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Elbahri HMH, AbdElmaged HMA, Awad MYM, Yousif YOE, Khalafalla SGA. Short-term functional and oncological outcomes of intralesional curettage supplemented by bone cementation for chondroblastoma : a cross-sectional study. Ann Med Surg (Lond) 2025; 87:2626-2632. [PMID: 40337433 PMCID: PMC12055065 DOI: 10.1097/ms9.0000000000003191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Accepted: 02/26/2025] [Indexed: 05/09/2025] Open
Abstract
Background Chondroblastoma is a rare, benign neoplasm accounting for less than 1% of all primary bone tumors. It is treated with complete surgical curettage with or without chemical or physical adjuvants. The present study aims to assess the functional and oncological outcomes of patients with chondroblastoma treated with intralesional curettage supplemented by bone cementation of the resulting bone defect. Materials and methods This study is an observational, descriptive, prospective hospital-based study conducted from April 2022 to August 2022 at the Ibrahim Malik Teaching Hospital and Future Hospital in Khartoum State, Sudan. It included patients with chondroblastoma who were treated with intralesional curettage and subsequent filling of the remaining bone cavity with bone cement. The researchers collected data from the patients' hospital records, as well as with the aid of the Musculoskeletal Tumor Society Scoring System, and analyzed them using SPSS V 28. Results The study population comprised 32 patients with a mean age of 20 ± 6 years; the majority were males, 62.5% (n = 20), and students by occupation, 66% (n = 21). The proximal tibia was the most commonly involved site, corresponding to 59% of the cases (n = 19). Functional evaluation using the Musculoskeletal Tumor Society Scoring System revealed a statistically significant improvement from a preoperative score of 62 ± 10 to a postoperative score of 91 ± 3 (P value = 0.001). No recurrence or need for amputation was reported. Almost half of the study participants, 47% (n = 15) experienced moderate to severe pain. Postoperatively, 97% (n = 31) were satisfied with pain relief, and all patients were satisfied with the procedure. Functional outcomes improve with time after surgery. Conclusion The study showed a favorable outcome regarding pain relief and functional restoration in patients with chondroblastoma. The oncological results were also satisfactory; no recurrence, or need for amputation was recorded.
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Affiliation(s)
- Hassan Mohammed Hassan Elbahri
- Department of Surgery, College of Medicine and Health Sciences, Arabian Gulf University (AGU), Bahrain
- Faculty of Medicine, International University of Africa (IUA), Khartoum, Sudan
| | - Hozifa Mohammed Ali AbdElmaged
- Assistant Professor of Orthopaedics, Alzaiem Alazhari University, Alhalfaya, Khartoum north, Khartoum, Sudan. Tel.: +249913069716
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Crisostomo BL, Daou JP, Garcia JG, Petrilli MDET, Viola DCM, Garcia RJ. EPIDEMOLOGICAL, RADIOGRAPHIC AND PROGNOSTIC EVALUATION OF CHONDROBLASTOMA. ACTA ORTOPEDICA BRASILEIRA 2025; 33:e283605. [PMID: 40206450 PMCID: PMC11978305 DOI: 10.1590/1413-785220243201e283605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 04/11/2025]
Abstract
Objective To describe the clinical and imaging characteristics of chondroblastoma and identify possible factors related to joint complications. Method This retrospective cohort study was carried out with data from the medical records of 23 patients diagnosed with chondroblastoma, subjecting them to statistical analyses. Result In total, 19 patients were included, 12 (63.2%) of which were mean with a mean age of 13.6±3.5 year. The relation with the local dimension equaled 57.9%, higher in the apophysis of the greater trochanter: 95.2% (p<0.001). Based on imaging, 15.8% patients had an open physis; 55.6%, no damaged physeal line; 42.1%, cortical rupture; 21.1%, secondary aneurysmal bone cyst; 26.7%, violated cartilage; and all cases, medullary edema. 15.8% of cases showed local recurrence and no metastasis. Moreover, 46.7% of patients had relevant secondary osteoarthritis related to the aggressiveness of the tumor according to the Enneking classification (p= 0.041). Conclusion The clinical outcome of chondroblastoma show no relation to age, sex, location, physeal status, or presence of calcifications or secondary aneurysmal bone cyst. Progression to secondary osteoarthritis configured the most frequent non-oncological complication and showed a direct relation with the severity of the chondroblastoma. Level of Evidence IV, Case Series.
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Affiliation(s)
- Bernardo Lopes Crisostomo
- Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas HC-FMUSP, Departamento de Ortopedia e Traumatologia DOT, Disciplina de Ortopedia Oncológica, Sao Paulo, SP, Brazil
| | - Julia Pozzetti Daou
- Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas HC-FMUSP, Departamento de Ortopedia e Traumatologia DOT, Disciplina de Ortopedia Oncológica, Sao Paulo, SP, Brazil
| | - Jairo Greco Garcia
- Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas HC-FMUSP, Departamento de Ortopedia e Traumatologia DOT, Disciplina de Ortopedia Oncológica, Sao Paulo, SP, Brazil
| | - Marcelo DE Toledo Petrilli
- Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas HC-FMUSP, Departamento de Ortopedia e Traumatologia DOT, Disciplina de Ortopedia Oncológica, Sao Paulo, SP, Brazil
| | - Dan Carai Maia Viola
- Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas HC-FMUSP, Departamento de Ortopedia e Traumatologia DOT, Disciplina de Ortopedia Oncológica, Sao Paulo, SP, Brazil
| | - Reynaldo Jesus Garcia
- Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas HC-FMUSP, Departamento de Ortopedia e Traumatologia DOT, Disciplina de Ortopedia Oncológica, Sao Paulo, SP, Brazil
- Hospital Israelita Albert Einstein, Grupo de Ortopedia Oncológica, São Paulo, SP, Brazil
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Hirozane T, Sekita T, Kobayashi E, Mori T, Asano N, Udaka T, Tajima T, Nakagawa R, Kikuta K, Yoshiyama A, Morioka H, Watanabe I, Anazawa U, Susa M, Horiuchi K, Suzuki Y, Morii T, Nakayama R. Clinical characteristics and outcomes of patients with chondroblastoma undergoing surgery with various adjuvant procedures: a retrospective study of 59 cases. BMC Surg 2025; 25:40. [PMID: 39856613 PMCID: PMC11761176 DOI: 10.1186/s12893-025-02782-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 01/16/2025] [Indexed: 01/27/2025] Open
Abstract
BACKGROUND Chondroblastoma is classified as a benign bone tumor. However, postoperative local recurrence remains a concern. We analyzed the factors contributing to chondroblastoma local recurrence and the clinical challenges associated with treating these patients. METHODS This retrospective study examined 59 patients followed up at our hospitals for ≥ 1 year after surgery during 1990-2020. The most common lesion site was the epiphyses of long bones (42 cases, 71%), including the femur, tibia, and humerus. Curettage was performed in 57 cases; 2 cases with an iliac lesion underwent resection. The median postoperative follow-up period was 47 months. Clinical features of chondroblastoma were retrospectively investigated, and local recurrence and postoperative functional outcomes were assessed. RESULTS Local recurrence occurred in 9% (5/57) of patients after curettage but not in the resected cases. The median time to local recurrence was 14 months. The local recurrence-free survival (LRFS) rate for all patients was 92.7% at 2 years and 88.3% at 5 years. All patients with local recurrence were aged < 17 years at the time of surgery. Local recurrence was observed in the proximal humerus in two cases and the calcaneus, acetabulum, and distal femur in one case each. None of the adjuvant procedures (high-speed burr, ablation, bone replacement materials, and preoperative denosumab) helped reduce local recurrence risk (P > 0.05). Trends toward fewer local recurrences were observed in the group treated using the high-speed burr and in the group not treated using bone replacement materials. Among the groups treated with bone replacement materials, artificial bone achieved the best LRFS rate, followed by allograft and autograft. At the final follow-up, the mean Musculoskeletal Tumor Society score was 29.8 (range: 25-30), indicating excellent postoperative functional outcomes. Joint degeneration was observed in five patients. Patients with local recurrence had a high degree of disability and joint deformity (P < 0.05). Two patients received preoperative denosumab and neither experienced local recurrence nor functional impairments. CONCLUSIONS Good oncological and functional outcomes were achieved. Age < 17 years was associated with a high risk of local recurrence after curettage (P = 0.0198). Patients with local recurrence exhibited poorer functional outcomes. High-speed burr may help reduce the recurrence risk. If bone grafts are necessary, materials with low biocompatibility, including artificial bone, may be optimal. Managing patients with chondroblastoma should encompass curative and functional aspects.
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Affiliation(s)
- Toru Hirozane
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-Ku, Tokyo, Japan.
- Department of Orthopaedic Surgery, Faculty of Medicine, Kyorin University, Mitaka, Tokyo, 181-8611, Japan.
| | - Tetsuya Sekita
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Chuo-Ku, Tokyo, Japan
| | - Eisuke Kobayashi
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Chuo-Ku, Tokyo, Japan
| | - Tomoaki Mori
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-Ku, Tokyo, Japan
| | - Naofumi Asano
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-Ku, Tokyo, Japan
| | - Toru Udaka
- Department of Orthopaedic Surgery, Faculty of Medicine, Kyorin University, Mitaka, Tokyo, 181-8611, Japan
- Division of Musculoskeletal Oncology and Orthopaedic Surgery, Tochigi Cancer Center, Utsunomiya, Tochigi, Japan
| | - Takashi Tajima
- Department of Orthopaedic Surgery, Faculty of Medicine, Kyorin University, Mitaka, Tokyo, 181-8611, Japan
| | - Rumi Nakagawa
- Division of Musculoskeletal Oncology and Orthopaedic Surgery, Tochigi Cancer Center, Utsunomiya, Tochigi, Japan
| | - Kazutaka Kikuta
- Division of Musculoskeletal Oncology and Orthopaedic Surgery, Tochigi Cancer Center, Utsunomiya, Tochigi, Japan
| | - Akira Yoshiyama
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Meguro-Ku, Tokyo, Japan
| | - Hideo Morioka
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Meguro-Ku, Tokyo, Japan
| | - Itsuo Watanabe
- Department of Orthopaedic Surgery, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Chiba, Japan
| | - Ukei Anazawa
- Department of Orthopaedic Surgery, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Chiba, Japan
| | - Michiro Susa
- Department of Orthopaedic Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Keisuke Horiuchi
- Department of Orthopaedic Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Yoshihisa Suzuki
- Department of Orthopaedic Surgery, Tachikawa Hospital, Tachikawa-Shi, Tokyo, Japan
| | - Takeshi Morii
- Department of Orthopaedic Surgery, Faculty of Medicine, Kyorin University, Mitaka, Tokyo, 181-8611, Japan
| | - Robert Nakayama
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-Ku, Tokyo, Japan
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Yang D, Wang Z. Chondroblastoma in 28 cases: The risk of local recurrence increases with larger tumor size. J Orthop Surg (Hong Kong) 2025; 33:10225536251328099. [PMID: 40085921 DOI: 10.1177/10225536251328099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2025] Open
Abstract
Introduction: Chondroblastoma (CBL) is a rare benign bone tumor with potentially local recurrence and metastases. At present, the local recurrence risk factors are controversial. The purpose of this study is to analysis local recurrence factors in our medical center. Methodology: A retrospective analysis was conducted on 18 male and 10 female patients who presented at our hospital between 2016 and 2023. The clinical data included radiological images, histological results, treatment modalities, functional outcomes, and local recurrence rates. Surgical interventions comprised curettage, followed by bone grafting and adjunctive techniques. Furthermore, all patients were stratified into two groups based on tumor volume, with a threshold of 25 cm3, to explore the relationship between tumor volume and recurrence. Results: Among the 28 patients, with an average age of 13 years (range: 9 to 16 years) and an average follow-up duration of 33 months (range: 8 to 91 months). The mean Musculoskeletal Tumor Society (MSTS) score was 27 points (range: 14 to 30). Notably, recurrence was observed in 3 pediatric patients. A statistically significant difference in recurrence rates was found between tumors with volumes less than 25 cm3 and those greater than 25 cm3 (p < .05). Conclusion: Curettage, combined with alcohol as an adjuvant, resulted in local control and good outcomes in most pediatric patients. It was noteworthy that a larger tumor size correlated with an increased likelihood of recurrence.
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Affiliation(s)
- Di Yang
- Department of Orthopedics Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Structural Birth Defect and Reconstruction
| | - Zhongliang Wang
- Department of Orthopedics Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Structural Birth Defect and Reconstruction
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Samargandi R, Bafail A, Le Nail LR, Berhouet J. Comprehensive Insights into Chondroblastoma Metastasis: Metastatic Patterns and Therapeutic Approaches. Cancers (Basel) 2024; 16:2283. [PMID: 38927987 PMCID: PMC11201376 DOI: 10.3390/cancers16122283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 06/19/2024] [Accepted: 06/19/2024] [Indexed: 06/28/2024] Open
Abstract
Chondroblastoma metastasis, though rare, represents a clinically significant and notably important aspect of bone tumors. Understanding its epidemiological characteristics, pathological features, and treatment modalities, despite its infrequency, is imperative for comprehensive patient management. This review aims to elucidate the epidemiology, molecular mechanisms, diagnostic challenges, and therapeutic strategies associated with chondroblastoma metastasis. The patterns, prognostic factors, and treatment outcomes were explored through an analysis of case studies and clinical reports. Notably, we highlighted emerging therapeutic perspectives aimed at improving patient outcomes. To the best of our knowledge, there has been no previous review addressing these matters cumulatively, highlighting a significant gap in the existing scholarly literature. By shedding light on the nuances of chondroblastoma metastasis, this review contributes to the advancement of knowledge in this field and informs clinical decision-making for improved patient care.
