Surgical hip dislocation for treatment of femoral head chondroblastoma: efficacy and safety.

PURPOSE: Femoral head chondroblastoma poses a surgical challenge. Anatomical limitations may lead to increased risk of local recurrence, damage to the articular cartilage, growth disturbances, and/or avascular necrosis (AVN). We are presenting our results with surgical hip dislocation approach with the aim to evaluate its efficacy in preventing recurrence and its safety, preserving a functional hip joint and avoiding complications. PATIENTS AND METHODS: Ten patients were managed using surgical hip dislocation with direct access to femoral head lesions, extended curettage through a modified trapdoor approach, and cement reconstruction. These were six males and four females, with a mean age of 17 ± 2.7 years (range: 14-20) and a mean follow-up of 34 ± 12 months (range: 17-57). The lesion extended into the neck in 60% of patients with the physis being either closed in seven or closing in three patients. RESULTS: We had a single case (10%) of recurrence at the trochanters for which re-curettage was done. However, all patients had their hips preserved with good function at the latest follow-up, and no serious complications recorded. The Musculoskeletal Tumor Society score improved significantly from a pre-operative median of 23.5 (range: 16-28) to a post-operative median of 29 (range: 26-30) (P = 0.005). CONCLUSION: This report describes a safe reproducible approach to effectively manage these locally aggressive lesions with good short-term results. This is done while maintaining the integrity of the articular surface, growth plate, as well as preserving the femoral head blood supply.

Chondroblastoma of the patella with secondary aneurysmal bone cyst, an easily misdiagnosed bone tumor:a case report with literature review.

BACKGROUND: Chondroblastoma (CB) is a rare, primary, benign bone tumor that commonly affects men aged 15-20 years. It is usually detected in the epiphysis of the long bones, such as the proximal femur, humerus, and tibia. The patella is an infrequent site. CB with secondary aneurysmal bone cyst (ABC) is extremely rare in the patella, which can be easily confused with other common bone tumors of the patella. Thus, it is necessary to make the right diagnosis to get a good outcome. CASE PRESENTATION: We have presented here the case of a 30-year-old man who was suffering from anterior knee pain for the past 6 months that had aggravated 2 weeks before the presentation. Osteolytic bone destruction in the patella could be detected in both his X-ray and computed tomography (CT) examinations, while the magnetic resonance imaging (MRI) detected a fluid level. Accordingly, secondary ABC was presumed. We diagnosed the condition as giant cell tumor (GCT) with secondary ABC and, accordingly, performed curettage inside the focus region with autogenous bone grafting following the patient's medical history, physical manifestations, results of physical and ancillary examinations, and the disease characteristics. However, the intraoperative and postoperative outcomes indicated that the patient's histopathology was consistent with that of typical CB, suggesting a definitive error in diagnosis. Accordingly, the patient was finally diagnosed with patella CB along with secondary ABC. CONCLUSIONS: Past studies have demonstrated that the 3 commonest bone tumors affecting the patella are GCT, CB, and ABC. CB with secondary ABC can be easily misdiagnosed as GCT with secondary ABC or ABC. Performing incision biopsy or excision biopsy and conducting histological examination may be the most effective method for suspected CB with secondary ABC.

Partial Articular Resurfacing Secondary to Pediatric Hip Chondroblastoma Curettage with a 5-YearFollow-Up: A Case Report.

CASE: This report describes a case of pediatric femoral head chondroblastoma, which was initially treated by minimally invasive curettage. At the 18-month follow-up, a subsequent osteochondral defect occurred, which was treated with a partial articular resurfacing system. At 5.5 years follow-up, he was symptom-free with minor degenerative x-ray changes. CONCLUSION: We describe a technique of focal anatomic hip resurfacing using the HemiCAP system in a pediatric chondroblastoma patient who presented with an osteochondral defect after primary curettage. This approach yielded good short-term to midterm results and is a potential alternative to total hip arthroplasty in young patients.

[Tumors affecting the temporomandibular joint - a literature review]. / Tumeurs de l'articulation temporomandibulaire ­ revue de la littérature.

