Chondromyxoid fibroma of the foot and ankle: 40 years' Scottish bone tumour registry experience

Chondromyxoid fibroma: A retrospective evaluation of 31 cases

OBJECTIVES

This study aimed to review a 35-year experience with chondromyxoid fibroma at our institution.

PATIENTS AND METHODS

The study retrospectively analyzed the records of 31 consecutive patients (17 males, 14 females; mean age: 30.5±15.7 years; range, 6 to 63 years) with chondromyxoid fibroma who were treated between January 1988 and December 2021. The clinical and radiological characteristics of lesions, tumor volume, and recurrence rates were assessed using the tumor archive of the hospital.

RESULTS

The mean follow-up duration was 65.9±42.0 months. Pelvis, proximal tibia, and distal femur were the most common sites of localization. The initial surgical treatment was performed on 27 patients at our clinic, while four patients were referred to the clinic after recurrence. The overall recurrence rate was 16.1%. Intralesional curettage was applied to 21 (77.8%) out of 27 patients. The cavity created after curettage was filled with bone graft (autograft or allograft) in 15 (55.5%) cases. Bone cement was applied in four (14.8%) cases. Resection was applied to five (18.5%) patients. In two (7.4%) cases, intralesional curettage alone was performed. One of these two patients experienced recurrence, resulting in a recurrence rate of 50% in this patient group. No recurrence was observed in other treatment groups.

CONCLUSION

Intralesional curettage and filling the defect with bone graft or cement were effective for local control in most cases. Curettage alone was associated with high recurrence rates.

Chondromyxoid Fibroma of Distal Phalanx of the Great Toe: A Rare Clinical Entity

Chondromyxoid fibroma is a rare benign tumor of cartilaginous origin with myxoid and fibrous components. It accounts for approximately 1% of bone tumors. Metaphysis of long bones is the most common location of this tumor. However, there a few case reports of this tumor arising from epiphysis of short tubular bones of the hand and feet.

An 11-year-old girl presented to our OPD with complaints of pain and a gradually progressive swelling of the right great toe. On examination, the swelling was diffuse with no signs of inflammation. X-ray examination revealed a well-defined, longitudinally oval lytic lesion in the right distal phalanx of great toe, involving the growth plate and, eroding the medial cortex. Computed tomography (CT) scan did not show any evidence of calcification, septations or involvement of soft tissue. Open biopsy and curettage was done and the specimen was sent for histopathological examination. Histopathological examination (HPE) showed a lobular pattern consisting of myxomatous stroma and immature cartilaginous cells in lacunae. The lobules were separated by fibrous septae. It was reported to be Chondromyxoid fibroma. The patient presented six months later with persisting pain and X-ray showed recurrence of the tumor. Hence, complete excision of the tumor was done and the defect was filled using synthetic bone graft. At six months follow up, the patient did not complain of pain and X-rays showed signs of bone formation with incorporation of the graft.

Chondromyxoid fibroma is a low grade tumor, which may demonstrate nuclear atypia histologically and mimic chondrosarcoma. Differentiating these two is of paramount importance to avoid over-diagnosis and aggressive treatment. Recurrence is common with marginal excision and especially in younger patients like in our case. Complete resection is the mainstay of management. Long-term follow up of patients is necessary to watch for malignant transformation, a rare complication. Chondromyxoid fibroma is an extremely rare neoplasm of bone. There are no specific radiologic features, and histopathology provides a definitive diagnosis. It should be considered in differential diagnosis of lytic lesion, and differentiated from other tumors, especially from chondrosarcoma to treat the patient appropriately.

Cystic bone tumors of the foot and ankle

Bone tumors are relatively rare in the foot and ankle region. Many of them present as cystic lesions on plain films. Due to the relative rarity of these lesions and the complex anatomy of the foot and ankle region, identification of such lesions is often delayed or they get misdiagnosed and mismanaged. This review discusses the most common cystic tumors of the foot and ankle including their radiographic features and principles of management.

Chondromyxoid fibroma of the distal fibula treated by percutaneous radiofrequency ablation

BACKGROUND

Percutaneous radiofrequency ablation (RFA) has been shown to be an effective treatment for soft tissue lesions and also benign bone tumors, especially osteoid osteoma. There are limited data regarding this technique in other bone tumors, specifically larger and more aggressive ones.

PURPOSES

To describe the use of RFA as a definitive treatment and an alternative to traditional open surgery for the treatment of chondromyxoid fibroma (CMF), a benign but locally aggressive bone tumor.

CASE PRESENTATION

An 11.5-year-old girl was diagnosed with a 4-cm lytic bone lesion of the distal fibula. Evaluation, including biopsy, revealed CMF. It was managed by fluoroscopy-guided RFA only. Six-year follow-up demonstrated complete healing without damage to the adjacent distal fibular growth plate.

DISCUSSION AND CONCLUSIONS

RFA induces local heat in the ablation field and causes tissue necrosis. The depth of heat penetration and the size of heated sphere are accurately controlled by modern types of ablation probes and accurate positioning. The current report demonstrates the ability to use this percutaneous technique for larger and more aggressive bone tumors than has been indicated previously.

