Peculiar chondroblastoma involving multiple tarsal bones

Chondroblastoma of foot bones; a clinicopathological study of 29 cases confirming the diagnostic utility of H3K36M and H3G34W antibodies at an uncommon site

OBJECTIVE

Chondroblastoma (CB) is a benign cartilaginous bone neoplasm which commonly occurs in long bones of adolescents. CB can uncommonly involve foot. Its mimics include both benign and malignant lesions. H3K36M immunohistochemical (IHC) stain is a helpful tool for establishing the diagnosis of CB in such challenging situations. In addition, H3G34W IHC stain helps to rule out giant cell tumor which is the closest differential of CB. Our objective was to describe the clinicopathological features and frequencies of H3K36M, H3G34W and SATB2 IHC stains in CB of foot.

MATERIALS AND METHODS

We reviewed H&E slides and blocks of 29 cases diagnosed as "chondroblastoma" of foot at our institutions.

RESULTS

Patient's age ranged from 6 to 69 (mean: 23.3 and median: 23) years. Males were almost 5 times more commonly affected than females. Talus and calcaneum were involved in 13 (44.8 %) cases each. Microscopically, tumors were composed of polygonal mononuclear cells and multinucleated giant cells and chondroid matrix. Other histological features included aneurysmal bone cyst-like (ABC-like) change (44.8 %), osteoid matrix (31 %), chicken-wire calcification (20.7 %), and necrosis (10.3 %). H3K36M was expressed in 100 % and SATB2 in 91.7 % cases. H3G34W was negative in all cases, where performed. One out of 11 patients with follow up information developed local recurrence after 48 months.

CONCLUSION

CB in foot occur at an elder age and show more frequent ABC-like changes as compared to long bones. Males are affected ~5:1 as compared to 2:1 in long bones. H3K36M are H3G34W are extremely useful diagnostic markers for CB, especially elderly (aged or higher) patients and we report the largest series of foot CB cases confirmed by immunohistochemistry.

Synchronous chondroblastomas in the knee joint: A case report

Introduction

A chondroblastoma (CB) is a benign chondroid bone tumor that typically arises in growing children. It frequently occurs in the proximal tibia, femur, and humerus. However, the biological behavior of CBs remains unclear because of their rarity. Herein, we report a rare case of synchronous CBs arising on the bilateral sides of the knee joint, suggesting the etiology of chronological tumorigenesis.

Presentation of case

An 18-year-old Japanese man with a complaint of right knee pain was referred to our hospital. Radiography revealed an expanding osteolytic lesion in the right proximal tibia. A small lesion in the distal femur was detected on magnetic resonance imaging. A biopsy of the tibial lesion revealed a pathological diagnosis of CB. Two-stage curettages were performed in the tibia and femur, and the pathological diagnosis of the femoral lesion was CB. No recurrence had occurred for 5 years in the tibia and a year in the femur with stable ambulation and a full range of motion.

Discussion

In our case, the CBs in the proximal tibia and distal femur co-occurred, suggesting that the seed of the CB emerged before the separation of these two bones. The key point to the generation of CB is that its origin could be initiated during mesenchymal condensation before the separation and differentiation of bones as if continental drifts.

Conclusion

We experienced a rare and suggestive case in CB etiology. An experience of synchronous CBs in the consecutive bones was suggestive of CB etiology and careful management.

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Report of a rare type of chondroblastomas in two consecutive long bones.

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Tumorigenesis of chondroblastoma is suggested at mesenchymal condensation.

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Chondroblastoma separation to different bones, resembling plate tectonics.

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Multiple chondroblastomas should be carefully treated or monitored.

