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Chondroblastoma

DEFINITION AND PATHOGENESIS

  • Primitive cells from physis compose the tumor

IMPORTANCE

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

CLINICAL FEATURES

  • <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

RADIOLOGIC FEATURES

  • 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

GROSS PATHOLOGY

  • 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

HISTOLOGIC AND MOLECULAR FEATURES

  • 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

DIFFERENTIAL CLINICOPATHOLOGIC DIAGNOSIS

  • 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

DISEASE COURSE AND TREATMENT

  • 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

REFERENCES

Bernstein AL, Jacobs AM, Oloff LM, Gilula L: Cyst and cystlike lesions of the foot. J Foot Surg 24:3-17,1985.

Bertoni F, Unni KK, Beabout JW, Harner SG, Dahlin DC: Chondroblastoma of the skull and facial bones. Am J Clin Pathol 88:1-9,1987.
Birch PJ, Buchanan R, Golding P, Pringle JAS: Chondroblastoma of the rib with widespread bone metastases. Histopathology 25:583-5,1994.

Blaauw G, Prick JJ, Versteege C: Chondroblastoma of the temporal bone. Neurosurgery 22:1102-7,1988.

Blan LG, Sun QF, Zhao WG, Shen JK, Tirakotai W, Bertalanffy H: Temporal bone chondroblastoma: a review. Neuropathology 25:159-64,2005.
Bloem JL, Mulder JD: Chondroblastoma: a clinical and radiologic study of 104 cases. Skeletal Radiol 14:1-9,1985.
Brien EW, Mirra JM, Ippolito V: Chondroblastoma arising from a nonepiphyseal site. Skeletal Radiol 24:220-2,1995.

Brien EW, Mirra JM, Kerr R: Benign and malignant cartilage tumors of bone and joint: their anatomic and theoretical basis with an emphasis on radiology, pathology and clincial biology. I. The intramedullary cartilage tumors. Skeletal Radiol 26:325-53,1997.
Brower AC, Moser RP, Kransdorf JM: The frequency and diagnostic significance of periostitis in chondroblastom. AJR 154:309-14,1990.
Bui P, Ivan D, Oliver D, Busaidy KF, Wilson J: Chondroblastoma of the temporomandibular joint: report of a case and literature review. J Oral Maxillofac Surg 67:405-9,2009.

Campanacci M: Bone and Soft Tissue Tumors: Clinical Features, Imaging, Pathology and Treatment. Ed 2, Springer, New York, pp 247-264,1999.

Chung OM, Yip SF, Ngan KC, Ng WF: Chondroblastoma of the lumbar spine with cauda equina syndrome. Spinal Cord 41:359-64,2003.
Clapper AT, DeYoung BR: Chondroblastoma of the femoral diaphysis: report of a rare phenomenon and review of literature. Hum Pathol 38:803-6,2007.

Codman EA: Epiphyseal chondromatous giant cell tumors of the upper end of the humerus. Surg, Gynec and Obstet 52:543-8,1931.
Cohen J, Cahen I: Benign chondroblastoma of the patella. J Bone Joint Surg 45A:824-6,1963.
Coughlan B, Feliz A, Ishida T, Czerniak B, Dorfman H: p53 expression and DNA ploidy of cartilage lesions. Hum Pathol 26:620-4,1995.
Crim JR, Gold RH, Mirra JM, Eckardt J: Case report 748: chondroblastoma of the femur with an aneurysmal bone cyst. Skeletal Radiol 21:403-5,1992.
Dahlin DC, Ivins JC: Benign chondroblastoma: a study of 125 cases. Cancer 30:401-13,1972.
Diwanji SR, Cho SG, Kong IK, Yoon TR: Hip pain in a 24-year-old woman. Clin Orthop 461:262-8,2007.

