Chondromyxoid fibroma of bone: a clinicopathologic review of 278 cases

An intracortical chondromyxoid fibroma in the diaphysis of the metatarsal

Chondromyxoid fibromas (CMFs) are rare, benign, primary tumors of bones, and occur in the metaphyses of the medullary canals of the long bones. The occurrence of intracortical CMFs is extremely rare. Very few cases of intracortical CMFs located in the long tubular bones have been reported to date. Moreover, even though the feet are the second most common site for CMF (after the knees), intracortical metatarsal CMF has not been reported previously, to our knowledge. We report an intracortical CMF occurring in the diaphysis of the metatarsal in a 17-year-old man. It showed the same imaging findings as usual intramedullary CMFs, except for its cortical location. The development and serial increase in this tumor over time are also demonstrated in this report. Additionally, we present a review of current literature on intracortical CMFs.

Radiological presentation of chondromyxoid fibroma in the sellar region: A CARE-compliant article and literature review

RATIONALE

Chondromyxoid fibroma (CMF) is a rare benign bone neoplasm which often occurs in the lower extremities. Little is known about the radiological and histological presentation of CMF in the sellar region.

PATIENT CONCERNS

A 16-year-old Asian male presented to the hospital 12 months ago with bilateral diplopia involving right visual fields, intermittent headaches, and dizziness.

INTERVENTIONS

After the patient underwent enough examinations, the lesion was surgically removed by curettage.

DIAGNOSIS

Postoperatively, the lesion was pathologically confirmed to be CMF.

OUTCOMES

There was no recurrence at the 12-month follow-up.

LESSONS

To the best of our knowledge, this is the second reported case of CMF in the sellar region which was clinically suspected to be a pituitary macroadenoma, craniopharyngioma, or schwannoma due to its location and radiographic features. We reviewed the morbidity, symptoms, radiographic features, pathological findings, and differential diagnosis of CMF. Because of its rarity, attention should be paid to avoid misdiagnosis of this lesion.

[Chondromyxoid fibroma of the mandible: a case report]

Chondromyxoid fibroma (CMF) is a rare benign bone tumor. This tumor mostly affects the long bones of the appendicular skeleton but rarely grows in the craniofacial region. In this article, a case of CMF of the mandible was presented to enhance our understanding of CMF. Its clinical manifestations, imaging characteristics, and treatment methods were discussed by analyzing the related literature.

[Protocol for the study of bone tumours and standardization of pathology reports]

Primary bone neoplasms represent a rare and heterogeneous group of mesenchymal tumours. The prevalence of benign and malignant tumours varies; the latter (sarcomas) account for less than 0.2% of all malignant tumours. Primary bone neoplasms are usually diagnosed and classified according to the criteria established and published by the World Health Organization (WHO 2013). These criteria are a result of advances in molecular pathology, which complements the histopathological diagnosis. Bone tumours should be diagnosed and treated in referral centers by a multidisciplinary team including pathologists, radiologists, orthopedic surgeons and oncologists. We analyzed different national and international protocols in order to provide a guide of recommendations for the improvement of pathological evaluation and management of bone tumours. We include specific recommendations for the pre-analytical, analytical, and post-analytical phases, as well as protocols for gross and microscopic pathology.

Safety and efficacy of angiographic occlusion of duodenal varices as an alternative to TIPS: review of 32 cases

BACKGROUND/RATIONALE OF STUDY: Analyze safety and efficacy of angiographic-occlusion-with-sclerotherapy/embolotherapy-without-transjugular-intrahepatic-portosystemic-shunt (TIPS) for duodenal varices. Although TIPS is considered the best intermediate-to-long term therapy after failed endoscopic therapy for bleeding varices, the options are not well-defined when TIPS is relatively contraindicated, with scant data on alternative therapies due to relative rarity of duodenal varices. Prior cases were identified by computerized literature search, supplemented by one illustrative case. Favorable clinical outcome after angiography defined as no rebleeding during follow-up, without major procedural complications.

RESULTS

Thirty-two cases of duodenal varices treated by angiographic-occlusion-with-sclerotherapy/embolotherapy- without-TIPS were analyzed. Patients averaged 59.5 ± 12.2 years old (female = 59%). Patients presented with melena-16, hematemesis & melena-5, large varices-5, growing varices-2, ruptured varices-1, and other- 3. Twenty-nine patients had cirrhosis; etiologies included: alcoholism-11, hepatitis C-11, primary biliary cirrhosis- 3, hepatitis B-2, Budd-Chiari-1, and idiopathic-1. Three patients did not have cirrhosis, including hepatic metastases from rectal cancer-1, Wilson's disease-1, and chronic liver dysfunction-1. Thirty-one patients underwent esophagogastroduodenoscopy before therapeutic angiography, including fifteen undergoing endoscopic variceal therapy. Therapeutic angiographic techniques included balloon-occluded retrograde-transvenous-obliteration (BRTO) with sclerotherapy and/or embolization-21, DBOE (double-balloon-occluded-embolotherapy)-5, and other-6. Twenty-eight patients (87.5%; 95%-confidence interval: 69-100%) had favorable clinical outcomes after therapeutic angiography. Three patients were therapeutic failures: rebleeding at 0, 5, or 10 days after therapy. One major complication (Enterobacter sepsis) and one minor complication occurred.

