Volume 4            Benign Chondroid TumorsEnchondroma---------------------------Case 120 & 548-567Multiple enchondromatos...
Chondroidforming Tumors
Enchondroma
Enchondroma  The enchondroma is one of the most common benign tumors seenin the skeletal system. It is centrally located a...
convert very gradually into a low grade chondrosarcoma. Theincidence of conversion is less than 5% of cases and almost alw...
CLASSICCase #12038 year femaleenchondromadistal femur
Bone scan
Coronal T-1 MRI                  tumor
Coronal T-2 MRI                  tumor
tumorAxial T-2 MRI
Tumor seen thru cortical window
Tumor curettement
tumorPhotomic
Closer up
High power
Curettement completed and ready for cement
cementCementation completed
Post op x-raytumor cavity filledwith radiolucentcement
Case #548                      periosteal                      chondroma57 year femaleenchondroma entirefemurSmaller perio...
Biopsy photomic
Post op x-rayfollowing removal ofperiosteal portion
8 year followup withplacement of a longstem THA for stresspain symptoms
Case #54948 year femaleenchondroma femur
Bone scan
Case #55059 year femaleenchondromadistal femur
Case #550.1     Enchondroma distal femur in a 60 year male
Bone scan
Cor T-1   Cor T-2Cor Gad
Sag T-1   Sag T-2
Axial GadAxial T-2
Case #55162 year maleenchondromaproximal humerus
Coronal T-1 MRI
CT scan
Curettement specimen
Low power photomic
Case #552              degenerative              arthritis   70 year male with enchondroma proximal humerus
Coronal T-1 MRI
Sagittal T-2 MRI
Case #55358 year femaleenchondromaproximal humerus
Case #554 42 year female enchondroma        tumor proximal humerus
Case #554.1           Enchondroma and ganglion cyst    47 year male with shoulder pain for 6 months
ganglionenchondroma                cyst       Coronal T-2 MRI
Sagittal T-2 enchondroma   Sagittal T-2 ganglion
ganglionTwo different T-2 axial cuts showing the enchondroma       and the right cut shows the ganglion
Case #554.2                Double enchondroma 52 year old male with incidental findings in R shoulder & L hip
Bone scan
Cor T-1’sCor T-2’s
Case #55555 year maleenchondromatibia
Bone scan
Coronal T-1 MRI
Coronal T-2 MRI                  tumor
Biopsy photomic
Case #55655 year male withenchondroma tibia
Lateral view
Axial T-1 MRI
tumorAxial T-2 MRI
Biopsy photomic
Case #557        40 year female with enchondroma fibula
Bone scan
Sagittal T-1 MRI
Axial T-1 MRI
Case #558    22 year male with enchondroma proximal phalanx
Biopsy photomic
Case #559        Periosteal chondroma                                       enchondroma    33 year female with periosteal ...
Oblique view
Case #560Pathologic fracture enchondroma proximal phalanx thumb                    29 year male
Case #561 23 yr male with path fracture thru enchondroma thumb
Case #561.1      48 year female with mild pain in hand 1 year
Cor T-1   STIR   Gad
Axial T-1         T-2 FS            Gad
Case #562     31 year female with enchondroma great toe
Amputationspecimen
Photomic
Case #564      11 yr boy with enchondroma lst metatarsal
Case #565     26 year male with enchondroma 5th metatarsal
Case #566       17 year male with enchondroma os calcis
Os calcis view
Case #56728 year femaleenchondroma scapula
MultipleEnchondromatosi         s Ollier’s Disease
Multiple Enchondromatosis (Ollier’s)    Multiple enchondromatosis or Ollier’s disease, is a rare non-familial cartilagenou...
CLASSIC          Case #568    3 year male with multiple enchondromatosis
Extremities
Macro section
Photomic
Case #5696 year maleOllier’s disease
Same patient
Case #5704.5 year maleOllier’s tibia
Case #571    71 year female with Ollier’s left lower extremity
Lateral view of knee
Photomic
Failure followingresurfacing TKAbecause of loosening
Post op x-ray with constrainedTKA
X-ray of cementedstem distal femoralresection prosthesis
Case #571.1                    Ollier’s   34 year male with life time shortening of left lower extremity     and more rece...
Sag T-1   T-2   Gad
Surgical exposure of soft tissue lump behind distal tibia
Case #57215 year femaleOllier’s disease
AP close up knee
Forearm disease
Case #57318 year maleOllier’s pelvisand ribs
Case #5742 year maleOllier’s lowerextremity
Case #57528 year maleOllier’s upperextremity
Multiple sites in radial half of hand
AP x-ray
Case #57619 year maleOllier’s femur
Case #577        22 year male with Ollier’s of the hand
tumorMacro section of amputation specimen
tumorClose up view of macro section
Case #578        40 year female with Ollier’s of the hand
Case #57910 year maleOllier’s hand
Case #58030 year femaleOllier’s hand
Case #5813 year maleOllier’s hand
Case #58219 year maleOllier’s feet
Case #583  5 year female with Ollier’s of hand ready for surgery
X-ray of both hands
Photo of deformed feet after hand surgery
Close up of deformed foot
Multiple Enchondromatosis            Plus         Soft tissue     Hemangiomatosis    Maffucci’ Disease
Maffucci’s Syndrome  Patients with multiple enchondromatosis or Ollier’s disease will onoccasion develop soft tissue heman...