Dwaik M, Devlin PB: Case report: metadiaphyseal chondroblastoma. Clin Radiol 45:131-3,1992.
Erickson JK, Rosenthal DI, Zaleske DJ, Gebhart MC, Cates JM: Primary treatment of chondroblastoma with percutaneous radiofrequency heat ablation: report of 3 cases. Radiology 221:463-8,2001.
Fechner RE, Wilde HD: Chondroblastoma in the metaphysis of the femoral neck. J Bone Joint Surg 56A:413-5,1974.
Fink BR, Temple HT, Chiracosta F, Mizel MS, Murphey MD: Chondroblastoma of the foot. Foot Ankle Int 18:236-42,1997.
Fobben ES, Dalinka MK, Schlebler ML, Burk DL, Fallon MD, Schmidt RG, Kressel HY: Magnetic resonance imaging appearance at 1.5 tesla of cartilagionous tumors involving the epiphysis. Skeletal Radiol 16:647-51,1987.
Frassica FJ, Unni KK, Beabout JW, Sim FH: Dedifferentiated chondrosarcoma. A Report of the Clinicopathological Features and Treatment of Seventy-eight Cases. J. Bone Joint Surg. 68-A:1197-1205, 1986.

Giudici MA, Moser RP Jr, Kransdorf MJ: Cartilaginous bone tumors. Radiol Clin North Am 31:237-59,1993.

Goga D, Fassio E, Fetissof F, Jan M: Chondrobalstoma of the temporomandibular region. J Oral Maxillofac Surg 57:1270-2,1999.
Green P, Whittaker RP: Benign chondroblastoma: case report with pulmonary metastasis. J Bone Joint Surg 57A:418-20,1975.
Hameed MR, Blacksin M, Das K, Patterson F, Benevenia J, Aisner S: Cortical chondroblastoma: report of a case and literature review of this lesion reported in unusual locations. Skeletal Radiol 35:295-7,2006.

Harvey JN, Gray C, Belchetz PE: Oncogenous osteomalacia and malignancy. Clin Endocrinol (Oxf) 37:379-82,1992.

Hasegawa T, Seki K, Yang P, : Differentiation and proliferative activity in benign and malignant cartilage tumors of bone. Hum Pathol 26:838-45,1995.
Hudson TM, Hawkins IF Jr: Radiological evaluation of chondroblastoma. Radiology 139:1-10,1981.
Huvos AG, Higinbotham NL, Marcove RC, O'Leary P: Aggressive chondroblastoma. Review of the literature on aggressive behavior and metastases with a report of one new case. Clin Orthop 126:266-72,1977.
Huvos AG, Marcove RC: Chondroblatoma of bone: a critical review. Clin Orthop 95:300-12,1973.

Ilasian H, Sundaram M, Unni KK: Vertebral chondroblastoma. Skeletal Radiol 32:66-71,2003.
Jaffe HL, Lichtenstein L: Benign chondroblastoma of bone. A reinterpretation of the so-called calcifying or chondromatous giant cell tumor. Am J Pathol 18:969-91,1942.

Jambhekar NA, Desai PB, Chitale DA, Patil P, Arya S: Benign metastasizing chondroblastoma: a case report. Cancer 82:675-8,1998.
Kahmann R, Gold RH, Eckardt JJ, Mirra JM: Case report 337: cystic chondroblastoma of calcaneus. Skeletal Radiol 14:301-4,1985.
Kahn LB, Wood FM, Ackerman LV: Malignant chondroblastoma: report of two cases and review of the literature. Arch Pathol 88:371-6,1969.
Keenan S, Bui-Mansfield LT: Musculoskeletal lesions with fluid-fuid level: a pictorial essay. J Comput Assist Tomog 30:517-24,2006.

Khalili K, White LM, Kandel RA, : Chondroblastoma with multiple distant soft tissue metastases. Skeletal Radiol 26:493-6,1997.

Kilgore WB, Parrish WM: Calcaneal tumors and tumor-like conditions. Foot Ankle Clin 10:541-65, vii,2005.
Kilpatrick SE, Pike EJ, Geisinger KR, Ward WF: Chondroblastoma of bone: use of fine-needle aspiration biopsy and potential diagnostic pitfalls. Diagn Cytopathol 16:65-71,1997.

Kirchhoff C, Buhmann S, Mussack T, Müller-Höcker J, Schmitt-Sody M, Jansson V, Dürr HR: Aggressive scapular chondroblastoma with secondary metastasis--a case report and review of literature. Eur J Med Res 11:128-34,2006.

Kondoh T, Hamada Y, Kamei K, Seto K: Chondroblastoma of the mandibular condyle: report of a case. J Oral Maxillofac Surg 60:198-203,2002.
Kudo T, Okada K, Hirano Y, Sageshima M: Chondroblastoma of a metacarpal bone mimicking an aneurysmal bone cyst: a case report and a review of the literature. Tohoku J Exp Med 194:251-7,2001.