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Affiliation(s)
- Ramy Samargandi
- Service de Chirurgie Orthopédique et Traumatologique, Centre Hospitalier Régional Universitaire (CHRU) de Tours, 1C Avenue de la République, 37170 Chambray-les-Tours, France; (L.-R.L.N.); (J.B.)
- Department of Orthopedic Surgery, Faculty of Medicine, University of Jeddah, Jeddah 23218, Saudi Arabia
| | - Abrar Bafail
- Service de Médecine Nucléaire, Centre Hospitalier Régional Universitaire (CHRU) de Tours, 1C Avenue de la République, 37170 Chambray-les-Tours, France;
| | - Louis-Romée Le Nail
- Service de Chirurgie Orthopédique et Traumatologique, Centre Hospitalier Régional Universitaire (CHRU) de Tours, 1C Avenue de la République, 37170 Chambray-les-Tours, France; (L.-R.L.N.); (J.B.)
| | - Julien Berhouet
- Service de Chirurgie Orthopédique et Traumatologique, Centre Hospitalier Régional Universitaire (CHRU) de Tours, 1C Avenue de la République, 37170 Chambray-les-Tours, France; (L.-R.L.N.); (J.B.)
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Tosyalı HK, Kaya H, Kececi B, Sabah D. Management of Chondroblastoma in Pediatric Patients: 21 Years of Single-Center Experience. CHILDREN (BASEL, SWITZERLAND) 2024; 11:672. [PMID: 38929251 PMCID: PMC11202176 DOI: 10.3390/children11060672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/22/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Chondroblastoma (CB), a rare benign bone tumor that produces chondrocytes, often develops in the epiphysis or apophysis of children and young adults. The treatment of these rare tumors is complex. The standard treatment protocol involves curettage with local adjuvants and bone graft or cement application. The authors examined 38 CBs to determine risk factors for local recurrence, complications, and functional outcomes following epiphyseal curettage. METHODS Twenty-two girls and sixteen boys aged 10 to 17 years with histologically confirmed chondroblastoma who arrived at our hospital between January 2000 and June 2021 were reviewed retrospectively. Clinical data, radiographic images, histological results, treatment, functional outcomes, and the local recurrence rate were examined-surgical treatment involved total tumor curettage, followed by bone grafting and adjuvant techniques. Local recurrences have also been reported. RESULTS The most frequently affected site was the proximal femur. Sites of involvement included the proximal femur in 10 (26.3%) cases, the proximal tibia in 8 (20.8%), the humerus in 5 cases (13.2%), the distal tibia in 4 cases (10.5%), the distal femur in 3 cases (7.9%), the supracetabular region in 3 cases (7.9%), the talus in 1 case (2.6%), the calcaneus in 1 case (2.6%), the scapula in 1 case (2.6%), the lumbar spine in 1 case (2.6%), and the iliac bone in 1 (2.6%) patient. The mean follow-up was 144.2 months (24 to 276). The local recurrence rate was 7.9%. The mean Musculoskeletal Tumor Society (MSTS) score was 28.3 points (17 to 30). The mean duration of symptoms at presentation was 5.8 (range, 1 to 28) months. CONCLUSION Aggressive curettage and bone grafting resulted in local control and good outcomes in most pediatric patients. In a relatively small proportion of cases, long-term complications and recurrence can occur due to growth plate damage and late diagnosis. In patients admitted to the pediatric clinic with pain, which is often accompanied by localized edema and joint effusion, early detection via advanced radiological scans (X-ray, CT, or MRI) may prevent delays in diagnosis.
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Affiliation(s)
- Hakan Koray Tosyalı
- Department of Orthopedics and Traumatology, Faculty of Medicine, Celal Bayar University, 45140 Manisa, Türkiye
| | - Hüseyin Kaya
- Department of Orthopedics and Traumatology, Faculty of Medicine, Ege University, 35040 Izmir, Türkiye; (H.K.); (B.K.); (D.S.)
| | - Burcin Kececi
- Department of Orthopedics and Traumatology, Faculty of Medicine, Ege University, 35040 Izmir, Türkiye; (H.K.); (B.K.); (D.S.)
| | - Dündar Sabah
- Department of Orthopedics and Traumatology, Faculty of Medicine, Ege University, 35040 Izmir, Türkiye; (H.K.); (B.K.); (D.S.)
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Brunet L, Torner F, Suñol M, Martínez J, Gracia I, Peiró A, Machado P. Chondroblastomas in Children and Young Adults: Revision of 55 Cases. J Pediatr Orthop 2024; 44:e184-e191. [PMID: 38084007 DOI: 10.1097/bpo.0000000000002589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
BACKGROUND Chondroblastomas are uncommon primary bone tumors localized in long bone epiphyses in children and young adults. The risk of metastasis is rare, but they have a high capacity for local recurrence. Surgical curettage with bone grafting or bone substitute is the preferred treatment. METHODS We performed an observational retrospective study of chondroblastomas treated in 2 hospitals in Barcelona from 1988 to 2018. We reviewed the location of the tumor, clinical presentation, imaging, histopathology, initial treatment, and cases of recurrence with a review of their treatment. We assessed the correlation between recurrence and index surgery, anatomic location, and certain histopathologic findings (presence of mitotic figures, necrosis, and positivity for protein S-100). RESULTS The series included 55 patients treated from 1988 to 2018, with ages ranging from 6 to 26, and a mean follow-up of 6.1 years (±3.7). The most common location was the distal femur metaphyseal/epiphyseal region. The most frequent clinical presentation was pain in the affected. Forty-five cases (81.8%) were treated with curettage of the tumor, and 4 cases (7.3%) with a wide resection. Forty-two cases (85.7%) received bone substitutes after curettage or resection. We found 5 cases of recurrence (9.1% recurrence rate); however, we could not find a statistically significant correlation between index surgery and recurrence ( P =0.24), anatomic location and recurrence ( P =0.49), or recurrence and histopathologic findings (mitotic figures, P =0.49; necrosis, P =0.60; positivity for protein S-100, P =0.52). In all the cases the treatment for the local recurrence was surgical, with a final healing rate of 100%. CONCLUSIONS Chondroblastomas should be considered in children and adolescents when presenting with pain and an image suggestive of a tumoral lesion on plain x-ray, most frequently in epiphyses of long bones.Surgical treatment is preferred, obtaining good results after curettage and bone substitute. Chondroblastomas are tumors with a high capacity for recurrence, therefore an adequate surgical technique and surgeon experience are paramount to achieve good outcomes. LEVEL OF EVIDENCE Level IV (case series). Therapeutic studies-investigating results or treatment.
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Affiliation(s)
- Laia Brunet
- Musculoskeletal Tumour Unit, Department of Orthopaedic Surgery-Hospital Sant Joan de Déu, Barcelona Cancer Center, Universitat de Barcelona
| | - Ferran Torner
- Musculoskeletal Tumour Unit, Department of Orthopaedic Surgery-Hospital Sant Joan de Déu, Barcelona Cancer Center, Universitat de Barcelona
| | - Mariona Suñol
- Pathology Department-Hospital Sant Joan de Déu, Universitat de Barcelona
| | - Judit Martínez
- Musculoskeletal Tumour Unit, Department Orthopaedic Surgery-Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona
| | - Isidre Gracia
- Musculoskeletal Tumour Unit, Department Orthopaedic Surgery-Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona
- School of Health Sciences, Blanquerna - University Ramon Llull, Barcelona, Spain
| | - Ana Peiró
- Musculoskeletal Tumour Unit, Department Orthopaedic Surgery-Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona
| | - Pau Machado
- Musculoskeletal Tumour Unit, Department Orthopaedic Surgery-Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona
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Ardakani AG, Morgan R, Matheron G, Havard H, Khoo M, Saifuddin A, Gikas P. Magnetic Resonance Imaging Features and Prognostic Indicators of Local Recurrence after Curettage and Cementation of Atypical Cartilaginous Tumour in the Appendicular Skeleton. J Clin Med 2023; 12:6905. [PMID: 37959370 PMCID: PMC10649515 DOI: 10.3390/jcm12216905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 10/26/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
Objective: The aim of this study is to determine MRI features that may be prognostic indicators of local recurrence (LR) in patients treated with curettage and cementation of atypical cartilaginous tumours (ACTs) in the appendicular skeleton. Materials and Methods: This study is a retrospective review of adult patients with histologically confirmed appendicular ACT. The data collected included age, sex, skeletal location and histology from curettage, the presence of LR and oncological outcomes. The pre-operative MRI characteristics of the ACT reviewed by a specialist MSK radiologist included lesion location, lesion length, degree of medullary filling, bone expansion, cortical status and the presence of soft tissue extension. Results: A total of 43 patients were included, including 9 males and 34 females with a mean age of 42.8 years (range: 25-76 years). Tumours were located in the femur (n = 19), humerus (n = 15), tibia (n = 5), fibula (n = 2) and radius and ulna (n = 1 each). A total of 19 lesions were located in the diaphysis, 12 in the metadiaphysis, 6 in the metaphysis and 6 in the epiphysis. The mean tumour length was 61.0 mm (range: 12-134 mm). The mean follow up was 97.7 months (range: 20-157 months), during which 10 (23.3%) patients developed LR, 7 (70%) of which were asymptomatic and 3 (30%) of which presented with pain. Four patients required repeat surgery with no associated death or evidence of metastatic disease. LR was significantly commoner with tumours arising in the epiphysis or metadiaphysis, but no MRI features were predictive of LR. Conclusions: No relationship was found between the apparent 'aggressiveness' of an ACT of the appendicular skeleton on MRI and the development of LR following treatment with curettage and cementation.
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Affiliation(s)
| | - Rebecca Morgan
- Department of Orthopaedic Oncology, Royal National Orthopaedic Hospital, London HA7 4LP, UK
| | - George Matheron
- Department of Orthopaedic Oncology, Royal National Orthopaedic Hospital, London HA7 4LP, UK
| | - Helard Havard
- Department of Orthopaedic Oncology, Royal National Orthopaedic Hospital, London HA7 4LP, UK
| | - Michael Khoo
- Department of Radiology, Royal National Orthopaedic Hospital, London HA7 4LP, UK
| | - Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital, London HA7 4LP, UK
| | - Panagiotis Gikas
- Department of Orthopaedic Oncology, Royal National Orthopaedic Hospital, London HA7 4LP, UK
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Rekhi B, Dave V, Butle A, Dutt A. Utility of immunohistochemical expression of H3.3K36M and DOG1 in the diagnosis of chondroblastomas: An experience from a tertiary cancer referral center. Ann Diagn Pathol 2023; 66:152174. [PMID: 37356274 DOI: 10.1016/j.anndiagpath.2023.152174] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 06/27/2023]
Abstract
Despite its characteristic clinicopathological features, chondroblastoma may pose a diagnostic challenge, given its morphological spectrum, potential for subdiagnostic appearances in limited biopsy specimens, and its potential mimicry of other entities. Recently, a characteristic H3F3B mutation underlying most chondroblastomas was described, which led to the identification of H3.3K36M as the corresponding diagnostic immunohistochemical marker. The present study is an evaluation of immunohistochemical features of 26 chondroblastomas, including DOG1 and H3.3K36M immunostaining. H3.3K36M immunostaining was graded as 1+, 2+ and 3+ in terms of staining intensity. There were 17 males and 9 females (M:F = 1.8:1) with ages ranging from 7 to 34 years (average = 16.7, median = 16). The most common location was proximal humerus (8, 30.7 %) followed by proximal tibia (5, 19.2 %), distal femur (3, 11.5 %), proximal femur (3, 11.5 %), pelvis (2,), followed by distal tibia, calcaneum, upper sternum, scapula, and D9 vertebra, in a single case, respectively. Eighteen (69.23 %) tumors displayed all the classic histopathological features. Immunohistochemically, the tumor cells were positive for S-100 P (19/22, 86.3 %), DOG1 (focal to patchy) (21/23 91.3 %), and H3.3K36M (26/26, 100 %). H3.3K36M tested in other tumors, constituting diagnostic mimics of a chondroblastoma, such as giant cell tumor of bone, chondromyxoid fibroma, and tenosynovial giant cell tumors, showed negative staining. Six tumors, initially diagnosed as chondroblastomas were reclassified into other entities with the help of negative H3.3K36M immunostaining. The present study reinforces H3.3K36M as a highly sensitive and specific marker for diagnosing chondroblastoma, including small biopsies, and in uncommon tumor sites with variable histopathological features. DOG1 is also useful in reinforcing a diagnosis of chondroblastoma in a clinicoradiological context, especially in laboratories lacking H3.3K36M immunostain. However, its staining pattern is variable.
