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An aggressive chondroblastoma of the knee treated with resection arthrodesis and limb lengthening using the Ilizarov technique

Tomić S, Lesić A, Bumbasirević M, Sopta J, Rakocević Z, Atkinson HD - J Orthop Surg Res (2010)

Bottom Line: At 13 years follow-up there are no signs of disease recurrence or failure at the fusion site.The patient is able to fully weight bear and stand independently on the operated leg.The case is discussed with reference to the literature.

Affiliation: North London Sports Orthopaedics (NLSO), Department of Trauma and Orthopaedics, North Middlesex University Hospital, Sterling Way, London N18 1QX, UK. dusch1@gmail.com.

ABSTRACT

This case report describes the management of a 15 year old male with a biologically aggressive chondroblastoma of the knee. Following CT, bone scan, angiography and an open biopsy, the diagnosis was confirmed histologically and immunohistochemically. The patient underwent a 13 cm en-bloc excision of the knee, and knee arthrodesis with simultaneous bone transport using an Ilizarov ring fixator. Following 136 days of bone transport, the patient achieved radiological and clinical bony union after a total frame time of 372 days. He then commenced 50% partial weight-bear in a protective knee brace and gradually worked up to full weight-bearing by 4 months. The patient developed superficial pin tract infections around the k-wires on 2 occasions; these settled with a cephalosporin antibiotic spray and local dressings. At 13 years follow-up there are no signs of disease recurrence or failure at the fusion site. The patient is able to fully weight bear and stand independently on the operated leg. Knee arthrodesis with simultaneous limb-lengthening is an effective treatment modality following en-bloc resection of an aggressive chondroblastoma. The case is discussed with reference to the literature.

High power microscopy showing polygonally-shaped mononuclear chondroblasts with an indistinct cytoplasm, and nuclei with central longitudinal grooves. Multinucleated giant cells and mitoses are present. (HE stain, 200×)
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Figure 4: High power microscopy showing polygonally-shaped mononuclear chondroblasts with an indistinct cytoplasm, and nuclei with central longitudinal grooves. Multinucleated giant cells and mitoses are present. (HE stain, 200×)

Mentions: The patient underwent open biopsy of the tibial lesion and microscopic histopathological analysis (HE stained and immunohistochemistry) confirmed an aggressive chondroblastoma (Figures 3, Figure 4, Figure 5, Figure 6). The tissue was composed of mononuclear polygon-shaped cells with a pink cytoplasm admixed with rare giant cells and chondroid stroma. The cells varied in both size and shape, with large nuclei, and were occasionally multinucleated. Up to 2 mitotic figures were present per high-power field. The cellular elements were separated by a scanty interstitial chondroid matrix with fine calcification arranged in a characteristic "chicken wire" pattern (Figures 3 and 4). The tumor cells showed a strong positivity for vimentin and S-100 protein. Proliferative factor Ki 67 was also positive in 20% of cells. (Figures 5 and 6).

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An aggressive chondroblastoma of the knee treated with resection arthrodesis and limb lengthening using the Ilizarov technique

Tomić S, Lesić A, Bumbasirević M, Sopta J, Rakocević Z, Atkinson HD - J Orthop Surg Res (2010)

High power microscopy showing polygonally-shaped mononuclear chondroblasts with an indistinct cytoplasm, and nuclei with central longitudinal grooves. Multinucleated giant cells and mitoses are present. (HE stain, 200×)
© Copyright Policy - open-access
Figure 4: High power microscopy showing polygonally-shaped mononuclear chondroblasts with an indistinct cytoplasm, and nuclei with central longitudinal grooves. Multinucleated giant cells and mitoses are present. (HE stain, 200×)
Mentions: The patient underwent open biopsy of the tibial lesion and microscopic histopathological analysis (HE stained and immunohistochemistry) confirmed an aggressive chondroblastoma (Figures 3, Figure 4, Figure 5, Figure 6). The tissue was composed of mononuclear polygon-shaped cells with a pink cytoplasm admixed with rare giant cells and chondroid stroma. The cells varied in both size and shape, with large nuclei, and were occasionally multinucleated. Up to 2 mitotic figures were present per high-power field. The cellular elements were separated by a scanty interstitial chondroid matrix with fine calcification arranged in a characteristic "chicken wire" pattern (Figures 3 and 4). The tumor cells showed a strong positivity for vimentin and S-100 protein. Proliferative factor Ki 67 was also positive in 20% of cells. (Figures 5 and 6).

Bottom Line: At 13 years follow-up there are no signs of disease recurrence or failure at the fusion site.The patient is able to fully weight bear and stand independently on the operated leg.The case is discussed with reference to the literature.

Affiliation: North London Sports Orthopaedics (NLSO), Department of Trauma and Orthopaedics, North Middlesex University Hospital, Sterling Way, London N18 1QX, UK. dusch1@gmail.com.

ABSTRACT

This case report describes the management of a 15 year old male with a biologically aggressive chondroblastoma of the knee. Following CT, bone scan, angiography and an open biopsy, the diagnosis was confirmed histologically and immunohistochemically. The patient underwent a 13 cm en-bloc excision of the knee, and knee arthrodesis with simultaneous bone transport using an Ilizarov ring fixator. Following 136 days of bone transport, the patient achieved radiological and clinical bony union after a total frame time of 372 days. He then commenced 50% partial weight-bear in a protective knee brace and gradually worked up to full weight-bearing by 4 months. The patient developed superficial pin tract infections around the k-wires on 2 occasions; these settled with a cephalosporin antibiotic spray and local dressings. At 13 years follow-up there are no signs of disease recurrence or failure at the fusion site. The patient is able to fully weight bear and stand independently on the operated leg. Knee arthrodesis with simultaneous limb-lengthening is an effective treatment modality following en-bloc resection of an aggressive chondroblastoma. The case is discussed with reference to the literature.

View Similar Images In: Results  - Collection
View Article: PubMed Central - HTML -  PubMed
Show All Figures - Show MeSH
getmorefigures.php?pmc=2921358&rFormat=json&query=null&req=5