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Vol 4 ppt
The document discusses several benign chondroid tumors including enchondroma, multiple enchondromatosis (Ollier's disease), Maffucci's syndrome, and periosteal chondroma. Enchondromas are common benign bone tumors that frequently occur in the hands and feet. Multiple enchondromatosis is a rare condition where multiple enchondromas form, often on one side of the body. Maffucci's syndrome involves multiple enchondromas along with soft tissue hemangiomas. Periosteal chondromas are similar to enchondromas but form on the surface of bones rather than internally.
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Vol 4 ppt
- 1. Volume 4 Benign Chondroid Tumors Enchondroma---------------------------Case 120 & 548-567 Multiple enchondromatosis-----------Case 568-583 Maffucci’s syndrome------------------Case 584-586 Periosteal chondroma------------------Case 121 & 587-607 Osteochondroma-----------------------Case 122 & 608-624 Multiple hereditary exostosis---------Case 625-631 Chondroblastoma-----------------------Case 123 & 632-646 Chondromyxoid fibroma--------------Case 124 & 647-651
- 2.
- 3.
- 4. Enchondroma Theenchondroma is one of the most common benign tumors seen in the skeletal system. It is centrally located and in 50% of the cases will be found in small tubular bones of hands and feet where it arises as a hamartomatous process and frequently remains un- diagnosed throughout the life of the patient until which time as they develop a pathologic fracture thru the lesion. The lesions have a typical geographic pattern with sharp margination and frequently demonstrate matrix calcification, especially as the patient ages. In the hand or foot, the lesions frequently cause marked thinning of the surrounding cortex and dilatation of the bone, whereas with enchondromas found in larger bones, there is minimal evidence of cortical invasion and little if any evidence of cortical thinning or dilatation. It is rare for an enchondroma to convert into a chondrosarcoma in the hand or foot, but in larger bones such as the femur or pelvis a primary enchondroma can
- 5. convert very graduallyinto a low grade chondrosarcoma. The incidence of conversion is less than 5% of cases and almost always in adults. In most cases, the enchondroma will be discovered as an incidental finding, because it is asymptomatic and non-disabling. There is no particular need to biopsy or bone graft the lesion unless the patient develops an interest in a specific sport or occupational activity that would put him at risk for fracture. If an acute fracture occurs, it is best to wait until the fracture heals and then consider the patient for a bone grafting procedure at a later date.
- 6. CLASSIC Case #120 38 yearfemale enchondroma distal femur
- 7.
- 8. Coronal T-1 MRI tumor
- 9. Coronal T-2 MRI tumor
- 10.
- 11. Tumor seen thrucortical window
- 12.
- 13.
- 14.
- 15.
- 16. Curettement completed andready for cement
- 17.
- 18. Post op x-ray tumorcavity filled with radiolucent cement
- 19. Case #548 periosteal chondroma 57 year female enchondroma entire femur Smaller periosteal chondroma proximal and posterior femur
- 20.
- 21. Post op x-ray followingremoval of periosteal portion
- 22. 8 year followupwith placement of a long stem THA for stress pain symptoms
- 23. Case #549 48 yearfemale enchondroma femur
- 24.
- 25. Case #550 59 yearfemale enchondroma distal femur
- 26. Case #550.1 Enchondroma distal femur in a 60 year male
- 27.
- 28. Cor T-1 Cor T-2 Cor Gad
- 29. Sag T-1 Sag T-2
- 30.
- 31. Case #551 62 yearmale enchondroma proximal humerus
- 32.
- 33.
- 34.
- 35.
- 36. Case #552 degenerative arthritis 70 year male with enchondroma proximal humerus
- 37.
- 38.
- 39. Case #553 58 yearfemale enchondroma proximal humerus
- 40. Case #554 42year female enchondroma tumor proximal humerus
- 41. Case #554.1 Enchondroma and ganglion cyst 47 year male with shoulder pain for 6 months
- 42. ganglion enchondroma cyst Coronal T-2 MRI
- 43. Sagittal T-2 enchondroma Sagittal T-2 ganglion
- 44. ganglion Two different T-2axial cuts showing the enchondroma and the right cut shows the ganglion
- 45. Case #554.2 Double enchondroma 52 year old male with incidental findings in R shoulder & L hip
- 46.
