Chondromyxoid fibroma: Difference between revisions

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==Historical Perspective==
==Historical Perspective==
In 1948, Jaffe and Lichtenstein described chondromyxoid fibroma for the first time.  
In 1948, Jaffe and Lichtenstein described chondromyxoid fibroma for the first time.<ref name="pmid18891025">{{cite journal| author=JAFFE HL, LICHTENSTEIN L| title=Chondromyxoid fibroma of bone; a distinctive benign tumor likely to be mistaken especially for chondrosarcoma. | journal=Arch Pathol (Chic) | year= 1948 | volume= 45 | issue= 4 | pages= 541-51 | pmid=18891025 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18891025  }} </ref>


==Classification==
==Classification==
Line 37: Line 37:


==Pathophysiology==
==Pathophysiology==
The exact pathogenesis of [disease name] is not fully understood.
*The exact etiology of chondromyxoid fibroma is unknown.<ref>{{cite book | last = Peabody | first = Terrance | title = Orthopaedic oncology : primary and metastatic tumors of the skeletal system | publisher = Springer | location = Cham | year = 2014 | isbn = 9783319073224 }}</ref>
*Chondromyxoid fibroma arises from the physeal remanant is the commonly proposed theory concerning the pathogenesis of chondromyxoid fibroma.<ref name="pmid9229417">{{cite journal| author=Brien EW, Mirra JM, Kerr R| title=Benign and malignant cartilage tumors of bone and joint: their anatomic and theoretical basis with an emphasis on radiology, pathology and clinical biology. I. The intramedullary cartilage tumors. | journal=Skeletal Radiol | year= 1997 | volume= 26 | issue= 6 | pages= 325-53 | pmid=9229417 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9229417  }} </ref>
*It is predominantly found in the metaphyses of the long bones.<ref name="pmid498016">{{cite journal| author=Cuvelier CA, Roels HJ| title=Cytophotometric studies of the nuclear DNA content in cartilaginous tumors. | journal=Cancer | year= 1979 | volume= 44 | issue= 4 | pages= 1363-74 | pmid=498016 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=498016  }} </ref>
*The bones involved by chondromyxoid fibroma includes tibia, distal femur, pelvis, feet and hands.<ref name="pmid9648559">{{cite journal| author=Halbert AR, Harrison WR, Hicks MJ, Davino N, Cooley LD| title=Cytogenetic analysis of a scapular chondromyxoid fibroma. | journal=Cancer Genet Cytogenet | year= 1998 | volume= 104 | issue= 1 | pages= 52-6 | pmid=9648559 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9648559  }} </ref>


OR
===Genetics===
 
*Chromosome 6 appears to be involved with chondromyxoid fibroma.<ref name="pmid12606137">{{cite journal| author=Buddingh EP, Naumann S, Nelson M, Neffa JR, Birch N, Bridge JA| title=Cytogenetic findings in benign cartilaginous neoplasms. | journal=Cancer Genet Cytogenet | year= 2003 | volume= 141 | issue= 2 | pages= 164-8 | pmid=12606137 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12606137  }} </ref><ref name="pmid498016">{{cite journal| author=Cuvelier CA, Roels HJ| title=Cytophotometric studies of the nuclear DNA content in cartilaginous tumors. | journal=Cancer | year= 1979 | volume= 44 | issue= 4 | pages= 1363-74 | pmid=498016 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=498016  }} </ref>
It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].
*The non-random clonal abnormalities involves 6p25, 6q13 and 6q23.<ref name="pmid498016">{{cite journal| author=Cuvelier CA, Roels HJ| title=Cytophotometric studies of the nuclear DNA content in cartilaginous tumors. | journal=Cancer | year= 1979 | volume= 44 | issue= 4 | pages= 1363-74 | pmid=498016 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=498016  }} </ref>
 
OR
 
[Pathogen name] is usually transmitted via the [transmission route] route to the human host.
 