Benign and malign tumors can affect the temporomandibular joint (TMJ) as any other articulation. Nevertheless, TMJ tumors are rare and mostly benign. Their clinical expression is varied including symptomatology similar to TMJ dysfunctional disorders, otologic or neurologic pathologies. In some cases, they remain totally asymptomatic. Hence, diagnosis is difficult since the symptomatology can be misleading with TMJ dysfunctional disorders or otologic disorders wrongly diagnosed. There is thus frequently a long delay between symptoms onset and diagnosis. The great variety of TMJ lesions explains the wide range of possible treatment modalities, mostly based on surgery. We provide here a review of the lesions originating from the TMJ. Tumoral or cystic mandibular lesion affecting the TMJ through local extension will not be discussed. Osteoma, osteoid osteoma, osteoblastoma, chondroma, osteochondroma, chondroblastoma, tenosynovial giant cell tumors, giant cell lesions, non-ossifying fibroma, hemangioma, lipoma or Langerhans cell histiocytosis are all possible diagnosis among the benign tumors found in the TMJ. Pseudotumors include synovial chondromatosis and aneurysmal bone cyst. Finally, malign tumors of the TMJ include mainly sarcomas (osteosarcoma, chondrosarcoma, synovial sarcoma, Ewing sarcoma, and fibrosarcoma), but also multiple myeloma and secondary metastases. We will review the clinical, radiological and histological aspects of each of these lesions. The treatment and the recurrence risk will also be discussed.

Chondroblastoma of the Distal Femur in an Adolescent.

An 11-year-old female was referred to physical therapy due to a 3-month history of right medial knee pain. The patient's medical diagnosis was Osgood-Schlatter disease, based on radiographs obtained at the initial pediatrician consultation. An MRI scan was obtained 2 weeks after starting physical therapy and revealed a bony lesion near the medial condyle of the right femur and damage to medial joint structures. Pathology after open biopsy and curettage of the lesion revealed a chondroblastoma. J Orthop Sports Phys Ther 2020;50(5):275. doi:10.2519/jospt.2020.9021.

Total Calcanectomy and Bilateral Iliac Bone Autograft Reconstruction for the Treatment of Calcaneal Chondroblastoma Involving a Secondary Aneurysmal Bone Cyst: A Case Report and Literature Review.

Chondroblastoma is a rare, benign, cartilaginous-derived tumor accounting for ∼1% to 2% of all primary bone tumors and almost 9% of all benign bone tumors. In this case report, we describe a patient with chondroblastoma and a secondary aneurysmal bone cyst, with the adjacent talus being mildly affected. The initial diagnosis was giant cell tumor and was then confirmed after computed tomography-assisted biopsy. We performed a total calcanectomy via bilateral structural iliac bone autografting to relieve pain and reconstruct the loadbearing function because of the presence of extensive lesions. The patient was pain free and expressed satisfaction with postsurgical dorsiflexion and plantarflexion function at the 60-month follow-up visit. Radiographic images showed that the autografted iliac bone was completely healed, with no evidence of local recurrence.

Chondroblastoma-like primary malignant giant cell tumor of the humerus - a case report.

35-year-old woman suffered prolonged pain in the left shoulder, where an aggressively growing tumor of the proximal humerus was revealed thereafter. The lesion caused massive osteolysis of the metaepiphysis with cortical disruption, but no soft tissue extension was evident. Given the unsatisfactory effect, the ongoing neoadjuvant chemotherapy was prematurely ceased and the resection 13 cm long segment of bone with modular prosthesis replacement followed. Histologically, clear-cut malignant tumor with both the presence of numerous reactive osteoclast-like giant cells and geographic structural deposition of chondroid matrix bore a close resemblance to chondroblastoma. Dominant cellular composition formed solid mosaic clusters of large, atypical, frequently binucleated cells with voluminous eosinophilic cytoplasm. Impressive nuclear pleomorphism was accentuated by both the grooving and atypical mitotic figures. Thorough sampling disclosed limited, but sharply contrasting parts, where biphasic arrangement of small uniform stromal elements together with regularly distributed, reactive osteoclasts suggested putative precursor giant cell lesion. Except the osteoclasts, all matrical and stromal cells were strongly SOX9 and D2-40 positive; in contrary desmin, SATB2, S100 and p63 yielded completely negative results. Detected H3F3A c.103G>T mutation in exon 2 finally established true nature of that peculiar neoplastic proliferation and lead to descriptive term of primary chondroblastoma-like malignant giant cell tumor. In the setting of all the microscopic variability, histogenesis and complex differential diagnosis of skeletal (malignant) giant cell lesions, there are discussed e.g. aggressive/malignant chondroblastoma, chondroblastoma-like osteosarcoma or giant cell-rich osteosarcoma and practical impact of specific mutational analysis results as well.

Clear Cell Chondrosarcoma With Chondroblastoma-Like Features: A Case for Team Diagnosis.

