Chondroblastoma

Chondroid tumors comprise a heterogenous group of benign to overt malignant neoplasms, which may be difficult to differentiate from one another by histological examination. A group of 43 such tumors was stained with nine relevant antibodies in an attempt to find consistent marker profile(s) for the different subgroups. Archival material from three extraskeletal myxoid chondrosarcomas, five chordomas, five chondromyxoid fibromas, five chondroblastomas and 25 chondrosarcomas was stained with antibodies against osteonectin, bcl-2, cox-2, actin, calponin, D2-40 (podoplanin), mdm-2, CD117 (c-kit) and YKL-40. All 25 chondrosarcomas showed a positive staining reaction for D2-40, none for actin and CD117, and a partial reactivity for bcl-2 (36%). Chondroblastomas (5/5) and chondromyxoid fibromas (2/5) were the only tumors with a positive reaction for actin, and all chondroblastomas (n=5) and extraskeletal myxoid chondrosarcomas (n=3) were positive for bcl-2. In contrast to all other tumors, two of three extraskeletal myxoid chondrosarcomas were also positive for CD17 and negative for osteonectin, cox-2, mdm-2 and actin. All five chordomas were negative for D2-40 and positive for mdm-2 and YKL-40. The diagnosis of chondrosarcoma may be aided by its positivity for D2-40 and YKL-40 and its lack of reactivity for actin and CD117. This should be seen in the light of no reaction for D2-40 in chordomas and a corresponding lack of reaction for osteonectin, cox-2, mdm-2 and actin in extraskeletal myxoid chondrosarcomas. A convincing immunoreactivity for calponin and/or actin in chondromyxoid fibromas and chondroblastomas may also be helpful in differentiating these tumors from chondrosarcomas.

BackgroundSeveral different strategies have been reported for the treatment of chondromyxoid fibromas, all with variable outcomes and high recurrence rates.MethodsWe report on 22 consecutive cases of chondromyxoid fibromas treated by intralesional curettage, four of which had adjuvant cementation at our institution between 2003 and 2010. We assessed the functional outcome using the Musculoskeletal Tumour Society (MSTS) scoring system.ResultsNine males and 16 females with a mean age of 36.5 years (range 11 to 73) and a mean follow-up of 60.7 months were included in the study. Local recurrence occurred in two patients (9%) within the first 2 years following the index procedure. This was treated by re-curettage only of the residual defect. Two postoperative complications occurred: a superficial wound infection in one patient and a transient deep peroneal nerve neurapraxia in the other. The mean postoperative MSTS score was 96.7%.ConclusionsIntralesional curettage and cementation is as an effective treatment strategy for chondromyxoid fibromas, providing satisfactory functional results with a low recurrence rate. Careful case selection with stringent clinical and radiographic follow-up is recommended.

BackgroundChondroblastoma (CBL) is a rare benign chondroid producing bone tumor that typically occurs in epiphysis or apophysis of growing children and young adults. Intralesional curettage is the treatment of choice, while resection is required in selected cases, even though the use of minimally invasive ablation techniques has been advocated. Authors reviewed a series of 75 CBLs with the aim of assess risk factors for local recurrence, the growth plate related complications after epiphyseal curettage and the risk of arthritis of the adjacent joint after epiphyseal curettage.MethodsWe retrospectively review 69 CBLs treated with intralesional curettage and 6 treated with resection from March 1995 to February 2020. The median age was 18.8 years (7 to 42, median 16). The site was proximal humerus in 18 cases, proximal tibia in 17, distal femur in 16, talus in 6, femur's head in 4, calcaneus in 3, acromion in 3, trochanteric region in 2, distal tibia in 2, patella in 2, supracetabular region in 1 and distal humerus in 1 patient.ResultsMean follow-up was 124.2 months (24 to 322, median 116). Among patients treated with curettage, 7.3% of local recurrence was observed and 12 (17.4%) patients developed osteoarthritis of the adjacent joint. Five patients (7.3%) presented limb length discrepancy of the operated limb ranging from 0.5 to 2 cm. Recurrence free survival rate was 94.2% at 5 and 91.6% at 10 years. A mean Musculoskeletal Tumor Society (MSTS) of 29.3 points (20 to 30, median 30) was observed.ConclusionMore than 90% of CBLs were successfully treated with aggressive curettage but segmental resection is required in selected cases. In a relatively small proportion of cases long term complications can occur due to growth plate damage or osteoarthritis.Trial registrationRetrospectively registered.

ObjectivesThis study aimed to evaluate the 7-year outcomes of proximal humeral chondroblastoma treated with intralesional curettage, electrocauterization of the cavity and bone grafting in pediatric patients.MethodsA total of 17 patients diagnosed with proximal humeral chondroblastoma who underwent surgical treatment consisting of intralesional curettage, cavity electrocauterization, and bone grafting at our center between January 1, 2008, and January 1, 2018, were retrospectively enrolled. All patients received postoperative splint immobilization for four weeks and were followed up for a minimum of seven years. Tumor recurrence was evaluated based on clinical manifestations and radiographic X-ray examination. Clinical outcomes included functional performance assessed using the Musculoskeletal Tumor Society (MSTS) score and the Quick Disabilities of the Arm, Shoulder and Hand (Quick DASH) scale, as well as postoperative complications.ResultsIn total, 17 patients with proximal humeral chondroblastoma were enrolled in our study, including 10 males and 7 females, with a mean age of 10.9 ± 1.8 years old (range from 8 to 14 years). Among these 17 cases, there were 6 cases with lesions extending through the epiphyseal plate, and 11 cases with lesions located inside the epiphysis. During follow-up, 1 patient suffered reoperation due to tumor recurrence. Shortening of the affected upper limb occurred in 9 patients (52.9%), which was significantly associated with a young age(P = 0.012). The mean shortening was 1.2 ± 0.9 cm compared with the contralateral limb. The overall mean postoperative MSTS was 27.5 ± 1.4 points, with no significant difference between observed the limb shortening group (27.3 ± 1.4) and the non-shortening group (27.8 ± 1.4,P = 0.550). The overall Quick DASH score averaged 4.8 ± 3.9 (0-15.9), and no statistically significant difference was detected between the shortening group (5.3 ± 4.5) and the non-shortening group (4.3 ± 2.8; P = 0.452).ConclusionsIntralesional curettage, cavity electrocauterization and bone grafting is an optional treatment for children with proximal humeral chondroblastoma but still has a risk of recurrence. Shortening of the affected upper limb is a common complication, which is possibly associated with young age but has no impact on the final functional outcomes.Level of evidenceLevel IV, retrospective case series.