Chondroblastoma: Difference between revisions
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==Natural History, Complications, and Prognosis== | ==Natural History, Complications, and Prognosis== | ||
If left untreated, | *If left untreated, few patients with chondroblastoma may progress to develop lung metastasis.<ref name="pmid4023729">{{cite journal| author=Bloem JL, Mulder JD| title=Chondroblastoma: a clinical and radiological study of 104 cases. | journal=Skeletal Radiol | year= 1985 | volume= 14 | issue= 1 | pages= 1-9 | pmid=4023729 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4023729 }} </ref> | ||
*Common complications of chondroblastoma include:<ref name="FitzgeraldBroehm2014">{{cite journal|last1=Fitzgerald|first1=Judd|last2=Broehm|first2=Cory|last3=Chafey|first3=David|last4=Treme|first4=Gehron|title=Chondroblastoma of the Knee Treated with Resection and Osteochondral Allograft Reconstruction|journal=Case Reports in Orthopedics|volume=2014|year=2014|pages=1–7|issn=2090-6749|doi=10.1155/2014/543959}}</ref><ref name="pmid4023729">{{cite journal| author=Bloem JL, Mulder JD| title=Chondroblastoma: a clinical and radiological study of 104 cases. | journal=Skeletal Radiol | year= 1985 | volume= 14 | issue= 1 | pages= 1-9 | pmid=4023729 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4023729 }} </ref><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> | |||
**Pathological [[fracture]] | |||
**Premature epiphyseal closure | |||
***Limb-length discrepancy | |||
***Angular deformity | |||
**Malignant transformation | |||
**[[Metastasis]] to other organs | |||
***[[Metastasis]] most frequently involves the [[lungs]] and tends to occur at the time of primary tumor recurrence | |||
***Other sites of metastasis are secondary bone sites, soft tissue, skin, or the [[liver]] | |||
*Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary. However, the [[prognosis]] is generally regarded as excellent.<ref name="pmid1449941">{{cite journal| author=Caterini R, Manili M, Spinelli M, Santori FS, Ippolito E| title=Epiphyseal chondroblastoma of bone. Long-term effects on skeletal growth and articular function in 15 cases treated surgically. | journal=Arch Orthop Trauma Surg | year= 1992 | volume= 111 | issue= 6 | pages= 327-32 | pmid=1449941 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1449941 }} </ref> | |||
*Factors that influence the outcome of the chondroblastoma include: | |||
**Extent of the tumor | |||
**Size and location of the tumor | |||
**Pulmonary [[metastasis]] | |||
**Tumor response to the therapy | |||
==Diagnosis== | ==Diagnosis== | ||
Revision as of 19:11, 19 December 2018
Template:Chondroblastoma For patient information click here
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: Codman tumor; Codman's tumor; Codman tumour; Codmans tumor; Chondroblastomas; Benign chondroblastoma; Epiphyseal chondroblastoma
Overview
Historical Perspective
- In 1928, Codman first described chondroblastoma as epiphyseal chondromatous giant cell tumors of the proximal humerus.
- In 1942, Jaffe and Lichenstein later recognized it as a distinct entity due to its chondorid matrix.[1]
Classification
Chondroblastoma can 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 pathogenesis of chondroblaroma is not fully understood.[3]
- Various theories have been proposed concerning the pathogenesis of chondroblastomas:
- Chondroblastoma tumors are of chondrogenic origin.[4]
- Chondroblastoma arises from osteoid matrix–containing type I collagen and the absence of true cartilage matrix production (Type II collagen).[5]
- chondroblastoma arises from an intraosseous proliferation of tendon sheath cells that have a predilection for chondroid formation.[6]
- Chondroblastomas typically occur in the epiphyses and apophysis of the long bones.
- The bones often involved by epiphyseal chondroblastomas are femur, tibia, and humerus.[7]
Genetics
- Chondroblastoma may have association with genetic abnormalities on chromosome 5 and 8.
- Recently a specific mutation in the histone 3 gene H3F3B (K36M), was identified in approximately 95% of chondroblastomas.[8][9]
Causes
There are no established causes for chondroblastoma.[10]
Differentiating Chondroblastoma from Other Diseases
- Chondroblastoma must be differentiated from following bone disorders:
| Disease | Epiphyseal lesion | Benign lesion that may metastasize to lung | Diagnosis | Treatment is curretage and bone grafting |
|---|---|---|---|---|
| Chondroblastoma | + | + | Radiology and biopsy | + |
| Giant Cell Tumor | + | + | Radiology and biopsy | + |
| Aneurysmal bone cyst | - | - | Radiology and biopsy | + |
| Osteoblastoma | - | - | Biopsy | + |
| Chondromyxoid Fibroma | - | - | Radiology and biopsy | + |
Epidemiology and Demographics
- Chondroblastoma is a rare benign bone tumor accounting for approximately 1% of all benign bone tumors.[11]
- Adolescents and children are most affected by chondroblastoma.