Clear cell chondrosarcoma (CCCS) is a rare variant of conventional chondrosarcoma with low-grade malignant features that may be confused radiographically and histologically with chondroblastoma. We report a case of a 50-year-old female who presented with 6 months of left hip pain. Initial radiographs demonstrated an osteolytic lesion with adjacent area of sclerosis in the proximal left femur. Magnetic resonance imaging demonstrated a marrow-infiltrative lesion with periosteal reaction and thickened enhancing periosteum. Biopsy of the sclerotic area demonstrated chondroblastoma-like findings, whereas biopsy of the lytic area showed features suggestive of CCCS. The patient eventually underwent en bloc resection and reconstruction with a proximal femoral megaprosthesis. The final diagnosis was CCCS. We present this unusual case with review of the radiographic and histologic features of CCCS with attention to its ability to mimic chondroblastomas. This case highlights the importance of sampling radiographically heterogeneous areas within a bone lesion to facilitate accurate diagnosis and appropriate management.

Temporal bone chondroblastoma totally invisible on MRI.

We report a case of temporal bone chondroblastoma that was totally invisible on MRI. The patient was a 64-year-old man who presented with several months history of vertigo. The CT scan with bone window setting showed destruction of the temporomandibular joint, the floor of the middle cranial fossa, and the superior semicircular canal. Calcific foci were seen within the tumor. On MR imaging, the tumor, situating mainly medial to the temporomandibular joint, showed no signal on both T1- and T2-weighted images. The tumor was not enhanced with gadolinium. In summary, the tumor was totally signal negative or "invisible" on pre- and postcontrast T1- and T2-weighted images. The tumor was resected through transpetrosal - transzygomatic approach.

[Chondroblastoma of the Temporal Bone Removed Using a Middle Cranial Fossa Approach].

We report a case of chondroblastoma of the middle cranial fossa, probably arising from the (infra) mandibular fossa, and expanding to the attic and external auditory canal that was successfully removed using a middle cranial fossa approach. No recurrences occurred during an 8-year postoperative follow-up period. Initial biopsy findings suggested a pathological diagnosis of giant cell tumor that was later confirmed to be a chondroblastoma based on an immunohistochemical study of S-100. This case study suggests a profound understanding of the clinical features, histopathological characteristics, and possible treatment. of chondroblastoma.

Condroblastoma de presentación atípica en concomitancia a osteomielitis crónica operado con cirugía radical: caso clínico / Chondroblastoma of atypical presentation in conjunction with chronic osteomyelitis operated through radical surgery: clinical case

INTRODUCCIÓN: El condroblastoma es un tumor óseo benigno representando menos del 1 por ciento del total de tumores óseos; se presenta principalmente en jóvenes. De etiología controversial, se desarrolla habitualmente en centros secundarios de osificación en huesos largos. No hay casos que describan su existencia junto a osteomielitis ni su tratamiento quirúrgico. CASO CLÍNICO: Mujer de 15 años con antecedente de osteomielitis de inicio reciente, diagnosticada con cintigrafía y biopsia en escápula izquierda; a pesar de tratamiento médico antibiótico con cloxacilina persiste dolor, eritema, impotencia funcional y aumento de volumen progresivo. Cintigrafía de control confirma nula respuesta a tratamiento inicial. Tomografía computada (TC) informa probable proceso tumoral osteolítico cortical con reacción de partes blandas en casi la totalidad de la escápula incluyendo cavidad glenoidea. Biopsia quirúrgica informa condroblastoma sospecha de variante agresiva resolviéndose con escapulectomía total con resección de cabeza humeral y posterior pexia clavículo-humeral. Biopsia definitiva de pieza quirúrgica informa osteomielitis crónica y condroblastoma agresivo. Evolución favorable en controles posteriores sin signos de recidiva local ni a distancia. DISCUSIÓN: La nula respuesta clínica al tratamiento inicial y su progresión hizo sospechar un proceso tumoral no diagnosticado inicialmente debido a que la biopsia no incluyó focos del condroblastoma. El manejo clásico del condroblastoma consiste en curetaje y relleno con autoinjerto; pero debido a la localización atípica, posibilidad de malignización y coexistencia con proceso osteomielítico crónico se optó por cirugía innovadora que consistió en resección total y posterior pexiaclavículo-humeral