CONCLUSIONS

This work suggests that angiographic-occlusion-with sclerotherapy/ embolotherapy-without-TIPS is relatively effective (~90% hemostasis-rate), and relatively safe (3% major-complication-rate). This therapy may be a useful treatment option for duodenal varices when endoscopic therapy fails and TIPS is relatively contraindicated.

Chondromyxoid Fibroma of Radius: A Case Report

Chondromyxoid fibroma (CMF) is a rare benign cartilaginous tumour accounting to less than 1% of bone tumours. It is most commonly seen in lower extremity involving tibia. CMF of radius is rare. We report a rare case of CMF of proximal radius in a 37-year-old female who presented with swelling and pain over right elbow. Wide local excision of proximal radius along with radial head was done and above elbow POP slab was applied for one month. Elbow range of movement exercises started after one month.

Chondromyxoid fibroma of the sacrum: A case report and literature review

BACKGROUND

Chondromyxoid fibroma (CMF) is an extremely rare, benign cartilaginous tumor that makes up <0.5% of all bone tumors, typically presenting in the second or third decade of life. CMF of the sacrum is exceedingly rare, with only seven documented cases reported in the neurosurgical literature.

CASE DESCRIPTION

We report a case of a 35-year-old female with a 3 month history of lower back pain after sustaining a fall on her sacrum/coccyx presenting with a progressive complaint of localized lower back pain, occasional urinary retention without incontinence, gluteal hypesthesia, and pressure below the gluteal crease. Imaging demonstrated a large, expansile enhancing soft-tissue lesion involving the sacrum, distal to the S2-3 disc space. The tumor was removed with partial sacrectomy for open en bloc resection with partial nerve sparing. The patient was found at 1.5-year follow-up with the improvement of symptoms, no recurrence, and no residual neurologic dysfunction.

CONCLUSION

Sacral CMF is a rare clinical entity that may mirror more aggressive sacral pathology, including chordoma, in both clinical presentation and imaging characteristics. A review of the available literature regarding diagnosis, surgical management options, and prognosis for sacral CMF is provided.

Chondromyxoid Fibroma of the Skull Base and Calvarium: Surgical Management and Literature Review

Chondromyxoid fibroma (CMF) is an exceedingly rare tumor that represents less than 1% of all primary bone neoplasms. Occurrence in the facial and cranial bones is extremely rare and frequently misdiagnosed.

Case Reports We report two cases of CMF, one in the sphenoclival skull base and the other involving the parietal bone in two young female patients. Excision was performed in both cases. Presenting symptoms, treatment, and follow-up are reported.

Methods A retrospective review of the literature on cranial CMF was performed. The location, demographics, presenting symptoms, and treatment of all calvarial and skull base CMF cases published since 1990 are summarized.

Discussion In our literature review, we found 67 published cases of cranial CMF. Mean age of all calvarial and skull base CMFs at diagnosis was 38.2 years old. Of the cases affecting the cranium, the sinonasal structures were most commonly involved. To our knowledge we report only the second case of CMF involving the parietal bone published in an English-language journal. Total resection is the best treatment, and should be the goal of surgical intervention. Curettage results in high recurrence rates. Radiotherapy in the setting of subtotal resection or recurrence cannot be definitively recommended and needs further investigation.

Chondromyxoid fibroma involving the sphenoid sinus: Case report and literature review

We present the case of a 62-year-old woman with chondromyxoid fibroma of the sphenoid sinus. Chondromyxoid fibroma is a rare bone tumor found most prevalently in long bones, so its presence at the cranial base is especially uncommon. The presence of a monoclonal gammopathy of undermined significance (MGUS) prompted consideration and investigation of a plasma cell disorder; however, CT and MRI findings followed by biopsy led to the correct diagnosis of chondromyxoid fibroma.

Chondromyxoid fibroma of the frontal bone mimicking meningioma

Chondromyxoid fibroma (CMF) is a rare benign cartilaginous tumor that usually arises from lower-extremity long-bone metaphyses, with approximately 5.4% of all CMFs presenting in the craniofacial bones. Chondromyxoid fibroma of the frontal bone is exceedingly rare, with only a few cases reported. Herein, we report another case of CMF arising from the frontal bone mimicking meningioma. We suggest that histopathologic examination is of vital importance for the diagnosis of CMF; complete surgical resection is the best treatment option for frontal CMF.