- 47.
- 48. Case #555 55 yearmale enchondroma tibia
- 49.
- 50.
- 51. Coronal T-2 MRI tumor
- 52.
- 53. Case #556 55 yearmale with enchondroma tibia
- 54.
- 55.
- 56.
- 57.
- 58. Case #557 40 year female with enchondroma fibula
- 59.
- 60.
- 61.
- 62. Case #558 22 year male with enchondroma proximal phalanx
- 63.
- 64. Case #559 Periosteal chondroma enchondroma 33 year female with periosteal chondroma and enchondroma in same ray
- 65.
- 66. Case #560 Pathologic fractureenchondroma proximal phalanx thumb 29 year male
- 67. Case #561 23yr male with path fracture thru enchondroma thumb
- 68. Case #561.1 48 year female with mild pain in hand 1 year
- 69. Cor T-1 STIR Gad
- 70. Axial T-1 T-2 FS Gad
- 71. Case #562 31 year female with enchondroma great toe
- 72.
- 73.
- 74. Case #564 11 yr boy with enchondroma lst metatarsal
- 75. Case #565 26 year male with enchondroma 5th metatarsal
- 76. Case #566 17 year male with enchondroma os calcis
- 77.
- 78. Case #567 28 yearfemale enchondroma scapula
- 79. Multiple Enchondromatosi s Ollier’s Disease
- 80. Multiple Enchondromatosis (Ollier’s) Multiple enchondromatosis or Ollier’s disease, is a rare non- familial cartilagenous dysplasia that is typically seen on one half of the body and appears similar to fibrous dysplasia. Extensive disease of the metaphyseal areas of long bone can result in bowing and shortening. In the case of the femur a major bowing is seen distally compared to the proximal bowing seen in fibrous dysplasia. The cortical thinning and epiphyseal involvement seen in Ollier’s disease is rarely seen in solitary enchondromas. The chance for malignant conversion to a low grade chondrosarcoma in adult life is about 25%.
- 81. CLASSIC Case #568 3 year male with multiple enchondromatosis
- 82.
- 83.
- 84.
- 85. Case #569 6 yearmale Ollier’s disease
- 86.
- 87. Case #570 4.5 yearmale Ollier’s tibia
- 88. Case #571 71 year female with Ollier’s left lower extremity
- 89. Lateral view ofknee
- 90.
- 91. Failure following resurfacing TKA becauseof loosening
- 92. Post op x-raywith constrained TKA
- 93. X-ray of cemented stemdistal femoral resection prosthesis
- 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. Sag T-1 T-2 Gad
- 96. Surgical exposure ofsoft tissue lump behind distal tibia
- 97. Case #572 15 yearfemale Ollier’s disease
- 98. AP close upknee
- 99.
- 100. Case #573 18 yearmale Ollier’s pelvis and ribs
- 101. Case #574 2 yearmale Ollier’s lower extremity
- 102. Case #575 28 yearmale Ollier’s upper extremity
- 103. Multiple sites inradial half of hand
- 104.
- 105. Case #576 19 yearmale Ollier’s femur
- 106. Case #577 22 year male with Ollier’s of the hand
- 107. tumor Macro section ofamputation specimen
- 108. tumor Close up viewof macro section
- 109. Case #578 40 year female with Ollier’s of the hand
- 110. Case #579 10 yearmale Ollier’s hand
- 111. Case #580 30 yearfemale Ollier’s hand
- 112. Case #581 3 yearmale Ollier’s hand
- 113. Case #582 19 yearmale Ollier’s feet
- 114. Case #583 5 year female with Ollier’s of hand ready for surgery
- 115. X-ray of bothhands
- 116. Photo of deformedfeet after hand surgery
- 117. Close up ofdeformed foot
- 118. Multiple Enchondromatosis Plus Soft tissue Hemangiomatosis Maffucci’ Disease
- 119. Maffucci’s Syndrome Patients with multiple enchondromatosis or Ollier’s disease will on occasion develop soft tissue hemangiomatosis in the same areas as the enchondromatosis is seen. This combination of both a bony cartilaginous and a soft tissue angiomatosis is known as Maffucci’s syndrome. The clinical appearance of the multiple enchondromatosis is the same as Ollier’s disease but with a higher potential for a malignant conversion to a low grade chondrosarcoma in adult life.
