Inflammatory reaction in chondroblastoma

 Objective. The objective of this study was to evaluate the inflammatory reaction accompanying chondroblastoma and to define the value of the finding in clinical practice. Design. We reviewed the clinical, radiographic, and magnetic resonance (MR) findings in six patients with histologically proven chondroblastoma. Results. In all cases, MR imaging showed marrow and soft tissue edema. In four of six cases, periosteal reaction related to intra-osseous edema was more clearly demonstrated on MR imaging than on radiographs. Follow-up MR studies after surgery were available in three patients and all showed disappearance of inflammatory responses such as marrow and soft tissue edema, and reactive synovitis. Conclusion. We propose that these inflammatory reactions of chondroblastomas are important signs for detecting residual tumor in recurrences after surgery, as well as for making a precise diagnosis. The MR changes may also be valuable in demonstrating eradication of the tumor.     

Diaphyseal chondroblastoma in a long bone: first report

Chondroblastoma is a rare benign bone tumor typically located in the epiphysis. We describe the first case of chondroblastoma arising in the diaphysis of a long bone. The patient was a 13-year-old girl who presented with pain over her right thigh. Radiographs showed a lytic lesion in the diaphysis of her right femur. A core biopsy and a subsequent surgical resection were performed.     

Ewing’s sarcoma of the thumb

 The case of a 51-year-old man with Ewing’s sarcoma of the thumb is presented. The tumor involved the distal phalanx of the right thumb, associated with an impressive extraskeletal mass. Histology revealed a round cell sarcoma with a positive immunoreactivity with monoclonal antibody O13. Five years after disarticulation at the metacarpophalangeal joint, the patient is alive without recurrence or metastasis.     

成软骨细胞瘤的MRI表现特点

目的 分析成软骨细胞瘤的MRI表现特点.方法 对经病理证实的20例成软骨细胞瘤的MRI信号特点、病灶形态和生长方式,以及周围骨髓和软组织有无水肿、有无骨膜反应、相邻关节有无积液等征象进行分析.结果 20例病灶在T1WI和T2WI上表现为不均质的混杂信号,病灶形态为分叶状;16例病灶呈膨胀性生长;18例病灶周围出现骨髓水肿;14例病灶周围软组织水肿;6例病灶周围有骨膜反廊;7例病灶突破骨皮质向周围突出;6例棚邻的关节有关节积液.结论 成软骨细胞瘤在MRI上多表现为分叶状和膨胀性生长,病变呈不均质混杂信号,病灶周围有明显的骨髓水肿和邻近软组织水肿.     

Intraosseous glomus tumor of the fibula

Glomus tumor is a rare, benign vascular tumor and intraosseous glomus tumor, which arises primarily within bone, is even rarer. Fewer than 20 cases have been reported in the literature. We present the case of a 34-year-old woman with glomus tumor primarily in the midshaft of the fibula that radiologically mimicked chondromyxoid fibroma, aneurysmal bone cyst or adamantinoma, together with a review of other reported cases. Received: 5 July 2000 Revision requested: 10 August 2000 Revision received: 28 August 2000 Accepted: 28 August 2000     

Malignant chondroblastoma presenting as a recurrent pelvic tumor with DNA aneuploidy and p53 mutation as supportive evidence of malignancy

We report a rare case of malignant chondroblastoma, which presented in a 47-year-old man as a recurrent tumor, 18 years following wide excision of a typical pelvic chondroblastoma. Radiologic studies of the recurrent tumor showed a large, lytic, destructive lesion of the right pelvic bones and femur, with a pathologic fracture of the latter, a large pelvic soft tissue mass, and multiple pulmonary metastases. Biopsy tissue showed typical features of chondroblastoma, but also increased nuclear atypia, hyperchromasia, and pleomorphism, compared to the original tumor, and, most significantly, abnormal mitotic figures. Immunohistochemical studies of the recurrent tumor revealed p53 mutation and extensive proliferative activity, and flow cytometric studies showed DNA aneuploidy, none of which was present in the original tumor. The patient received chemotherapy and radiation, but died of disease eight months after presentation. We also review chondroblastoma in general, to assign this unusual lesion to a tumor subtype. Received: 29 March 1999 Revision requested: 27 April 1999 Revision received: 23 June 1999 Accepted: 29 June 1999     