Chondromyxoid Fibroma of the Mandible in an Adolescent: Case Report and Microsurgical Reconstructive Option

Chondromyxoid fibroma is a rare bony tumor that usually presents in the lower extremities of middle-aged adults. Involvement of the craniofacial skeleton is extremely rare. We present the unique case of an adolescent boy with a chondromyxoid fibroma of the mandible. The chondromyxoid fibroma in this patient recurred after initial treatment with curettage. We treated the recurrence with resection of the involved mandible and immediate reconstruction using a vascularized musculo-osseus seventh rib flap (“Eve procedure”). Despite complex reconstruction in adolescents due to skeletal immaturity, the rib flap has successfully grown with the patient up to 3 years postoperatively. Therefore, we believe the musculo-osseus rib flap is a feasible solution for complex ramus and condyle reconstruction of the growing mandible in the adolescent patient.

Tibial cortical lesions: a multimodality pictorial review

Shin pain is a common complaint, particularly in young and active patients, with a wide range of potential diagnoses and resulting implications. We review the natural history and multimodality imaging findings of the more common causes of cortically-based tibial lesions, as well as the rarer pathologies less frequently encountered in a general radiology department.

Chondromyxoid fibroma management: a single institution experience of 22 cases

Background

Several different strategies have been reported for the treatment of chondromyxoid fibromas, all with variable outcomes and high recurrence rates.

Methods

We report on 22 consecutive cases of chondromyxoid fibromas treated by intralesional curettage, four of which had adjuvant cementation at our institution between 2003 and 2010. We assessed the functional outcome using the Musculoskeletal Tumour Society (MSTS) scoring system.

Results

Nine males and 16 females with a mean age of 36.5 years (range 11 to 73) and a mean follow-up of 60.7 months were included in the study. Local recurrence occurred in two patients (9%) within the first 2 years following the index procedure. This was treated by re-curettage only of the residual defect. Two postoperative complications occurred: a superficial wound infection in one patient and a transient deep peroneal nerve neurapraxia in the other. The mean postoperative MSTS score was 96.7%.

Conclusions

Intralesional curettage and cementation is as an effective treatment strategy for chondromyxoid fibromas, providing satisfactory functional results with a low recurrence rate. Careful case selection with stringent clinical and radiographic follow-up is recommended.

Chondromyxoid fibroma of zygoma: A rare case report

Chondromyxoid fibroma (CMF) is a rare benign mesenchymal tumor of the bone. Clinically, it is characterized by a lobular growth pattern and histologically by chondroid and myxoid differentiation. The tumor is rare in the craniofacial bones with only 2% of all reported cases. Extragnathic location in the facial skeleton is extremely rare. Most of the cases reported either originate from gnathic sites or in the cranium. A case of CMF in a 3½-year-old male is presented here, which arose from the root of zygomatic arch. A detailed clinical history and histopathological picture of one more case is added to the literature. It is important to document such cases so that better light can be shed on future reviews and conclusions. This shall facilitate better treatment approaches and prognosis. This case is the first reported case of involvement of the zygomatic arch in a pediatric patient.

Surface chondromyxoid fibroma of the distal ulna: unusual tumor, site, and age

Chondromyxoid fibroma (CMF) is a rare benign cartilage congener tumor comprising less than 1 % of primary bone tumors. Although the age range is wide, it is most commonly seen in the second and third decades. The most frequent location of CMF is in the long tubular bones of the lower extremities, particularly the proximal tibia and distal femur. Although the majority of chondromyxoid fibromas present as intramedullary tumors, a subgroup of chondromyxoid fibromas arising as surface lesions of the bone has recently been described. These are associated with an older mean age and an increased incidence of matrix calcifications. Chondromyxoid fibromas are rare in the distal ulna. We report a CMF presenting as a surface lesion of the distal metaphysis of the left ulna in a 41-year-old woman. We reviewed the literature on chondromyxoid fibromas involving the ulna and found that out of 22 cases, 1 was in the distal ulna, 13 in the proximal ulna, and in the remaining 8 the ulnar sites were unspecified. No case of chondromyxoid fibroma in the published literature had been designated as a surface lesion. Our own unpublished data include 70 chondromyxoid fibromas, 4 of which are in the ulna. Two of these are in the distal portion.

