Periosteal chondroma exhibits a notable tendency to involve the proximal humerus and distal femur. Periosteal chondromas are most common in the metaphyses of long bones followed by the small tubular bones of the hands and feet. To describe the characteristic imaging findings of juxtacortical chondroma in children. Additional names for this lesion are parosteal chondroma and juxtacortical chondroma. Original article periosteal chondroma of the proximal. Backgroundsofttissue chondroma stc is a rare benign soft tissue. Nov 10, 2014 differentiation on mri between enchondroma and chondrosarcoma was the subject of two separate studies. Scalloping of cortical bone is possible, but there is no marrow involvement. This is the presentation of a unique case of periosteal chondroma arising in the left distal tibial metaphysis of a 25. Backgroundsofttissue chondroma stc is a rare benign soft tissue tumor that arises primarily in acral extraskeletal locations. Periosteal chondroma is a rare, benign cartilaginous tumor that arises from the periosteal tissues. Erosion of the underlying cortex may be noted, 10 and some longstanding tumors may be associated with subchondral sclerosis. Periosteal chondroma, also known as juxtacortical chondroma, is a rare benign cartilaginous neoplasm of bone surface that occurs.
In contrast, periosteal chondromas presented with symptomatic lesion such. It is usually small, measuring less than 3 cm in diameter and of similar histology to a juxtacortical or periosteal chondroma, which is located between the bone and. Imaging features of periosteal chondroma manifesting as a subcutaneous mass in the index finger hidetomokosaka, 1 junnishio, 1 taikimatsunaga, 1 mikikoaoki, 2 hiroshiiwasaki, 2 andmasatoshinaito 1 department of orthopaedic surgery, faculty of medicine, fukuoka university, nanakuma, jonanku,fukuoka,j apan. Imaging features have been reported previously and are characterized by cortical scalloping with overhanging edges, chondroid matrix, and soft tissue mass. These tests provide clear pictures of dense structures like bone, and are helpful in diagnosing chondromas. Intracapsular and paraarticular chondroma of the infrapatellar hoffas fat pad. Wittig, i am writing at a loss to find adequate words to thank you for all that you have done for me. Extraskeletal chondroma occurs mostly around hands and toes. Kissing periosteal chondroma and osteochondroma request pdf. Periosteal chondroma of the ribreport of a case and. Extraskeletal chondromas are rare, benign, cartilaginous tumor without the. Periosteal chondroma definition of periosteal chondroma by. Rare usually 3 cm or less surface of long bone or small bones of hand feet usually teens to twenties, more common in males sites.
This is known as an enchondroma protuberans, and may either be seen sporadically or as part of ollier disease 2. Imaging features of periosteal chondroma manifesting as a. A case report suk ki jang 1, hyeok jin hong 1, eun mee han 2, su min kang 1, jin young yoo 1, in oak ahn 1 intracapsular and paraarticular chondroma is a rare benign lesion of the large joints mostly the knee. Aug 07, 2016 periosteal chondroma histologically the tumor is very similar to enchondroma, but it more frequently displays features of cell proliferation high cellularity, nuclear plumpness, and frequent doublenucleated cells. It develops adjacent to the cortex of the bone and is rimmed by an intact periosteal membrane. Periosteal bone definition of periosteal bone by medical. Pathology outlines juxtacortical periosteal chondroma. Reactive marrow changes are commonly seen at mr imaging, but true marrow invasion is rare. Differential diagnosis of the current case includes soft tissue chondroma and periosteal chondrosarcoma. Cytogenetics studies of periosteal chondromas are scarse.
They share histologic features with lowgrade chondrosarcoma, and are sometimes classified under the umbrella term low grade chondral series tumors. They are thought to account for 2% of benign bone tumors. It is the periosteal counterpart of medullary enchondroma. Miller sf 2014 imaging features of juxtacortical chondroma in children. Periosteal or juxtacortical chondroma arises at the surface of the bone. Developed by renowned radiologists in each specialty, statdx provides comprehensive decision support you can rely on periosteal chondroma. Chondroma, bones, neoplasms, cartilage, neoplasms, femur, phalanx, computed tomography, magnetic resonance imaging. Imaging characteristics of periosteal chondroma involving the distal tibia forming a thin shell like structure were found in the periphery of the tumor fig. Fifty percent of periosteal chondromas occur in the long bone of the arm. It is therefore important to be familiar with the imaging features of periosteal chondroma for its accurate diagnosis and appropriate treatment. After the evaluation, a radiologic diagnosis of chondroma or chondrosarcoma was obtained. Periosteal chondroma, also known as juxtacortical chondroma, is a benign cartilaginous neoplasm of the bone surface that accounts for periosteal chondroma is a rare benign hyaline cartilage neoplasm situated on the bone surface. Periosteal chondroma tends to develop within and beneath the periosteal connective tissue. Occasionally, stcs may arise in more proximal nonacral locations.