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Affiliation(s)
- Bharat Rekhi
- Department of Pathology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India; Homi Bhabha National Institute (HBNI) University, Parel, Mumbai, Maharashtra, India.
| | - Vinayak Dave
- Department of Pathology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Ashwin Butle
- Homi Bhabha National Institute (HBNI) University, Parel, Mumbai, Maharashtra, India; Integrated Cancer Genomics Laboratory, Advanced Centre for Treatment Research Education In Cancer (ACTREC), Khargar, Navi Mumbai, Maharashtra, India
| | - Amit Dutt
- Homi Bhabha National Institute (HBNI) University, Parel, Mumbai, Maharashtra, India; Integrated Cancer Genomics Laboratory, Advanced Centre for Treatment Research Education In Cancer (ACTREC), Khargar, Navi Mumbai, Maharashtra, India
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10
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Lan C, Bateni C, Theriault R, Scott M, Randall RL, Bindra J. Recurrent chondroblastoma of the acetabulum in an adult. Radiol Case Rep 2023; 18:2637-2640. [PMID: 37266376 PMCID: PMC10230822 DOI: 10.1016/j.radcr.2023.04.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/22/2023] [Accepted: 04/27/2023] [Indexed: 06/03/2023] Open
Abstract
Chondroblastoma is a rare, benign neoplasm of chondroblast cell origin, accounting for less than 1% of primary bone tumors. It is usually diagnosed in the second decade of life with most of the cases involving the long bones such as the femur and humerus. Furthermore, over 90% of cases are in individuals under 30 years of age. In older adults, chondroblastomas are typically found in bones in the foot, such as the talus and calcaneus. Treatment is usually local curettage of the lesion with a relatively low rate of recurrence. In this case report, we present a patient with an atypical age of initial presentation at 49 years, a rare location of the chondroblastoma in the acetabulum, and a recurrence 14 years after surgical resection in the same location. The lesion's radiographic findings of intralesional calcifications alongside the high-signal, heterogeneous composition on T2-weighted MRI were supportive of the atypical diagnosis of chondroblastoma in this patient.
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Affiliation(s)
- Christopher Lan
- School of Medicine, University of California, Davis, 4610 X St, Sacramento, CA 95817, USA
| | - Cyrus Bateni
- Department of Radiology, University of California Davis School of Medicine, 4860 Y St. Suite 3100 Sacramento, CA 95817, USA
| | - Raminta Theriault
- Department of Orthopaedic Surgery, University of California Davis School of Medicine, 4860 Y St. Suite 3800 Sacramento, CA 95817, USA
| | - Michelle Scott
- Department of Orthopaedic Surgery, University of California Davis School of Medicine, 4860 Y St. Suite 3800 Sacramento, CA 95817, USA
| | - Robert Lawrence Randall
- Department of Orthopaedic Surgery, University of California Davis School of Medicine, 4860 Y St. Suite 3800 Sacramento, CA 95817, USA
| | - Jasjeet Bindra
- Department of Radiology, University of California Davis School of Medicine, 4860 Y St. Suite 3100 Sacramento, CA 95817, USA
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11
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Zheng BW, Zheng BY, Niu HQ, Zou MX, Wu HL, Wang M, Li XL. Clinicopathological characteristics and prognostic factors in axial chondroblastomas: a retrospective analysis of 61 cases and comparison with extra-axial chondroblastomas. World J Surg Oncol 2023; 21:188. [PMID: 37344889 PMCID: PMC10283327 DOI: 10.1186/s12957-023-03063-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 06/04/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND A comprehensive understanding of the clinical characteristics and prognostic factors associated with axial chondroblastoma (ACB) is still lacking. This study aimed to understand the clinical characteristics and prognostic factors of axial chondroblastoma (ACB) and compare them with extra-axial chondroblastoma (EACB). METHODS A retrospective review of our institution's local database was conducted, encompassing a total of 132 CB patients, of which 61 were diagnosed with ACB and 71 with EACB. Immunohistochemistry was employed to evaluate the expression levels of vimentin, S100, and cytokeratin. RESULTS ACB and EACB shared similar characteristics, with the exception of advanced age, tumor size, elevated Vim expression, incidence of surrounding tissue invasion, and postoperative sensory or motor dysfunction. While wide resection and absence of surrounding tissue invasion consistently showed a favorable association with survival in both ACB and EACB cohorts during univariate analysis, most parameters exhibited differential prognostic significance between the two groups. Notably, the significant prognostic factors for local recurrence-free survival in the ACB cohort included the type of resection and the presence of chicken-wire calcification. In the multivariate analysis of overall survival, the type of resection emerged as a significant predictor in the ACB cohort, whereas in the EACB group, the type of resection and the occurrence of postoperative sensory or motor dysfunction were predictive of overall survival. CONCLUSION There may exist distinct biological behaviors between ACB and EACB, thereby providing valuable insights into the prognostic characteristics of ACB patients and contributing to enhanced outcome prediction in this particular patient population.
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Affiliation(s)
- Bo-Wen Zheng
- Department of Spine Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001 China
- Musculoskeletal Tumor Center, People’s Hospital, Peking University; Beijing Key Laboratory of Musculoskeletal Tumor, Beijing, China
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011 China
| | - Bo-Yv Zheng
- Department of Orthopedics Surgery, General Hospital of the Central Theater Command, Wuhan, 430061 China
| | - Hua-Qing Niu
- Department of Ophthalmology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014 China
| | - Ming-Xiang Zou
- Department of Spine Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001 China
- Department of Spine Surgery, Hengyang Medical School, The First Affiliated Hospital, University of South China, 69 Chuanshan Road, Hengyang, Hunan 421001 China
| | - Hai-Lin Wu
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011 China
| | - Ming Wang
- Department of Spine Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001 China
- Department of Spine Surgery, Hengyang Medical School, The First Affiliated Hospital, University of South China, 69 Chuanshan Road, Hengyang, Hunan 421001 China
| | - Xue-Lin Li
- Department of Spine Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001 China
- Department of Spine Surgery, Hengyang Medical School, The First Affiliated Hospital, University of South China, 69 Chuanshan Road, Hengyang, Hunan 421001 China
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12
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Zheng BW, Huang W, Liu FS, Zhang TL, Wang XB, Li J, Lv GH, Yan YG, Zou MX. Clinicopathological and Prognostic Characteristics in Spinal Chondroblastomas: A Pooled Analysis of Individual Patient Data From a Single Institute and 27 Studies. Global Spine J 2023; 13:713-723. [PMID: 33896211 DOI: 10.1177/21925682211005732] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
STUDY DESIGN Retrospective pooled analysis of individual patient data. OBJECTIVES Spinal chondroblastoma (CB) is a very rare pathology and its clinicopathological and prognostic features remain unclear. Here, we sought to characterize the clinicopathological data of a large spinal CB cohort and determine factors affecting the local recurrence-free survival (LRFS) and overall survival (OS) of patients. METHODS Electronic searches using Medline, Embase, Google Scholar and Wanfang databases were performed to identify eligible studies per predefined criteria. A retrospective review was also conducted to include additional patients at our center. RESULTS Twenty-seven studies from the literature and 8 patients from our local institute were identified, yielding a total of 61 patients for analysis. Overall, there were no differences in clinicopathological characteristics between the local and literature cohorts, except for absence or presence of spinal canal invasion by tumor on imagings and chicken-wire calcification in tumor tissues. Univariate Kaplan-Meier analysis revealed that previous treatment, preoperative or postoperative neurological deficits, type of tumor resection, secondary aneurysmal bone cyst (ABC), chicken-wire calcification and radiotherapy correlated closely with LRFS, though only type of tumor resection, chicken-wire calcification and radiotherapy were predictive of outcome based on multivariate Cox analysis. Analyzing OS, we found that a history of preoperative treatment, concurrent ABC, chicken-wire calcification, type of tumor resection and adjuvant radiotherapy had a significant association with survival, whereas only type of tumor resection remained statistically significant after adjusting for other covariables. CONCLUSION These data may be helpful in prognostic risk stratification and individualized therapy decision making for patients.
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Affiliation(s)
- Bo-Wen Zheng
- Health Management Center, The First Affiliated Hospital, University of South China, Hengyang, China
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wei Huang
- Health Management Center, The First Affiliated Hospital, University of South China, Hengyang, China
| | - Fu-Sheng Liu
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Tao-Lan Zhang
- Department of Radiation Oncology, Indiana University School of Medicine, IU Simon Comprehensive Cancer Center, IN, USA
| | - Xiao-Bin Wang
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jing Li
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Guo-Hua Lv
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yi-Guo Yan
- Department of Spine Surgery, The First Affiliated Hospital, University of South China, Hengyang, China
| | - Ming-Xiang Zou
- Department of Spine Surgery, The First Affiliated Hospital, University of South China, Hengyang, China
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13
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Gu H, Sun L, Cui J, Yu L, Wang J. Distal Femoral Non-Epiphyseal Cortical Chondroblastoma Confirmed with H3F3B p. Lys36Met Mutation. Fetal Pediatr Pathol 2023; 42:320-326. [PMID: 36048092 DOI: 10.1080/15513815.2022.2116618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background: Chondroblastoma is a primary bone tumor typically arising from the intramedullary space of the epiphysis or epimetaphysis. A non-epiphyseal chondroblastoma is uncommon. Case report: An 11-year-old girl presented with an eccentric cortical osteolytic lesion in the distal femur metaphysis. The typical morphology, diffuse H3.3 K36M immunohistochemical expression and H3F3B point mutation (c. 110A > T) unequivocally supported the diagnosis of chondroblastoma. Discussion: We described a non-epiphyseal cortical-based chondroblastoma involving the distal femur harboring the typical H3F3B mutation. Non-epiphyseal chondroblastoma may harbor the H3F3B mutation.
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Affiliation(s)
- Haiyan Gu
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lingling Sun
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jiufa Cui
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lan Yu
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jigang Wang
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China
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14
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Muratori F, Scanferla R, Roselli G, Frenos F, Campanacci DA. Long term outcome of surgical treatment of chondroblastoma: analysis of local control and growth plate/articular cartilage related complications. BMC Musculoskelet Disord 2023; 24:139. [PMID: 36814214 PMCID: PMC9945643 DOI: 10.1186/s12891-023-06239-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 02/10/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Chondroblastoma (CBL) is a rare benign chondroid producing bone tumor that typically occurs in epiphysis or apophysis of growing children and young adults. Intralesional curettage is the treatment of choice, while resection is required in selected cases, even though the use of minimally invasive ablation techniques has been advocated. Authors reviewed a series of 75 CBLs with the aim of assess risk factors for local recurrence, the growth plate related complications after epiphyseal curettage and the risk of arthritis of the adjacent joint after epiphyseal curettage. METHODS We retrospectively review 69 CBLs treated with intralesional curettage and 6 treated with resection from March 1995 to February 2020. The median age was 18.8 years (7 to 42, median 16). The site was proximal humerus in 18 cases, proximal tibia in 17, distal femur in 16, talus in 6, femur's head in 4, calcaneus in 3, acromion in 3, trochanteric region in 2, distal tibia in 2, patella in 2, supracetabular region in 1 and distal humerus in 1 patient. RESULTS Mean follow-up was 124.2 months (24 to 322, median 116). Among patients treated with curettage, 7.3% of local recurrence was observed and 12 (17.4%) patients developed osteoarthritis of the adjacent joint. Five patients (7.3%) presented limb length discrepancy of the operated limb ranging from 0.5 to 2 cm. Recurrence free survival rate was 94.2% at 5 and 91.6% at 10 years. A mean Musculoskeletal Tumor Society (MSTS) of 29.3 points (20 to 30, median 30) was observed. CONCLUSION More than 90% of CBLs were successfully treated with aggressive curettage but segmental resection is required in selected cases. In a relatively small proportion of cases long term complications can occur due to growth plate damage or osteoarthritis. TRIAL REGISTRATION Retrospectively registered.
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Affiliation(s)
- Francesco Muratori
- Department of Orthopaedic Oncology and Reconstructive Surgery, AOU Careggi, Florence, Italy.
| | | | | | - Filippo Frenos
- Department of Orthopaedic Oncology and Reconstructive Surgery, AOU Careggi, Florence, Italy
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15
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Slavchev SA, O'Connor PJ, Georgiev GP. Chondroblastoma Affecting the Apophysis of the Greater Trochanter in a Child. Cureus 2023; 15:e34908. [PMID: 36938209 PMCID: PMC10015304 DOI: 10.7759/cureus.34908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2023] [Indexed: 02/15/2023] Open
Abstract
Chondroblastomas are rare primary bone tumours typically affecting the epiphyses and less frequently the apophyses of the growing skeleton. Most cases are treated by intralesional curettage with or without local adjuvants and this technique can produce good long-term outcomes. Herein, we describe a case of chondroblastoma of the greater trochanter in a 12-year-old male child that was treated by intralesional curettage and grafting with calcium phosphate bone cement (Neocement Inject® P, Bioceramed, Loures, Portugal). A brief review of the literature is also presented.
