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  • Primitive cells from physis compose the tumor


  • Benign lesion occurring in characteristic locations, histologically confused with malignant lesions
  • (Codman's tumor when in the proximal humerus)


  • <1% of all bone tumors; 70% present in 2nd decade (22 ± 9.9 yrs average age reported)
  • Pain, limitation of motion of the adjacent joint
  • M:F = 2-3:1
  • ~1/6 occur in each of these locations: proximal humerus, proximal tibia, distal femur, proximal femur
  • Other sites
    • Foot
    • scapula, patella, distal radius, distal humerus, proximal fibula
  • Cauda equina syndrome in a lumbar location has been described
  • Rare to have 2 separate or adjacent bones involved ± synchronously
  • Occasionally will metastasize
  • ESR may be ?
  • Oncogenous osteomalacia has been reported


  • 40% lucent eccentric epiphyseal(secondary ossification center) lesion only; periostitis (due to inflammatory reaction to chondroblastoma rather than mechanical stress across a weakened epiphysis) present in 47-60%
    • Rare non-epiphyseal locations (metadiaphyseal) have been described
  • Geographic borders, 70% with physis still open (rarely apophyseal in location)
  • Unlike GCT, >½ have a sclerotic rim
  • Calcific punctate densities best seen on CT when minute (can be seen on plain x-ray)
  • Cortical margin intact, 20% with disruption of subchondral bone
  • Lesion rarely can be extremely large or have a bubbly expanded appearance (esp. if recurrent)
  • CT depicts matrix mineralization, marginal sclerosis, cortical erosion and any periosteal reaction soft tissue extension, joint effusion, and fluid levels
  • MRI useful especially if extension beyond the physis, will reveal associated synovitis, surrounding edema, joint effusion, and occassionally cystic regions
  • T2-weighted images: low to intermediate signal intensity
  • Lobular internal architecture, fine lobular margins
  • 77% with adjacent bone marrow edema, soft tissue edema
  • Lobulated low signal intensity rim
  • 92% with low signal intensity foci within tumor corresponding to calcifications
  • 67% with adjacent joint effusion
  • Bone scan is of limited value but shows moderate to intense uptake; rarely, multiple lesions have been reported


  • Irregularly lobulated, ± hemorrhage, bluish gray, and gritty lesion that expands the epiphysis, ± degenerative cysts
  • 20% of cases demonstrate joint seeding (via ligaments or previous surgery)
  • Joint effusion, chronic synovitis, and tumor implants within the synovium


  • Polygonal-shaped chondroblasts with distinct borders surrounded by dense eosinophilic chondroid matrix
  • Lobulated and indented large nucleus
  • Mitotic figures are rare and typical (1/3-5 hpf)
  • Chondroid usually scant, rarely with ossification
  • Calcification in a "chicken-wire" or honeycomb pattern not universally present
  • Osteoclast-like giant cells almost universal, probably reactive
  • Hemorrhage and necrosis, with foci of foam cells and cholesterol deposits, even ABC changes (15% reported)
  • Hyaline cartilage sometimes seen
  • Spindle-shaped stromal cells occasionally in foci
  • Special stains
  • Reticulin reveals a honeycomb pattern
  • S100 usually +
  • EM reveals microvillous processes, nuclear lobulation, large nucleoli, inner nuclear membrane nuclear substance deposits
  • Ring chromosome 4 has been reported in one case


  • GCT (esp if larger lesion)
  • Small cell osteosarcoma if chondroid mistaken for osteoid
  • Infection (including TB)
  • Gout
  • RA
  • PVNS
  • Eosinophilic granuloma
  • Enchondroma
  • Clear cell chondrosarcoma
  • Mesenchymal chondrosarcoma
  • Malignant lymphoma
  • Degenerative cysts/osteonecrosis (esp in the femoral head with subchondral collapse)
  • UBC
  • Fibrous dysplasia
  • NOF (fibroxanthoma)
  • Chondromyxoid fibroma


  • Curettage, chemical tx with cryotherapy or phenolization, grafting or PMMA packing
  • Recurrence reported about 5-35% (esp in difficult pelvic lesions)
  • Local seeding can occur
  • Penetration into the joint during curettage must be avoided
  • Articular cartilage may be destroyed by the lesion
  • Vascularized gluteus medius grafting after elevation of femoral head articular collapse has been reported
  • Primary tx with percutaneous radiofrequency heat ablation has been reported
  • Rarely metastasizes (reported up to 3%) to lungs as benign lesion
  • Distant soft tissue metastases have been reported
  • Malignant degeneration, "malignant chondroblastoma" of lesions have been reported as late as 18 yrs after resection


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