It does not infiltrate the adjacent soft tissue but may increase in size. Juxtacortical chondroma is a rare benign bone lesion in children. Patients present with a swelling or palpable mass that may be painful. Periosteal chondroma, also known as juxtacortical chondroma, is a benign cartilaginous neoplasm of the bone surface that accounts for periosteal chondroma exhibits a notable tendency to involve the proximal humerus and distal femur.
The periosteum is a membrane several cell layers thick that covers almost all of every bone. The mass seemed to be homogenous in nature, welldefined with some amorphous calcified foci inside. The exact cause of periosteal chondromas is unknown. Periosteal chondroma is a rare benign hyaline cartilage neoplasm situated on the bone surface. In order to accurately diagnose either type of chondroma, your doctor will order imaging or tissue tests.
Periosteal chondroma childrens hospital of philadelphia. Evaluation criteria included lesion location, mineralization, and size. Tumor biology rare, slowgrowing, benign, generally active cartilage lesion not known to metastasize arises on the surface of bone with underlying cortical scalloping age second through fourth decades gender m. Periosteal chondroma is a rare benign hyaline cartilage neoplasm that occurs most commonly in the metaphases of long tubular bones. It is made up of cartilage, a tough, flexible connective tissue found in many areas in the body. Furthermore, the mass is relatively small, measuring 2. The rarity of this condition often presents a diagnostic challenge.
Chondromas are noncancerous tumors made of cartilage. The radiographic features of 22 cases of histologically proven periosteal chondroma are analized in detail. Search for similar articles you may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search. These lesions are benign cartilage neoplasms and share the same basic pathology.
The role of computed tomography ct and magnetic resonance imaging mri in characterisation of bone tumours is largely centred on the assessment of local staging. Jul 11, 2019 nojima t, unni kk, mcleod ra, pritchard dj. We report a rare case of periosteal chondroma arising from the left clavicle of a 56 year old male. Imaging features of juxtacortical chondroma in children. No consistent abnormality has been detected, although we observed one case of a periosteal chondroma with a t2. Imaging features of periosteal chondroma manifesting as a subcutaneous mass in the index finger.
Meticulous analysis of initial and followup plain radiographs. An enchondroma grows within a bone and ultimately causes it to expand. Periosteal chondroma is a rare benign tumor of hyaline cartilage. Periosteal chondroma, also known as juxtacortical chondroma, is a benign cartilaginous neoplasm of the bone surface that accounts for chondromas. A diagnosis of periosteal chondrosarcoma was made, and wide resection was performed. The cytoplasm of the tumor cells was strongly positive for periodic acidschiff reaction. On mri, periosteal chondroma typically appears as a well circumscribed, juxtacortical mass with intermediate signal intensity on t1weighted images and high signal intensity on t2weighted images. Details of the image periosteal chondroma modality. Imaging of rare appendicular nonacral softtissue chondromas in. The presentation and imaging appearance, including the lobulated and exophytic morphology, are most consistent a benign juxtacortical chondroma. Periosteal juxtacortical chondroma the typical radiographic appearance of a periosteal chondroma is that of a welldefined surface lesion with stippled or punctate calcifications. Periosteal chondroma is a painful cartilaginous lesion that arises from surface of cortex deep to the periosteum, producing broad based cartilaginous mass that may extend into soft tissues.
The difficulty in clearly defining distinct imaging features differentiating benign and lowgrade malignant periosteal chondroid lesions is similar to the problem of differentiating benign and lowgrade malignant intramedullary chondroid lesions on imaging 17, 18. The signs and symptoms of periosteal chondroma are similar to those of solitary enchondroma. Juxtacortical chondroma jcc is a rare benign cartilaginous tumor originating from the periosteum. Juxtacortical chondroma radiology reference article. The imaging findings in our case were consistent with the abovementioned findings. Imaging diagnosis of solitary tumors of the phalanges and. A clinicopathologic study of 46 patients with periosteal chondroma and 14 patients with periosteal chondrosarcoma revealed that periosteal chondroma tended to affect younger patients and that the lesion was usually smaller. We present the scottish bone tumour registry experience of this rare lesion. Imaging diagnosis of solitary tumors of the phalanges and metacarpals of the hand july 2015, volume 205 number 1. Imaging of rare appendicular nonacral softtissue chondromas.