Pseudotetraploid clone with structural chromosomal rearrangements in a chondromyxoid fibroma: a case report

Chondromyxoid fibroma is a rare benign tumor accounting for 1-2% of primary bone tumors. Most of the patients are young males in the 2nd and 3rd decades of life. Metaphyses of long bones are predominantly affected. The histology of this tumor is well established, but its genetic mechanism remains poorly characterized. To our knowledge, only 22 abnormal cytogenetic analyses have been reported, and all contained diploidy or near-diploidy karyograms as their primary event, and inv(6)(p25)(q13) and rearrangements involving regions 6p23-25, 6q12-15, and 6q23-27 constituted a recurrent observation. In this report, a pseudotetraploidy tumor clone with multiple numerical and structural aberrations involving 6p23 as well as other chromosomal loci was identified in a chondromyxoid fibroma from the metaphysis of the left fibula of an 18-year-old male, which has not been reported. The finding may relate to the atypical-looking large cells often seen in this benign tumor.

Chondromyxoid fibroma of the temporal bone: A rare entity

Chondromyxoid fibroma (CMF) is the least common benign tumor of the cartilaginous origin. It is very unusual to find these tumors in the skull bones. We report one such case involving the temporal bone. Till date, only nine such cases including this patient, involving the temporal bone have been reported to the best of our knowledge. Grant Medical College and Sir J.J Group of Hospitals, Byculla, Mumbai, Maharashtra, India. A 12-year-old female patient presented with a history of headache associated with left earache of 1 month duration. This was followed by swelling over the left preauricular region 15 days later. Imaging was suggestive of an expansile lesion involving the squamous part of the left temporal bone with calcifications suggestive of a benign chondroid lesion. The patient was operated upon with left temporal incision and complete excision of the lesion. The patient had relief from headache, earache and swelling, with no evidence of new neurological deficit in the post-operative period. CMF of the skull bone is an extremely rare tumor. Differential diagnosis should be kept in mind, especially in cases of calcified lesions and includes chordoma, chondroid chondroma, and low-grade myxoid chondrosarcoma. En-bloc complete excision should be the aim to achieve cure.

Chondroblastoma and chondromyxoid fibroma

Chondroblastoma and chondromyxoid fibroma are benign but locally aggressive bone tumors. Chondroblastoma, a destructive lesion with a thin radiodense border, is usually seen in the epiphysis of long bones. Chondromyxoid fibroma presents as a bigger, lucent, loculated lesion with a sharp sclerotic margin in the metaphysis of long bones. Although uncommon, these tumors can be challenging to manage. They share similarities in pathology that could be related to their histogenic similarity. Very rarely, chondroblastoma may lead to lung metastases; however, the mechanism is not well understood.

Chondromyxoid fibroma of calcaneus

BACKGROUND

Chondromyxoid fibroma is a rare benign primary bone tumor composed of immature myxoid mesenchymal and cartilaginous tissue. Its occurrence in calcaneus is very rare and few cases of calcaneal involvement have been reported in literature. We report five cases of CMF in calcaneus.

METHODS

Five cases, with the final diagnosis of chondromyxoid fibroma of the calcaneal bone are included in this report. Preoperative tumor workup was performed for our patients. We reviewed and recorded demographic data and the sign and symptoms of patients at presentation to our center. Mode of treatments, postoperative complications and recurrence were also studied. Curettage, high speed burring and bone grafting was performed in 4 of our patients and in the remaining case we only carried out curettage and burring.

RESULTS

Of the five patients, 3 were male and 2 were female. The mean age at presentation was 21. Two of our cases had previous surgery in other centers and had been referred to our clinic because of recurrence. The chief complaint in all of our patients was heel pain. The mean follow up period was 25.2 months. All of our patients had a delay in the diagnosis of tumor. We did not have any recurrence in our patients during follow up period.

CONCLUSIONS

This case series shows that chondromyxoid fibroma is not necessarily as exceedingly rare as generally reported in the current literature. This tumor should be considered in the differential diagnosis in patients with ankle and heel pain.

Myxoma of the vomer bone

Myxomas of bone in the head and neck are rare tumors. We present a 68 year old female with pain and epistaxis who was found to have the first reported case of a myxoma arising within the vomer bone. Some atypical magnetic resonance imaging features are described, however, myxoma imaging features are often non-specific and typically evoke a benign differential diagnosis. Surgical excision is the treatment of choice.

Chondromyxoid fibroma of the clavicle extending to the adjacent joint: a case report

Chondromyxoid fibroma is a rare benign bone tumour usually involving bones of the lower extremity in young adults. We present a case of chondromyxoid fibroma of the left clavicle extending to the adjacent joint in a 84-year-old man. The tumour had breached the hyaline cartilage of acromioclavicular joint. The tumour was excised en bloc, and the humeral head was curetted and grafted with autogenous cancellous bone. Postoperatively, the patient had an uneventful recovery and regained excellent function of the left shoulder without any pain or stiffness. At the 18-month follow-up, there was no sign of recurrence.

