A chondroblastoma is a rare, benign cartilaginous tumour. It usually arises from cartilage in secondary ossification centres in epiphyseal plates and apophyses of the growing, immature bone. Most lesions are seen in adolescence and young adults during the period of active epiphyseal growth. It usually involves the tibia also known as the shinbone, the femur also known as the thighbone, and the humerus (long bone of the arm), although 10% of them do arise in hands or feet.
Because the cortical bone (external layer of the bone), articular cartilage (joint cartilage), and joint capsule usually act as natural barriers preventing tumour extension, it is unusual for chondroblastoma to ex¬hibit cortical erosion or invasion inside the neighbouring joint.
What are the clinical features of chondroblastoma ?
Chondroblastomas are uncommon, accounting for approximately 1 to 2% of all primary bone tumours. There is a definite male predominance and it usually occurs in the second decade of life.
The most common clinical feature is pain, especially in pathologic fracture, and it usually takes several months before it occurs. Approximately, 20-50% of the patients have a history of trauma.
The other common clinical findings are localized swelling, a decreased range of neighbouring joint motion and tenderness on touching.
How is a chondroblastoma diagnosed ?
The collaboration of radiologists, bone pathologists and orthopaedic surgeons is needed to accurately diagnose and treat chondroblastomas.
A chondroblastoma is detected radiologically and confirmed histopathologically.
Radiologically, chondroblastoma is generally an ovoid, well-circumscribed, radiolucent area with a clear, defined sclerotic margin. There may be erosion of the epiphysis or neighbouring metaphysis of a long bone. The cortical bone, that forms the external part of the bone, may be whole and unbroken or it may also expand, but penetration of the bone is unusual.
Histopathologically, the chondroblastomas consist of primitive chondroblasts (cartilage forming cells). Chondroblasts are round or oval cells that contain a pink cytoplasm. The presence of a cartilaginous intercellular matrix is seen surrounding the chondroblasts, with areas of focal calcification Mitotic figures and cellular atypias are uncommon.
How is chondroblastoma treated ?
The first line of treatment for Chondroblastoma is surgical removal as the tumour is inclined to exhibit aggressive behaviour in spite of being benign. Surgery for chondroblastoma involves curettage and bone resection. The bony defect that is left in the bone can be filled with bone graft or polymethylmethacrylate and fixed in place by internal fixation.
Although the outcome of this tumour is good after operating, chondroblastomas have the danger of recurrence and metastases. To prevent the above, the close follow-up is warranted.
Plain radiography of the area is recommended post-surgery, to monitor the site.
What are the complications of chondroblastomas ?
The main challenges are local recurrences after surgery and the likelihood of malignant change.
However due to localization of the tumour, there exists complication risks like joint cartilage injury with resultant premature arthritis and growth plate injury with resultant growth disturbance. There is also risk of recurrence probably due to inadequate resection and/or aggressive behaviour of the tumour.
What are the factors that contribute to recurrences of chondroblastoma ?
- Young age
- Aggressiveness of Chondroblastoma
- The anatomic site of Chondroblastoma, and
- Association of a component of an aneurysmal bone cyst, in chondroblastoma
- Inadequate surgical excision of the lesion.
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Disclaimer: The content provided here is meant for general informational purposes only and hence SHOULD NOT be relied upon as a substitute for sound professional medical advice, care or evaluation by a qualified doctor/physician or other relevantly qualified healthcare provider.