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Affiliation(s)
| | - Philip J O'Connor
- Orthopaedics and Traumatology, Medical University of Sofia, Sofia, BGR
| | - Georgi P Georgiev
- Orthopaedics and Traumatology, Medical University of Sofia, Sofia, BGR
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16
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Benign Bone Lesions Found in Childhood. Orthop Clin North Am 2023; 54:59-74. [PMID: 36402511 DOI: 10.1016/j.ocl.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Benign bone tumors are a wide variety of usually asymptomatic neoplasms, which in most cases are diagnosed due to secondary causes. As such, their real incidence is unknown. In the majority of cases, plain radiographs are enough for diagnosis; more advanced imaging, such as CT scan or MRI is sometimes performed for equivocal lesions. Treatment approach depends on whether the lesion is symptomatic and the risk of further progression, or development of secondary malignancies. When non expectant management is decided, treatment options include minimally invasive methods and surgery.
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17
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Sakamoto A, Noguchi T, Matsuda S. Reconstruction using low-porosity β-tricalcium phosphate for a chondroblastoma in the proximal humeral epiphysis. J Surg Case Rep 2022; 2022:rjac526. [PMID: 36479225 PMCID: PMC9722241 DOI: 10.1093/jscr/rjac526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/27/2022] [Indexed: 12/12/2022] Open
Abstract
Chondroblastoma is a locally aggressive tumor, commonly occurring in the epiphysis of long bones. Damage after curettage at the joint surface can occur. Low porosity β-tricalcium phosphate (β-TCP) blocks are characterized by their high compression resistance. Reconstruction in which low-porosity β-TCP blocks are used as a strut have been reported for bone tumors around the knee. In the current report, a 13-year-old female with a chondroblastoma that extended to the subchondral bone of the proximal humeral epiphysis was treated with curettage and strut reconstruction using low-porosity β-TCP blocks. The implanted β-TCP blocks were incorporated without damage or shoulder dysfunction. Application of the strut reconstruction method using low-porosity β-TCP blocks is suitable for a chondroblastoma of the epiphysis in the humerus.
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Affiliation(s)
- Akio Sakamoto
- Correspondence address. Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin, Kawahara-cho 54, Sakyo-ku, Kyoto 606-8507, Japan. Tel: +81-75-751-3366; Fax: +81-75-751-8409. E-mail:
| | - Takashi Noguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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18
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Premalignant Conditions of Bone. JAAOS: GLOBAL RESEARCH AND REVIEWS 2022; 6:01979360-202210000-00004. [PMID: 36227850 PMCID: PMC9575816 DOI: 10.5435/jaaosglobal-d-22-00097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/29/2022] [Indexed: 01/10/2023]
Abstract
Development of malignancy is a multifactorial process, and there are multitude of conditions of bone that may predispose patients to malignancy. Etiologies of malignancy include benign osseous conditions, genetic predisposition, and extrinsic conditions. New-onset pain or growth in a previously stable lesion is that should concern for malignant change and should prompt a diagnostic workup for malignancy.
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19
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Katagiri H, Takahashi M, Murata H, Wasa J, Miyagi M, Honda Y. Direct femoral head approach without surgical dislocation for femoral head chondroblastoma: a report of two cases. BMC Surg 2022; 22:327. [PMID: 36038855 PMCID: PMC9422087 DOI: 10.1186/s12893-022-01766-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 08/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chondroblastomas are rare, benign, locally aggressive lesions that appear in the epiphysis. Surgery for femoral head chondroblastoma (FHCB) is difficult. Conventional treatment with curettage via a drilled tunnel along the femoral neck can damage the growth plate and is associated with high local recurrence rates. The trapdoor procedure, which directly facilitates lesion access from the femoral head articular surface, can reduce local recurrence and avoid growth plate damage, although it requires surgical dislocation. Little is known about the long-term results of this direct articular surface approach, and there are no case reports on trapdoor procedures without dislocation. CASE PRESENTATION We report two cases (patients aged 12 and 15 years) of FHCB presented with coxalgia treated using the trapdoor procedure without surgical dislocation. Both surgeries were performed with patients in the semi-lateral position. The hip joint was exposed via an anterior approach, and a capsulotomy was performed at the superior rim of the acetabulum, followed by the external rotation of the hip joint. With a fine osteotome, a rectangular flap (trapdoor) was opened on the cartilage surface in the lateral non-weight-bearing area, and curettage of the lesion followed by bone and/or bone substitute grafting was performed. Subsequently, the trapdoor was replaced in its original position. There has been no local recurrence or femoral head aseptic necrosis after more than 6 and 12 years for patients 1 and 2, respectively. Both patients had musculoskeletal tumor society scores of 100% at follow-up and are enjoying a normal active life. CONCLUSIONS This direct femoral head approach without dislocation may be a simple treatment alternative for FHCB.
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Affiliation(s)
- Hirohisa Katagiri
- Division of Orthopaedic Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka Prefecture, 411-8777, Japan.
| | - Mitsuru Takahashi
- Division of Orthopaedic Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka Prefecture, 411-8777, Japan
| | - Hideki Murata
- Division of Orthopaedic Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka Prefecture, 411-8777, Japan
| | - Junji Wasa
- Division of Orthopaedic Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka Prefecture, 411-8777, Japan
| | - Michihito Miyagi
- Division of Orthopaedic Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka Prefecture, 411-8777, Japan
| | - Yosuke Honda
- Division of Orthopaedic Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka Prefecture, 411-8777, Japan
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20
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Martin JR, Auran RL, Duran MD, de Comas AM, Jacofsky DJ. Management of Primary Aggressive Tumors of the Knee. J Knee Surg 2022; 35:585-596. [PMID: 35181876 DOI: 10.1055/s-0042-1743221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Primary bone sarcomas and aggressive benign bone tumors are relatively rare. It is essential to recognize features that are concerning for these aggressive tumors based on a patient's history, physical exam, and radiographs. Physicians and other health care providers should have a high suspicion for these tumors and promptly refer these patients to orthopaedic oncologists. A multidisciplinary, team-based approach is required to obtain an accurate diagnosis and provide comprehensive care. This review discussed the appropriate work-up, biopsy principles, relevant peri-operative medical management, and surgical treatment options for patients with aggressive primary bone tumors around the knee. Primary bone sarcomas (osteosarcoma and chondrosarcoma) and aggressive benign bone tumors (giant cell tumor, chondroblastoma, and chondromyxoid fibroma) that have a predilection to the distal femur and proximal tibia are the focus of this review.
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Affiliation(s)
- John R Martin
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Arizona
| | - Richard L Auran
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Arizona
| | - Michael D Duran
- The Center for Orthopedic Research and Eduction (CORE) Institute, Phoenix, Arizona
| | - Amalia M de Comas
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Arizona.,The Center for Orthopedic Research and Eduction (CORE) Institute, Phoenix, Arizona
| | - David J Jacofsky
- The Center for Orthopedic Research and Eduction (CORE) Institute, Phoenix, Arizona
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21
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De Salvo S, Pavone V, Coco S, Dell’Agli E, Blatti C, Testa G. Benign Bone Tumors: An Overview of What We Know Today. J Clin Med 2022; 11:699. [PMID: 35160146 PMCID: PMC8836463 DOI: 10.3390/jcm11030699] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/14/2022] [Accepted: 01/27/2022] [Indexed: 12/14/2022] Open
Abstract
Nonmalignant bone tumors represent a wide variety of different entities but maintain many common features. They usually affect young patients, and most can be diagnosed through imaging exams. Often asymptomatic, they can be discovered incidentally. Due to their similarities, these tumors may be challenging to diagnose and differentiate between each other, thus the need for a complete and clear description of their main characteristics. The aim of this review is to give a picture of the benign bone tumors that clinicians can encounter more frequently in their everyday work.
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Affiliation(s)
| | | | | | | | | | - Gianluca Testa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy; (S.D.S.); (V.P.); (S.C.); (E.D.); (C.B.)
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22
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Abo-Elsoud M, Sadek W, Salah-Eldeen M, Abosenna W. Surgical hip dislocation for treatment of femoral head chondroblastoma: efficacy and safety. INTERNATIONAL ORTHOPAEDICS 2021; 46:653-660. [PMID: 34799777 DOI: 10.1007/s00264-021-05264-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/05/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Femoral head chondroblastoma poses a surgical challenge. Anatomical limitations may lead to increased risk of local recurrence, damage to the articular cartilage, growth disturbances, and/or avascular necrosis (AVN). We are presenting our results with surgical hip dislocation approach with the aim to evaluate its efficacy in preventing recurrence and its safety, preserving a functional hip joint and avoiding complications. PATIENTS AND METHODS Ten patients were managed using surgical hip dislocation with direct access to femoral head lesions, extended curettage through a modified trapdoor approach, and cement reconstruction. These were six males and four females, with a mean age of 17 ± 2.7 years (range: 14-20) and a mean follow-up of 34 ± 12 months (range: 17-57). The lesion extended into the neck in 60% of patients with the physis being either closed in seven or closing in three patients. RESULTS We had a single case (10%) of recurrence at the trochanters for which re-curettage was done. However, all patients had their hips preserved with good function at the latest follow-up, and no serious complications recorded. The Musculoskeletal Tumor Society score improved significantly from a pre-operative median of 23.5 (range: 16-28) to a post-operative median of 29 (range: 26-30) (P = 0.005). CONCLUSION This report describes a safe reproducible approach to effectively manage these locally aggressive lesions with good short-term results. This is done while maintaining the integrity of the articular surface, growth plate, as well as preserving the femoral head blood supply.
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Affiliation(s)
- Mohamed Abo-Elsoud
- Department of Orthopaedics and Traumatology, Kasralainy School of Medicine, Cairo University, Cairo, Egypt.
| | - Wael Sadek
- Department of Orthopaedics and Traumatology, Kasralainy School of Medicine, Cairo University, Cairo, Egypt
| | - Mostafa Salah-Eldeen
- Department of Orthopaedics and Traumatology, Kasralainy School of Medicine, Cairo University, Cairo, Egypt
| | - Wesam Abosenna
- Department of Orthopaedics and Traumatology, Kasralainy School of Medicine, Cairo University, Cairo, Egypt
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23
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Boo S, Saad A, Khan Z, Davies AM, James SL, Botchu R. Tumors of the Acromion Process—A Pictorial Review. Indian J Radiol Imaging 2021; 31:850-857. [PMID: 35136496 PMCID: PMC8817813 DOI: 10.1055/s-0041-1735916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction
Acromion is essential for stabilizing the shoulder complex. Tumors of the acromion are rare. We report the largest series of acromion tumor and tumor-like lesion.
Materials and Methods
A retrospective review of the oncology and radiology database within our tertiary center for orthopaedic oncology was performed to identify all tumors of the acromion over the past 30 years and imaging was reviewed.
Results
We identified a total of 31 lesions arising in the acromion and chondrosarcoma was the commonest.
Conclusion
One needs to be aware of tumor and tumor-like lesions of acromion.
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Affiliation(s)
- S.L. Boo
- Department of Musculoskeletal Radiology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - A. Saad
- Department of Orthopedic Oncology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Z. Khan
- Department of Orthopedic Oncology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - A. M. Davies
- Department of Musculoskeletal Radiology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - S. L. James
- Department of Musculoskeletal Radiology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - R. Botchu
- Department of Musculoskeletal Radiology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom
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Huang C, Lü XM, Fu G, Yang Z. Chondroblastoma in the Children Treated with Intralesional Curettage and Bone Grafting: Outcomes and Risk Factors for Local Recurrence. Orthop Surg 2021; 13:2102-2110. [PMID: 34599644 PMCID: PMC8528993 DOI: 10.1111/os.13153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To review the outcomes of surgical management in the pediatric patients with extremity chondroblastoma. Especially the risk factors of recurrence and growth disorder. And discuss a potential method to decrease the rate of growth disorder by preventing the premature physeal closure. METHODS Fifteen girls and twenty-seven boys aged from two to 14 years (mean, 11 years) with histologically proven chondroblastoma, who presented from January 2011 to June 2018 at our Hospital, were retrospectively reviewed. Clinical data, radiographic images, histological findings, treatment, functional outcomes, and local recurrence rate were analyzed. Surgical treatment included complete curettage of the tumor and the walls of the lesion followed by bone grafting, No adjuvant methods were used. Recurrence was defined as a return of symptoms and an expansion radiolucency at the operated site. It was confirmed by the histopathological analysis. When recurrence was diagnosed, the medical data were analyzed to detect the effect of different factors on local recurrence. Functional outcome was measured according to Sailhan's functional criteria, designed to provide a standardized method of assessing pediatric chondroblastoma patient postoperatively. RESULTS The proximal part of the femur was the most frequently involved site. All the patients had at least 24 months of follow-up; mean duration was 30 months (range, 24-60 months). The local recurrence rate was 9.5%. Three resolved after repeat surgeries without further recurrence, one had a second recurrence and received another more aggressive curettage. Local recurrence of chondroblastoma was associated with age (P < 0.05), while not associated with sex, tumor location, the radiological character of the lesion or the grafting method (P > 0.05). No pulmonary metastasis was noted at latest follow-up. Five patients suffered from premature closure of physis due to physis injury. Thirty-one patients (73.8%) had a good outcome, and all returned to normal unrestricted activities. Six patients (14.3%) had a fair outcome due to occasional pain, asymmetric range of motion, or radiographic joint changes without arthritis. And five patients (11.9%) had a poor outcome because of chronic pain, loss of joint motion impairing normal life activities, or a limb-length discrepancy and limp. CONCLUSIONS Aggressive curettage and bone grafting resulted in local control and good outcomes in most pediatric patients. Being less than 12 years of age was the risk factor for recurrence. For those growing patients, premature physeal closure was observed after the curettage, interpositional technique with PMMA would be a good choice for prevention.