Chondromyxoid fibroma with secondary aneurysmal bone cyst of the rib

Chondromyxoid fibroma (CMF) is a rare, benign cartilaginous tumor, comprising less than 1% of primary bone tumors, and usually occurs in the metaphysis of a long tubular bone around the knee. We report a rare case of CMF of the rib. The patient was a 25-year-old man who visited the hospital for left upper back pain. Roentgenography revealed an 8-cm mass in the left upper lung field; computed tomography revealed a large multicystic tumor with aneurysmal bone cyst (ABC)-like features in the posterior mediastinum. ABCs are also a rare benign tumor representing 2.5% of primary bone tumors, and most of ABCs are located in the metaphysis of long bones and vertebrae. To the best of my knowledge, there is no report of CMF with secondary ABC of the rib. We performed total resection of the tumor. Complete tumor resection may be the best treatment option for a cure.

Chondromyxoid fibroma of the lumbar spine: case report and literature review

PURPOSE

Chondromyxoid fibroma (CMF) is a benign tumour of the bone that typically occurs in long bone metaphysis. Spinal involvement is uncommon, but more frequent in the cervical and thoracic segments. Lumbar involvement is extremely rare. We report the ninth case of lumbar CMF and the first one involving the articular process of the vertebra. A review of the literature is also intended making special emphasis on the differential diagnosis with other benign spinal tumours of the bone.

METHODS

A 21-year-old Caucasian male suffering from low back pain that increased with sports and interrupted sleep was diagnosed with a tumoural lesion in the right inferior articular process of L5.

RESULTS

Complete surgical excision of the tumour was accomplished. Histological diagnosis confirmed a CMF. The patient remains asymptomatic at 1-year follow-up.

CONCLUSION

Despite the low incidence of CMF in the lumbar spine, differential diagnosis must include this subtype of lesion among other benign tumours of the bone and cartilage. Histological diagnosis is essential in order to provide the patient with an accurate management of the pathology. Recurrence rate is to be considered even in the case of complete surgical excision. Radiotherapy administration is controversial due to suspicion of malignant transformation of the tumour.

Translocation t(12;17)(q24.1;q21) as the sole anomaly in a nasal chondromesenchymal hamartoma arising in a patient with pleuropulmonary blastoma

The identification of recurrent chromosomal abnormalities in benign and malignant mesenchymal neoplasms has provided important pathogenetic insight as well as powerful diagnostic adjuncts. Nasal chondromesenchymal hamartoma (NCMH), an extremely rare benign tumor arising in the sinonasal tract of infants and children, has not been previously subjected to cytogenetic analysis. Histopathologically composed of mixed mesenchymal elements, NCMH exhibits a relatively wide differential diagnosis to include chondromyxoid fibroma, chondroblastoma, aneurysmal bone cyst, fibrous dysplasia, and osteochondromyxoma. An interesting association with pleuropulmonary blastoma has been reported in a small subset of NCMH patients. In the current study, cytogenetic analysis of a NCMH arising in an 11-year-old boy with a past medical history of pleuropulmonary blastoma revealed a novel 12;17 translocation, t(12;17)(q24.1;q21), as the sole anomaly.

Fine needle aspiration cytology in two cases of chondromyxoid fibroma of bone and review of literature

We report the cytological features of two cases of chondromyxoid fibroma (CMF) confirmed by histopathology examination. First case was a 40-year-old male who presented with a foot swelling, and the second case was a 16-year-old male with a lesion at the angle of jaw. A fine needle aspiration cytology (FNAC) was performed in both the cases. In first case, a correct diagnosis of CMF could be offered on FNAC. In the second case, though the cytology diagnosis was a sarcoma considering the cytological, radiological and clinical features, the histopathological examination confirmed the same to be a CMF. The cases are being discussed to highlight the usefulness of FNAC to diagnose these uncommon benign bone lesions and the potential pitfalls in the cytological diagnosis of chondroid lesions.

Soft tissue chondromyxoid fibroma of the foot: sonographic findings

Chondromyxoid fibroma is a rare benign bone tumor, which represents less than 1% of primary bone tumors. However, chondromyxoid fibroma developing in the soft tissue is extremely rare. We report the sonographic findings in a case of soft tissue chondromyxoid fibroma in the foot confirmed pathologically.

A t(1;9)(q10;q10) translocation with additional 6q23 and 9q22 rearrangements in a case of chondromyxoid fibroma

Chondromyxoid fibroma (CMF) is a rare cartilaginous tumor of bone. It typically presents in the long tubular bones and to a lesser extent in the small bones of the hands and feet of young adults. To date, several cytogenetic abnormalities have been described in association with CMF. We studied a phalangeal CMF from a 13-year-old female by cytogenetic methods. We found a novel unbalanced translocation between the long arms of chromosomes 1 and 9, resulting in loss of 1p. In addition, rearrangements involving the 6q23 and 9q22 regions were also observed. To our knowledge, this is the first report in the literature describing this novel chromosomal translocation in CMF.