MRI of fractures of the distal radius: comparison with conventional radiographs

Objective. To compare the evaluation of fractures of the distal radius with MRI and conventional radiographs. To demonstrate the ability of MRI to detect unsuspected soft tissue derangement accompanying this common injury. Design and patients. Twenty-one consecutive inpatients admitted following fracture of the distal radius underwent preoperative evaluation with both conventional radiographs and MRI. In each case, analysis was made of both the osseous and soft tissue injury. MRI findings were compared with those identified on conventional radiographs and at subsequent surgical fixation. Results. Of 21 patients with fractures of the distal radius, 20 had extension to the radiocarpal articulation, 14 had distal radio-ulnar joint extension and 5 had avulsion of the ulnar styloid.Occult carpal bone fractures accompanying fracture of the distal radius were identified in two patients: one of the capitate and the other of the second metacarpal base. Ten patients (48%) had associated soft tissue injury: six patients had scapholunate ligament rupture, two patients had disruption of the triangular fibrocartilage, one patient had extensor carpi ulnaris tenosynovitis and one patient had a tear of a dorsal radiocarpal ligament. Of five patients with ulnar styloid avulsions, none had evidence of triangular fibrocartilage tears. Conclusion. MRI affords better evaluation of osseous injury accompanying distal radial fractures than conventional radiographs. Intra-articular soft tissue injury accompanies distal radial fractures in almost 50% of cases. Scapholunate ligament disruption commonly accompanies intra-articular fracture through the lunate facet of the distal radius. Fracture of the ulnar styloid is infrequently associated with tear of the triangular fibrocartilage.     

Giant chondroblastoma of the scapula with pulmonary metastases

A 53-year-old man presented with a 12-year history of a progressively growing solid mass at his left shoulder. A 39×30×18-cm and 14.440-kg mass including the scapula was resected. Pathologic features were specific for chondroblastoma. During the 36-month follow-up, he had multiple inoperable metastatic lesions in his lungs. Histology of the transthoracic needle biopsy showed the metastatic nodules had features specific for chondroblastoma; however, the microscopic features additionally had hyperchromasia and increased mitotic activity in some areas. In the English literature, there are a few cases of chondroblastoma located in the scapula. It is exceptional to see this lesion in the sixth decade of life and with pulmonary metastases.     

Chondroblastoma with multiple distant soft tissue metastases

 A case of metachronous distant soft tissue metastases from a primary rib chondroblastoma, occurring in a 60-year-old man 17 years following resection of the initial lesion, is described. Metastatic chondroblastomas are very rare and almost always involve the lungs. Discussed herein are the clinical, radiologic, and pathologic findings of this unusual case with comparison of our findings to other reports of metastasizing chondroblastomas.     

跗骨成软骨细胞瘤的影像表现

目的 探讨跗骨成软骨细胞瘤的影像表现.方法 回顾分析经病理证实的134例成软骨细胞瘤的部位分布情况,对其中11例跗骨成软骨细胞瘤的X线和5例CT表现进行分析.结果 11例跗骨成软骨细胞瘤患者中,病变位于距骨6例、跟骨3例、足舟骨2例.距骨体后部及跟骨后结节为好发部位,X线表现以膨胀性骨质破坏为主(10/11),局部边缘轻度硬化(11/11),骨嵴常见(9/11),关节面破坏常见(7/11),可见斑点状钙化(6/11);CT对关节面破坏(5/5)、小的骨嵴(5/5)以及细小钙化(2/5)的显示更明显.结论 距骨、跟骨是跗骨成软骨细胞瘤好发部位,影像表现具有一定特点,但应结合其发病部位与其他疾病鉴别.     