- The age distribution of chondroblastoma is between 10-25 years.[12][13]
- The mean age of the patients with osteoid osteoma is 22 years.[12][13]
- Men are more commonly affected than women, with a 2:1 ratio.
- There is no racial predilection to chondroblastoma.
Risk Factors
There are no established risk factors for chondroblastoma.
Screening
There is insufficient evidence to recommend routine screening for chondroblastoma.
Natural History, Complications, and Prognosis
- If left untreated, few patients with chondroblastoma may progress to develop lung metastasis.[14]
- Common complications of chondroblastoma include:[1][14][15]
- Pathological fracture
- Premature epiphyseal closure
- Limb-length discrepancy
- Angular deformity
- Malignant transformation
- Metastasis to other organs
- Metastasis most frequently involves the lungs and tends to occur at the time of primary tumor recurrence
- Other sites of metastasis are secondary bone sites, soft tissue, skin, or the liver
- Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as excellent.[16]
- Factors that influence the outcome of the chondroblastoma include:
- Extent of the tumor
- Size and location of the tumor
- Pulmonary metastasis
- Tumor response to the therapy
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
- ↑ 1.0 1.1 Fitzgerald, Judd; Broehm, Cory; Chafey, David; Treme, Gehron (2014). "Chondroblastoma of the Knee Treated with Resection and Osteochondral Allograft Reconstruction". Case Reports in Orthopedics. 2014: 1–7. doi:10.1155/2014/543959. ISSN 2090-6749.
- ↑ 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.
- ↑ Peabody, Terrance (2014). Orthopaedic oncology : primary and metastatic tumors of the skeletal system. Cham: Springer. ISBN 9783319073224.
- ↑ Mii Y, Miyauchi Y, Morishita T, Miura S, Honoki K, Aoki M; et al. (1994). "Ultrastructural cytochemical demonstration of proteoglycans and calcium in the extracellular matrix of chondroblastomas". Hum Pathol. 25 (12): 1290–4. PMID 8001922.
- ↑ Aigner T, Loos S, Inwards C, Perris R, Perissinotto D, Unni KK; et al. (1999). "Chondroblastoma is an osteoid-forming, but not cartilage-forming neoplasm". J Pathol. 189 (4): 463–9. doi:10.1002/(SICI)1096-9896(199912)189:4<463::AID-PATH476>3.0.CO;2-N. PMID 10629544.
- ↑ Brien EW, Mirra JM, Ippolito V (1995). "Chondroblastoma arising from a nonepiphyseal site". Skeletal Radiol. 24 (3): 220–2. PMID 7610417.
- ↑ Punit A, Nadkarni S, Doomra T (2014). "Chondroblastoma of Diaphysis of Radius in a Seven Year Old Child". J Orthop Case Rep. 4 (3): 32–5. doi:10.13107/jocr.2250-0685.191. PMC 4719322. PMID 27298978.
- ↑ Amary MF, Berisha F, Mozela R, Gibbons R, Guttridge A, O'Donnell P; et al. (2016). "The H3F3 K36M mutant antibody is a sensitive and specific marker for the diagnosis of chondroblastoma". Histopathology. 69 (1): 121–7. doi:10.1111/his.12945. PMID 26844533.
- ↑ Behjati S, Tarpey PS, Presneau N, Scheipl S, Pillay N, Van Loo P; et al. (2013). "Distinct H3F3A and H3F3B driver mutations define chondroblastoma and giant cell tumor of bone". Nat Genet. 45 (12): 1479–82. doi:10.1038/ng.2814. PMC 3839851. PMID 24162739.
- ↑ Peabody, Terrance (2014). Orthopaedic oncology : primary and metastatic tumors of the skeletal system. Cham: Springer. ISBN 9783319073224.
- ↑ Dahlin DC, Ivins JC (1972). "Benign chondroblastoma. A study of 125 cases". Cancer. 30 (2): 401–13. PMID 5051664.
- ↑ 12.0 12.1 Bulanov DV, Semenova LA, Makhson AN, Bulycheva IV (2007). "[Chondrosarcoma of the larynx]". Arkh Patol. 69 (6): 50–2. PMID 18290384.
- ↑ 13.0 13.1 Turcotte RE, Kurt AM, Sim FH, Unni KK, McLeod RA (1993). "Chondroblastoma". Hum Pathol. 24 (9): 944–9. PMID 8253461.
- ↑ 14.0 14.1 Bloem JL, Mulder JD (1985). "Chondroblastoma: a clinical and radiological study of 104 cases". Skeletal Radiol. 14 (1): 1–9. PMID 4023729.
- ↑ 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.
- ↑ Caterini R, Manili M, Spinelli M, Santori FS, Ippolito E (1992). "Epiphyseal chondroblastoma of bone. Long-term effects on skeletal growth and articular function in 15 cases treated surgically". Arch Orthop Trauma Surg. 111 (6): 327–32. PMID 1449941.