Various differential diagnoses were accounted for, including extraskeletal chondroma, extraskeletal osteochondroma, soft tissue chondrosarcoma, periosteal chondroma and periosteal chondromyxoid fibroma. Enchondromas, also known as chondromas 7, are relatively common intramedullary cartilage neoplasms with benign imaging features. Periosteal chondroma usually demonstrates peripheral enhancement after intravenous gadolinium administration 10. It is similar in appearance and location to periosteal osteosarcoma. On magnetic resonance imaging mri, the lesion is best seen on t2weighted images as a welldefined lobular mass see the first image below.
Extraskeletal chondroma, also referred to as chondroma of soft parts, is a benign soft tissue tumor composed mainly of hyaline cartilage with no connection to bone or periosteum. Periosteal chondroma can be seen from children to adults in all age groups, is located in the backbone of long bones or metaphysis, mostly occur in the proximal humerus. Periosteal chondroma medigoo health medical tests and. In contrast to enchondroma, periosteal chondroma also known as parosteal chondroma or juxtacortical chondroma. Concurrent soft tissue chondroma and periosteal chondroma of thumb 258 european journal of general medicine case a 34yearold man presented with a hard mass on the radial aspect of left thumb. A total of 7 cases with abnormal karyotypes have been reported table 1. Periosteal and soft tissue chondromas orthoinfo aaos. Male patients are more commonly affected than female patients. In this case, the size of the tumor was approximately 9 cm in the longest diameter but. Jan 23, 2015 periosteal chondroma is a rare benign cartilage tumor located on the cortical bone, which may be mistaken clinically and histologically for other and more common tumors in this location. No evidence of osteolysis, bony erosion or periosteal reaction. A rare type of chondroma benign chondrogenic lesion which occur on surface of long bones. The current study reports the case of periosteal chondroma located in the distal femur of a 14yearold female.
Detection and characterization is usually done by conventional radiographs cr, followed by magnetic resonance imaging mri. Is petct an accurate method for the differential diagnosis between chondroma and chondrosarcoma. In xrays, a periosteal chondroma shows up as a soft tissue shadow with erosion of the underlying bone. Enchondromas have a somewhat variable appearance by imaging, although characterization by excluding suspicious features is key. I myself would not feel confident making a call of juxtacortical chondroma based on imaging alone, most cases will require a careful biopsy, making sure the lesion is fully sampled. Like enchondroma, periosteal chondroma is a benign neoplasm composed of hyaline cartilage. Periosteal chondroma is a relatively rare benign cartilaginous neoplasm usually seen in young adults. Schinz, baensch, friedl, and uehlinger 3 briefly refer to parosteal chondromas, which may be the softtissue phase of the same entity or perhaps a form of extraperiosteal chondroma. This is the presentation of a unique case of periosteal chondroma arising in the left distal tibial metaphysis of a 25yearold female patient with a history of antecedent trauma. Juxtacortical chondromas, also known as periosteal chondromas, are rare benign chondral tumors that arise from the periosteum of tubular bones. Plain radiographs and computed tomography scans showed a. We could only find one reported case in the english literature of periosteal chondroma arising from the research and to the.
However, it is known that benign periosteal or juxtacortical chondromas can have atypia. Additionally, if the mass is in the early stages of periosteum chondroma formation, the cortex may not yet be eroded, making it nearly impossible for a ct scan to distinguish between cc and periosteal chondroma based on this characteristic. Nov 22, 2014 in this case, imaging features of the tumor were characteristic of a periosteal chondroma but not of a periosteal chondrosarcoma. Periosteal chondroma and periosteal chondrosarcoma are rare juxtacortical chondroid tumors that arise in the deep layer of the periosteum. Children usually present with a mildly painful mass, which prompts diagnostic imaging studies. Bizarre parosteal osteochondromatous proliferation bpop is a benign lesion of bone, and numerous questions remain unresolved regarding its etiology, diagnosis, and treatment.