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Affiliation(s)
- Cong Huang
- Department of Pediatric Orthopaedics, Beijing Jishuitan Hospital, Peking University, Beijing, China
| | - Xue-Min Lü
- Department of Pediatric Orthopaedics, Beijing Jishuitan Hospital, Peking University, Beijing, China
| | - Gang Fu
- Department of Pediatric Orthopaedics, Beijing Jishuitan Hospital, Peking University, Beijing, China
| | - Zheng Yang
- Department of Pediatric Orthopaedics, Beijing Jishuitan Hospital, Peking University, Beijing, China
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Zheng BW, Niu HQ, Wang XB, Li J. Sacral chondroblastoma — a rare location, a rare pathology: A case report and review of literature. World J Clin Cases 2021; 9:5709-5716. [PMID: 34307629 PMCID: PMC8281409 DOI: 10.12998/wjcc.v9.i20.5709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/28/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chondroblastoma (CB) is an intermediate tumor of cartilage origin. CB involving the sacrum is a very rare pathology.
CASE SUMMARY A 17-year-old male with sacral CB was diagnosed as CB during the first surgery, and 18 mo later, the tumor recurred and a second surgery was performed with the same pathology result of CB.
CONCLUSION We recommend complete removal of the tumor in a timely manner, provided that surgical conditions are met. At the same time, other diseases should be carefully differentiated in terms of imaging or pathological features so as to avoid erroneous diagnostic conclusions.
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Affiliation(s)
- Bo-Wen Zheng
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - Hua-Qing Niu
- Department of Orthopedics Surgery, General Hospital of the Central Theater Command, Wuhan 430061, Hubei Province, China
| | - Xiao-Bin Wang
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - Jing Li
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
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26
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Letter to the Editor Regarding "Temporal Bone Chondroblastoma: Systematic Review of Clinical Features and Outcomes". World Neurosurg 2021; 148:235. [PMID: 33770842 DOI: 10.1016/j.wneu.2020.12.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 01/16/2023]
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27
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Shi J, Zhao Z, Yan T, Guo W, Yang R, Tang X, Qu H, Dong S. Surgical treatment of benign osteolytic lesions in the femoral head and neck: a systematic review. BMC Musculoskelet Disord 2021; 22:549. [PMID: 34134687 PMCID: PMC8210383 DOI: 10.1186/s12891-021-04442-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/02/2021] [Indexed: 12/29/2022] Open
Abstract
Background and objectives Treatment of benign osteolytic lesions in the femoral head and neck can be extremely challenging, particularly in children with open physis or for aggressive tumors with pathological fracture. There remains the difficult management decision as to whether to perform complete excision of the involved area or only curettage. Moreover, there is no agreed consensus on the optimal approach to lesion access when performing curettage, which included the transcervical, open and direct approach. The current systematic review aims to provide guidance for selection of surgical methods in clinical practice by comparing the advantages and drawbacks of different procedures. Methods A comprehensive literature search of PubMed, Embase and Web of Science databases were executed for human studies restricted to the English language. The search was filtered to include studies published from January 1980 to January 2020. Results A total of 33 articles including 274 patients were enrolled in the final analysis. The most common diagnosis was chondroblastoma (CBT) (104, 38.0%), followed by giant cell tumor (GCT) (56, 20.4%). There were 57 (20.8%) patients with pathological fracture. Intralesional curettage was performed in 257 (93.8%) patients with the local recurrence of 12.5% at the mean follow-up of 51.5 months. The patients who were presented with open physis or curetted via transcervical approach developed higher local recurrence in patients with CBT (P < 0.001). The local recurrence rate of GCT is 33.3% after curettage, while 8 of 9 (88.9%) patients with fracture were treated successfully with joint preservation. Two of 45 (4.4%) patients developed avascular necrosis (AVN) of femoral head after surgical hip dislocation. The reported Musculoskeletal Tumor Society (MSTS) Score was comparable among patients with different approaches to curettage. Conclusion The majority of benign osteolytic lesions in the femoral head and neck can be treated with intralesional curettage with acceptable local tumor control and satisfactory function. The incidence of local recurrence might be decreased dramatically for lesion access under direct visualization. The native joint maintenance could be achieved even in patients with aggressive lesions presenting pathological fracture. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04442-y.
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Affiliation(s)
- Jingtian Shi
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China
| | - Zhiqing Zhao
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China
| | - Taiqiang Yan
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China.
| | - Wei Guo
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China
| | - Rongli Yang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China
| | - Xiaodong Tang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China
| | - Huayi Qu
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China
| | - Sen Dong
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China
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Zheng BW, Zheng BY, Niu HQ, Wang XB, Li J. Letter to the Editor concerning the article "Clinical outcomes of chondroblastoma treated using synthetic bone substitute: risk factors for developing radiographic joint degeneration". World J Surg Oncol 2021; 19:171. [PMID: 34118947 PMCID: PMC8199794 DOI: 10.1186/s12957-021-02235-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/06/2021] [Indexed: 11/29/2022] Open
Abstract
The purpose of this letter to the Editor is to report some shortcomings in the statistical analysis and variable grouping in the recent publication of the article “Clinical outcomes of chondroblastoma treated using synthetic bone substitute: risk factors for developing radiographic joint degeneration,” and to further explore some of the factors that may affect the clinical prognosis of chondroblastoma patients. We also suggest future prospective controlled studies with large samples to improve the limitations encountered by Outani et al. (World J Surg Oncol. 18(1):47, 2020) due to insufficient statistical power of variables and lack of controls.
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Affiliation(s)
- Bo-Wen Zheng
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, 139 Renminzhong Road, Changsha, 410011, Hunan, China
| | - Bo-Yv Zheng
- Department of Orthopedics Surgery, General Hospital of the Central Theater Command, Wuhan, 430061, China
| | - Hua-Qing Niu
- Department of Orthopedics Surgery, General Hospital of the Central Theater Command, Wuhan, 430061, China
| | - Xiao-Bin Wang
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, 139 Renminzhong Road, Changsha, 410011, Hunan, China
| | - Jing Li
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, 139 Renminzhong Road, Changsha, 410011, Hunan, China.
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Zheng BW, Yang ML, Huang W, Zheng BY, Zhang TL, Li J, Lv GH, Yan YG, Zou MX. Prognostic Significance of Tumor-Associated Macrophages in Chondroblastoma and Their Association with Response to Adjuvant Radiotherapy. J Inflamm Res 2021; 14:1991-2005. [PMID: 34040412 PMCID: PMC8139723 DOI: 10.2147/jir.s308707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 04/22/2021] [Indexed: 12/23/2022] Open
Abstract
Objective Chondroblastoma (CB) is a rare and locally growing cartilage-derived tumor. Currently, clinical implications of tumor-associated macrophages (TAMs) in CB remain unclear. In this study, we sought to analyze the relationship between TAM parameters (including densities of CD68+ and CD163+ cells as well as the CD163+/CD68+ ratio) and clinicopathological characteristics and survival of patients. Methods Immunohistochemistry was used to assess TAM subtypes for CD68 and CD163, as well as the expression levels of p53, CD34, and Ki-67 on tumor cells in 132 tissue specimens retrieved between July 2002 and April 2020. Then, TAM parameters were retrospectively analyzed for their associations with patient outcomes (local recurrence-free survival [LRFS] and overall survival [OS]) and clinicopathological features. Results TAM densities were significantly higher in axial chondroblastoma tissue than in extra-axial chondroblastoma tissue. Moreover, the number of CD163+ TAMs was positively correlated with tumor invasion of surrounding tissues and high expression of CD34 and Ki-67 on tumor cells, whereas CD163+ cell density and the CD163/CD68 ratio were negatively associated with patient response to adjuvant radiotherapy. Univariate Kaplan-Meier analysis revealed that the number of CD68+ and CD163+ lymphocytes was significantly associated with both LRFS and OS. Multivariate Cox regression analysis showed that CD163+ and CD68+ cell levels were independent prognostic factors of LRFS, while TAM data independently predicted OS. More importantly, in subgroup analysis based on three significant factors in univariate survival analysis (including tumor location, adjuvant radiotherapy, and surrounding tissue invasion by tumors), the TAM parameters still displayed good prognostic performance. Conclusion These data suggest that TAM may significantly affect the biological behavior of CB. We hypothesize that modulating the TAM level or polarization status in the microenvironment may be an effective approach for CB treatment.
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Affiliation(s)
- Bo-Wen Zheng
- Department of Spine Surgery, The First Affiliated Hospital, University of South China, Hengyang, 421001, People's Republic of China.,Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, People's Republic of China
| | - Min-Liang Yang
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, People's Republic of China
| | - Wei Huang
- Health and Management Centre, The First Affiliated Hospital, University of South China, Hengyang, 421001, People's Republic of China
| | - Bo-Yv Zheng
- Department of Orthopedics Surgery, General Hospital of the Central Theater Command, Wuhan, 430061, People's Republic of China
| | - Tao-Lan Zhang
- Department of Radiation Oncology, Indiana University School of Medicine, IU Simon Comprehensive Cancer Center, Indianapolis, IN, 46202, USA
| | - Jing Li
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, People's Republic of China
| | - Guo-Hua Lv
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, People's Republic of China
| | - Yi-Guo Yan
- Department of Spine Surgery, The First Affiliated Hospital, University of South China, Hengyang, 421001, People's Republic of China
| | - Ming-Xiang Zou
- Department of Spine Surgery, The First Affiliated Hospital, University of South China, Hengyang, 421001, People's Republic of China
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Chen J, Jie K, Feng W, Zeng H, Cao H, Deng P, Wu K, Ye P, Li J, Qi X, Zeng J, Zeng Y. Total Calcanectomy and Bilateral Iliac Bone Autograft Reconstruction for the Treatment of Calcaneal Chondroblastoma Involving a Secondary Aneurysmal Bone Cyst: A Case Report and Literature Review. J Foot Ankle Surg 2021; 59:616-624. [PMID: 32354519 DOI: 10.1053/j.jfas.2019.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/24/2019] [Accepted: 10/01/2019] [Indexed: 02/03/2023]
Abstract
Chondroblastoma is a rare, benign, cartilaginous-derived tumor accounting for ∼1% to 2% of all primary bone tumors and almost 9% of all benign bone tumors. In this case report, we describe a patient with chondroblastoma and a secondary aneurysmal bone cyst, with the adjacent talus being mildly affected. The initial diagnosis was giant cell tumor and was then confirmed after computed tomography-assisted biopsy. We performed a total calcanectomy via bilateral structural iliac bone autografting to relieve pain and reconstruct the loadbearing function because of the presence of extensive lesions. The patient was pain free and expressed satisfaction with postsurgical dorsiflexion and plantarflexion function at the 60-month follow-up visit. Radiographic images showed that the autografted iliac bone was completely healed, with no evidence of local recurrence.