- 120. CLASSIC Case #584 33 yearmale Maffucci’s disease
- 121.
- 122. phleboliths phleboliths X-ray forearm
- 123.
- 124.
- 125. Macrosection thru largeenchondroma
- 126.
- 127. Case #585 36 yearfemale with Muffucci’s syndrome
- 128.
- 129.
- 130.
- 131. hemangioma enchondroma Gross specimen
- 132. Case #586 25 year female with Muffucci’s syndrome hands
- 133.
- 134. Periosteal Chondroma The periosteal chondroma has the same basic pathology as the enchondroma except that it occurs on the surface of a tubular bone. It can occur as a hamartomatous process in growing patients but as with enchondroma it is usually asymptomatic and growth stops at bone maturity. The lesions are found in large bones, such as the humerus and femur, and in the small bones of the hand and foot. Radiographically one sees slight erosion into the adjacent cortex but the lesion will not penetrate into the medullary canal. There will be a sclerotic response at the base that extends around the periphery of the lesion taking on the appearance of a blister on the surface of the bone with matrix calcification seen mainly at the periphery but found also in the central area. The lesions usually stop growing before they reach the upper limit of 3-4 cm in diameter. If growth continues beyond this, one must strongly consider the possibility of a peripheral surface type chondrosarcoma
- 135. that would continueto grow after bone maturity. Periosteal sarcoma is a similar chondroid lesion found typically on large bones. It demonstrates a more aggressive pattern, permeation into surrounding cortical structures and a more aggressive histology with some osteoid formation. Osteo- chondroma also has a similar appearance but would demonstrate a more mature bony base on which a cap of cartilage is typically seen. In the case of the periosteal chondroma, the cartilage extends down into the depths of the tumor. Treatment consists of a simple resection without disturbing the subadjacent cortex so that bone grafting or internal fixation devices are not necessary. The recurrence rate is very low after maturity.
- 136. CLASSIC Case #121 17 yearfemale periosteal chondroma distal femur
- 137.
- 138.
- 139.
- 140.
- 141.
- 142.
- 143. Case #587 42 yearmale with combined periosteal chondroma and enchondroma next to each other in femur
- 144. enchondroma Bone scan periosteal chondroma
- 145. enchondroma periosteal chondroma Sagittal CT scan
- 146. Axial CT scanat level of enchondroma
- 147. periosteal chondroma enchondroma CT scan
- 148. Coronal T-1 MRI enchondroma
- 149.
- 150. Case #588 22 yearmale periosteal chondroma femur
- 151. Case #589 16 yearmale periosteal chondroma distal femur
- 152.
- 153. Case #590 12 yearfemale periosteal chondroma proximal femur
- 154.
- 155. Case #592 11 yearfemale periosteal chondroma proximal tibia
- 156.
- 157.
- 158.
- 159.
- 160. Case #593 19 year female with periosteal chondroma tibia
- 161. Case #594 26 yearmale periosteal chondroma proximal humerus tumor tumor
- 162.
- 163. small enchondroma Coronal T-1MRI tumor
- 164.
- 165. Case #595 46 year female with periosteal chondroma humerus
- 166.
- 167.
- 168.
- 169.
- 170.
- 171. Case #595.1 Periosteal chondroma 17 year old female with slight pain right shoulder for 1 year
- 172. Sag T-1 T-2 Gad
- 173. Axial T-1 T-2 Gad
- 174. Case #596 14 yearmale periosteal chondroma proximal humerus
- 175.