Bone tumors of the pediatric foot: imaging appearances

Tumors of the foot are rare in children. This review illustrates radiographic, CT and MR imaging findings of foot bone tumors in children based on all cases presented in a tertiary pediatric hospital during the 15-year period of 1999-2014. This search revealed 155 tumors of the foot, 72 of the bones and 83 of the soft tissues. Osteochondroma, bone cyst and fibrous dysplasia were the most frequent benign bone lesions. Ewing sarcoma was the most common malignant osseous tumor. Some tumors showed higher prevalence in certain age ranges and others showed predilection for specific bones. Radiographs are useful for diagnosis in the majority of cases but CT and MR imaging provide additional valuable information in select cases for diagnosis and determining extent of the lesions. Radiologists should be aware of some typical imaging findings in bone tumors of the foot in order to establish diagnosis and facilitate patient management.

[Chondromyxoid fibroma of the mandible: a case report]

Chondromyxoid fibroma (CMF) is a rare benign bone tumor. This tumor mostly affects the long bones of the appendicular skeleton but rarely grows in the craniofacial region. In this article, a case of CMF of the mandible was presented to enhance our understanding of CMF. Its clinical manifestations, imaging characteristics, and treatment methods were discussed by analyzing the related literature.

Chondroblastoma and chondromyxoid fibroma

Chondroblastoma and chondromyxoid fibroma are benign but locally aggressive bone tumors. Chondroblastoma, a destructive lesion with a thin radiodense border, is usually seen in the epiphysis of long bones. Chondromyxoid fibroma presents as a bigger, lucent, loculated lesion with a sharp sclerotic margin in the metaphysis of long bones. Although uncommon, these tumors can be challenging to manage. They share similarities in pathology that could be related to their histogenic similarity. Very rarely, chondroblastoma may lead to lung metastases; however, the mechanism is not well understood.

Chondromyxoid fibroma of calcaneus

BACKGROUND

Chondromyxoid fibroma is a rare benign primary bone tumor composed of immature myxoid mesenchymal and cartilaginous tissue. Its occurrence in calcaneus is very rare and few cases of calcaneal involvement have been reported in literature. We report five cases of CMF in calcaneus.

METHODS

Five cases, with the final diagnosis of chondromyxoid fibroma of the calcaneal bone are included in this report. Preoperative tumor workup was performed for our patients. We reviewed and recorded demographic data and the sign and symptoms of patients at presentation to our center. Mode of treatments, postoperative complications and recurrence were also studied. Curettage, high speed burring and bone grafting was performed in 4 of our patients and in the remaining case we only carried out curettage and burring.

RESULTS

Of the five patients, 3 were male and 2 were female. The mean age at presentation was 21. Two of our cases had previous surgery in other centers and had been referred to our clinic because of recurrence. The chief complaint in all of our patients was heel pain. The mean follow up period was 25.2 months. All of our patients had a delay in the diagnosis of tumor. We did not have any recurrence in our patients during follow up period.

CONCLUSIONS

This case series shows that chondromyxoid fibroma is not necessarily as exceedingly rare as generally reported in the current literature. This tumor should be considered in the differential diagnosis in patients with ankle and heel pain.

The imaging of cartilaginous bone tumours. I. Benign lesions

Benign cartilage tumours of bone are the most common benign primary bone tumours and include osteochondroma, (en)chondroma, periosteal chondroma, chondroblastoma and chondromyxoid fibroma. These neoplasms often demonstrate typical imaging features, which in conjunction with lesion location and clinical history, often allow an accurate diagnosis. The aim of this article is to review the clinical and imaging features of benign cartilage neoplasms of bone, as well as the complications of these lesions.

Chondromyxoid fibroma of the lateral malleolus: a case report

Chondromyxoid fibromas account for <1% of primary bone neoplasms. We report one such case occurring in the distal fibula of a 27-year-old woman. The patient underwent curettage, followed by phenolisation, insertion of a Steinmann pin, and cementation. This treatment reduced morbidity, restored stability, and enabled rapid functional recovery. There was no recurrence after 2 years.

Chondromyxoid fibroma of the distal phalanx of the big toe

Chondromyxoid fibroma rarely arises in the distal phalanx of the toe. It shows a wide spectrum of histology, mimicking other primary bone tumors. A 40-year-old woman had persistent swelling of her big toe after a minor injury a few years ago before a consultation. A radiographic and magnetic resonance imaging study suggested a highly aggressive tumor. Amputation was performed, and pathology of the lesion showed chondromyxoid fibroma.

Computed tomography of the bones of the foot: neoplastic disease

Magnetic resonance imaging is the imaging modality of choice as a conjunctive study to radiography for imaging bone tumors of the foot. However, there will be cases where computed tomography (CT) is performed, and CT is superior in evaluating the bone cortex and identifying pathological fractures, periosteal reaction, or matrix mineralization. This article reviews osseous foot neoplasms. Clinical and imaging findings are discussed, as well as applications where CT provides valuable information.