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Affiliation(s)
- Jinlun Chen
- Surgeon, Department of Orthopaedic Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ke Jie
- Resident, First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wenjun Feng
- Surgeon, Department of Orthopaedic Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Huiliang Zeng
- Surgeon, Department of Orthopaedic Surgery, Foshan Hospital of Traditional Chinese Medicine, Foshan, China
| | - Houran Cao
- Resident, First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Peng Deng
- Surgeon, First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Keliang Wu
- Resident, First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Pengcheng Ye
- Surgeon, Department of Orthopaedic Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jie Li
- Surgeon, Department of Orthopaedic Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xinyu Qi
- Resident, First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jianchun Zeng
- Surgeon, Department of Orthopaedic Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yirong Zeng
- Surgeon and Professor, Department of Orthopaedic Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
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Williams AK, Crawford B, Federman NC, Bernthal N, Arkader A. What's New in Pediatric Orthopaedic Tumor Surgery. J Pediatr Orthop 2021; 41:e174-e180. [PMID: 33027233 DOI: 10.1097/bpo.0000000000001689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pediatric Orthopaedic Oncology is a developing subspecialty within the field of Pediatric Orthopaedics. Traditionally, the field of Orthopaedic Oncology has been focused on the skeletally mature individual, and the research tends to be all encompassing rather than truly evaluating isolated populations. The purpose of this review is to summarize the most clinically relevant literature in the field of Pediatric Orthopaedic Oncology over the last 6 years. METHODS We evaluated the PubMed database utilizing keywords for pediatric orthopaedic oncology: sarcoma, osteosarcoma, Ewing sarcoma, bone cyst. In additionally, we further broadened our search by searching for relevant articles in the contents sections of major orthopaedic surgery journals that routinely publish both pediatric and orthopaedic oncology literature. In keeping with "What's New," we selected the most clinically relevant articles published in the last 6 years from January 1, 2014 through February 2020. Basic science and systemic therapies literature was widely reviewed and the research and clinical trials most relevant to pediatric sarcoma and neoplastic processes found in the pediatric population were included. RESULTS Our search yielded 60 articles that met general criteria, from which 14 were determined to be most relevant to the goals of this paper. Of the papers presented in this review, there were papers related to management of benign tumors/tumor-like conditions, bone cysts, limb salvage procedures, and amputation procedures. Ultimately included in the review were 5 studies related to limb salvage, 4 related to bone cysts, 1 related to multiple hereditary exostoses, 2 related to osteofibrous dysplasia, 1 related to chondroblastoma, and 1 discussing cementation in skeletally immature patients. They were level III, IV, and V studies. Basic science and systemic therapies literature was widely reviewed and the research and clinical trials most relevant to pediatric sarcoma and neoplastic processes found in the pediatric population were included. Our search of the basic science and systemic therapies literature yielded 19 sources were found to be pertinent to our aims and 18 of those sources were published between 2015 and 2020. CONCLUSIONS There are many, varied, and creative procedures in the realm of limb salvage, though there remains a lack of high-level evidence to support some of the more novel procedures. In regards to benign bone tumors, despite a more solid base of literature, there still does not seem to be consensus as to the best treatment. In particular, there continue to be many schools of thought on the treatment of benign bone cysts. Research in the basic science arena and systemic therapies are advancing in exciting ways in regards to pediatric sarcoma. Orthopaedic oncologic research specific to the pediatric population overall continues to be impeded by low sample sizes and inadequate levels of evidence, which limits the ability of surgeons to draw definitive conclusions from the literature.
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Affiliation(s)
- Amy K Williams
- Department of Orthopaedic Surgery, Miller Children's Hospital, Long Beach
| | | | - Noah C Federman
- Pediatric Hematology and Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | - Alexandre Arkader
- Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadephia, PA
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Yang ML, Niu HQ, Zheng BY, Wang XB, Li J, Zheng BW. Letter to Editor Regarding "Clinicopathologic Analysis of Chondroblastoma in Adults: A Single-Institution Case Series" by Negri et al. Int J Surg Pathol 2021; 29:228-229. [PMID: 33435772 DOI: 10.1177/1066896920985284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Min-Liang Yang
- 70566The Second Xiangya Hospital, Central South University, Changsha, China
| | - Hua-Qing Niu
- General Hospital of the Central Theater Command, Wuhan, China
| | - Bo-Yv Zheng
- 4334The University of Sydney, Sydney, New South Wales, Australia
| | - Xiao-Bin Wang
- 70566The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jing Li
- 70566The Second Xiangya Hospital, Central South University, Changsha, China
| | - Bo-Wen Zheng
- 70566The Second Xiangya Hospital, Central South University, Changsha, China
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Deventer N, Deventer N, Gosheger G, de Vaal M, Budny T, Laufer A, Heitkoetter B, Luebben T. Chondroblastoma: Is intralesional curettage with the use of adjuvants a sufficient way of therapy? J Bone Oncol 2020; 26:100342. [PMID: 33364155 PMCID: PMC7750402 DOI: 10.1016/j.jbo.2020.100342] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/12/2020] [Accepted: 11/21/2020] [Indexed: 12/27/2022] Open
Abstract
Chondroblastoma represents a rare pathology. An aggressive intralesional curettage leads to low recurrence rates. Hydrogen peroxide as adjuvant lowers the risk of local recurrence. Background Chondroblastoma is a rare benign cartilaginous bone tumor that represents 1–2% of all primary bone tumors. It is characterized by aggressive growth, possible recurrence after surgical treatment and, in rare cases, metastasis. Surgical management is the primary treatment and includes intralesional curettage with or without adjuvants. Local recurrence rates vary between less than 10% up to more than 30%. Methods In this retrospective study between 2009 and 2020 we analysed 38 cases of chondroblastoma with a mean follow-up of 27.9 months who underwent a surgical treatment in our institution. Epidemiological data, radiographic and histological examinations, different surgical techniques, complications and local recurrence were evaluated to comment on the question if curettage with or without adjuvants is a sufficient way of therapy. Results The study includes 25 male (65.8%) and 13 female (34.2%) patients with a mean age of 17.2 (11–51) years. The most common location of manifestation was the proximal epiphyseal humerus (34.2%), followed by the proximal tibia (26.3%) and the distal femur (15.8%). Joint involvement occurred in 28 patients (73.7%). In all cases intralesional curettage was performed; in 25 cases (65.8%) the resulting cavity was filled with bone substitute, in 7.9% (3 cases) with bone cement and in 10.5% (4 cases) with autogenous bone graft. Adjuvant hydrogen peroxide was used in 64.9% of the cases. The overall recurrence rate was 39.5% (15 cases). The following subgroup analysis showed a recurrence rate of 100% (4/4 cases) after curettage and defect reconstruction with autogenous bone. In the case of intralesional curettage and filling of the cavity with bone substitute but without use of adjuvant the recurrence rate was 50% (4/8 cases). A low recurrence rate of 11.8% (2 cases) was observed in the case of intralesional curettage, using hydrogen peroxide as adjuvant (17 cases) and bone substitute for defect reconstruction. Conclusions Chondroblastoma represents a rare pathology. Therapeutically an aggressive intralesional curettage with use of hydrogen peroxide as adjuvant and filling up the defect with bone substitute leads to low recurrence rates.
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Affiliation(s)
- Niklas Deventer
- Department of Orthopedics and Tumororthopedics, University Hospital Munster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Nils Deventer
- Department of Orthopedics and Tumororthopedics, University Hospital Munster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Georg Gosheger
- Department of Orthopedics and Tumororthopedics, University Hospital Munster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Marieke de Vaal
- Department of Orthopedics and Tumororthopedics, University Hospital Munster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Tymoteusz Budny
- Department of Orthopedics and Tumororthopedics, University Hospital Munster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Andrea Laufer
- Department of Orthopedics and Tumororthopedics, University Hospital Munster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Birthe Heitkoetter
- Gerhard-Domagk-Institute of Pathology, University Hospital Munster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Timo Luebben
- Department of Orthopedics and Tumororthopedics, University Hospital Munster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
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Papke DJ, Hung YP, Schaefer IM, Bredella MA, Charville GW, Reith JD, Fletcher CDM, Nielsen GP, Hornick JL. Clinicopathologic characterization of malignant chondroblastoma: a neoplasm with locally aggressive behavior and metastatic potential that closely mimics chondroblastoma-like osteosarcoma. Mod Pathol 2020; 33:2295-2306. [PMID: 32601382 PMCID: PMC8007083 DOI: 10.1038/s41379-020-0604-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/11/2020] [Accepted: 06/11/2020] [Indexed: 12/17/2022]
Abstract
Chondroblastoma is currently classified as a benign neoplasm; however, chondroblastoma and chondroblastoma-like osteosarcoma have morphologic overlap, raising the possibility that some tumors diagnosed as chondroblastoma-like osteosarcoma might actually represent malignant chondroblastoma. The H3F3B K36M point mutation, which has not been reported in osteosarcoma, is identified in 95% of chondroblastomas and is reliably detectable by immunohistochemistry (IHC). We reviewed 11 tumors diagnosed as atypical chondroblastoma, malignant chondroblastoma, or chondroblastoma-like osteosarcoma (median follow-up: 8.8 years; range: 4 months-26.4 years). Seven chondroblastomas with cytologic atypia and permeative growth were designated "malignant chondroblastoma"; six were H3K36M-positive by IHC. Relative to conventional chondroblastoma, malignant chondroblastoma occurred in older individuals (median: 52 years; range: 29-57 years) and arose at unusual sites. Three of four tumors with long-term follow-up recurred, and one patient died of widespread metastases. One was found to have chromosomal copy number alter4ations and a SETD2 mutation in addition to H3F3B K36M. The four remaining tumors were classified as chondroblastoma-like osteosarcoma. Chondroblastoma-like osteosarcoma occurred in younger patients (median: 21 years; range: 19-40 years) than malignant chondroblastoma. In contrast to malignant chondroblastoma, all had regions of malignant cells forming bone. Two of three patients with long-term follow-up developed recurrences, and two died of disease, one with widespread metastases. No mutations in H3F3A/H3F3B were detected by Sanger sequencing. While malignant chondroblastoma and chondroblastoma-like osteosarcoma show significant morphologic overlap, they have distinct clinical presentations and genetic findings. When considering this challenging differential diagnosis, IHC using histone H3 mutation-specific antibodies is a critical diagnostic adjunct.
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Affiliation(s)
- David J. Papke
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Yin P. Hung
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Inga-Marie Schaefer
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Miriam A. Bredella
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Gregory W. Charville
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - John D. Reith
- Department of Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - G. Petur Nielsen
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jason L. Hornick
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
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Popovic A, Naous R, Damron TA. LCH of the Scapula in a 2-Year-Old Masquerading as an ABC: A Case Report and Literature Review. Open Orthop J 2020. [DOI: 10.2174/1874325002014010130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
We describe a unique case of Langerhans Cell Histiocytosis (LCH) arising in the scapula of a 2-year old male child masquerading as an aneurysmal bone cyst (ABC) at clinical presentation and on imaging. Scapular involvement is only occasionally noted in LCH cases. Solitary bone involvement in our patient’s age group is uncommon in LCH without multi-organ involvement. Careful pathologic examination and immunohistochemistry was crucial in establishing this diagnosis due to the presence of a solitary lesion with fluid-fluid levels.
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Abstract
PURPOSE Chondroblastoma is a benign, but potentially locally aggressive, bone tumor with predilection for the epiphysis of long bones in growing children. Historically, there is a reported 2% risk of lung metastasis, however these cases are mostly in the form of isolated single reports and the vast majority in adults. The purpose of this study was to identify the "true" risk of lung metastases at presentation in skeletally immature patients with a benign chondroblastoma, and therefore revisit the need for routine chest staging. METHODS This was a multi-institution, international retrospective study of children and adolescents diagnosed and treated for a benign chondroblastoma. We focused on the screening and diagnosis of lung metastasis, type of staging utilized and the incidence of local recurrence. Detailed review of the available literature was also performed for comparison. RESULTS The final studied cohort included 130 children with an average age of 14.5 years (range: 6 to 18 y). There were 94 boys and 36 girls. Lesions more often involved the proximal humerus (32/130), proximal tibia (30/130), and proximal femur (28/130). At an average follow-up of 50 months, there were 15 local recurrences (11% rate) and no cases of lung metastasis. All patients underwent chest imaging at presentation. The overall reported lung metastases rate in the pulled literature review (larger series only) was 0.4% (7/1625), all patients were skeletally mature. CONCLUSIONS This is the largest cohort of pediatric-exclusive chondroblastoma in the literature. Despite minor differences in management between the centers included, the recurrence rate was similar and there was no evidence of lung metastasis (0 in 130). The incidence of distant involvement in a true benign chondroblastoma in children is much lower than the 2% previously reported in the literature, and the need for routine chest staging should be revisited. LEVEL OF EVIDENCE Level III.
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Bram JT, Mahmoud MAH, Arkader A. Chondroblastoma of the Navicular Bone: A Report of 2 Pediatric Cases. JBJS Case Connect 2020; 10:e1900480. [PMID: 32910575 DOI: 10.2106/jbjs.cc.19.00480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE Two patients presenting to the clinic with midfoot pain were found to have pathologic fractures through chondroblastomas of the navicular bone. Patient 1 was a 15-year-old boy who experienced multiple recurrences despite more aggressive interventions. Patient 2 was a 13-year-old boy who experienced full recovery after lesion resection. CONCLUSION Navicular chondroblastoma is a rare site of presentation, with only 3 documented cases. Given the potential aggressive nature of these lesions with significant cortical destruction and soft-tissue extension, the navicular represents a difficult anatomic location to manage.