- 176. Case #598 62 year male with periosteal chondroma thumb
- 177.
- 178.
- 179.
- 180.
- 181. Case #599 8 yearfemale with periosteal chondroma 4th metacarpal
- 182. Case #599.1 Periosteal chondroma finger 10 yr male with non tender lump base of middle finger for yrs
- 183. Cor T-2 Sag T-2 Axial T-1 Axial T-2
- 184. Case #600 25year female with periosteal chondroma 3rd metatarsal
- 185. Case #601 26 year male with periosteal chondroma ring finger
- 186. Case #602 54year male with periosteal chondroma 5th metatarsal
- 187. Case #602.1 2006 2010 77 yr male with none tender firm mass on 2nd toe for years
- 188. Case #603 18 yearmale periosteal chondroma 3rd toe
- 189. Case #604 33 year male with soft tissue chondroma finger
- 190.
- 191.
- 192.
- 193.
- 194. Case #605 19 yearmale periosteal chondroma C-2
- 195.
- 196.
- 197. Case #606 38 year male with periosteal chondroma ischium
- 198. Case #607 6l year female with periosteal chondroma clavicle
- 199.
- 200. Osteochondroma The solitaty osteochondroma or exostosis is one of the most common benign bone tumors seen in the skeleton. As in the enchondroma, this condition is developmental, or hamartomatous in nature arising from the outer edge of the growth plate and growing down the metaphyseal side where it tends to point away from the adjacent joint. Because it originates from the growth plate, it continues to grow during the growing years of the patient and then stops at maturity. It is made up of a bony base with a pedunc- ulated stock with fatty marrow extending up inside the stock that has a cartilagenous cap giving it the appearance of a cauliflower. Histologically, the cap has features of a normal growth plate if a biopsy is performed during the growing years. Most of these lesions arise from large bones, especially about the knee joint, proximal femur, and proximal humerus. In the proximal humerus, the osteochondroma is usually sessile-based without a typical pedunc-
- 201. ulated stock andis frequently misdiagnosed for that reason. Multiple hereditary exostosis presents with multiple lesions through- out the skeletal system and is considered to be an autosomal dominant disorder, being one-tenth as common as the solitary osteochondroma 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 event compared to the 1% chance of a malignant conversion in multiple hereditary exostosis. It is the cartilaginous cap that converts into a low grade secondary type of peripheral chondrosarcoma with an excellent prognosis for survival compared to a central chondro- sarcoma. These malignant conversions usually arise from large osteochondromas seen in more proximal locations, such as around the hip or pelvis. Because osteochondromata are usually without symptoms, surgical treatment is frequently unnecessary unless the lesions create mechanical problems such as around the knee joint
- 202. where larger lesionscan interfere with normal ambulation. Sometimes, a large proximal lesion with a cartilage cap exceeding 2 cm should be prophylactically resected in order to avoid a possible chondrosarcoma. When removing an osteochondroma, it is necessary only to remove the complete cartilaginous cap, leaving most of the bony base intact to avoid a facture.
- 203. CLASSIC Case #122 25 yearmale osteochondroma tibia
- 204.
- 205.
- 206. cartilage cap fatty marrow Macro section
- 207. Case #608 17 year male with osteochondroma humerus
- 208.
- 209.
- 210.
- 211.
- 212. Case #609 30 yearmale sessile based osteochondroma humerus Coronal T-1 MRI
- 213. Coronal proton densityMRI cap
- 214. cap Axial T-1 MRI
- 215. cap fatty marrow Axial T-2 MRI
- 216. Case #610 14 yearmale with sessile based osteochondroma humerus
- 217.
- 218.
- 219.
- 220.
- 221. Case #611 10 yearmale sessile based osteochondroma proximal humerus
- 222.
- 223. Case #612 25 yearmale osteochondoma scapula
- 224.
- 225.
- 226. Case #613 32 year male with osteochondroma proximal femur
- 227.
- 228.