Kunze E, Graewe T, Peitsch E: Histology and biology of metastatic chondroblastoma. Report of a case with a review of the literature. Pathol Res Pract 182:113-23,1987.
Kurt A-M, Turcotte RE, McLeod RA, Unni KK, Sim FH: Chondroblastoma of bone. Orthopedics 13:787-90,1990.
Kurt A-M, Unni KK, Sim FH, McLeod RA: Chondroblastoma of bone. Hum Pathol 20:965-76,1989.

Kurth AA, Warzecha J, Rittmeister M, Schmitt E, Hovy L: Recurrent chondroblastoma of the upper thoracic spine. A case report and review of the literature. Arch Orthop Trauma Surg 120:544-7,2000.
Kyriakos M, Land VJ, Penning L, Parker SG: Metastatic chondroblastoma. Report of a fatal case with review of the literature on atypical, aggressive, and malignant chondroblastoma. Cancer 55:1770-89,1985.
Lewis MM, Bullough PG: An unusual case of cystic chondroblastoma of the patella. Clin Orthop 121:188-90,1976.

Li XN, Peng ZG, Zhao JP, Zhang ZK. Chondroblastoma of the navicular bone. Iran J Radiol. 2014 Oct 20;11(4): e10848. doi: 10.5812/iranjradiol.10848.
Malawer MM, Dunham W: Cryosurgery and acrylic cementation as surgical adjuncts in the treatment of aggressive (benign) bone tumors. Analysis of 25 patients below the age of 21. Clin Orthop 262:42-57,1991.

Mandell GA, Harcke HT, Kumar SJ: Chondroid lesions of the extremities. Top Magn Reson Imaging 4:56-65,1991.

Matsuno T, Hasegawa I, Masuda T: Chondroblastoma arising from triradiate cartilage. Report of two cases with review of the literature. Skeletal Radiol 16:216-22,1987.
Mayo-Smith W, Rosenberg AE, Khurana JS, Kattapuram SV, Romero LH: Chondroblastoma of the ribs. A case report and review of the literature. Clin Orthop 251:230-4,1990.
McLaughlin RE, Sweet RE, Webster T, Merritt WM: Chondroblastoma of the pelvis suggestive of malignancy. J Bone Joint Surg 57:549-51,1975.
McLeod RA, Beabout JW: The roentgenographic features of chondroblastoma. AJR 118:464-71,1973.
Mermelstein LE, Friedlaender GE, Katz LD: Cystic chondrobalstoma. Orthopedics 20:69-71,1997.

Mirra JM, Picci P, and Gold RH. Intramedullary cartilage- and chondroid-producing tumors. In Bone Tumors. Clinical, radiologic and pathologic correlations. Lea & Febiger. Philadelphia, 1989, pp 439-690.
Mirra JM, Ulich TR, Eckardt JJ, Bhuta S: "Aggressive" chondroblastoma. Light and ultramicroscopic findings after en bloc resection. Clin Orthop 178:276-84,1983.
Moser RP, Jr:: Cartilaginous Tumors of the Skeleton. AFIP Atlas of Radiologic-Pathologic Correlations. Fascicle II. Davidson AJ (Ed). Mosby-Year Book, St. Louis, 1990.
Moser RP, Brockmole DM, Vinh TN, : Chondroblastoma of the patella. Skeletal Radiol 17:413-9,1988.
Ostrowski ML, Hohnson ME, Truong LD, Hicks MJ, Smith FE, Spjut HJ: Malignant chondroblastoma presenting as a recurrent pelvic tumor with DNA aneuploidy and p53 mutation as supportive evidence of malignancy. Skeletal Radiol 28:644-50,1999.
Oxtoby JM, Davies AM: MRI characteristics of chondroblastoma. Clin Radiol 51:22-6,1996.

Papaioannou G, Sebire NJ, McHugh K: Imaging of the unusual pediatric 'blastomas'. Cancer Imaging 9:1-11,2009.