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Affiliation(s)
- Joshua T Bram
- 1Division of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Zekry KM, Yamamoto N, Hayashi K, Takeuchi A, Araki Y, Alkhooly AZA, Abd-Elfattah AS, Fouly EH, Elsaid ANS, Tsuchiya H. Surgical treatment of chondroblastoma using extended intralesional curettage with phenol as a local adjuvant. J Orthop Surg (Hong Kong) 2020; 27:2309499019861031. [PMID: 31315494 DOI: 10.1177/2309499019861031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The aim of this study is to report the clinical and radiological outcomes following surgical treatment of chondroblastoma by means of an extended intralesional curettage using high-speed burr, with phenol as a local adjuvant which is followed by the implantation of synthetic bone graft, aiming to lower the recurrence rate of this tumor. PATIENTS AND METHODS This retrospective study included 20 patients with chondroblastoma lesions during the period between 2000 and 2015. RESULTS Fifteen males and five females were followed up for a mean of 63.35 (26-144) months with average age at the time of presentation was 20.8 (range: 12-32) years. Nineteen patients (95%) were complaining of pain at the time of presentation, and the lesion was discovered accidently in one patient. The mean operative time was 138.5 min (75-250). At the most recent follow-up, all patients had regained full physical function without pain at the operation site. CONCLUSION The aggressive treatment of chondroblastoma by an extended intralesional curettage using high-speed burr with phenol as a local adjuvant seems effective in lowering the incidence of local recurrence and secondary more aggressive surgeries. Implantation of the bone defects that result from curettage with the synthetic bone substitutes is a good alternative due to rapid restoration of the mechanical strength with good remodeling.
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Affiliation(s)
- Karem M Zekry
- 1 Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan.,2 Department of Orthopaedic Surgery, Faculty of Medicine, Minia University, Minya, Egypt
| | - Norio Yamamoto
- 1 Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Katsuhiro Hayashi
- 1 Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Akihiko Takeuchi
- 1 Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Yoshihiro Araki
- 1 Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Ali Zein Aa Alkhooly
- 2 Department of Orthopaedic Surgery, Faculty of Medicine, Minia University, Minya, Egypt
| | | | - Ezzat H Fouly
- 2 Department of Orthopaedic Surgery, Faculty of Medicine, Minia University, Minya, Egypt
| | | | - Hiroyuki Tsuchiya
- 1 Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
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Maru T, Imanishi J, Torigoe T, Saita K, Kadono Y, Yazawa Y. Navigation-assisted surgery for chondroblastoma arising in the femoral head: A case report. Int J Surg Case Rep 2020; 70:8-12. [PMID: 32334178 PMCID: PMC7183096 DOI: 10.1016/j.ijscr.2020.03.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 03/28/2020] [Indexed: 01/17/2023] Open
Abstract
We reported the first case to use navigation for the femoral head chondroblastoma. Visualization of tumor on navigation helps to minimize unnecessary destruction. Navigation assistance is an optimal surgical option for chondroblastoma in the femoral head. Introduction Surgery for chondroblastoma in the femoral head is challenging due to its inaccessibility, with high risk of local recurrence and poor functional outcomes reported. We herein report the first case of chondroblastoma in the femoral head treated by navigation-assisted surgery. Presentation of case A 12-year-old girl presented with persistent left hip pain and limited hip range of motion. Imaging studies revealed a well-defined osteolytic lesion in the left femoral head accompanied by extensive intra-osseous oedematous change. The bone lesion was radiologically diagnosed as chondroblastoma. With navigation assistance, curettage was performed via the anterior approach. The tumor was fully accessible from the femoral neck. After curettage, the bony defect was filled with bone substitute. The pathological diagnosis was chondroblastoma. The post-operative course was uneventful. Thirty months postoperatively, the patient was free of pain with full hip range of motion, and MR images showed no evidence of recurrence or osteonecrosis. Discussion This case is the first to use a navigation system for the treatment of chondroblastoma in the femoral head. The navigation system can minimize damage to intact structures and increase the efficiency of curettage by visualizing access to the tumor. Conclusion Navigation assistance is an optimal surgical option for chondroblastoma in the femoral head.
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Affiliation(s)
- Takanori Maru
- Department of Orthopaedic Oncology and Surgery, Saitama Medical University International Medical Center, Japan; Department of Orthopaedic Surgery, Saitama Medical Center, Saitama Medical University, Japan
| | - Jungo Imanishi
- Department of Orthopaedic Oncology and Surgery, Saitama Medical University International Medical Center, Japan; Department of Orthopaedic Surgery, Saitama Medical University Hospital, Japan.
| | - Tomoaki Torigoe
- Department of Orthopaedic Oncology and Surgery, Saitama Medical University International Medical Center, Japan
| | - Kazuo Saita
- Department of Orthopaedic Surgery, Saitama Medical Center, Saitama Medical University, Japan
| | - Yuho Kadono
- Department of Orthopaedic Surgery, Saitama Medical University Hospital, Japan
| | - Yasuo Yazawa
- Department of Orthopaedic Oncology and Surgery, Saitama Medical University International Medical Center, Japan
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Outani H, Kakunaga S, Hamada K, Takenaka S, Nakai S, Yasuda N, Imura Y, Naka N, Araki N, Ueda T, Yoshikawa H. Clinical outcomes of chondroblastoma treated using synthetic bone substitute: risk factors for developing radiographic joint degeneration. World J Surg Oncol 2020; 18:47. [PMID: 32122388 PMCID: PMC7053063 DOI: 10.1186/s12957-020-01829-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 02/27/2020] [Indexed: 12/19/2022] Open
Abstract
Background Chondroblastoma (CB) is a rare locally aggressive bone tumor that commonly occurs in the epiphysis or apophysis of long bones. Although surgical treatment of CB carries potential risk for physeal or articular cartilage damage, risk factors for joint degeneration have not been well described. In addition, we have mainly used synthetic bone substitute (SBS) to fill the bone defect after intralesional curettage as treatment for CB. This study thus aimed to evaluate the incidence of and risk factors for adjacent-joint radiographic degeneration after SBS treatment for CB. Methods We retrospectively reviewed 48 patients treated for CB at our institutions between 1996 and 2017. Clinical data, radiographic images, treatments, and local recurrence were analyzed. Results We identified 40 patients [29 males and 11 females with a mean age of 19 years (range, 8–35 years)] who received SBS to fill the defect after curettage with a minimum follow-up of 1 year. The mean follow-up period was 71 months (range, 13–239 months). A total of 8 patients (20%) developed local recurrence. Radiographic analysis showed that 5 patients (16.7%) developed radiographic joint degeneration. Joint degeneration was significantly associated with the affected joint (p = 0.004). Conclusions Curettage and SBS filling had been found to be a reasonable treatment method for CB, which commonly occurs in the epiphysis or apophysis. Radiographic joint degeneration was not uncommon after CB treatment, especially in the talus and proximal humerus.
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Affiliation(s)
- Hidetatsu Outani
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Shigeki Kakunaga
- Department of Orthopaedic Surgery, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka, 540-0006, Japan
| | - Kenichiro Hamada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Satoshi Takenaka
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Sho Nakai
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Naohiro Yasuda
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yoshinori Imura
- Musculoskeletal Oncology Service, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Norifumi Naka
- Musculoskeletal Oncology Service, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Nobuhito Araki
- Department of Orthopaedic Surgery, Ashiya Municipal Hospital, 39-1 Asahigaoka-cho, Ashiya, Hyogo, 659-8502, Japan
| | - Takafumi Ueda
- Department of Orthopaedic Surgery, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka, 540-0006, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
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Karkhur Y, Tiwari A, Verma T, Maini L. Unusual presentation of chondroblastoma mimicking Trevor's disease. J Postgrad Med 2019; 63:197-199. [PMID: 28272066 PMCID: PMC5525486 DOI: 10.4103/0022-3859.201414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Chondroblastoma is a benign bone tumor, represents 1%–2% of all primary bone tumors, typically seen in patients 10–25-year-old and more common in males. It occurs most frequently in the distal femur, proximal tibia, and proximal humerus. Soft tissue extension is extremely rare. Adjacent joints may develop effusions, but the tumor mass protruding into the joint has never been seen in case of chondroblastoma. We report a rare case of intra-articular chondroblastoma arising from proximal tibia in a 16-year-old boy and growing into the knee joint mimicking an intra-articular osteochondroma.
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Affiliation(s)
- Y Karkhur
- Department of Orthopaedics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - A Tiwari
- Department of Orthopaedics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - T Verma
- Department of Orthopaedics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - L Maini
- Department of Orthopaedics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
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Liu Q, He H, Yuan Y, Zeng H, Long F, Tian J, Luo W. Have the difficulties and complications of surgical treatment for chondroblastoma of the adjoining knee joint been overestimated? J Bone Oncol 2019; 17:100240. [PMID: 31193486 PMCID: PMC6535629 DOI: 10.1016/j.jbo.2019.100240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/08/2019] [Accepted: 05/08/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Chondroblastoma is difficult to treat as the tumor is surrounded by both articular cartilage and the epiphyseal plate. The differences in joint shape further complicate the problem. This retrospective study evaluates the efficacy of intraregional aggressive curettage and allogeneic bone grafting for treating chondroblastoma of the adjoining knee joint. METHODS From February 2010 to February 2017, 36 patients with chondroblastoma of the adjoining knee joint were identified. All patients were treated with intraregional aggressive curettage, phenolization, and allogeneic bone grafting. Follow-up for lesion healing, local recurrence, functional outcomes and secondary osteoarthritis were assessed both clinically and radiologically. RESULTS Thirty-six patients (mean age 17 years) were enrolled with a mean follow-up of 51.8 months (18-98 months). The tumor locations were as follows: distal femur (14), proximal tibia (20), and patella (2). Only 1 patient relapsed, 10 months post-operation. All patients had good bone healing. No knee varus or valgus deformity developed. The mean Musculoskeletal Tumor Society functional score was 28.6 ± 1.1 post-operation. At the last follow-up, secondary osteoarthritis was found in 1 patient, the patient was asymptomatic. CONCLUSIONS Intraregional aggressive curettage, phenolization, and allogeneic bone grafting are effective for treatment of chondroblastoma of the adjoining knee joint.
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Affiliation(s)
- Qing Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Hongbo He
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Yuhao Yuan
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Hao Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Feng Long
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Jian Tian
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Wei Luo
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China
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Bernthal NM, Upfill-Brown A, Burke ZDC, Ishmael CR, Hsiue P, Hori K, Hornicek F, Eckardt JJ. Long-term follow-up of custom cross-pin fixation of 56 tumour endoprosthesis stems: a single-institution experience. Bone Joint J 2019; 101-B:724-731. [PMID: 31154850 DOI: 10.1302/0301-620x.101b6.bjj-2018-0993.r1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
AIMS Aseptic loosening is a major cause of failure in cemented endoprosthetic reconstructions. This paper presents the long-term outcomes of a custom-designed cross-pin fixation construct designed to minimize rotational stress and subsequent aseptic loosening in selected patients. The paper will also examine the long-term survivorship and modes of failure when using this technique. PATIENTS AND METHODS A review of 658 consecutive, prospectively collected cemented endoprosthetic reconstructions for oncological diagnoses at a single centre between 1980 and 2017 was performed. A total of 51 patients were identified with 56 endoprosthetic implants with cross-pin fixation, 21 of which were implanted following primary resection of tumour. Locations included distal femoral (n = 36), proximal femoral (n = 7), intercalary (n = 6), proximal humeral (n = 3), proximal tibial (n = 3), and distal humeral (n = 1). RESULTS The median follow-up was 132 months (interquartile range (IQR) 44 to 189). In all, 20 stems required revision: eight for infection, five for structural failure, five for aseptic loosening, and two for tumour progression. Mechanical survivorship at five, ten, and 15 years was 84%, 78%, and 78%, respectively. Mechanical failure rate varied by location, with no mechanical failures of proximal femoral constructs and distal femoral survivorship of 82%, 77%, and 77% at five, ten, and 15 years. The survivorship of primary constructs at five years was 74%, with no failure after 40 months, while the survivorship for revision constructs was 89%, 80%, and 80% at five, ten, and 15 years. CONCLUSION The rate of mechanical survivorship in our series is similar to those reported for other methods of reconstruction for short diaphyseal segments, such as compressive osseointegration. The mechanical failure rate differed by location, while there was no substantial difference in long-term survival between primary and revision reconstructions. Overall, custom cross-pin fixation is a viable option for endoprosthetic reconstruction of short metaphyseal segments with an acceptable rate of mechanical failure. Cite this article: Bone Joint J 2019;101-B:724-731.
