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Chondroblastoma of the medial cuneiform bone in a 32-year-old woman.

Arıkan M, Aktas E, Toğral G, Yıldırım A, Kandemir O - Am J Case Rep (2014)

Bottom Line: Oncology.After 18 month follow up, osteointegration was observed with the defect completely filled and the patient was free of disease and pain.Meticulous curettage of the lesion from a small window with removal of the lesion followed by injectable phosphocalcic cement application with autologous PRP can be considered as a curative and technically simple treatment method.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Oncology, Ankara Oncology Training and Research Hospital, Ankara, Turkey.

ABSTRACT

Unlabelled: Patient: Female, 32.

Final diagnosis: Chondroblastoma.

Symptoms: Pain.

Medication: -.

Clinical procedure: -.

Specialty: Oncology.

Objective: Unusual clinical course.

Background: 1% of all bone tumors are Chondroblastomas. Chondroblastomas, initially considered to be an osteoclastoma variant are benign, cartilaginous tumors which usually occur in the epiphysis of long bones, especially in the humerus, tibia, and femur, most common in children and young adults between the ages of 10 and 20 years. 4% of all chondroblastomas settle in the talus whereas cuneiform and other tarsal bones are very rare sites for the development of this benign chondroid lesion.

Case report: A case of chondroblastoma involving the medial cuneiform of the left foot of a 32 year old woman is described. The patient presented with moderate localized pain and tenderness over the medial aspect of her left foot. Radiographs showed a lytic expansile lesion within the right cuneiform bone indicating a bone tumor. Biopsy demonstrated cellular areas made up of round, polygonal cells, with round-oval nucleus and chondroblasts that appear with a thin calcification rim. Intralesional curettage and synthetic bone grafting with PRP (Platelet-Rich Plasma) application was performed for its treatment. After 18 month follow up, osteointegration was observed with the defect completely filled and the patient was free of disease and pain.

Conclusions: A painful, expansile, thin, sclerotic lesion detected at the cuneiform should arise suspicion for chondroblastoma even at age over 20 years. Meticulous curettage of the lesion from a small window with removal of the lesion followed by injectable phosphocalcic cement application with autologous PRP can be considered as a curative and technically simple treatment method.

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(A) Microscopic examination of the lesion.Hematoxylin-eosin stained tissue showing sheets of cells with oval to elongated nuclei on a background of chondroid matrix (×200). (B) Microscopic examination of the lesion. Reticulin stain (×200).
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f3-amjcaserep-15-317: (A) Microscopic examination of the lesion.Hematoxylin-eosin stained tissue showing sheets of cells with oval to elongated nuclei on a background of chondroid matrix (×200). (B) Microscopic examination of the lesion. Reticulin stain (×200).

Mentions: Conventional radiographs of the left foot showed an irregular, patchy, lytic, radiolucent area within the cuneiform bone, suggesting a bone tumor. The affected bone showed septations and minimal calcifications with mild expansion. The tumor occupied the entire medial cuneiform bone, with no involvement of the adjacent tarsal bones (Figure 1). T1-weighted magnetic resonance images (MRI) showed a hypointense lesion (Figure 2A), whereas the lesion was hyperintense on T2-weighted images (Figure 2B). MRI sequences showed the involvement of the entire medial cuneiform bone, sparing the navicular and first metatarsal bone. On the basis of the clinical findings and imaging studies, the differential diagnosis initially suggested an aneurysmal bone cyst, giant-cell tumor, or a bone cyst. A mini-incision open biopsy was performed and indicated a benign chondroid tumor. The microscopic examination of the tissue revealed sheets of cells exhibiting oval-to-elongated nuclei in a background of chondroid matrix (Figure 3A, 3B). The histopathological diagnosis was reported as chondroblastoma. After the patient was informed about the diagnosis, aggressive intralesional curettage of the lesion was performed. After performing electrocauterization of the debrided cavity, we filled the defect with 15 mL of synthetic bone substitute (Cementek LV™, France) combined with autologous platelet-rich plasma (PRP).