CLASSICCase #58433 year maleMaffucci’s disease
X-ray tibias
phleboliths            phlebolithsX-ray forearm
Hand x-ray
Hand amputation specimen
Macrosection thru large enchondroma
Photomic of enchondroma
Case #58536 year female withMuffucci’s syndrome
Lateral view showingphleboliths
Opposite femur
Lateral view withphleboliths
hemangiomaenchondroma              Gross specimen
Case #586    25 year female with Muffucci’s syndrome hands
PeriostealChondroma
Periosteal Chondroma    The periosteal chondroma has the same basic pathology as theenchondroma except that it occurs on t...
that would continue to grow after bone maturity.   Periosteal sarcoma is a similar chondroid lesion found typicallyon larg...
CLASSICCase #12117 year femaleperiosteal chondromadistal femur
Bone scan
CT scan
Axial proton density MRI
Sagittal proton density MRI
Sagittal T-2 MRI
Photomic
Case #58742 year male withcombined periostealchondroma andenchondroma next toeach other in femur
enchondromaBone scan            periosteal chondroma
enchondroma                             periosteal chondroma          Sagittal CT scan
Axial CT scan at level of enchondroma
periosteal              chondromaenchondroma   CT scan
Coronal T-1 MRI                  enchondroma
Axial T-1 MRI
Case #58822 year maleperiosteal chondromafemur
Case #58916 year maleperiosteal chondromadistal femur
AP view
Case #59012 year femaleperiosteal chondromaproximal femur
Frog leg lateral
Case #59211 year femaleperiosteal chondromaproximal tibia
Another view
CTscan
Axial proton density MRI
Photomic
Case #593     19 year female with periosteal chondroma tibia
Case #59426 year maleperiosteal chondromaproximal humerus                       tumor                           tumor
CT scan
small enchondromaCoronal T-1 MRI                  tumor
Photomic
Case #595   46 year female with periosteal chondroma humerus
CT scan
Another CT cut
Coronal T-1 MRI
Coronal T-2 MRI
Photomic
Case #595.1                  Periosteal chondroma17 year old female withslight pain right shoulderfor 1 year
Sag T-1   T-2   Gad
Axial T-1   T-2Gad
Case #59614 year maleperiosteal chondromaproximal humerus
AP view
Case #598     62 year male with periosteal chondroma thumb
Axial T-1 MRI
Coronal proton density MRI
T-2 MRI
Photomic
Case #5998 year female with periosteal chondroma 4th metacarpal
Case #599.1              Periosteal chondroma finger  10 yr male with non tender lump base of middle finger for yrs
Cor T-2      Sag T-2Axial T-1   Axial T-2
Case #600 25 year female with periosteal chondroma 3rd metatarsal
Case #601   26 year male with periosteal chondroma ring finger
Case #602 54 year male with periosteal chondroma 5th metatarsal
Case #602.1      2006                           2010     77 yr male with none tender firm mass on 2nd toe for years
Case #60318 year maleperiosteal chondroma3rd toe
Case #604     33 year male with soft tissue chondroma finger
Lateral x-ray
Oblique view
Surgical excision
Photomic
Case #60519 year maleperiosteal chondromaC-2
Bone scan
CT scan
Case #606    38 year male with periosteal chondroma ischium
Case #607   6l year female with periosteal chondroma clavicle
Osteochondroma
Osteochondroma    The solitaty osteochondroma or exostosis is one of the mostcommon benign bone tumors seen in the skeleto...
ulated stock and is frequently misdiagnosed for that reason.Multiple hereditary exostosis presents with multiple lesions t...
where larger lesions can interfere with normal ambulation.Sometimes, a large proximal lesion with a cartilage cap exceedin...
CLASSICCase #12225 year maleosteochondromatibia
Lateral view
cartilage capfatty marrowSagittal T-1 MRI
cartilage cap      fatty marrowMacro section
Case #608       17 year male with osteochondroma humerus
marrowAxial T-1 MRI                cap
marrowSagittal T-1MRI
capCoronal T-2 MRI
capMacro section
Case #60930 year malesessile basedosteochondromahumerusCoronal T-1 MRI
Coronal proton density MRI                             cap
cap      Axial T-1 MRI
cap        fatty marrow      Axial T-2 MRI
Case #61014 year male with sessile based osteochondroma humerus
Bone scan
Coronal T-1 MRI
Cut surgicalspecimen               cap
cartilage capPhotomic
Case #61110 year malesessile basedosteochondromaproximal humerus
Lateral view
Case #61225 year maleosteochondomascapula
Scapular view
cartilage capResected specimen
Case #613   32 year male with osteochondroma proximal femur
Frog leg lateral
CT scan
Case #61412 year femaleosteochondromaproximal femur
Case #61515 year maleosteochondromadistal femur
capCut specimen in path lab
cartilage cap      cartilage                  Photomic
Case #616    23 year male with osteochondroma distal femur
cap      Cut specimen in path lab
cartilage capPhotomic
Case #617   26 year male with osteochondroma proximal fibula
Lateral view
Case #618  18 year male with sessile based osteochondroma tibia
Case #61911 year malesessile basedosteochondromadistal tibia
Case #62038 year maleosteochondromaL-5
Lateral view
Bone scan
CT scan
capCoronal T-2 MRI
Case #621 6 year male with osteochondroma C-6 spinous process
CT scan
Case #62126 year maleosteochondromailium
capCut specimen in path lab
Case #621.1     22 year female with painless lump right iliac crest for years
Axial T-1   Gad
Cor T-2   Sag T-2
Case #623     31 year female with osteochondroma ant 3rd rib
Case #624            16 year male subungual exostosis
AP x-ray
Multiple Hereditary    Exostosis
CLASSIC        Case #625   15 year male with multiple hereditary exostoses
Tibia and fibula
Lateral view
Case #625.1                 Multiple hereditary exostoses50 yr old female with short stature and R hip pain for years
AP and lateral of right hip
AP and lat tibia
Proximal humeral x-rays
AP and lateral of femur
Lateral ankleOblique foot
Case #62613 year femalemultiple exostosesforearm
Distal femur
Case #62720 year malemultiple exostosesknee
Lateral view
Case #628       15 year male with multiple exostoses hips
Case #629   26 year female with multiple exostoses thorax & arms
Case #63031 year malemultiple exostosesscapula & humerus
Scapular view
CT scan
Case #63126 year malemultiple exostosesleg
Chondroblastoma
Chondroblastoma    The chondroblastoma is a benign, cartilage forming tumor seenin the metaepiphyseal area of bone in chil...