OR
 
Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.
 
OR
 
 
[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].
 
OR
 
The progression to [disease name] usually involves the [molecular pathway].
 
OR
 
The pathophysiology of [disease/malignancy] depends on the histological subtype.


==Causes==
==Causes==
Disease name] may be caused by [cause1], [cause2], or [cause3].
There are no established causes for chondromyxoid fibroma.<ref name="pmid6337162">{{cite journal| author=Gherlinzoni F, Rock M, Picci P| title=Chondromyxoid fibroma. The experience at the Istituto Ortopedico Rizzoli. | journal=J Bone Joint Surg Am | year= 1983 | volume= 65 | issue= 2 | pages= 198-204 | pmid=6337162 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6337162  }} </ref>
 
OR
 
Common causes of [disease] include [cause1], [cause2], and [cause3].
 
OR
 
The most common cause of [disease name] is [cause 1]. Less common causes of [disease name] include [cause 2], [cause 3], and [cause 4].
 
OR
 
The cause of [disease name] has not been identified. To review risk factors for the development of [disease name], click [[Pericarditis causes#Overview|here]].


==Differentiating ((Page name)) from Other Diseases==
==Differentiating ((Page name)) from Other Diseases==
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
Aneurysmal bone cyst must be differentiated from following bone disorders:
 
{|
OR
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Bubbly lytic lesion on x-ray'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Lakes of Blood on histology'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Diagnosis
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Treatment is curretage and bone grafting
|-
! align="center" style="background:#DCDCDC;" + |Chondromyxoid Fibroma
| align="center" style="background:#F5F5F5;" + | -
| align="center" style="background:#F5F5F5;" + | -
| align="center" style="background:#F5F5F5;" + |[[Radiology]] and [[biopsy]]
| align="center" style="background:#F5F5F5;" + | +
|-
! align="center" style="background:#DCDCDC;" + |Unicameral bone cyst
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | -
| align="center" style="background:#F5F5F5;" + |[[Radiology]] and [[biopsy]]
| align="center" style="background:#F5F5F5;" + | -
|-
! align="center" style="background:#DCDCDC;" + |Non ossifying fibroma
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | -
| align="center" style="background:#F5F5F5;" + |[[Radiology]] and [[biopsy]]
| align="center" style="background:#F5F5F5;" + | -
|-
! align="center" style="background:#DCDCDC;" + |Giant cell tumor
| align="center" style="background:#F5F5F5;" + | -
| align="center" style="background:#F5F5F5;" + | -
| align="center" style="background:#F5F5F5;" + |[[Radiology]] and [[Biopsy]]
| align="center" style="background:#F5F5F5;" + | +
|-
! align="center" style="background:#DCDCDC;" + |Chondroblastoma
| align="center" style="background:#F5F5F5;" + | -
| align="center" style="background:#F5F5F5;" + | -
| align="center" style="background:#F5F5F5;" + |[[Biopsy]]
| align="center" style="background:#F5F5F5;" + | +
|-
! align="center" style="background:#DCDCDC;" + |Aneurysmal bone cyst
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |[[Radiology]] and [[biopsy]]
| align="center" style="background:#F5F5F5;" + | +
|-
! align="center" style="background:#DCDCDC;" + |Osteoblastoma
| align="center" style="background:#F5F5F5;" + | -
| align="center" style="background:#F5F5F5;" + | -
| align="center" style="background:#F5F5F5;" + |[[Radiology]] and [[biopsy]]
| align="center" style="background:#F5F5F5;" + | +
|-
! align="center" style="background:#DCDCDC;" + |Telangiectatic osteosarcoma
| align="center" style="background:#F5F5F5;" + | -
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |[[Radiology]] and [[biopsy]]
| align="center" style="background:#F5F5F5;" + | -
|}


[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].