Chondromyxoid fibroma of C1: first case report

BACKGROUND: Chondromyxoid fibroma (CMF) is a rare, benign primary bone tumor. The cervical spine is an uncommon site for this tumor, with only 10 reported cases to date and none involving the first cervical vertebra (C1). CASE REPORT: Female patient, 25-year-old monozygotic female twin, presented with cervical pain. Radiographic imaging demonstrated a contrast-enhanced, right-sided lytic lesion of the insufflated type in C1, with a punched-out appearance and extending to the anterior arch. A postero-lateral and a posterior approach were performed in two steps to resect the tumor followed by occipitocervical fixation. Pathology confirmed the diagnosis of CMF. At one year, the patient remains disease free with excellent spinal stability. CONCLUSION: Spinal surgeons may need to treat rare spinal tumors. Despite the proximity to neural and vascular structures, the goal of surgery is always a radical resection due to high recurrence rates.

MRI of chondromyxoid fibroma

BACKGROUND

Chondromyxoid fibroma is a rare benign primary bone tumor of cartilage. Despite a characteristic radiographic appearance, chondromyxoid fibroma with atypical radiographic findings may mimic more common tumors.

PURPOSE

To describe the MR findings of chondromyxoid fibroma.

MATERIAL AND METHODS

MR images of 19 histopathologically confirmed chondromyxoid fibromas were retrospectively analyzed for signal intensity, periosteal reaction, adjacent abnormal bone marrow and soft tissue signal, and patterns of contrast enhancement.

RESULTS

All cases of chondromyxoid fibroma showed hypointense to intermediate signal intensity and internal hyperintense foci were observed in seven (37%) cases on T1-weighted images. On T2-weighted images, all lesions were hyperintense: peripheral intermediate signal band with central hyperintense signal in 11 (58%) of 19 lesions, whereas diffusely hyperintense with heterogeneous pattern in eight (42%). Periosteal reaction was observed in 11 (58%) of 19 cases. Adjacent abnormal bone marrow or soft tissue signal was observed in 12 (63%) or 14 (74%) of 19 cases, respectively. On contrast-enhanced T1-weighted images, peripheral nodular enhancement was observed in 69% (11/16) and diffuse contrast enhancement was observed in 31% (5/16) with homogeneous (n = 3) or heterogeneous (n = 2) patterns. Among the cases with peripheral nodular enhancement, the peripheral nodular enhancing portion generally corresponded to the peripheral intermediate signal band on T2-weighted images, although the peripheral enhancement was not as wide as a band of intermediate signal intensity. On the other hand, the central non-enhancing portion generally corresponded to the central hyperintense signal intensity on T2-weighted images.

CONCLUSION

The helpful features of chondromyxoid fibroma are the peripheral intermediate signal band and central hyperintense signal on T2-weighted images, generally corresponding to the peripheral nodular enhancement and central non-enhancing portion on contrast-enhanced T1-weighted images, respectively.

[Jaw osteosarcomas]

INTRODUCTION

Osteosarcoma (OS) is the most frequent bone malignant tumor. It is usually found on long bones, 5 to 10% are located on jaws, accounting for 0.5 to 1% of all facial tumors. There is little published data which concerns only few patients. Our aim was to study retrospectively cases of facial bone OS in adults, and to compare our results with published data to suggest an optimal management scheme.

PATIENTS AND METHOD

Thirty-three patients were managed for an OS, from January 1997 to January 2007. Fourteen patients with a maxillary and mandibular OS, treated in first-intention in our unit, were included. The following data were analyzed: age; personal history; circumstance of discovery; clinical, functional, and physical signs; loco-regional extension and metastasis radiological investigation. The histological slides were systematically reviewed. The protocol, therapeutic outcome, and follow-up were studied.

RESULTS

The mean age at diagnosis was 43. Swelling was the most frequent functional sign. The mean delay before management was 3.4 months. The most frequent radiological presentation was a lytic and hyperdense image. The diagnosis was suggested after CT scan in 57.1% of cases. The biopsy was correlated to the anatomopathological analysis in 78.6% of cases. The most common treatment was surgical exeresis completed by chemotherapy. The 5-year survival rate was 50%.

DISCUSSION

Jaw OS are specific because of their localization and specific bone ultrastructure. Their management remains controversial: should they be managed like limb OS or treated more specifically? Neoadjuvant chemotherapy, even if it delays exeresis for 3 months, seems to stop the growth or reduce the tumor. An early anatomopathological analysis of the surgical piece determines adjuvant therapy. The negative prognostic factors are: maxillary localization because of limited exeresis margins, tumoral size, and osteoblastic sub-type.