the appearance of chicken wire under the microscope. Giant cellsare frequently associated with the chondroid tissue that g...
CLASSIC Case #123  12 year female with chondroblastoma proximal tibia
Coronal post gad MRI
Sagittal T-2 MRI
Photomic
Case #632     26 year male with chondroblastoma prox tibia
Lateral view
Sagittal T-1 MRI
Sagittal T-2 MRI
Photomic
Case #632.1         Chondroblastoma pseudotumor (geode)              52 yr female with pain in knee for 1 yr
Cor T-1   T-2
Axial T-2Sag T-1
Case #633     21 year female with chondroblastoma prox tibia
Case #634   16 year male with chondroblastoma distal femur
Lateral view
Coronal proton density MRI
Sagittal proton density MRI
Axial proton density MRI
Curettement of tumorfrom window inintercondylar notch                       tumor
Photomic
Higher power
Case #63518 year malechondroblastomadistal femur
CT scan
Photomic
Case #63620 year male with chondroblastoma & ABC prox femur
tumorAxial T-2 MRI
Coronal T-2 MRI                  tumor                  edema
Photomic
Post op x-ray withcement & DHS
Case #636.1             Chondroblastoma with ABC       21 yr male with left hip pain for 4 mos.
Axial CT scans
Cor PD   Gad
Axial T-1               T-2            T-2   Gad
PO bone graft
Case #63712 year female with chondroblastoma prox femoral epiphysis
CT scan
Another CT cut
cartilagegiant cells              Photomic
Case #63813 year female with chondroblastoma prox fem epiphysis
Case #639    15 year male with chondroblastoma prox humerus
CT scan
Axial T-1 MRI
Coronal T-2 MRI
tumorMacro section
Photomic
Photomic with giant cells
Case #640 15 year male with chondroblastoma proximal humerus
Coronal T-1 MRI
tumor Coronal T-2 MRI
Photomic with giant cells
Another photomic
Case #64124 year femalechondroblastomapelvis
CT scan
Another CT cut
Photomic
Case #642                 CT scan       21 year male with chondroblastoma ilium
Another CT cut
tumor    T-2 MRI
Case #643  43 year female with chondroblastoma distal humerus
CT scan
Case #644   11 year male with chondroblastoma lateral malleolus
Sagittal T-1 MRI
Axial T-2 MRI
Photomic
Case #64512 year femalechondroblastomadistal fibula
Case #646       18 year male with chondroblastoma talus
Lateral view
Chondromyxoid   Fibroma
Chondromyxoid Fibroma    Chondromyxoid fibroma is a very rare solitary benign tumor seenin bone. It occurs typically in th...
Treatment for this lesion consists of a simple curettement and bonegrafting. The fairly high recurrence rate of 25% can be...
CLASSICCase #12411 year malechondromyxoid fibromaproximal tibia
Tomogram cut
Surgical exposure of tumor
Low power photomic
giant cellsmyxoid         Higher power
Surgical curettement completed ready for bone graft
Placement of fibular strut and cancellous graft
Post op x-ray
Case # 124.1                    AP and lat x-ray  50 year male with chondromyxoid fibroma proximaltibia with 6 months of a...
Coronal T-1 MRI
Coronal PD FS MRI
Axial PD FS MRI
Axial Gad MRI
Case #647   12 year female with chondromyxoid fibroma tibia
Case #648   13 year female with chondromyxoid fibroma tibia
Case #64925 year femalechondromyxoidfibroma 1st metatarsal
Oblique view
Photomic
Photomic
Case #649.1             Chondromyxoid fibroma os calcis              44 year old male with heel pain 1 year
Sag T-1          Axial T-1Axial PD       Axial Gad
Photo micSurgical curettement
Case #6507 year femalechondromyxoidfibroma ulna
Photomic
Case #651    25 year female with chondromyxoid fibroma rib
Photomic
Case #651.160 year female with chondromyxoid fibroma distal sacrum
Sag T-1   Sag T-2
Axial T-1Axial T-2
Coronal T-1
Upcoming SlideShare
Loading in …5
×

Vol 4 ppt

1,267 views

Published on

0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
1,267
On SlideShare
0
From Embeds
0
Number of Embeds
35
Actions
Shares
0
Downloads
26
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

Vol 4 ppt

  1. 1. Volume 4 Benign Chondroid TumorsEnchondroma---------------------------Case 120 & 548-567Multiple enchondromatosis-----------Case 568-583Maffucci’s syndrome------------------Case 584-586Periosteal chondroma------------------Case 121 & 587-607Osteochondroma-----------------------Case 122 & 608-624Multiple hereditary exostosis---------Case 625-631Chondroblastoma-----------------------Case 123 & 632-646Chondromyxoid fibroma--------------Case 124 & 647-651
  2. 2. Chondroidforming Tumors
  3. 3. Enchondroma
  4. 4. Enchondroma The enchondroma is one of the most common benign tumors seenin the skeletal system. It is centrally located and in 50% of the caseswill be found in small tubular bones of hands and feet where itarises as a hamartomatous process and frequently remains un-diagnosed throughout the life of the patient until which time asthey develop a pathologic fracture thru the lesion. The lesionshave a typical geographic pattern with sharp margination andfrequently demonstrate matrix calcification, especially as thepatient ages. In the hand or foot, the lesions frequently causemarked thinning of the surrounding cortex and dilatation of thebone, whereas with enchondromas found in larger bones, thereis minimal evidence of cortical invasion and little if any evidenceof cortical thinning or dilatation. It is rare for an enchondroma toconvert into a chondrosarcoma in the hand or foot, but in largerbones such as the femur or pelvis a primary enchondroma can
  5. 5. convert very gradually into a low grade chondrosarcoma. Theincidence of conversion is less than 5% of cases and almost alwaysin adults. In most cases, the enchondroma will be discovered as anincidental finding, because it is asymptomatic and non-disabling.There is no particular need to biopsy or bone graft the lesion unlessthe patient develops an interest in a specific sport or occupationalactivity that would put him at risk for fracture. If an acutefracture occurs, it is best to wait until the fracture heals and thenconsider the patient for a bone grafting procedure at a later date.