==Epidemiology and Demographics==
==Epidemiology and Demographics==

Revision as of 15:38, 21 January 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rohan A. Bhimani, M.B.B.S., D.N.B., M.Ch.[2]

Synonyms and keywords:

Overview

Historical Perspective

In 1948, Jaffe and Lichtenstein described chondromyxoid fibroma for the first time.[1]

Classification

Chondromyxoid fibromacan be classified based on imaging findings.


Enneking (MSTS) Staging System

  • The Enneking surgical staging system (also known as the MSTS system) for benign musculoskeletal tumors based on radiographic characteristics of the tumor host margin.[2]
  • It is widely accepted and routinely used classification.
Stages Description
1 Latent: Well demarcated borders
2 Active: Indistinct borders
3 Aggressive: Indistinct borders


Pathophysiology

  • The exact etiology of chondromyxoid fibroma is unknown.[3]
  • Chondromyxoid fibroma arises from the physeal remanant is the commonly proposed theory concerning the pathogenesis of chondromyxoid fibroma.[4]
  • It is predominantly found in the metaphyses of the long bones.[5]
  • The bones involved by chondromyxoid fibroma includes tibia, distal femur, pelvis, feet and hands.[6]

Genetics

  • Chromosome 6 appears to be involved with chondromyxoid fibroma.[7][5]
  • The non-random clonal abnormalities involves 6p25, 6q13 and 6q23.[5]

Causes

There are no established causes for chondromyxoid fibroma.[8]

Differentiating ((Page name)) from Other Diseases

Aneurysmal bone cyst must be differentiated from following bone disorders:

Disease Bubbly lytic lesion on x-ray Lakes of Blood on histology Diagnosis Treatment is curretage and bone grafting
Chondromyxoid Fibroma - - Radiology and biopsy +
Unicameral bone cyst + - Radiology and biopsy -
Non ossifying fibroma + - Radiology and biopsy -
Giant cell tumor - - Radiology and Biopsy +
Chondroblastoma - - Biopsy +
Aneurysmal bone cyst + + Radiology and biopsy +
Osteoblastoma - - Radiology and biopsy +
Telangiectatic osteosarcoma - + Radiology and biopsy -


Epidemiology and Demographics

The incidence/prevalence of [disease name] is approximately [number range] per 100,000 individuals worldwide.

OR

In [year], the incidence/prevalence of [disease name] was estimated to be [number range] cases per 100,000 individuals worldwide.

OR

In [year], the incidence of [disease name] is approximately [number range] per 100,000 individuals with a case-fatality rate of [number range]%.


Patients of all age groups may develop [disease name].

OR

The incidence of [disease name] increases with age; the median age at diagnosis is [#] years.

OR

[Disease name] commonly affects individuals younger than/older than [number of years] years of age.

OR

[Chronic disease name] is usually first diagnosed among [age group].

OR

[Acute disease name] commonly affects [age group].


There is no racial predilection to [disease name].

OR

[Disease name] usually affects individuals of the [race 1] race. [Race 2] individuals are less likely to develop [disease name].


[Disease name] affects men and women equally.

OR

[Gender 1] are more commonly affected by [disease name] than [gender 2]. The [gender 1] to [gender 2] ratio is approximately [number > 1] to 1.


The majority of [disease name] cases are reported in [geographical region].

OR

[Disease name] is a common/rare disease that tends to affect [patient population 1] and [patient population 2].

Risk Factors

There are no established risk factors for [disease name].

OR

The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.

Screening

There is insufficient evidence to recommend routine screening for [disease/malignancy].

OR

According to the [guideline name], screening for [disease name] is not recommended.

OR

According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].

Natural History, Complications, and Prognosis

If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].

OR

Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].

OR

Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.

Diagnosis

Diagnostic Study of Choice

The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].

OR

The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].

OR

The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].

OR

There are no established criteria for the diagnosis of [disease name].

History and Symptoms

The majority of patients with [disease name] are asymptomatic.