- 229. Case #614 12 yearfemale osteochondroma proximal femur
- 230. Case #615 15 yearmale osteochondroma distal femur
- 231. cap Cut specimen inpath lab
- 232. cartilage cap cartilage Photomic
- 233. Case #616 23 year male with osteochondroma distal femur
- 234. cap Cut specimen in path lab
- 235.
- 236. Case #617 26 year male with osteochondroma proximal fibula
- 237.
- 238. Case #618 18 year male with sessile based osteochondroma tibia
- 239. Case #619 11 yearmale sessile based osteochondroma distal tibia
- 240. Case #620 38 yearmale osteochondroma L-5
- 241.
- 242.
- 243.
- 244.
- 245. Case #621 6year male with osteochondroma C-6 spinous process
- 246.
- 247. Case #621 26 yearmale osteochondroma ilium
- 248. cap Cut specimen inpath lab
- 249. Case #621.1 22 year female with painless lump right iliac crest for years
- 250. Axial T-1 Gad
- 251. Cor T-2 Sag T-2
- 252. Case #623 31 year female with osteochondroma ant 3rd rib
- 253. Case #624 16 year male subungual exostosis
- 254.
- 255. Multiple Hereditary Exostosis
- 256. CLASSIC Case #625 15 year male with multiple hereditary exostoses
- 257.
- 258.
- 259. Case #625.1 Multiple hereditary exostoses 50 yr old female with short stature and R hip pain for years
- 260. AP and lateralof right hip
- 261. AP and lattibia
- 262.
- 263. AP and lateralof femur
- 264.
- 265. Case #626 13 yearfemale multiple exostoses forearm
- 266.
- 267. Case #627 20 yearmale multiple exostoses knee
- 268.
- 269. Case #628 15 year male with multiple exostoses hips
- 270. Case #629 26 year female with multiple exostoses thorax & arms
- 271. Case #630 31 yearmale multiple exostoses scapula & humerus
- 272.
- 273.
- 274. Case #631 26 yearmale multiple exostoses leg
- 275.
- 276. Chondroblastoma The chondroblastoma is a benign, cartilage forming tumor seen in the metaepiphyseal area of bone in children and young adults. The histologic appearance is typical of a giant cell tumor in young adults. The chondroblastoma is one fifth as common as the giant cell tumor and the majority of cases will occur during the second decade of life. It is rare to find the giant cell tumor in patients under the age of 13 years. The most common location for the chondroblastoma is in the epiphysis of the distal femur, proximal tibia, and proximal humerus. These lesions are usually located near a joint and are quite painful because of a secondary inflamm- atory synovitis of the adjacent joint that can masquerade as a pyarthrosis. It is not unusual to find an aneurysmal bone cyst associated with the chondroblastoma, similar to the situation seen with giant cell tumors. Histologically, one sees round polyhedral- shaped stromal cells located in clear cytoplasmic halos that gives
- 277. the appearance ofchicken wire under the microscope. Giant cells are frequently associated with the chondroid tissue that gives the appearance of a giant cell tumor. It is very rare for a chondro- blastoma to convert to a malignant tumor, however, as in the case of giant cell tumor, they can metastasize to the lung and still carry an excellent prognosis for survival. Treatment consists of a simple curettement of the lesion followed by packing the defect with either bone graft or bone cement. There is a relatively low (10%) recurrence rate.
- 278. CLASSIC Case #123 12 year female with chondroblastoma proximal tibia
- 279.
- 280.
- 281.
- 282. Case #632 26 year male with chondroblastoma prox tibia
- 283.
- 284.
- 285.
- 286.
- 287. Case #632.1 Chondroblastoma pseudotumor (geode) 52 yr female with pain in knee for 1 yr
- 288. Cor T-1 T-2
- 289.
- 290. Case #633 21 year female with chondroblastoma prox tibia
- 291. Case #634 16 year male with chondroblastoma distal femur
- 292.
- 293.
- 294.
- 295.
- 296. Curettement of tumor fromwindow in intercondylar notch tumor
- 297.
- 298.