The purpose of this study was to determine whether the imaging features of periosteal chondroid tumors correlate with histopathology. By definition, these tumors are of chondroid origin, arising in the periosteal layer of tubular bones, and are sometimes termed juxtacortical. Radiographically, the typical periosteal chondroma was a small, wellmarginated tumor on the outer surface of a long bone. The imaging modalities included conventional radiography n 17, ct n 10, and mr imaging. Peidro, l, suso, s, alcantara, e periosteal chondroma of the clavicle. The proximal humerus is the single most frequently affected site followed by the distal femur. Correct diagnosis is crucial in guiding surgical management. Physical examination revealed a slightly protuberant, subcutaneous mass. Radiographic and imaging features of enchondroma that are considered worrisome due to the potential for malignancy include large size, a large unmineralized component, significant thinning of the adjacent cortex, and bone scan activity greater than that of the anterior. Histologically the tumor is very similar to enchondroma, but it more frequently displays features of cell proliferation high cellularity, nuclear plumpness, and frequent doublenucleated cells.
Periosteal chondroma is a benign hyaline cartilage tumor of the bone surface that develops from the periosteum. They are often found in the small bones of the hands and feet. We report a case of intracapsular and paraarticular. Periosteal chondroma usually demonstrates peripheral enhancement after intravenous gadolinium administration. Abstractperiosteal chondrosarcoma is an extremely rare lowgrade malignant cartilaginous tumor arising from the. We present a unique case of periosteal chondroma arising in the proximal phalanx of the left index finger in a 12yearold boy. Periosteal osteosarcoma is a distinct type of surface osteosarcoma arises from the surface of the boneperiosteum it arises from the inner layer of the periosteum and therefore elevates the periosteum and produces a periosteal reaction. Being somewhat painful and causing some swelling in most instances, it usually requires surgical management consisting of either en bloc marginal excision or thorough curettage, equally effective. We presented three cases of periosteal chondroma in the proximal tibia of a 7yearold girl case 1, a 12yearold boy case 2 and a 15year8month old boy case 3. Special scientific paper session iss 2009 program tuesday. In the first study, choi et al compared the mri findings of 18 patients with lowgrade chondrosarcoma and 16 patients with enchondroma, patients with lowgrade chondrosarcoma, and reported significantly higher incidence of mri findings p periosteal reactions need to be ossified to be detectable radiographically, which typically takes between 10 days to 3 weeks following insult. It has been reported that the median size of periosteal chondrosarcomas was considerably larger than that of chondromas 7, 8. Case report imaging features of periosteal chondroma. Mri confirmed the extraosseous, extrasynovial location of the lesion.
It is a slowly growing neoplasm of comparatively small size, which develops within and beneath the periosteal connective tissue and characteristically erodes and. It may be difficult to differentiate from a periosteal chondrosarcoma. As lichtenstein pointed out, mason 2 used the term periosteal chondroma in a paper on tumors of the hand in 1937. Concurrent soft tissue chondroma and periosteal chondroma of. Periosteal chondroma atlas of musculoskeletal oncology. Mild degeneration of the left knee joint was also noted. The differential considerations include a periosteal chondroma, a lipoma, a subperiosteal hematoma, an inflammatory process, a giant cell tumor of tendon sheath, and a parosteal osteosarcoma. Intramedullary extension, adjacent intramedullary edema, softtissue edema, and intrinsic characteristics were also evaluated on mr imaging. Periosteal chondroma is one type of chondroma, occurred in the surface of bone, the periosteum, the tendons and ligament. This slowgrowing tumor erodes and induces sclerosis in the contiguous cortical bone, producing the characteristic popcorn appearance.
Chondromas are generally classified as enchondroma, periosteal chondroma and extraskeletal chondroma according to their location, in which enchondroma is the most common and the rest are rare. The size of the lesion is the most important factor. Periosteal definition of periosteal by the free dictionary. The typical tumor consisted in an area of outer cortex remodeling scalloping involving the metaphyseal lesion of a long bone with slightly overhanging edges and a small amount of cartilage calcified matrix adjacent to the scalloping.
Benign and malignant periosteal chondroid tumors were first described in the 1950s and are now recognized as distinct disease entities 1,2,3,4. About the only parts not covered by this membrane are the parts covered by cartilag. You were so generous to give up your time on a weekend to operate on my femur. Periosteal osetosarcoma tends to be more diaphyseal, a little less ossified, and has a more rapid growth pattern as compared to juxtacortical chondroma. In conclusion, in this case, although the imaging findings were suggestive of a slowgrowing benign mass such as periosteal chondroma, the remote history of penetrating trauma to the region led us to consider a foreign body granulation tissue formation in the differential diagnosis, as well as a periosteal chondroma. Petcomputed tomography ct revealed abnormal linear uptake with an suv max of 2. Bizarre parosteal osteochondromatous proliferation. It was difficult to differentiate periosteal chondrosarcoma from periosteal chondroma on the basis of size and the radiological and mri findings. The potential for confusion with periosteal and even parosteal osteosarcoma mandates.
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