  6. 6. CLASSICCase #12038 year femaleenchondromadistal femur
  7. 7. Bone scan
  8. 8. Coronal T-1 MRI tumor
  9. 9. Coronal T-2 MRI tumor
  10. 10. tumorAxial T-2 MRI
  11. 11. Tumor seen thru cortical window
  12. 12. Tumor curettement
  13. 13. tumorPhotomic
  14. 14. Closer up
  15. 15. High power
  16. 16. Curettement completed and ready for cement
  17. 17. cementCementation completed
  18. 18. Post op x-raytumor cavity filledwith radiolucentcement
  19. 19. Case #548 periosteal chondroma57 year femaleenchondroma entirefemurSmaller periostealchondroma proximaland posterior femur
  20. 20. Biopsy photomic
  21. 21. Post op x-rayfollowing removal ofperiosteal portion
  22. 22. 8 year followup withplacement of a longstem THA for stresspain symptoms
  23. 23. Case #54948 year femaleenchondroma femur
  24. 24. Bone scan
  25. 25. Case #55059 year femaleenchondromadistal femur
  26. 26. Case #550.1 Enchondroma distal femur in a 60 year male
  27. 27. Bone scan
  28. 28. Cor T-1 Cor T-2Cor Gad
  29. 29. Sag T-1 Sag T-2
  30. 30. Axial GadAxial T-2
  31. 31. Case #55162 year maleenchondromaproximal humerus
  32. 32. Coronal T-1 MRI
  33. 33. CT scan
  34. 34. Curettement specimen
  35. 35. Low power photomic
  36. 36. Case #552 degenerative arthritis 70 year male with enchondroma proximal humerus
  37. 37. Coronal T-1 MRI
  38. 38. Sagittal T-2 MRI
  39. 39. Case #55358 year femaleenchondromaproximal humerus
  40. 40. Case #554 42 year female enchondroma tumor proximal humerus
  41. 41. Case #554.1 Enchondroma and ganglion cyst 47 year male with shoulder pain for 6 months
  42. 42. ganglionenchondroma cyst Coronal T-2 MRI
  43. 43. Sagittal T-2 enchondroma Sagittal T-2 ganglion
  44. 44. ganglionTwo different T-2 axial cuts showing the enchondroma and the right cut shows the ganglion
  45. 45. Case #554.2 Double enchondroma 52 year old male with incidental findings in R shoulder & L hip
  46. 46. Bone scan
  47. 47. Cor T-1’sCor T-2’s
  48. 48. Case #55555 year maleenchondromatibia
  49. 49. Bone scan
  50. 50. Coronal T-1 MRI
  51. 51. Coronal T-2 MRI tumor
  52. 52. Biopsy photomic
  53. 53. Case #55655 year male withenchondroma tibia
  54. 54. Lateral view
  55. 55. Axial T-1 MRI
  56. 56. tumorAxial T-2 MRI
  57. 57. Biopsy photomic
  58. 58. Case #557 40 year female with enchondroma fibula
  59. 59. Bone scan
  60. 60. Sagittal T-1 MRI
  61. 61. Axial T-1 MRI
  62. 62. Case #558 22 year male with enchondroma proximal phalanx
  63. 63. Biopsy photomic
  64. 64. Case #559 Periosteal chondroma enchondroma 33 year female with periosteal chondroma and enchondroma in same ray
  65. 65. Oblique view
  66. 66. Case #560Pathologic fracture enchondroma proximal phalanx thumb 29 year male
  67. 67. Case #561 23 yr male with path fracture thru enchondroma thumb
  68. 68. Case #561.1 48 year female with mild pain in hand 1 year
  69. 69. Cor T-1 STIR Gad
  70. 70. Axial T-1 T-2 FS Gad
  71. 71. Case #562 31 year female with enchondroma great toe
  72. 72. Amputationspecimen
  73. 73. Photomic
  74. 74. Case #564 11 yr boy with enchondroma lst metatarsal
  75. 75. Case #565 26 year male with enchondroma 5th metatarsal
  76. 76. Case #566 17 year male with enchondroma os calcis
  77. 77. Os calcis view
  78. 78. Case #56728 year femaleenchondroma scapula
  79. 79. MultipleEnchondromatosi s Ollier’s Disease
  80. 80. Multiple Enchondromatosis (Ollier’s) Multiple enchondromatosis or Ollier’s disease, is a rare non-familial cartilagenous dysplasia that is typically seen on one halfof the body and appears similar to fibrous dysplasia. Extensivedisease of the metaphyseal areas of long bone can result in bowingand shortening. In the case of the femur a major bowing is seendistally compared to the proximal bowing seen in fibrous dysplasia.The cortical thinning and epiphyseal involvement seen in Ollier’sdisease is rarely seen in solitary enchondromas. The chance formalignant conversion to a low grade chondrosarcoma in adult lifeis about 25%.
