, and discuss the complications after the procedure, including the recurrence rate. Furthermore, we review the best imaging method to evaluate the therapeutic response of RFA and for the detection of residual disease early after the ablation. A comprehensive PubMed and Google Scholar search followed the Preferred Reporting Items for Systematic Review and Meta-Analysis 2020 checklist guidelines. Ninety-seven patients were identified after reviewing the available full texts of nine articles. The results of the current review provide further evidence to support the use of RFA as an alternative option to surgery.

Giant cell tumor of bone: Epidemiological profile (fifth version) – A study protocol

The giant cell tumor of bone (GCTB) represents approximately 5% of primary bone tumors, and more than half of cases affect individuals between 20 and 50 years of age. Despite being a benign neoplasm, 3 to 5% of cases may show pulmonary metastases, besides it has high potential for bone destruction at the main site of the lesion, often in the epiphyses of long bones, which may lead to serious functional problems in affected patients. Multidisciplinary treatment of GCTB has been a cause for discussion in the last decade due to the discovery of drugs such as denosumab that prevent tumor progression and may be useful in cases of patients with local recurrences and unresectable tumors. The therapeutic basis of GCTB remains the isolated surgical treatment by intralesional (with adjuvants), marginal or wide resection. Intralesional treatment presents higher rates of recurrence, however it preserves the adjacent joint function and much of the individual bone stock. Resection with wide margins presents lower recurrence rates but has shown worse functional results and frequent complications in bone reconstructions. Current knowledge of GCTB surgical outcomes has been based on major world series - there is a lack of Brazilian epidemiological and surgical data on this specific type of neoplasm, except for a few series of cases. The primary objective of this paper is to identify the epidemiological profile of GCTB; the secondary objectives are to describe the surgical aspects in the main diagnostic centers and treatment of bone tumors, to analyze the clinical and surgical aspects of patients with GCTB of wrist and hand, and to analyze the clinical and surgical aspects of patients with knee GCTB. These findings may help in the maintenance or change of national guidelines for the treatment of GCTB. This study protocol was submitted to ethical assessment under the CAAE (Ethical Appreciation Presentation Certificate) registry No. 94280918.0.0000.5327 (5th version), evaluated through the substantiated opinion No. 4.770.705, and approved by the Institutional Research Ethics Committee on June 12, 2022.