Peh WC, Shek TW, Ip WY: Metadiaphyseal chondroblastoma of the thumb. Skeletal Radiol 29:176-80,2000.
Politi M, Consolo U, Panziera G, Capelli P, Bonetti F: Chondrobalstoma of the temporal bone. Case report. J Craniomaxillofac Surg 19:319-22,1991.

Posl M, Werner M, Amling M, Ritzel H, Delling G: Malignant transformation of chondroblastoma. Histopathology 29:477-80,1996.

Prohaska DJ, Kneidel TW: Chondroblastoma in a metatarsal. J Foot Ankle Surg 37:63-5,1998.
Ramappa AJ, Lee FYI, Tang P, Carlson JR, Gebhardt MC, Mankin HJ: Chondroblatoma of bone. J Bone Joint Surg 82A:1140-5,2000.
Reyes CV, Kathuria S: Recurrent and aggressive chondroblastoma of the pelvis with late malignant neoplastic changes. Am J Surg Pathol 3:449:55,1979.
Riddell RJ, Louis CJ, Bromberger NA: Pulmonary metastases from chondroblastoma of the tibia: report of a case. J Bone Joint Surg 55:848-53,1973.
Robbin MR, Murphey MD: Benign chondroid neoplasms of bone. Semin Musculoskelet Radiol 4:45-58,2000.

Rodgers WB, Mankin HJ: Metastatic malignant chondroblastoma. Am J Orthop 25:846-9,1996.
Scarborough MT, Moreau G: Benign cartilage tumors. Orthop Clin North Am 27:583-9,1996.
Schajowicz F, Gallardo H: Epiphyseal chondroblastoma of bone. A clinicopathological study of sixty nine cases. J Bone Joint Surg 52:205-26,1970.

Schuppers HA, van der Eijken JW: Chondroblastoma during the growing age. J Pediatr Orthop 7:293-7,1998.
Simon MA, Springfield DS: Surgery for Bone and Soft Tissue Tumors, Philadelphia, Lippincott-Raven, pp 190-191,1998.
Sirsat MV, Doctor VM: Benign chondroblastoma of bone: report of a case of malignant transformation. J Bone Joint Surg 52:741-5,1970.
Springfield DS, Capanna R, Gherlinzoni F, Picci P, Campanacci M: Chondroblastoma: a review of seventy cases. J Bone Joint Surg 67A:748-55,1985.
Stricker SJ: Extraarticular endoscopic excision of femoral head chondroblastoma. J Pediatr Orthop 15:578-81, 1995.
Thompson MS, Woodward JS Jr: The use of the arthroscope as an adjunct in the resection of a chondroblastoma of femoral head. Arthroscopy 11:106-11,1995.
Turcotte RE, Kurt AM, Sim FH, Unni KK, McLeod RA: Chondroblastoma. Hum Pathol 24:944-9,1993.

van Zelderen-Bhola SL, Bovée JV, Wessels HW, Mollevanger P, Nijhuis JV, van Eendenburg JD, Taminiau AH, Hogendoom PC: Cancer Genet Cytogenet 105:109-12,1998.
Varma BP, Gupta IM: Atypical chondroblastoma of tibia. Report of a recurrent lesion. Clin Orthop 89:241-5,1972.

Varvares MA, Cheney ML, Goodman ML, Ceisler E, Montgomery WW: Chondroblastoma of the temporal bone. Case report and literature review. Ann Otol Rhinol Laryngol 101:763-9,1992.

Vialle R, Feydy A, Rillardon L, Tohme-Noun C, Anract P, Colombat M, De Pinieux G, Drapé JL, Guigui P. J Neurosurg Spine 2:596-600,2005.
Weatherall PT, Maale GE, Mendelsohn DB, Sherry CS, Erdman WE, Pascoe HR: Chondroblastoma: classic and confusing appearance at MR imaging. Radiology 190:467-74,1994.
Wirman JA, Crissman JD, Aron BF: Metastatic chondroblastoma. Report of an unusual case treated with radiotherapy. Cancer 44:87-93,1979.
Wolfe MW, Halvorson TL, Bennett JT, : Chondroblastoma of the patella presenting as knee pain in an adolescent. Am J Orthop 24:61-4,1995.
Yamamura S, Sato K, Sugiura H, Iwata H: Inflammatory reaction in chondroblastoma. Skeletal Radiol 25:371-6,1996.

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