  81. 81. CLASSIC Case #568 3 year male with multiple enchondromatosis
  82. 82. Extremities
  83. 83. Macro section
  84. 84. Photomic
  85. 85. Case #5696 year maleOllier’s disease
  86. 86. Same patient
  87. 87. Case #5704.5 year maleOllier’s tibia
  88. 88. Case #571 71 year female with Ollier’s left lower extremity
  89. 89. Lateral view of knee
  90. 90. Photomic
  91. 91. Failure followingresurfacing TKAbecause of loosening
  92. 92. Post op x-ray with constrainedTKA
  93. 93. X-ray of cementedstem distal femoralresection prosthesis
  94. 94. Case #571.1 Ollier’s 34 year male with life time shortening of left lower extremity and more recent onset of soft tissue mass in lower leg
  95. 95. Sag T-1 T-2 Gad
  96. 96. Surgical exposure of soft tissue lump behind distal tibia
  97. 97. Case #57215 year femaleOllier’s disease
  98. 98. AP close up knee
  99. 99. Forearm disease
  100. 100. Case #57318 year maleOllier’s pelvisand ribs
  101. 101. Case #5742 year maleOllier’s lowerextremity
  102. 102. Case #57528 year maleOllier’s upperextremity
  103. 103. Multiple sites in radial half of hand
  104. 104. AP x-ray
  105. 105. Case #57619 year maleOllier’s femur
  106. 106. Case #577 22 year male with Ollier’s of the hand
  107. 107. tumorMacro section of amputation specimen
  108. 108. tumorClose up view of macro section
  109. 109. Case #578 40 year female with Ollier’s of the hand
  110. 110. Case #57910 year maleOllier’s hand
  111. 111. Case #58030 year femaleOllier’s hand
  112. 112. Case #5813 year maleOllier’s hand
  113. 113. Case #58219 year maleOllier’s feet
  114. 114. Case #583 5 year female with Ollier’s of hand ready for surgery
  115. 115. X-ray of both hands
  116. 116. Photo of deformed feet after hand surgery
  117. 117. Close up of deformed foot
  118. 118. Multiple Enchondromatosis Plus Soft tissue Hemangiomatosis Maffucci’ Disease
  119. 119. Maffucci’s Syndrome Patients with multiple enchondromatosis or Ollier’s disease will onoccasion develop soft tissue hemangiomatosis in the same areasas the enchondromatosis is seen. This combination of both a bonycartilaginous and a soft tissue angiomatosis is known as Maffucci’ssyndrome. The clinical appearance of the multiple enchondromatosisis the same as Ollier’s disease but with a higher potential for amalignant conversion to a low grade chondrosarcoma in adult life.
  120. 120. CLASSICCase #58433 year maleMaffucci’s disease
  121. 121. X-ray tibias
  122. 122. phleboliths phlebolithsX-ray forearm
  123. 123. Hand x-ray
  124. 124. Hand amputation specimen
  125. 125. Macrosection thru large enchondroma
  126. 126. Photomic of enchondroma
  127. 127. Case #58536 year female withMuffucci’s syndrome
  128. 128. Lateral view showingphleboliths
  129. 129. Opposite femur
  130. 130. Lateral view withphleboliths
  131. 131. hemangiomaenchondroma Gross specimen
  132. 132. Case #586 25 year female with Muffucci’s syndrome hands
  133. 133. PeriostealChondroma
  134. 134. Periosteal Chondroma The periosteal chondroma has the same basic pathology as theenchondroma except that it occurs on the surface of a tubularbone. It can occur as a hamartomatous process in growing patientsbut as with enchondroma it is usually asymptomatic and growthstops at bone maturity. The lesions are found in large bones, suchas the humerus and femur, and in the small bones of the hand andfoot. Radiographically one sees slight erosion into the adjacentcortex but the lesion will not penetrate into the medullary canal.There will be a sclerotic response at the base that extends aroundthe periphery of the lesion taking on the appearance of a blisteron the surface of the bone with matrix calcification seen mainlyat the periphery but found also in the central area. The lesionsusually stop growing before they reach the upper limit of 3-4 cmin diameter. If growth continues beyond this, one must stronglyconsider the possibility of a peripheral surface type chondrosarcoma
  135. 135. that would continue to grow after bone maturity. Periosteal sarcoma is a similar chondroid lesion found typicallyon large bones. It demonstrates a more aggressive pattern,permeation into surrounding cortical structures and a moreaggressive histology with some osteoid formation. Osteo-chondroma also has a similar appearance but would demonstratea more mature bony base on which a cap of cartilage is typicallyseen. In the case of the periosteal chondroma, the cartilageextends down into the depths of the tumor. Treatment consists of a simple resection without disturbingthe subadjacent cortex so that bone grafting or internal fixationdevices are not necessary. The recurrence rate is very low aftermaturity.