软骨母细胞瘤的影像诊断价值

目的：分析软骨母细胞瘤的影像学特征及诊断价值。方法：回顾性分析24例经病理证实的软骨母细胞瘤的影像学资料,其中24例均有X线平片,20例CT扫描,12例MRI检查。结果：24例中,X线表现为骨质破坏（22例）,病灶周围硬化边（15例）,病灶内明显的斑点状及片状钙化（14例）。20例CT均显示清晰骨质破坏及硬化边,伴有明显的斑点/片状钙化（18例）,骨膜反应（5例）及周围软组织肿胀（9例）。12例MRI显示边界清楚的长T1、长短混杂T2信号,5例可见明显的骨髓水肿,3例显示骨膜反应,增强4例强化较明显。结论：软骨母细胞瘤的影像学表现多具有一定的特征性,综合分析X线、CT、MRI表现有助于正确诊断。     

Jansen type of spondylometaphyseal dysplasia

Metaphyseal dysplasia, type Jansen (JMD), is a rare skeletal dysplasia with characteristic radiographic abnormalities. Of the various types of metaphyseal dysplasia, JMD shows the most severe alteration in metaphyseal architecture. All of the long tubular bones, including those of the hands and feet, show metaphyseal irregularity with a fragmented appearance and slight widening. The adjacent physes are abnormally widened, while the epiphyses tend to be slightly enlarged, rounded but otherwise normal. The spine in infancy and childhood usually appears normal. This report describes a young girl with metaphyseal changes typical of JMD except for the hands and feet, which appeared normal. She also showed very unusual abnormalities of the spine. This appears, therefore, to represent a unique osteochondrodysplasia for which we propose the term spondylometaphyseal dysplasia, type Jansen. Received: 4 April 1999 Revision requested: 6 April 1999 Revision received: 29 November 1999 Accepted: 1 December 1999     

少见部位软骨母细胞瘤的影像学表现

目的:探讨少见部位软骨母细胞瘤(CB)的影像学表现。方法:回顾性分析经病理证实的20例少见部位CB的影像学资料,分析其病灶位置、形态、密度及增强表现等特征。结果:20例中病灶位于距骨6例,跟骨5例,髌骨4例,肩胛骨2例,髂骨2例,坐骨1例。病灶在X线和CT上主要表现为类圆形或不规则形,以膨胀性溶骨性骨破坏为主,周围可见硬化边,其内有或无分隔,边缘可见骨嵴,病灶内偶尔可见点状及片状钙化。病灶在MRI上表现为不均匀的长T1、长T2信号。结论:少见部位软骨母细胞瘤发病率低,影像学表现具有相对特征性和多样性,应结合临床、影像学和病理学特征进行综合诊断,避免误诊。     

Unusual chondroblastoma of the hand with large extraosseous soft tissue component

Chondroblastoma is a rare, benign primary cartilaginous bone tumor that typically arises in the epiphyses of the long bones. Radiologically, a well-defined lytic lesion with thin sclerotic margins is commonly found. The tumor is characterized histologically as an admixture of chondroblasts and multinucleated giant cells with chondroid matrix and pericellular calcifications. We present a case of a chondroblastoma of the hand with an unusual large extraosseous soft tissue component. The mass demonstrated diffuse calcifications and radiolucent lesions in the dorsal aspect of the hamate and metacarpals. Differential diagnoses included synovial chondromatosis, soft tissue chondroma, and tenosynovial giant cell tumor. The patient underwent open biopsy of the mass with plans for excision. Final histopathologic diagnosis was of chondroblastoma of the hamate with a large soft tissue component. A marginal excision of the lesion with curettage and cementation was performed.     