OR

The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].

Physical Examination

Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

Laboratory Findings

An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].

OR

Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

OR

[Test] is usually normal among patients with [disease name].

OR

Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].

OR

There are no diagnostic laboratory findings associated with [disease name].

Electrocardiogram

There are no ECG findings associated with [disease name].

OR

An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

X-ray

There are no x-ray findings associated with [disease name].

OR

An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

Echocardiography or Ultrasound

There are no echocardiography/ultrasound findings associated with [disease name].

OR

Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

CT scan

There are no CT scan findings associated with [disease name].

OR

[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

MRI

There are no MRI findings associated with [disease name].

OR

[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

Other Imaging Findings

There are no other imaging findings associated with [disease name].

OR

[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

Other Diagnostic Studies

There are no other diagnostic studies associated with [disease name].

OR

[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].

Treatment

Medical Therapy

There is no treatment for [disease name]; the mainstay of therapy is supportive care.

OR

Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].

OR

The majority of cases of [disease name] are self-limited and require only supportive care.

OR

[Disease name] is a medical emergency and requires prompt treatment.

OR

The mainstay of treatment for [disease name] is [therapy].

OR   The optimal therapy for [malignancy name] depends on the stage at diagnosis.

OR

[Therapy] is recommended among all patients who develop [disease name].

OR

Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].

OR

Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].

OR

Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].

OR

Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

Surgery

Surgical intervention is not recommended for the management of [disease name].

OR

Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]

OR

The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].

OR

The feasibility of surgery depends on the stage of [malignancy] at diagnosis.

OR

Surgery is the mainstay of treatment for [disease or malignancy].

Primary Prevention

There are no established measures for the primary prevention of [disease name].

OR

There are no available vaccines against [disease name].

OR

Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

OR

[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].

Secondary Prevention

There are no established measures for the secondary prevention of [disease name].

OR

Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].

References

  1. JAFFE HL, LICHTENSTEIN L (1948). "Chondromyxoid fibroma of bone; a distinctive benign tumor likely to be mistaken especially for chondrosarcoma". Arch Pathol (Chic). 45 (4): 541–51. PMID 18891025.
  2. Jawad MU, Scully SP (2010). "In brief: classifications in brief: enneking classification: benign and malignant tumors of the musculoskeletal system". Clin Orthop Relat Res. 468 (7): 2000–2. doi:10.1007/s11999-010-1315-7. PMC 2882012. PMID 20333492.
  3. Peabody, Terrance (2014). Orthopaedic oncology : primary and metastatic tumors of the skeletal system. Cham: Springer. ISBN 9783319073224.
  4. Brien EW, Mirra JM, Kerr R (1997). "Benign and malignant cartilage tumors of bone and joint: their anatomic and theoretical basis with an emphasis on radiology, pathology and clinical biology. I. The intramedullary cartilage tumors". Skeletal Radiol. 26 (6): 325–53. PMID 9229417.
  5. 5.0 5.1 5.2 Cuvelier CA, Roels HJ (1979). "Cytophotometric studies of the nuclear DNA content in cartilaginous tumors". Cancer. 44 (4): 1363–74. PMID 498016.
  6. Halbert AR, Harrison WR, Hicks MJ, Davino N, Cooley LD (1998). "Cytogenetic analysis of a scapular chondromyxoid fibroma". Cancer Genet Cytogenet. 104 (1): 52–6. PMID 9648559.
  7. Buddingh EP, Naumann S, Nelson M, Neffa JR, Birch N, Bridge JA (2003). "Cytogenetic findings in benign cartilaginous neoplasms". Cancer Genet Cytogenet. 141 (2): 164–8. PMID 12606137.
  8. Gherlinzoni F, Rock M, Picci P (1983). "Chondromyxoid fibroma. The experience at the Istituto Ortopedico Rizzoli". J Bone Joint Surg Am. 65 (2): 198–204. PMID 6337162.


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