  136. 136. CLASSICCase #12117 year femaleperiosteal chondromadistal femur
  137. 137. Bone scan
  138. 138. CT scan
  139. 139. Axial proton density MRI
  140. 140. Sagittal proton density MRI
  141. 141. Sagittal T-2 MRI
  142. 142. Photomic
  143. 143. Case #58742 year male withcombined periostealchondroma andenchondroma next toeach other in femur
  144. 144. enchondromaBone scan periosteal chondroma
  145. 145. enchondroma periosteal chondroma Sagittal CT scan
  146. 146. Axial CT scan at level of enchondroma
  147. 147. periosteal chondromaenchondroma CT scan
  148. 148. Coronal T-1 MRI enchondroma
  149. 149. Axial T-1 MRI
  150. 150. Case #58822 year maleperiosteal chondromafemur
  151. 151. Case #58916 year maleperiosteal chondromadistal femur
  152. 152. AP view
  153. 153. Case #59012 year femaleperiosteal chondromaproximal femur
  154. 154. Frog leg lateral
  155. 155. Case #59211 year femaleperiosteal chondromaproximal tibia
  156. 156. Another view
  157. 157. CTscan
  158. 158. Axial proton density MRI
  159. 159. Photomic
  160. 160. Case #593 19 year female with periosteal chondroma tibia
  161. 161. Case #59426 year maleperiosteal chondromaproximal humerus tumor tumor
  162. 162. CT scan
  163. 163. small enchondromaCoronal T-1 MRI tumor
  164. 164. Photomic
  165. 165. Case #595 46 year female with periosteal chondroma humerus
  166. 166. CT scan
  167. 167. Another CT cut
  168. 168. Coronal T-1 MRI
  169. 169. Coronal T-2 MRI
  170. 170. Photomic
  171. 171. Case #595.1 Periosteal chondroma17 year old female withslight pain right shoulderfor 1 year
  172. 172. Sag T-1 T-2 Gad
  173. 173. Axial T-1 T-2Gad
  174. 174. Case #59614 year maleperiosteal chondromaproximal humerus
  175. 175. AP view
  176. 176. Case #598 62 year male with periosteal chondroma thumb
  177. 177. Axial T-1 MRI
  178. 178. Coronal proton density MRI
  179. 179. T-2 MRI
  180. 180. Photomic
  181. 181. Case #5998 year female with periosteal chondroma 4th metacarpal
  182. 182. Case #599.1 Periosteal chondroma finger 10 yr male with non tender lump base of middle finger for yrs
  183. 183. Cor T-2 Sag T-2Axial T-1 Axial T-2
  184. 184. Case #600 25 year female with periosteal chondroma 3rd metatarsal
  185. 185. Case #601 26 year male with periosteal chondroma ring finger
  186. 186. Case #602 54 year male with periosteal chondroma 5th metatarsal
  187. 187. Case #602.1 2006 2010 77 yr male with none tender firm mass on 2nd toe for years
  188. 188. Case #60318 year maleperiosteal chondroma3rd toe
  189. 189. Case #604 33 year male with soft tissue chondroma finger
  190. 190. Lateral x-ray
  191. 191. Oblique view
  192. 192. Surgical excision
  193. 193. Photomic
  194. 194. Case #60519 year maleperiosteal chondromaC-2
  195. 195. Bone scan
  196. 196. CT scan
  197. 197. Case #606 38 year male with periosteal chondroma ischium
  198. 198. Case #607 6l year female with periosteal chondroma clavicle
  199. 199. Osteochondroma
  200. 200. Osteochondroma The solitaty osteochondroma or exostosis is one of the mostcommon benign bone tumors seen in the skeleton. As in theenchondroma, this condition is developmental, or hamartomatousin nature arising from the outer edge of the growth plate andgrowing down the metaphyseal side where it tends to point awayfrom the adjacent joint. Because it originates from the growth plate,it continues to grow during the growing years of the patient andthen stops at maturity. It is made up of a bony base with a pedunc-ulated stock with fatty marrow extending up inside the stock thathas a cartilagenous cap giving it the appearance of a cauliflower.Histologically, the cap has features of a normal growth plate if abiopsy is performed during the growing years. Most of these lesionsarise from large bones, especially about the knee joint, proximalfemur, and proximal humerus. In the proximal humerus, theosteochondroma is usually sessile-based without a typical pedunc-
  201. 201. ulated stock and is frequently misdiagnosed for that reason.Multiple hereditary exostosis presents with multiple lesions through-out the skeletal system and is considered to be an autosomaldominant disorder, being one-tenth as common as the solitaryosteochondroma which is not inherited. The conversion of a solitary osteochondoma to a chondro-sarcoma can only occur in the adult. It is an extremely rare eventcompared to the 1% chance of a malignant conversion in multiplehereditary exostosis. It is the cartilaginous cap that converts into alow grade secondary type of peripheral chondrosarcoma with anexcellent prognosis for survival compared to a central chondro-sarcoma. These malignant conversions usually arise from largeosteochondromas seen in more proximal locations, such as aroundthe hip or pelvis. Because osteochondromata are usually withoutsymptoms, surgical treatment is frequently unnecessary unless thelesions create mechanical problems such as around the knee joint
  202. 202. where larger lesions can interfere with normal ambulation.Sometimes, a large proximal lesion with a cartilage cap exceeding2 cm should be prophylactically resected in order to avoid apossible chondrosarcoma. When removing an osteochondroma, itis necessary only to remove the complete cartilaginous cap,leaving most of the bony base intact to avoid a facture.