Chondroblastoma of the medial cuneiform bone in a 32-year-old woman.

Arıkan M, Aktas E, Toğral G, Yıldırım A, Kandemir O - Am J Case Rep (2014)

(A) Microscopic examination of the lesion.Hematoxylin-eosin stained tissue showing sheets of cells with oval to elongated nuclei on a background of chondroid matrix (×200). (B) Microscopic examination of the lesion. Reticulin stain (×200).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4116344&req=5

f3-amjcaserep-15-317: (A) Microscopic examination of the lesion.Hematoxylin-eosin stained tissue showing sheets of cells with oval to elongated nuclei on a background of chondroid matrix (×200). (B) Microscopic examination of the lesion. Reticulin stain (×200).
Mentions: Conventional radiographs of the left foot showed an irregular, patchy, lytic, radiolucent area within the cuneiform bone, suggesting a bone tumor. The affected bone showed septations and minimal calcifications with mild expansion. The tumor occupied the entire medial cuneiform bone, with no involvement of the adjacent tarsal bones (Figure 1). T1-weighted magnetic resonance images (MRI) showed a hypointense lesion (Figure 2A), whereas the lesion was hyperintense on T2-weighted images (Figure 2B). MRI sequences showed the involvement of the entire medial cuneiform bone, sparing the navicular and first metatarsal bone. On the basis of the clinical findings and imaging studies, the differential diagnosis initially suggested an aneurysmal bone cyst, giant-cell tumor, or a bone cyst. A mini-incision open biopsy was performed and indicated a benign chondroid tumor. The microscopic examination of the tissue revealed sheets of cells exhibiting oval-to-elongated nuclei in a background of chondroid matrix (Figure 3A, 3B). The histopathological diagnosis was reported as chondroblastoma. After the patient was informed about the diagnosis, aggressive intralesional curettage of the lesion was performed. After performing electrocauterization of the debrided cavity, we filled the defect with 15 mL of synthetic bone substitute (Cementek LV™, France) combined with autologous platelet-rich plasma (PRP).

Bottom Line: Oncology.After 18 month follow up, osteointegration was observed with the defect completely filled and the patient was free of disease and pain.Meticulous curettage of the lesion from a small window with removal of the lesion followed by injectable phosphocalcic cement application with autologous PRP can be considered as a curative and technically simple treatment method.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Oncology, Ankara Oncology Training and Research Hospital, Ankara, Turkey.

ABSTRACT

Unlabelled: Patient: Female, 32.

Final diagnosis: Chondroblastoma.

Symptoms: Pain.

Medication: -.

Clinical procedure: -.

Specialty: Oncology.

Objective: Unusual clinical course.

Background: 1% of all bone tumors are Chondroblastomas. Chondroblastomas, initially considered to be an osteoclastoma variant are benign, cartilaginous tumors which usually occur in the epiphysis of long bones, especially in the humerus, tibia, and femur, most common in children and young adults between the ages of 10 and 20 years. 4% of all chondroblastomas settle in the talus whereas cuneiform and other tarsal bones are very rare sites for the development of this benign chondroid lesion.

Case report: A case of chondroblastoma involving the medial cuneiform of the left foot of a 32 year old woman is described. The patient presented with moderate localized pain and tenderness over the medial aspect of her left foot. Radiographs showed a lytic expansile lesion within the right cuneiform bone indicating a bone tumor. Biopsy demonstrated cellular areas made up of round, polygonal cells, with round-oval nucleus and chondroblasts that appear with a thin calcification rim. Intralesional curettage and synthetic bone grafting with PRP (Platelet-Rich Plasma) application was performed for its treatment. After 18 month follow up, osteointegration was observed with the defect completely filled and the patient was free of disease and pain.

Conclusions: A painful, expansile, thin, sclerotic lesion detected at the cuneiform should arise suspicion for chondroblastoma even at age over 20 years. Meticulous curettage of the lesion from a small window with removal of the lesion followed by injectable phosphocalcic cement application with autologous PRP can be considered as a curative and technically simple treatment method.

Show MeSH
Related in: MedlinePlus