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8 things you should know about Pathology of Chondroblastoma

 

Dr Sampurna Roy MD   

 

 
 

                

Mononuclear neoplastic cells with intermixed multinucleated giant cells (right), tumor cells surrounded by dark blue “chicken wire” calcifications (left center), and fibrochondroid islands

 

Fitzgerald J, Broehm C, Chafey D, Treme G. Chondroblastoma of the Knee Treated with Resection and Osteochondral Allograft Reconstruction. Case Reports in Orthopedics. 2014;2014:543959. doi:10.1155/2014/543959.

 

 

(1) First described by Ewing in 1928, chondroblastomas were originally named "epiphyseal chondroblastomatous giant cell tumors of the proximal humerus" by Codman in 1931. These tumours are often still termed Codman tumours.

 

(2) In 1942 Jaffe and Lichenstein suggested that the lesion was a specific type of tumour, distinct from giant cell tumour, and proposed the name "benign chondroblastoma".

 

(3) It is a rare benign tumour  that accounts for 1% of all primary bone neoplasms. Most patients are between 10 and 25 years of age at diagnosis with  a 2:1 male predominance.

 

(4) These lesions typically originate from chondroblasts within the epiphyses of long bones, and are most common in the proximal humerus, distal femur, or proximal tibia. Chondroblastoma occurring outside of the epiphyses of long bones is rare, with lesions of the craniofacial skeleton accounting for 6.6 to 7.1% of all cases

 

(5) The radiological feature of chondroblastoma is typically a lytic lesion arising in the epiphysis with an eccentric location, mostly without periosteal reaction.

 

 

 

 

 

                  

Homogeneous spread of round to polygonal-shaped mononuclear cells having an eosinophilic cytoplasm and a round-to ovoid-shaped nucleus.

These hypercellular elements are separated by fragmented bony trabeculae and interstitial fibrocartilaginous matrices.

Multinucleated giant cells are disseminated, and vascular cavities are also abundant.

 

Tonogai I, Takahashi M, Manabe H, et al. A Massive Chondroblastoma in the Proximal Humerus Simulating Malignant Bone Tumors. Case Reports in Orthopedics. 2013;2013:673576.

 

 

(6) Microscopically, it is a highly cellular tumor  composed of uniform round to polygonal cells with well-defined cytoplasmic borders, round to ovoid nuclei, predominantly growing in cellular sheets.

There are scattered multinucleated osteoclastic giant cells arranged either singly or in groups. Pericellular "chicken wire-like" calcifications are identified pathognomonic of chondroblastoma.

"The 3 important histopathological features of chondroblastoma are mononuclear cells (chondroblasts), osteoclastic-like giant cells, and a chondromyxoid stroma surrounding neoplastic cells"

 

(7) Chondroblastoma must be differentiated from other giant cell tumors. The osteoclastic-like giant cells seen in chondroblastomas can have striking histological similarities to giant cell reparative granulomas, aneurysmal bone cysts, giant cell tumors, and chondromyxoid fibromas.

 

(8) Though normally benign, histologically aggressive forms of the disease can also occur, with associated high recurrence rates and occasional lung metastases.

 

 

          

                    

Immunohistochemical staining for S-100 protein (a) and for CD68 (b)

Immunohistochemical examination showed strong positive staining for S-100 protein in mononuclear cells, and for CD68 (PGM1), which is a marker of histiocytes, in multinuclear giant cells and some mononuclear cells.

 

Tonogai I, Takahashi M, Manabe H, et al. A Massive Chondroblastoma in the Proximal Humerus Simulating Malignant Bone Tumors. Case Reports in Orthopedics. 2013;2013:673576.

 

Further reading:

 

Massive Chondroblastoma in the Proximal Humerus Simulating Malignant Bone Tumors. Case Reports in Orthopedics. 2013;2013:673576

 

Chondroblastoma of the Knee Treated with Resection and Osteochondral Allograft Reconstruction

 

Chondroblastoma in the long bone diaphysis: a report of two cases with literature review

 

Chondroblastoma of the femoral head: management and outcome

 

Chondroblastoma of the Temporal Bone: A Case Series, Review, and Suggested Management Strategy

 

Chondroblastoma of the Medial Cuneiform Bone in a 32-Year-Old Woman

 

 

 

 

 


 

 

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