A rare case of epiphyseal chondromyxoid fibroma of the proximal tibia

Chondromyxoid fibroma is an uncommon benign cartilaginous tumor of the bone. It occurs most frequently in the metaphysis of long tubular bones, and an epiphyseal location is exceedingly rare. We present here an unusual case of a chondromyxoid fibroma that occurred in the epiphysis of the proximal tibia with an open growth plate. MR imaging findings of this tumor, which has, to the best of our knowledge, never been described in an epiphyseal location, makes the present case unique.

Intracortical chondromyxoid fibroma of the tibia

Intracortical chondromyxoid fibroma is an extremely rare benign neoplasm of cartilaginous origin that usually occurs as an eccentric lesion at the medullar metaphyseal region of long bones. We report the clinicoradiologic aspect of a new case located in the metaphyseal region of the upper tibia and discuss about the differential diagnosis.

Chondromyxoid fibroma of the skull base invading the occipitocervical junction: report of a unique case and discussion

Chondromyxoid fibroma (CMF) is a rare bone tumor representing less than 1% of total bone neoplasms. It is a slow-growing, locally destructive tumor that usually affects the metaphyseal region of long bones. The occurrence of this tumor in the skull base or cervical spine is exceptionally rare. We present the first case of CMF originating in the clivus and extending into the atlas and discuss the surgical management of this case.

Chondromyxoid fibroma of the rib mimics a chondrosarcoma on 18F-FDG PET/CT

Chondromyxoid fibroma (CMF) is a rare benign bone tumor of chondroid origin that occurs mostly in the metaphyses of long bones. CMF can occasionally mimic a chondrosarcoma on CT, and the literature on the 18F-FDG PET/CT imaging characteristics of CMF tumors is limited. In the presented case, a large histologically proven CMF chest wall mass was initially misinterpreted as a chondrosarcoma. This case highlights a potential pitfall in the PET/CT evaluation of these rare benign bone tumors.

Chondromyxoid fibroma of the nasal septum: case report and review of literature

BACKGROUND

Chondromyxoid fibroma (CMF) is a rare bone tumor, accounting for less than 0.5% of all bone tumors, with a predilection for lower extremity bone metaphyses. Involvement of the head and neck is extremely rare, with only 3 cases reported in the nasal septum in world literature.

METHODS

This is a case report of a CMF in the nasal septum of a 49-year-old woman with a 6-month history of congestion. MRI showed a bilobed mass originating from the nasal septum. Histologic and immunoperoxidase staining as well as electron microscopic studies were performed. A literature review was performed.

RESULTS

The patient underwent a midface-degloving approach for surgical resection. The final pathology was prototypic of CMF. The patient was disease-free 16 months postoperatively.

CONCLUSIONS

CMF is a rare, benign neoplasm occasionally occurring in the head and neck. Surgical resection is often curative. CMF must be differentiated from chondrosarcoma, given the substantial differences in treatment.

Phenotypic diversity in chondromyxoid fibroma reveals differentiation pattern of tumor mimicking fetal cartilage canals development: an immunohistochemical study

Chondromyxoid fibroma represents a rare benign cartilaginous tumor of young patients occurring in a subcortical metaphyseal location. The histogenesis of chondromyxoid fibroma has not yet been postulated, even though the conventional histology and recent immunohistochemical studies on phenotype of the mesenchymal cells and extracellular matrix components suggested its origin in immature cartilage. Therefore, we wished to compare the morphological pattern of immature cartilage tissue with chondromyxoid fibroma to investigate a possible developmental counterpart of chondromyxoid fibroma. Archival paraffin-embedded tissues from 4 fetal femora and 10 cases of chondromyxoid fibroma were analyzed simultaneously using histochemistry (safranin O) and established immunohistochemical antibodies (CD34, CD163, and smooth muscle actin). Vascularized cartilage canals growing into the fetal cartilage from the perichondrium displayed characteristic glomeruloid structures with central arterioles within the immature mesenchymal stroma and numerous superficial sinusoidal blood vessels accompanied by macrophage infiltration. Similarly, each case of chondromyxoid fibroma demonstrated admixture of two characteristic components: immature fibrous tissue of vascularized stroma with accumulation of macrophages in areas of superficial sinusoidal proliferation, and variable amounts of lobulated chondroid tissue. Based on the observed substantial morphological similarity between the cartilage canals and chondromyxoid fibroma, we suggest that the chondromyxoid fibroma represents a neoplasm originating from or mimicking the fetal cartilage canals within the immature cartilage.