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Affiliation(s)
- N M Bernthal
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | - A Upfill-Brown
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | - Z D C Burke
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | - C R Ishmael
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | - P Hsiue
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | - K Hori
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | - F Hornicek
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | - J J Eckardt
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
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Liu Q, He HB, Zeng H, Yuan YH, Long F, Tian J, Luo W. Modified trapdoor procedures by surgical dislocation approach to treat chondroblastoma of the femoral head. Bone Joint J 2019; 101-B:732-738. [PMID: 31154843 DOI: 10.1302/0301-620x.101b6.bjj-2018-1599.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIMS The aim of this study was to evaluate the efficacy of the surgical dislocation approach and modified trapdoor procedure for the treatment of chondroblastoma of the femoral head. PATIENTS AND METHODS A total of 17 patients (ten boys, seven girls; mean age 16.4 years (11 to 26)) diagnosed with chondroblastoma of the femoral head who underwent surgical dislocation of the hip joint, modified trapdoor procedure, curettage, and bone grafting were enrolled in this study and were followed-up for a mean of 35.9 months (12 to 76). Healing and any local recurrence were assessed via clinical and radiological tests. Functional outcome was evaluated using the Musculoskeletal Tumour Society scoring system (MSTS). Patterns of bone destruction were evaluated using the Lodwick classification. Secondary osteoarthritis was classified via radiological analysis following the Kellgren-Lawrence grading system. Steinberg classification was used to evaluate osteonecrosis of the femoral head. RESULTS The epiphyseal plate was open, closing, and closed in five, five, and seven patients, respectively. In total, eight, six, and three patients were classified as having Lodwick classification IA, IB, and IC, respectively. Allogeneic and autogenous bone grafting was used in 13 and four patients, respectively. All patients had good bone healing and no local recurrence was observed. One patient developed osteonecrosis of the femoral head (Steinberg IA) and one developed secondary osteoarthritis of the hip joint (Kellgren-Lawrence Grade II). The mean postoperative MSTS functional score was 27.7 (24 to 30). CONCLUSION Surgical dislocation and modified trapdoor procedures are safe and effective techniques for treating chondroblastoma in the femoral head. Cite this article: Bone Joint J 2019;101-B:732-738.
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Affiliation(s)
- Q Liu
- Central South University, Xiangya Hospital, Department of Orthopaedics, Changsha, China.,Central South University, Second Xiangya Hospital, Department of Spine Surgery, Changsha, China
| | - H-B He
- Central South University, Xiangya Hospital, Department of Orthopaedics, Changsha, China
| | - H Zeng
- Central South University, Xiangya Hospital, Department of Orthopaedics, Changsha, China
| | - Y-H Yuan
- Central South University, Xiangya Hospital, Department of Orthopaedics, Changsha, China
| | - F Long
- Central South University, Xiangya Hospital, Department of Orthopaedics, Changsha, China
| | - J Tian
- Central South University, Xiangya Hospital, Department of Orthopaedics, Changsha, China
| | - W Luo
- Central South University, Xiangya Hospital, Department of Orthopaedics, Changsha, China
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Abstract
BACKGROUND Chondroblastoma is a rare cartilaginous benign bone tumor that commonly arises in long bones of young people. Surgical management is the primary treatment of choice for chondroblastoma and it entails adequate intralesional curettage alone or in combination with adjuvants. This study was performed to describe the epidemiological characteristics and clinical and radiologic results of intralesional curettage of chondroblastoma. METHODS This was a retrospective study which included an analysis of 91 patients with chondroblastoma who were treated with intralesional curettage and were followed up between 1994 and 2014 for at least 3 years. Epidemiological data, clinical symptoms, radiologic and histologic investigations, surgery, functional outcomes, complications, and local recurrence rate were analyzed. RESULTS There were 60 males (65.9%) and 31 females (34.1%) with a mean age of 16.4 years. The most commonly involved bone was the proximal tibia in 24 patients (26.4%), followed by distal femur in 20 patients (22%), proximal humerus in 17 patients (18.7%) and proximal femur in 15 patients (16.6%). All patients underwent intralesional curettage. High-speed burr was used in 66 patients (72.5%). The resultant cavity was filled with autogenous bone graft, bone substitute, bone cement or a combination of bone graft and cement. Four patients (4.4%) had complications. Three patients (3.3%) developed local recurrence. Age, site, history of previous intervention or pathologic fracture had no impact on the rate of recurrence. The mean Musculoskeletal Tumor Society (MSTS) score was 28.88 (range, 24 to 30) points. CONCLUSIONS Thorough curettage using high-speed burr and bone-grafting or bone cement in the treatment of chondroblastoma has good local control, low recurrence rate and excellent functional long-term outcome. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Lu C, Ramirez D, Hwang S, Jungbluth A, Frosina D, Ntiamoah P, Healey J, Zhu G, Chen W, Klein M, Hameed M. Histone H3K36M mutation and trimethylation patterns in chondroblastoma. Histopathology 2018; 74:291-299. [PMID: 30098026 DOI: 10.1111/his.13725] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 08/07/2018] [Indexed: 12/19/2022]
Abstract
AIMS Histones are essential components of chromatin, and mutations in histones lead to alterations in methylation and acetylation, which play an important role in tumorigenesis. Most of the chondroblastomas harbour the H3K36M mutation. With the availability of a mutation-specific antibody, we sought to assess the sensitivity of this antibody and the alterations of histone methylation in a series of chondroblastoma cases. METHODS AND RESULTS Immunohistochemical staining with antibodies against H3K36M, trimethylated histones (H3K27me3 and H3K36me3) and an osteoblastic marker (SATB2) was performed on 27 chondroblastomas from 27 patients. The clinical and radiological characteristics of each patient were reviewed. All 27 tumours showed typical radiological and histological features of chondroblastoma, with a subset of cases showing secondary aneurysmal bone cyst changes (11/27), giant-cell-rich foci (4/27), and matrix-rich areas mimicking chondromyxoid fibroma (1/27). All except one case (26/27, 96%) showed positive H3K36M immunostaining (nuclear). In the majority of cases, there was a diffuse staining pattern. Immunohistochemical staining for H3K27me3 and H3K36me3 showed a heterogeneous staining pattern in all cases, regardless of mutation status. None of the cases showed loss of positivity or diffuse positivity. Focal or diffuse SATB2 expression was seen in 21 of 26 tumours (81%). CONCLUSION Our results demonstrate that the vast majority of chondroblastomas are positive for H3K36M by immunohistochemical analysis, confirming its diagnostic value. H3K27me3 expression and H3K36me3 expression are heterogeneous in these tumours.
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Affiliation(s)
- Chuanyong Lu
- Department of Pathology, Montefiore Medical Center, Bronx, NY, USA.,Department of Pathology, Memorial Sloan Kettering Cancer Center, Great Neck, NY, USA.,Department of Pathology, Hospital for Special Surgery, Great Neck, NY, USA
| | - Daniel Ramirez
- Department of Pathology, Northwell Health, Great Neck, NY, USA
| | - Sinchun Hwang
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Achim Jungbluth
- Department of Pathology, Memorial Sloan Kettering Cancer Center, Great Neck, NY, USA
| | - Denise Frosina
- Department of Pathology, Memorial Sloan Kettering Cancer Center, Great Neck, NY, USA
| | - Peter Ntiamoah
- Department of Pathology, Memorial Sloan Kettering Cancer Center, Great Neck, NY, USA
| | - John Healey
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Guo Zhu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, Great Neck, NY, USA
| | - Wen Chen
- Department of Pathology, Washington DC VA Medical Center, Washington, DC, USA
| | - Michael Klein
- Department of Pathology, Hospital for Special Surgery, Great Neck, NY, USA
| | - Meera Hameed
- Department of Pathology, Memorial Sloan Kettering Cancer Center, Great Neck, NY, USA
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Yang J, Li K, Deng H, Feng J, Fei Y, Jin Y, Liao C, Li Q. CT cinematic rendering for pelvic primary tumor photorealistic visualization. Quant Imaging Med Surg 2018; 8:804-818. [PMID: 30306061 DOI: 10.21037/qims.2018.09.21] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Pelvic tumors can be both complicated and challenging, and computed tomography (CT) has played an important role in the diagnosis and treatment planning of these conditions. Cinematic rendering (CR) is a new method of 3D imaging using CT volumetric data. Unlike traditional 3D methods, CR uses the global illumination model to produce high-definition surface details and shadow effects to generate photorealistic images. In this pictorial review, a series of primary pelvic tumor cases are presented to demonstrate the potential value of CR relative to conventional volume rendering (VR). This technique holds great potential in disease diagnosis, preoperative planning, medical education and patient communication.
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Affiliation(s)
- Jun Yang
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming 650118, China
| | - Kun Li
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming 650118, China
| | - Huiyuan Deng
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming 650118, China
| | - Jun Feng
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming 650118, China
| | - Yong Fei
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming 650118, China
| | - Yiren Jin
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming 650118, China
| | - Chengde Liao
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming 650118, China
| | - Qinqing Li
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming 650118, China
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Fritzsche H, Schaser KD, Hofbauer C. [Benign tumours and tumour-like lesions of the bone : General treatment principles]. DER ORTHOPADE 2018; 46:484-497. [PMID: 28451704 DOI: 10.1007/s00132-017-3429-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Benign bone lesions are much more common than malignant lesions. Some benign bone tumors have a characteristic and typical radiographic appearance, while others are more challenging. Therapy of benign bone tumors differs greatly. While the majority of benign bone tumors do not require surgical therapy, other specific lesions, e. g. aneurysmal bone cysts or giant cell tumors (GCT) of the bone require surgery due to their locally aggressive behavior. DIAGNOSTICS The major challenge for the radiologist and/or pathologist is the differentiation between a benign and low-grade malignant lesion (e. g. enchondroma versus low-grade chondrosarcoma) for which all available clinical and radiographic information is mandatory. Therefore, surgical therapy is rather more often performed than necessary due to uncertainty in many cases. THERAPY Novel systemic therapies are available for fibrous dysplasia and GCT of the bone: Fibrous dysplasia can be treated with bisphosphonates, and GCT responds to denosumab. In fact, denosumab has been approved for the treatment of irresectable GCT. Osteoid osteoma is fairly easy to recognize and also to treat given the characteristic clinical presentation and rapid and effective response to local therapy (possible as percutaneous thermo-/laser ablation). In summary, several therapeutic options exist for benign bone tumors, and the choice depends upon the tendency/risk of local recurrence, the rate of surgical complications, options for defect reconstruction, postoperative functional deficits, and specific patient characteristics.
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Affiliation(s)
- H Fritzsche
- UniversitätsCentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum "Carl-Gustav-Carus" der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - K-D Schaser
- UniversitätsCentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum "Carl-Gustav-Carus" der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - C Hofbauer
- UniversitätsCentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum "Carl-Gustav-Carus" der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
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Konishi E, Nakashima Y, Mano M, Tomita Y, Kubo T, Araki N, Morii E, Yoshikawa H, Haga H, Toguchida J, Ueda T, Osawa M, Hoshi M, Inoue T, Aono M, Yanagisawa A. Chondroblastoma of extra-craniofacial bones: Clinicopathological analyses of 103 cases. Pathol Int 2018; 67:495-502. [PMID: 28971570 DOI: 10.1111/pin.12586] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 08/09/2017] [Indexed: 12/12/2022]
Abstract
We elucidated clinicopathological characteristics of chondroblastoma (CB) in Japan, and reliable clinicopathologic parameters predicting local recurrence and/or metastasis. Clinicopathological profiles of 103 CB (80 male, 23 female) in extra-craniofacial bones were retrieved. Numerical scoring of nine pathological and five radiological features was statistically analyzed to determine prognostic significance. Age ranged 8-61 years (average 19.6 years). Frequently involved sites were femur, tibia, calcaneus, patella and humerus. Radiologically, tumors were 2-80 mm (average 31.1 mm) in size. Marginal sclerosis and calcification were common. Histologically, pink cartilage, mitoses, and chicken-wire calcification were often seen. Within a follow-up period [2-260 months (average 53.5 months)], the local recurrence rate was 15.5%. No patient had metastasis. Recurrence was most frequently observed at the femur. By log-rank analysis, only cyst formation in images was significant for predicting recurrence free survival (RFS). By Cox hazard analysis with representative clinico-radiological and pathological features, only age (≥16 years) and cyst formation were significant predictors for RFS. Pathological features were not significant in both uni- and multivariate analyses.
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Affiliation(s)
- Eiichi Konishi
- Department of Pathology, Kyoto Prefectural University of Medicine Graduate School of Medicine, Kyoto, Japan
| | - Yasuaki Nakashima
- Department of Diagnostic Pathology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masayuki Mano
- Department of Pathology, Osaka National Hospital, Osaka, Japan
| | - Yasuhiko Tomita
- Department of Pathology, Osaka Medical Center of Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Toshikazu Kubo
- Department of Orthopaedics, Kyoto Prefectural University of Medicine Graduate School of Medicine, Kyoto, Japan
| | - Nobuhito Araki
- Department of Orthopaedic Surgery, Osaka Medical Center of Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Eiichi Morii
- Department of Pathology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hironori Haga
- Department of Diagnostic Pathology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Junya Toguchida
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takafumi Ueda
- Department of Orthopedic Surgery, Osaka National Hospital, Osaka, Japan
| | - Masahiko Osawa
- Department of Diagnostic Pathology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Manabu Hoshi
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Takeshi Inoue
- Department of Pathology, Osaka City General Hospital, Osaka, Japan
| | - Masanari Aono
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Akio Yanagisawa
- Department of Pathology, Kyoto Prefectural University of Medicine Graduate School of Medicine, Kyoto, Japan
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Abstract
Giant cell rich lesions of the temporal bone encompass a wide spectrum of disease that includes infectious, reactive, and neoplastic processes. When dealing with any lesion that can potentially involve bone, it is important to understand both the clinical presentation and to correlate the histologic findings with the radiologic imaging. This review discusses the clinical, the pathologic features including the differential diagnosis, and the treatment of some of the more commonly encountered giant cell rich entities in this region.
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