INTRODUCTION: A Chondroblastoma is a benign bone tumor, corresponding to less than 1 percent of all bone tumors, and affecting mainly young people. Commonly developing in secondary centers of ossification in large bones, there are no cases describing its existence along with osteomyelitis, nor its surgical treatment. CLINICAL CASE: Woman (15 Y/O) with a history of osteomyelitis onset caused by a recent fall is diagnosed through scintigraphy and biopsy in the left scapule. Despite treatment with cloxacillin, pain persisted, erythema developed, with a progressive increase of volume and functional impotence. Control scintigraphy confirms no response to initial treatment. Computed Tomography (CT) informs of a probable cortical osteolysis tumoral process with soft tissue reactions in almost the entire scapule including glenoid cavity. Surgical biopsy shows chondroblastoma and, suspecting an agressive variant, it is resolved to perform a total scapulectomy with resection of scapule head and subsequent humerus-claviclepexia. Definitive biopsy of surgical piece shows chronic osteomyelitis and agressive chondroblastoma. The evolution of the patient is normal on follow-up controls, not presenting any signs of local neither distant relapse. DISCUSSION: The non-existence of a response to the initial treatment and its progression made us suspect of a natural process that was not diagnosed initially because the biopsy didn't include chondroblastoma focus. The usual chondroblastoma treatment consists of curetting and autograft filling; but due to the atypical location, and the possibility of coexistence with malignant and chronic osteomyelitic process we chose to apply an innovative surgery that consisted of total resection and subsequent pexia.

What are the results using the modified trapdoor procedure to treat chondroblastoma of the femoral head?

BACKGROUND: Treatment of chondroblastoma in the femoral head is challenging owing to the particular location and its aggressive nature. There is little published information to guide the surgeon regarding the appropriate approach to treating a chondroblastoma in this location. We developed a modified trapdoor procedure to address this issue. The primary modification is that the window surface of the femoral head is covered by the ligamentum teres rather than cartilage as in the traditional procedure. QUESTIONS/PURPOSES: We assessed (1) the clinical presentation of chondroblastoma of the femoral head and treatment results with the modified trapdoor procedure in terms of (2) the frequency of local recurrence, (3) complications, and (4) functional outcomes using the Musculoskeletal Tumor Society (MSTS) score. METHODS: Between 1999 and 2010, we treated 14 patients for chondroblastoma of the femoral head. All patients received the modified trapdoor procedure. Of those, 13 were available for followup at a minimum of 36 months (mean, 66 months; range, 36-117 months) and one patient was lost to followup. There were nine males and four females, with a mean age of 18 years (range, 9-29 years). Clinical features were ascertained by chart and radiographic review, and recurrence, complications, and functional outcomes (MSTS score) were recorded from chart review. Patterns of bone destruction were evaluated using the Lodwick classification, which ranges from IA (geographic appearance with sclerotic rim) to III (permeative appearance). RESULTS: The symptoms at diagnosis were pain in nine patients and discomfort in four. The mean duration of symptom was 11 months (range, 1-36 months). The physis was open in two patients, closing in one, and closed in 10. The patterns of bone destruction were evaluated as Lodwick Class IA in six patients, Lodwick Class IB in five, and Lodwick Class IC in two. At latest followup, no local recurrence was observed. Two patients had postoperative complications. One had avascular necrosis of the femoral head and was treated with prosthesis replacement. The other had asymptomatic heterotopic ossification in the surgical field. The mean MSTS score was 29.6 (range, 28-30). CONCLUSIONS: Based on this small series, we believe our modified trapdoor procedure is a safe, effective means of treating a chondroblastoma in the femoral head, but additional clinical evaluation with more patients is necessary to confirm our findings. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

Chondroblastoma with secondary aneurysmal bone cyst of the capitate.

Chondroblastoma is a benign tumor that typically arises in the epiphysis of a long bone. There have been only 2 reported cases of chondroblastoma involving the capitate. This is the first report of chondroblastoma with secondary aneurysmal bone cyst involving the capitate. A 33-year-old man presented with a 3-year history of pain and swelling of the right wrist. Radiography as well as computed tomography showed a radiolucent area and no matrix calcification within the capitate. Magnetic resonance imaging revealed a homogeneous signal that was low on T1-weighted images and high on T2-weighted images and showed only slight enhancement. On the basis of imaging findings, the authors chose excisional biopsy. The bone tumor in the capitate was explored through a dorsal approach by dividing the extensor tendons. After repeated curettages, bone graft substitute using allograft bone was packed into the capitate. Histologically, the authors diagnosed this tumor as a chondroblastoma with a secondary aneurysmal bone cyst. At the final 2-year follow-up, there was evidence of bone union, full range of motion, and recovery and no evidence of recurrence. Although the recurrence of chondroblastoma is occasionally reported, the principal treatment is intralesional curettage and bone graft. High-speed burring, phenol, bone cement, and cryosurgery have been reported to reduce local recurrence. Complete excision of the carpal bone seems to be overtreatment.

Image guided radiofrequency thermo-ablation therapy of chondroblastomas: should it replace surgery?

