Arthroscopic Resection for Benign Fibrous Histiocytoma in the Epiphysis of the Femur

Chondroblastoma of proximal tibia diagnosed by arthroscopy-guided biopsy: a case report

Chondroblastoma considered a rare form of osseous neoplasm contributes less than 1% of all bone tumours. It is typically found in young patients with chief complaints of moderate pain with joint stiffness. It develops as a lytic lesion in the epiphysis of long bones which might spread to the metaphysis. We report a case of an 18-year-old patient who presented with progressive right knee pain which aggravated with movements. Investigations included X-ray, magnetic resonance imaging (MRI), and biochemical assessment. A focal, well-defined, lesion in the upper end of the tibia with surrounding marrow oedema was observed and diagnostic arthroscopy was taken for management. Histopathology of specimen observed chondroblasts proliferation with areas of mature cartilage, and giant cells confirming intrasynovial chondroblastoma. Usually, surgery is the treatment of choice; however, possibilities of the secondary bone cyst, haemosiderin deposition on the joint, etc., make treatment approaches uncertain. Diagnostic arthroscopy is a rare but essential modality in such cases due to better visuals, complete tumour excision, and combination with adjuvant therapies. Chondroblastoma, if untreated, proves detrimental, hence, a thorough evaluation is critical for overall better outcomes.

Arthroscopic management of Juxta-articular chondroblastoma with bone substitutes - A case report

Chondroblastoma, a rare benign bone tumour arising from the epiphysis, accounts for approximately 1% of all primary bone tumours and is known to be locally aggressive with potential for metastases and local recurrence. Open surgical curettage is associated with high risk of recurrence and potential for damage to the physis resulting in growth disturbances. We report a 14-year-old girl with chondroblastoma involving the distal femoral epiphysis in whom an arthroscopic approach was employed for thorough curettage of the lesion under direct vision followed by cavity management using bone graft substitute. At seven years follow-up she is asymptomatic, has normal knee function and her radiographs have shown good osteointegration of the synthetic graft with no evidence of recurrence. By combining the principles of intra-articular and endosteal arthroscopy in select patients, both tumour excision and cavity management can be done arthroscopically.

Giant cell tumor of bone in an eighteenth-century Italian mummy

Giant cell tumor (GCT) of the bone is a locally aggressive and rarely metastasizing neoplasm. It is composed of neoplastic mononuclear stromal cells with a monotonous appearance admixed with macrophages and osteoclast-like giant cells. In a small subset of cases, GCT is malignant. Terminology previously related to this entity, and which is no longer supported by the World Health Organization, includes osteoclastoma and benign fibrous histiocytoma (BFH). Giant cells occur in numerous other pathologic conditions of the bone, which accounts for the misrepresentation of these non-GCT tumors in the early literature. Non-ossifying fibroma (NOF), aneurysmal bone cyst, and chondroblastoma have been erroneously labeled GCT for this reason. A single description of an ancient GCT was reported by Brothwell and Sandison and subsequently mentioned by Aufderheide and Rodrìguez-Martìn who were astonished that more of these tumors had not been identified in archaeological cases. To the best of our knowledge, no other cases of ancient GCT have been cited in the paleopathology literature. The study of this type of neoplasm in antiquity can be used as a means to better understand its characteristics and behavior and to expand the depth of time of the etiology of these lesions. We report a case of GCT of the left femur observed following the total body CT imaging of a partially mummified adult female, dating to eighteenth century.

"Dry Arthroscopy" is a Valuable Tool in the Excisional Curettage of Chondroblastoma: A Case Series

Introduction:

Chondroblastomas are benign, locally aggressive bone tumors that occur in the epiphysis of young patients, requiring surgical excision. The anatomic locations of these lesions pose technical challenges to the surgeon; their proximity to the articular surface and the physis make surgical approach and visualization difficult. This case series describes the use of intramedullary arthroscopic assistance during excisional curettage of three distal femoral chondroblastomas.

Case Report:

Three patients with distal femoral chondroblastomas underwent excisional curettage with intraosseous “dry” arthroscopic assistance. We describe a two-tunnel technique, using medial and lateral windows so the arthroscope and working instruments could be within the lesion simultaneously; as well as two variations of a single-tunnel technique.

Conclusion:

Achieving adequate ex­­­posure and visualization, while protecting the articular surface and physis, during excision of chondroblastomas, is essential for avoiding local recurrence and complications. “Dry” arthroscopic assistance provides the surgeon with an enhanced view of the tumor and tumor cavity, minimizes invasiveness, and has the potential to reduce complications without compromising the completeness of the excision.