Metaphyseal and diaphyseal chondroblastomas

• Published in: Skeletal radiology Vol. 40; no. 12; pp. 1563 - 1573
• Main Authors: Maheshwari, Aditya V., Jelinek, James S., Song, Albert J., Nelson, Kenneth J., Murphey, Mark D., Henshaw, Robert M.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-12-2011; Springer; Springer Nature B.V
• Subjects: Adolescent; Adult; Biological and medical sciences; Bone Neoplasms - diagnosis; Child; Child, Preschool; Chondroblastoma - diagnosis; Chondroblastoma - surgery; Diaphyses; Diseases of the osteoarticular system; Female; Humans; Imaging; Infant; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Medicine & Public Health; Nuclear Medicine; Orthopedics; Osteoarticular system. Muscles; Pathology; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Radiology; Retrospective Studies; Scientific Article; Tumors of striated muscle and skeleton; Young Adult; Metadiaphyseal chondroblastoma; Extra-epiphyseal chondroblastoma; Bone tumor; MRI; Radiographs; Metaphyseal chondroblastoma; Diaphyseal chondroblastoma; Chondroblastoma; Nuclear medicine; Radiodiagnosis; Diseases of the osteoarticular system; Exploration; Nuclear magnetic resonance imaging; Metaphysis; Radiography; Orthopedics; Medical imagery; Benign neoplasm; Bone
• ISSN: 0364-2348; 1432-2161
• DOI: 10.1007/s00256-011-1227-y

Objective
Epiphyseal/apophyseal locations are important diagnostic radiological features of chondroblastomas (CB). Although the tumor may secondarily involve the metaphysis, reports of primary metaphyseal or diaphyseal CB without any epiphyseal or apophyseal involvement are exceptionally rare and frequently present as a diagnostic dilemma. The purpose of this study was to present seven cases of pure metaphyseal and/or diaphyseal CB along with a review of pertinent literature.
Methods
A retrospective review of databases at two major referral centers revealed 390 cases of CB between 1960 and 2009. Out of these, seven histologically proven CB cases (1.8%) were found to be radiologically located in metaphysis and/or diaphysis, without involving the epiphysis and/or apophysis, and formed the study cohort.
Results
There were four males and three females (age range 2–25 years). Locations included proximal femur (
n
 = 1), distal femur (2), proximal humerus (2), clavicle (1), and proximal radius (1). All lesions showed marginal sclerosis. A periosteal reaction was seen in five cases (71%), cortical expansion in four cases (57%), and chondroid matrix in four cases (57%). A CT (two cases) demonstrated a matrix in both cases. An MR (one case) showed extensive perilesional edema. Bone scan (one case) showed intense uptake.
Conclusion
Pure metaphyseal and/or diaphyseal CB are exceedingly rare. A presumptive diagnosis may be considered in the appropriate age group in the presence of chondroid matrix, perilesional edema, periosteal reaction, and marginal sclerosis. Regardless of all the diagnostic possibilities, biopsy may still be required. However, knowledge of this entity will help make the final diagnosis and guide the correct treatment.