OBJECTIVE: To assess the safety and effectiveness of image-guided radiofrequency ablation (RF ablation) in the treatment of chondroblastomas as an alternative to surgery. MATERIALS AND METHODS: Twelve patients with histologically proven chondroblastoma at our institution from 2003 to date. We reviewed the indications, recurrences and complications in patients who underwent RF ablation. RESULTS: Twelve patients were diagnosed with chondroblastoma. Out of these, 8 patients (6 male, 2 female, mean age 17 years) with chondroblastoma (mean size 2.7 cm) underwent RF ablation. Multitine expandable electrodes were used in all patients. The number of probe positions needed varied from 1 to 4 and lesions were ablated at 90 °C for 5 min at each probe position. The tumours were successfully treated and all patients became asymptomatic. There were no recurrences. There were 2 patients with knee complications, 1 with minor asymptomatic infraction of the subchondral bone and a second patient with osteonecrosis/chondrolysis. CONCLUSION: Radiofrequency ablation appears to be a safe and effective alternative to surgical treatment with a low risk of recurrence and complications for most chondroblastomas. RF ablation is probably superior to surgery when chondroblastomas are small (less than 2.5 cm) with an intact bony margin with subchondral bone and in areas of difficult surgical access.

Primary aggressive chondroblastoma of the humerus: an unusual imaging presentation.

Chondroblastoma is an uncommon primary benign cartilage-producing neoplasm representing only 1% of all primary bone neoplasia, with male preponderance. It has a predilection to present in any bone ossified in the endochondral pattern. Epiphyseal location, small size, geographic margins, and cartilaginous matrix are virtually pathognomonic radiologic features of this tumor. The tumor rarely transgresses the parent bone to invade adjacent structures. We describe a histologically proven case of chondroblastoma, invading the adjacent glenohumeral joint in a 15-year-old female presented with shoulder pain, in which radiological features belied the nature of the tumor.

Chondroblastoma associated with aneurysmal cyst of the navicular bone: a case report.

Chondroblastoma is a rare tumor. It is usually benign; however, it can have an aggressive course before or after operative treatment, even resulting in pulmonary metastases. The foot is a rare location for chondroblastoma, and to our knowledge, chondroblastoma occurring in the navicular bone has not been reported previously in the English literature. We describe a case of navicular chondroblastoma case associated with an aneurysmal bone cyst. Treatment consisted of aggressive curettage, phenolization, and bone allograft. The patient was able to resume normal activities after treatment, and there was no recurrence of the chondroblastoma during a follow-up of 3 years.

Arthroscopic guided biopsy and radiofrequency thermoablation of a benign neoplasm of the tibial spines area: a treatment option.

BACKGROUND: Lesions located in the area of the tibial spines are rare. In most cases, treatment follows histological diagnosis, but when imaging and clinical data are considered to be "very" characteristic for benign lesions, such as chondroblastoma or osteoid osteoma, treatment may be performed without biopsy. Traditional curettage requires opening the joint, which presents a high risk of contamination of the joint itself and surrounding structures, such as the popliteal area, with possible contamination of the neurovascular bundle when performing curettage with the posterior approach. In this case, the re-excision of a local recurrence would be extremely difficult. RESULTS: We describe a technique using arthroscopic guidance for radiofrequency thermoablation of a benign lesion in the tibial spines area. We report on an illustrative case. The patient so treated, reported immediate relief from the pain, and after two weeks, was free of pain. The biopsy performed before the treatment confirmed the radiological diagnosis of chondroblastoma. At one year of follow-up, the patient is without pain, with a 0-130° range of motion, has no activity limitations and is apparently free of disease. CONCLUSION: This technique allows a radiofrequency thermoablation of a lesion in the tibial spines area and in the posterior tibial surface to be performed without opening the joint, monitoring the tibial plateau surface, probably decreasing the risk of cartilage damage. Unfortunately, in the case presented, the high pressure from the arthroscopy's pump broke the tibial plateau surface creating a communication to the tibial tunnel used for thermoablation.

A rare case of metaphyseodiaphyseal chondroblastoma of proximal femur presenting with constitutional symptoms in a six-year-old child.

Primary metaphyseodiaphyseal chondroblastoma is rare. To our knowledge, very few such cases have been reported in the English literature. Insidious onset of pain is the most common complaint in patients with chondroblastoma. A clinical presentation of constitutional symptoms along with a metaphyseodiaphyseal lesion on radiographs in a young child usually points toward a diagnosis of Ewing's sarcoma or infection. Here, we document a case of metaphyseodiaphyseal chondroblastoma of femur in a 6-year-old child presenting with chief local complaints of an intermediate onset pain and swelling along with systemic complaints of fever and malaise. The patient was operated by excision of the tumor and reconstruction using autogenous-free fibular graft.