  203. 203. CLASSICCase #12225 year maleosteochondromatibia
  204. 204. Lateral view
  205. 205. cartilage capfatty marrowSagittal T-1 MRI
  206. 206. cartilage cap fatty marrowMacro section
  207. 207. Case #608 17 year male with osteochondroma humerus
  208. 208. marrowAxial T-1 MRI cap
  209. 209. marrowSagittal T-1MRI
  210. 210. capCoronal T-2 MRI
  211. 211. capMacro section
  212. 212. Case #60930 year malesessile basedosteochondromahumerusCoronal T-1 MRI
  213. 213. Coronal proton density MRI cap
  214. 214. cap Axial T-1 MRI
  215. 215. cap fatty marrow Axial T-2 MRI
  216. 216. Case #61014 year male with sessile based osteochondroma humerus
  217. 217. Bone scan
  218. 218. Coronal T-1 MRI
  219. 219. Cut surgicalspecimen cap
  220. 220. cartilage capPhotomic
  221. 221. Case #61110 year malesessile basedosteochondromaproximal humerus
  222. 222. Lateral view
  223. 223. Case #61225 year maleosteochondomascapula
  224. 224. Scapular view
  225. 225. cartilage capResected specimen
  226. 226. Case #613 32 year male with osteochondroma proximal femur
  227. 227. Frog leg lateral
  228. 228. CT scan
  229. 229. Case #61412 year femaleosteochondromaproximal femur
  230. 230. Case #61515 year maleosteochondromadistal femur
  231. 231. capCut specimen in path lab
  232. 232. cartilage cap cartilage Photomic
  233. 233. Case #616 23 year male with osteochondroma distal femur
  234. 234. cap Cut specimen in path lab
  235. 235. cartilage capPhotomic
  236. 236. Case #617 26 year male with osteochondroma proximal fibula
  237. 237. Lateral view
  238. 238. Case #618 18 year male with sessile based osteochondroma tibia
  239. 239. Case #61911 year malesessile basedosteochondromadistal tibia
  240. 240. Case #62038 year maleosteochondromaL-5
  241. 241. Lateral view
  242. 242. Bone scan
  243. 243. CT scan
  244. 244. capCoronal T-2 MRI
  245. 245. Case #621 6 year male with osteochondroma C-6 spinous process
  246. 246. CT scan
  247. 247. Case #62126 year maleosteochondromailium
  248. 248. capCut specimen in path lab
  249. 249. Case #621.1 22 year female with painless lump right iliac crest for years
  250. 250. Axial T-1 Gad
  251. 251. Cor T-2 Sag T-2
  252. 252. Case #623 31 year female with osteochondroma ant 3rd rib
  253. 253. Case #624 16 year male subungual exostosis
  254. 254. AP x-ray
  255. 255. Multiple Hereditary Exostosis
  256. 256. CLASSIC Case #625 15 year male with multiple hereditary exostoses
  257. 257. Tibia and fibula
  258. 258. Lateral view
  259. 259. Case #625.1 Multiple hereditary exostoses50 yr old female with short stature and R hip pain for years
  260. 260. AP and lateral of right hip
  261. 261. AP and lat tibia
  262. 262. Proximal humeral x-rays
  263. 263. AP and lateral of femur
  264. 264. Lateral ankleOblique foot
  265. 265. Case #62613 year femalemultiple exostosesforearm
  266. 266. Distal femur
  267. 267. Case #62720 year malemultiple exostosesknee
  268. 268. Lateral view
  269. 269. Case #628 15 year male with multiple exostoses hips
  270. 270. Case #629 26 year female with multiple exostoses thorax & arms
  271. 271. Case #63031 year malemultiple exostosesscapula & humerus
  272. 272. Scapular view
  273. 273. CT scan
  274. 274. Case #63126 year malemultiple exostosesleg
  275. 275. Chondroblastoma
  276. 276. Chondroblastoma The chondroblastoma is a benign, cartilage forming tumor seenin the metaepiphyseal area of bone in children and young adults.The histologic appearance is typical of a giant cell tumor in youngadults. The chondroblastoma is one fifth as common as the giantcell tumor and the majority of cases will occur during the seconddecade of life. It is rare to find the giant cell tumor in patientsunder the age of 13 years. The most common location for thechondroblastoma is in the epiphysis of the distal femur, proximaltibia, and proximal humerus. These lesions are usually locatednear a joint and are quite painful because of a secondary inflamm-atory synovitis of the adjacent joint that can masquerade as apyarthrosis. It is not unusual to find an aneurysmal bone cystassociated with the chondroblastoma, similar to the situation seenwith giant cell tumors. Histologically, one sees round polyhedral-shaped stromal cells located in clear cytoplasmic halos that gives
  277. 277. the appearance of chicken wire under the microscope. Giant cellsare frequently associated with the chondroid tissue that gives theappearance of a giant cell tumor. It is very rare for a chondro-blastoma to convert to a malignant tumor, however, as in the caseof giant cell tumor, they can metastasize to the lung and stillcarry an excellent prognosis for survival. Treatment consists of a simple curettement of the lesionfollowed by packing the defect with either bone graft or bonecement. There is a relatively low (10%) recurrence rate.