- 299. Case #635 18 yearmale chondroblastoma distal femur
- 300.
- 301.
- 302. Case #636 20 yearmale with chondroblastoma & ABC prox femur
- 303.
- 304. Coronal T-2 MRI tumor edema
- 305.
- 306. Post op x-raywith cement & DHS
- 307. Case #636.1 Chondroblastoma with ABC 21 yr male with left hip pain for 4 mos.
- 308.
- 309. Cor PD Gad
- 310. Axial T-1 T-2 T-2 Gad
- 311.
- 312. Case #637 12 yearfemale with chondroblastoma prox femoral epiphysis
- 313.
- 314.
- 315. cartilage giant cells Photomic
- 316. Case #638 13 yearfemale with chondroblastoma prox fem epiphysis
- 317. Case #639 15 year male with chondroblastoma prox humerus
- 318.
- 319.
- 320.
- 321.
- 322.
- 323. Photomic with giantcells
- 324. Case #640 15year male with chondroblastoma proximal humerus
- 325.
- 326.
- 327. Photomic with giantcells
- 328.
- 329. Case #641 24 yearfemale chondroblastoma pelvis
- 330.
- 331.
- 332.
- 333. Case #642 CT scan 21 year male with chondroblastoma ilium
- 334.
- 335. tumor T-2 MRI
- 336. Case #643 43 year female with chondroblastoma distal humerus
- 337.
- 338. Case #644 11 year male with chondroblastoma lateral malleolus
- 339.
- 340.
- 341.
- 342. Case #645 12 yearfemale chondroblastoma distal fibula
- 343. Case #646 18 year male with chondroblastoma talus
- 344.
- 345. Chondromyxoid Fibroma
- 346. Chondromyxoid Fibroma Chondromyxoid fibroma is a very rare solitary benign tumor seen in bone. It occurs typically in the second or third decade of life and affects men more than women. By far the more common location for this lesion is in the proximal tibial metaphysis, followed second by the distal femur and the first ray of the foot. This lesion is 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 peripheral margin giving it a pseudoloculated appearance similar to that of a solitary bone cyst. The adjacent cortex is frequently thinned out and slightly dilated, similar to the pattern that is seen in fibrous dysplasia. Histologically, there will be evidence of benign fibrous tissue with large areas of myxomatous degeneration with reactive macrophage activity seen at the periphery of the lesion that could suggest the diagnosis of a chondrosarcoma.
- 347. Treatment for thislesion consists of a simple curettement and bone grafting. The fairly high recurrence rate of 25% can be reduced by a more aggressive, marginal resection of the tumor. Occasionally, this lesion can convert into a chondrosarcoma.
- 348. CLASSIC Case #124 11 yearmale chondromyxoid fibroma proximal tibia
- 349.
- 350. Surgical exposure oftumor
- 351.
- 352. giant cells myxoid Higher power
- 353. Surgical curettement completedready for bone graft
- 354. Placement of fibularstrut and cancellous graft
- 355.
- 356. Case # 124.1 AP and lat x-ray 50 year male with chondromyxoid fibroma proximal tibia with 6 months of a tender tumor mass anterior tibia
- 357.
- 358.
- 359. Axial PD FSMRI
- 360.
- 361. Case #647 12 year female with chondromyxoid fibroma tibia
- 362. Case #648 13 year female with chondromyxoid fibroma tibia
- 363. Case #649 25 yearfemale chondromyxoid fibroma 1st metatarsal
- 364.
- 365.
- 366.
- 367. Case #649.1 Chondromyxoid fibroma os calcis 44 year old male with heel pain 1 year
- 368. Sag T-1 Axial T-1 Axial PD Axial Gad
- 369.
- 370. Case #650 7 yearfemale chondromyxoid fibroma ulna
- 371.
- 372. Case #651 25 year female with chondromyxoid fibroma rib
- 373.
- 374. Case #651.1 60 yearfemale with chondromyxoid fibroma distal sacrum
- 375. Sag T-1 Sag T-2
- 376.
- 377.