Chondroblastoma of the Foot: 40 Cases From a Single Institution

Chondroblastoma (CB) of the foot is a rare lesion. The purpose of this report was to report a large series from a single institution to analyze clinical, radiographic, and histologic characteristics; treatment; and local recurrence. We present 40 patients (30 males, 10 females; mean age 25 years) diagnosed and treated for CB of the foot from 1975 to 2012. The mean follow-up visit was 55 months (range 7 months to 11 years). Clinical presentation, histology, imaging, surgical treatment, and local recurrence were evaluated. Males were more affected than females. The main symptom was pain (100%) accompanied by swelling (35%), with median duration of 12 months. The talus (50%) and calcaneus (37.5%) were the most affected bones. All patients underwent surgery: curettage (10 cases), curettage and bone graft (15 cases), curettage and cement (13 cases), wide resection (1 case), and Chopart amputation (1 case). Ten patients (25%) had secondary aneurysmal bone cyst. One patient had local recurrence after surgery. In conclusion, patients with CB of the foot are usually older than 20 years, and males are most affected. The hindfoot is the most affected area. Surgical treatment is required, and intralesional curettage and packing with cement or graft is curative in most cases. Local recurrence in foot is lower than in other locations.

Primary Tumors of the Foot and Ankle

Tumors of the foot and ankle are rarely encountered in the general patient population. Even among studies of tumor patients, foot and ankle neoplasms are uncommon. Given the weight-bearing demands of the foot and its relatively small area, even small masses are likely to be symptomatic and/or palpable to both patient and physician. Only 3% of osseous neoplasms are found in this region, while 8% of benign soft tissue tumors and 5% of malignant soft tissue tumors are localized to the foot and ankle. Despite the rarity of presentation, it is important for orthopaedic surgeons to be familiar with the diagnostic criteria and therapeutic options for these patients, as each tumor varies in its presentation, level of aggressiveness, and natural history of the disease. With appropriate diagnostic tests and treatment, patients can anticipate a reasonable chance of survival and preservation of function. In this review article, the authors survey the current literature regarding the presentation, diagnostic workup, and treatment for the most common benign and malignant tumors of the foot and ankle.

LEVELS OF EVIDENCE

Level IV: Literature Review.

Bone multicentric epithelioid hemangioendothelioma of the lower and upper extremities with pulmonary metastases: A case report

The present study reports a rare case of bone multicentric epithelioid hemangioendothelioma (EH) involving the upper and lower extremities simultaneously, with visceral involvement of the lung. Osteolytic lesions were first identified in the right distal femur and proximal tibia. Slight increased radionuclide uptake was observed in the right shoulder joint on bone scintigraphy, however, this was ignored, as no clinical symptoms were present. The patient was initially misdiagnosed with multifocal chondroblastoma, and an extra-articular curettage of lesions was performed in the proximal tibia and medial femoral condyle, which was filled with bone cement. The histopathological diagnosis was corrected post-operatively following immunohistochemical analysis, which indicated EH, and subsequently, an amputation of the right leg at thigh level was performed. In addition, multiple lytic lesions in the right shoulder joint and pulmonary metastases were identified on whole-body radiological examination. Radiotherapy was administered to the right shoulder joint, however, the patient refused chemotherapy or further surgery. At 15 months after the initial surgery, the patient currently remains alive. This case indicates that an improved understanding with regard to the clinical features of this disease may prevent misdiagnosis and improve EH treatment.

Metachronous Bilateral Chondroblastoma of the Proximal Part of the Femur with a Pathologic Fracture: A Case Report

CASE

A twenty-two-year-old man presented with metachronous bilateral chondroblastoma of the proximal part of the femur with a pathologic fracture. The pathologic fracture on the right side was treated with tumor resection and total hip arthroplasty. Within forty-three months, the chondroblastoma in the left femoral head was detected and treated with the same protocol as the chondroblastoma on the right side. No metastatic lesion was evident at this time; because of its benign appearance histologically, the lesion was diagnosed as a metachronous lesion.

CONCLUSION

In a patient who has been previously diagnosed with and treated for chondroblastoma, skeletal pain at another site may represent a metachronous lesion.

Chondroblastoma of the medial cuneiform bone in a 32-year-old woman

Patient: Female, 32

Final Diagnosis: Chondroblastoma

Symptoms: Pain

Medication: —

Clinical Procedure: —

Specialty: Oncology