  278. 278. CLASSIC Case #123 12 year female with chondroblastoma proximal tibia
  279. 279. Coronal post gad MRI
  280. 280. Sagittal T-2 MRI
  281. 281. Photomic
  282. 282. Case #632 26 year male with chondroblastoma prox tibia
  283. 283. Lateral view
  284. 284. Sagittal T-1 MRI
  285. 285. Sagittal T-2 MRI
  286. 286. Photomic
  287. 287. Case #632.1 Chondroblastoma pseudotumor (geode) 52 yr female with pain in knee for 1 yr
  288. 288. Cor T-1 T-2
  289. 289. Axial T-2Sag T-1
  290. 290. Case #633 21 year female with chondroblastoma prox tibia
  291. 291. Case #634 16 year male with chondroblastoma distal femur
  292. 292. Lateral view
  293. 293. Coronal proton density MRI
  294. 294. Sagittal proton density MRI
  295. 295. Axial proton density MRI
  296. 296. Curettement of tumorfrom window inintercondylar notch tumor
  297. 297. Photomic
  298. 298. Higher power
  299. 299. Case #63518 year malechondroblastomadistal femur
  300. 300. CT scan
  301. 301. Photomic
  302. 302. Case #63620 year male with chondroblastoma & ABC prox femur
  303. 303. tumorAxial T-2 MRI
  304. 304. Coronal T-2 MRI tumor edema
  305. 305. Photomic
  306. 306. Post op x-ray withcement & DHS
  307. 307. Case #636.1 Chondroblastoma with ABC 21 yr male with left hip pain for 4 mos.
  308. 308. Axial CT scans
  309. 309. Cor PD Gad
  310. 310. Axial T-1 T-2 T-2 Gad
  311. 311. PO bone graft
  312. 312. Case #63712 year female with chondroblastoma prox femoral epiphysis
  313. 313. CT scan
  314. 314. Another CT cut
  315. 315. cartilagegiant cells Photomic
  316. 316. Case #63813 year female with chondroblastoma prox fem epiphysis
  317. 317. Case #639 15 year male with chondroblastoma prox humerus
  318. 318. CT scan
  319. 319. Axial T-1 MRI
  320. 320. Coronal T-2 MRI
  321. 321. tumorMacro section
  322. 322. Photomic
  323. 323. Photomic with giant cells
  324. 324. Case #640 15 year male with chondroblastoma proximal humerus
  325. 325. Coronal T-1 MRI
  326. 326. tumor Coronal T-2 MRI
  327. 327. Photomic with giant cells
  328. 328. Another photomic
  329. 329. Case #64124 year femalechondroblastomapelvis
  330. 330. CT scan
  331. 331. Another CT cut
  332. 332. Photomic
  333. 333. Case #642 CT scan 21 year male with chondroblastoma ilium
  334. 334. Another CT cut
  335. 335. tumor T-2 MRI
  336. 336. Case #643 43 year female with chondroblastoma distal humerus
  337. 337. CT scan
  338. 338. Case #644 11 year male with chondroblastoma lateral malleolus
  339. 339. Sagittal T-1 MRI
  340. 340. Axial T-2 MRI
  341. 341. Photomic
  342. 342. Case #64512 year femalechondroblastomadistal fibula
  343. 343. Case #646 18 year male with chondroblastoma talus
  344. 344. Lateral view
  345. 345. Chondromyxoid Fibroma
  346. 346. Chondromyxoid Fibroma Chondromyxoid fibroma is a very rare solitary benign tumor seenin bone. It occurs typically in the second or third decade of life andaffects men more than women. By far the more common locationfor this lesion is in the proximal tibial metaphysis, followedsecond by the distal femur and the first ray of the foot. This lesionis slow growing and is associated with mild symptoms of pain.Radiographically, there is a lytic lesion of bone with a soap-bubbly appearance secondary to the thin sclerotic peripheralmargin giving it a pseudoloculated appearance similar to that ofa solitary bone cyst. The adjacent cortex is frequently thinned outand slightly dilated, similar to the pattern that is seen in fibrousdysplasia. Histologically, there will be evidence of benign fibroustissue with large areas of myxomatous degeneration with reactivemacrophage activity seen at the periphery of the lesion that couldsuggest the diagnosis of a chondrosarcoma.
  347. 347. Treatment for this lesion consists of a simple curettement and bonegrafting. The fairly high recurrence rate of 25% can be reduced bya more aggressive, marginal resection of the tumor. Occasionally,this lesion can convert into a chondrosarcoma.
  348. 348. CLASSICCase #12411 year malechondromyxoid fibromaproximal tibia
  349. 349. Tomogram cut
  350. 350. Surgical exposure of tumor
  351. 351. Low power photomic
  352. 352. giant cellsmyxoid Higher power
  353. 353. Surgical curettement completed ready for bone graft
  354. 354. Placement of fibular strut and cancellous graft
  355. 355. Post op x-ray
  356. 356. Case # 124.1 AP and lat x-ray 50 year male with chondromyxoid fibroma proximaltibia with 6 months of a tender tumor mass anterior tibia
  357. 357. Coronal T-1 MRI
  358. 358. Coronal PD FS MRI
  359. 359. Axial PD FS MRI
  360. 360. Axial Gad MRI
  361. 361. Case #647 12 year female with chondromyxoid fibroma tibia
  362. 362. Case #648 13 year female with chondromyxoid fibroma tibia
  363. 363. Case #64925 year femalechondromyxoidfibroma 1st metatarsal
  364. 364. Oblique view
  365. 365. Photomic
  366. 366. Photomic
  367. 367. Case #649.1 Chondromyxoid fibroma os calcis 44 year old male with heel pain 1 year
  368. 368. Sag T-1 Axial T-1Axial PD Axial Gad
  369. 369. Photo micSurgical curettement
  370. 370. Case #6507 year femalechondromyxoidfibroma ulna
  371. 371. Photomic
  372. 372. Case #651 25 year female with chondromyxoid fibroma rib
  373. 373. Photomic
  374. 374. Case #651.160 year female with chondromyxoid fibroma distal sacrum
  375. 375. Sag T-1 Sag T-2
  376. 376. Axial T-1Axial T-2
  377. 377. Coronal T-1

×