足跗骨软骨母细胞瘤的影像学表现

目的:总结分析足跗骨软骨母细胞瘤的影像学表现。方法:回顾性分析经临床病理证实的发生于足跗骨的5例软骨母细胞瘤的X线、CT及MRI表现。结果:5例均单发,2例位于跟骨,2例位于距骨,1例位于舟骨。X线主要表现为圆形或卵圆形透亮影,边界清楚,5例均可见病灶边缘硬化带形成,病灶内未见明显钙化。CT扫描显示肿瘤呈膨胀性生长,骨质破坏区边界锐利、硬化,灶周软组织肿胀,未见骨膜反应及软组织肿块,增强扫描呈轻度不均匀强化。MRI可见病灶形态呈分叶状,呈长、稍长T1信号,混杂T2信号,伴有灶周骨髓水肿及关节腔积液,灶周软组织水肿,增强扫描亦呈轻度不均匀强化。结论:足跗骨软骨母细胞瘤较少见,其影像学表现具有一定特征性。     

Synovial osteochondromatosis complicating pilon fracture of the tibia

A case of previously undiagnosed synovial osteochondromatosis complicating a tibial pilon fracture is presented. The entrapment of osteochondral bodies within the fracture margin prevented complete reduction of the fracture and necessitated surgical intervention. Received: 27 December 2000 Revision requested: 26 January 2001 Revision received: 19 March 2001 Accepted: 21 March 2001     

软骨母细胞瘤影像学表现(附10例报告)

目的:探讨软骨母细胞瘤的影像学表现。方法:回顾性分析10例经病理证实的软骨母细胞瘤的影像学资料,10例均有X线平片检查,其中7例同时做CT扫描,3例做了MR检查。结果:10例中,8例X线平片显示病灶边缘清晰,可见偏心膨胀性改变,4例病变累及骨骺,4例X线示病灶内有明显的不规则钙化。7例行CT扫描显示病灶边界清晰和斑点、片状钙化。3例MRI检查显示病灶边界清楚,T1WI低信号、T2WI混杂稍高信号。结论:X线检查是软骨母细胞瘤的首选检查方法,CT和MRI是必要的补充检查方法。软骨母细胞瘤的影像学表现具有一定的特征性,结合临床病史可以提高该病诊断和鉴别诊断能力。     

Radiological diagnosis of abductor denervation after hip surgery

A case of total hip arthroplasty through a direct lateral approach is described. The patient had a markedly positive Trendelenburg test at follow-up. Radiographs showed features consistent with the denervation of the gluteus medius. This was confirmed on CT scan. The standard post-operative radiograph following a total hip replacement may suggest denervation of the gluteus medius. Received: 20 July 2000 Revision requested: 23 August 2000 Revision received: 8 October 2000 Accepted: 10 October 2000     

False positive 18F-FDG PET in an ischial chondroblastoma; an analysis of glucose transporter 1 and hexokinase II expression

We report a rare case of chondroblastoma arising from the ischium which showed an increased ¹⁸F-FDG uptake. Chondroblastoma is an uncommon lesion and usually involves the epiphysis of long bones. However, in this case, the tumor appeared as a well-defined osteolytic lesion in the ischium on radiographs. MR imaging demonstrated two components in the tumor: a solid one and a multilobular cystic component. ¹⁸F-FDG PET imaging revealed an increased uptake in the ischium. The ¹⁸F-FDG uptake resembled the results observed in malignant bone tumors. A histological diagnosis of chondroblastoma was obtained from tissue of an open biopsy. An immunohistochemical analysis demonstrated weak expression of both Glut-1 and HK-II. These findings suggest that Glut-1 and HK-II expression are not strongly related to FDG uptake in chondroblastoma.     

Periprosthetic soft tissue recurrence of chondroblastoma after attempted en bloc excision from the proximal humerus

A case of soft tissue recurrence of chondroblastoma after attempted en bloc excision and endoprosthetic replacement is described. This tumor in the proximal humerus recurred after initial curettage and was subsequently treated by attempted en bloc excision with positive microscopic margins. The patient then presented with a large soft tissue recurrence surrounding the endoprosthesis. This periprosthetic recurrence necessitated re-excision and revision of the endoprosthesis. Recurrence is not uncommon following curettage of chondroblastoma. However, less is known about soft tissue recurrence after en bloc resection of this tumor with positive margins. A subset of chondroblastoma may exist with more locally aggressive behavior.