INTERESTING CASE OF CYTOLOGY.

1. Associate Professor- Dept. Of Pathology
Nizam’s Institute Of Medical Sciences
Hyderabad

2.  20 year female at Ortho O.P
 C/o Pain & Stiffness left elbow since one year
 Unable to move/extend left elbow fully.
 Nursing student.
 No other co-morbidities.
 No History of trauma (or) no accidental fall.

4. Figure-1 : Radiograph of elbow joint anteroposterior & lateral views showing an well-defined lytic lesion (arrow) in the
subarticular location of lateral epicondyle at the lower end of left humerus.
There is no soft tissue component or periosteal reaction.

5. • Figure-2 : Plain CT of elbow joint sagittal reconstruction views showing an well-defined lytic lesion in the
subarticular location of lateral epicondyle at the lower end of left humerus.
• There are foci of calcification within the lesion, with multiple areas of cortical break.
• There is no periosteal reaction.
• Small soft tissue component is seen along posterior aspect of humerus.

6.  Multi slice CT scan
 21x21mm lytic lesion seen arising from lateral
epicondyle of humerus involving radio-humeral joint.
 Lesion shows narrow zone of transition with no
surrounding sclerosis, no internal matrix calcification.
 Cortex-thinned out with multiple cortical defects.
 Surrounding soft tissue edema and swelling.
 S/o lytic lesion-giant cell tumor / Chon droid Lesion.

7. Figure3- : Axial T2 weighted- (A), fat suppressed (B) and post contrast (C) of left elbow showing an well-defined lytic lesion
in the subarticular location of lateral epicondyle at the lower end of left humerus.
• The lesion is heterogeneously hyper intense on T2 weighted and fat suppressed images with a soft tissue component along
the posterior aspect and olecranon fossa (arrows).
• There is associated adjacent marrow edema (big arrow).
• Post contrast images showing, the lesion is showing peripheral enhancement, while the soft tissue is showing homogeneous
contrast enhancement.
A

8.  Lesion in epiphyseo-metaphyseal region of lateral
supracondylar region of left humerus.
 Hypo intense on T1 and hyper intense on T2w/STIR sequence.
 Articular cartilage, proximal ends of radius and ulna spared.
 Minimal joint effusion.
 No change in marrow intensity.
 S/o Chronic Osteomyelitis.

9. PAP stain 4x
Figure 1&2 : Pap staining Smear showing Abundant bluish green colored Chrondromyxoid
matrix (pap ×20x)

10. Pap staining Smear showing Abundant myxiod areas, chondromyxoid matrix (pap ×20x)

11. PAP 40X

12. MGG 10X MGG 10X
Figure 4 - MGG stain smear show clusters and singly scattered cells with matrix. -shows magenta pink to
purple chondromyxoid matrix

13. MGG 20X
Figure 5 - Cells are round to spindle with few stellate or fibroblast like cells, nuclei showing
uniform chromatin, scant to moderate cytoplasm. INSET-shows magenta pink to purple
chondromyxoid matrix

14. MGG 40 X MGG 4 X
Figure 6 - Cells are round to spindle with few stellate or fibroblast like cells, nuclei showing uniform
chromatin, scant to moderate cytoplasm. SMALL -shows magenta pink to purple chondromyxoid
matrix

15. CELL BLOCK 10X
Figure 7: Cellblock section shows Scant cellular and show few scattered spindle to
stellate cells and chondromyxoid matrix in background of red blood cells and fibrin.

16. Biopsy 40X
Figure 8 : H&E Section shows scattered spindle to stellate cells. background shows
Chondromyxoid material

24.  Large, atypical tumor cells( a )
adjacent to the cartilaginous
matrix or dispersed in the myxoid
and chondroid background matrix
 ( b and c ), which is more
abundant than osteoid matrix.
Note tumor cells resembling
osteoblasts and mitoses (MGG).
 ( d ) Malignant cartilage with
atypical chondroblasts
embedded in a chondroid matrix
(H&E)

25. A rare, benign chondrogenic lesion
 M:F = 2:1
80% of patients under 25 years of
age
• Cytological features
• Mononuclear
chondroblasts
characterized by well
defined cytoplasm and
round nuclei
• Multinucleated osteoclast-like cell
• Fragments of chondroid matrix
• The nucleus is grooved

26. GRADE--I (WELLDIFFERENTIATED)
• Low cellularity
• Fragments of hyaline cartilage with
lacunar spaces containing neoplastic
chondrocytes.
• Binucleated chondrocytes are present
• No mitotic figures seen.
• Little or no myxoid – chondroid matrix
present..

28.  One of the rarest benign tumors of cartilaginous origin
 This tumor was first described as a distinct entity by Jaffe
and Lichtenstein in 1948
 It represents <0.5% of all bone tumors
 2 nd – 3 rd decade.
 Chondromyxoid fibroma arises usually in the
metaphysical region of long tubular bones,
especially the tibia
 (CMF) is one such tumor that is characterized by
incomplete cartilage differentiation
 A genetic rearrangement may affect chromosome
6 (position q13)

29. • The specific cytological features included varying
combinations of chondroid, myxoid and fibroid elements
organized in a pseudo lobulated architecture
• Cytological features: Myxoid background matrix
Cartilaginous fragments (with chondroblast-like cells in
lacunae)
 Dispersed or clustered stellate or spindle-shaped
myofibroblastic cells .
 Osteoclastic giant cells present particularly at the periphery.
 Differential diagnosis – Chondrosarcoma , Enchondroma
and chondroblastoma,Chrondobalstic Osteosarcoma

30.  Treatment for Chrondromyxoid fibroma : Intralesional curettage and
bone grafting .
 The most common method of treating CMF is with curettage. In this
procedure, the tumor is scraped out of the bone.
 Recurrence of the tumor is the most serious complication of
treatment
 It is very important in planning treatment to differentiate CMF from
more aggressive, cancerous tumors like Chondrosarcoma (or)
Osteosarcoma.

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