[An unusual cranial vault tumor: the chondromyxoid fibroma]

Chondromyxoid fibroma is an uncommon benign bone tumor of cartilaginous origin. It is often located in long bone metaphysis. We report a case involving the left frontotemporal cranial vault in a 44-year-old woman. Fifteen cranial vault cases have been reported in the international literature. Surgical resection of the lesion with tumor-free margins is the key factor to cure it and avoid local recurrence.

Aberrations of 6q13 mapped to the COL12A1 locus in chondromyxoid fibroma

Chondromyxoid fibroma, a rare benign bone tumor, may be mistaken for chondrosarcoma. Although cytogenetic studies of chondromyxoid fibroma are few, rearrangements of the long arm of chromosome 6, frequently expressed as an inv(6)(p25q13), are prominent. In this study, conventional cytogenetic analysis of 16 chondromyxoid fibroma samples from 14 patients revealed rearrangements of chromosome 6 in 10 of 11 clonally abnormal specimens. In addition to 6q13 rearrangements, recurrent 6p25 and 6q25 anomalies were detected. Notably, an identical t(6;9)(q25;q22) translocation was identified in two cases, suggesting that it represents a distinct translocation of chondromyxoid fibroma. In an effort to further define the aberrant 6q13 breakpoint and identify the molecular consequences, a fluorescence in situ hybridization (FISH)-based positional cloning strategy on chondromyxoid fibroma abnormal metaphase and interphase cells using a series of bacterial and plasmid artificial chromosome (BAC/PAC) probe combinations spanning a 6.1 Mb region was employed. The breakpoint on 6q13 was located within the COL12A1 gene, a collagen gene purportedly involved in another benign bone tumor, subungual exostosis. The findings of this study expand our knowledge of chromosomal alterations in chondromyxoid fibroma, identify COL12A1 as the likely gene candidate within the recurrent 6q13 breakpoint, and provide an alternative approach for detecting 6q13 anomalies in nondividing cells of chondromyxoid fibroma. The latter could potentially be utilized as an adjunct in diagnostically challenging cases.

Fine-needle aspiration biopsy of chondromyxoid fibroma: an investigation of four cases

We describe the cytologic features of chondromyxoid fibroma in fine-needle aspiration biopsy specimens in 4 patients. We analyzed rapid Romanowsky- and Papanicolaou-stained slides with a respect to overall cellularity, the presence of hypercellular chondromyxoid fragments (HCFs), nuclear atypia, cytoplasmic features, and the presence of giant cells. The most consistent and diagnostically useful feature was the presence of HCFs, which were present in all 4 cases. Mild to moderate nuclear atypia was additionally present in all 4 cases. Most cases were hypocellular (3/4). Giant cells were present in 2 cases, with 1 case exhibiting a hypercellular smear with numerous giant cells. All 4 cases were confirmed in subsequent histologic biopsy material. Strict attention to clinical, radiographic, and cytologic features, especially the presence of HCFs, can aid in the specific diagnosis of chondromyxoid fibroma on FNAB.

Benign cartilaginous tumors of bone: from morphology to somatic and germ-line genetics

Benign cartilaginous tumors of bones, intrinsic to their name, are tumors forming cartilaginous matrix with a clinically benign behavior. In this group, we recognize osteochondromas, (en)chondromas, chondroblastomas, and chondromyxoid fibromas. This group includes common tumors, that is, osteochondroma and (en)chondroma as well as rare tumors such as chondroblastoma and chondromyxoid fibroma. Several benign and malignant tumors may mimic benign cartilaginous tumors of bones. We reviewed the main morphologic features and the differential diagnosis is discussed. The genetics of these tumors is intriguing ranging from single gene event (ie, EXT mutation in multiple osteochondromas) to heterogeneous rearrangements with no recurrent involved chromosomal regions such as in chondroblastoma. The main genetic findings are hereby reviewed.

Chondromyxoid fibroma of the skull base: differential diagnosis and radiotherapy: two case reports and a review of the literature

Chondromyxoid fibromas are uncommon tumours mostly arising in long bones of young males. Involvement of the skull base is extremely rare. We describe two new cases of base of the skull chondromyxoid fibromas. The tumours were incompletely excised and irradiated with protons because of the high risk of complications of another surgical procedure. The rationale for proton therapy was based on the intimate relations between the tumour and the organs at risk. Skull base chondromyxoid fibroma is a very rare, slowly growing benign tumour that can cause severe disabilities due to tumour compression of critical structures. Only surgical resection has been shown to be relatively effective. We report two cases of incompletely excised lesions treated by postoperative high-dose radiation including proton therapy with no active disease and complication. Our review of the literature allows us to conclude that histological diagnosis of lesions in this site is a trap for pathologists and that radiotherapy is not contraindicated.