An intracortical chondromyxoid fibroma in the diaphysis of the metatarsal

Cement arthrodesis of the knee using combined intramedullary nail, plate and screws after wide excision in huge chondromyxoid fibroma of proximal tibia, a case report

Introduction and importance

Chondromyxoid fibroma is a rare benign cartilaginous neoplasm, a mixture of benign cartilage and fibrous and myxoid tissue. It usually affects young people, commonly in the second and third decades of life with male being predominant. Differential diagnosess in chondromyxoid fibroma, are giant cell tumor, bone cyst, enchondroma, osteoblastoma, and low-grade chondrosarcoma.

Case presentation

We present a case of an 18-years-old male, with chief complaint of pain on the right knee since 3 year ago with an increasing size reaching diameter of 55 cm within three years. The radiograph and MRI revealed lytic blastic expansile multiloculated lesion, with wide transitional zone, and periosteal reaction on the epymetadiaphyseal part of right proximal tibia. The surgical procedure was performed consist of wide excision, reconstruction by cement knee arthrodesis using Kuntscher-nail, dynamic compression plate, bone cement and gastrocnemius flap.

Clinical discussion

After 3 months of surgery follow-up, there was no sign of recurrence, the patient walked partially weight bearing with a crutch. In 1 years post operative follow up, the Muscukoskeletal Tumor Society Scoring (MSTS) was 80%. There was no sign of recurrence.

Conclusion

In cases with large tumor size, wide excision with bone and soft tissue reconstructive surgery is required as mechanical and biological reconstruction. The cement arthrodesis provides a faster duration of surgery, lower risk of infection, and good functional outcome.

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Chondromyxoid fibroma is a rare benign cartilaginous neoplasm, mixture of benign cartilage and fibrous and myxoid tissue

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There are no specific recommendation in management of chondromyxoid fibroma due to limited published article with chondromyxoid fibroma.

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The mechanical and biological reconstruction are very important during reconstructive surgery.

Juxtacortical chondromyxoid fibroma in the small bones: two cases with unusual location and a literature review

Chondromyxoid fibroma is a rare bone tumor of cartilaginous origin, representing less than 1% of all bone tumors. It preferentially arises in the eccentric location of the metaphysis of a long tubular bone. Juxtacortical locations are reported infrequently in the long bones and even more rarely in short tubular bones, with only three cases documented. Here we present two new cases of juxtacortical chondromyxoid fibroma in the small bones. One was an intracortical osteolytic lesion of the metatarsal bone of the foot with degenerative atypia that histologically should be differentiated from chondrosarcoma. The other was a phalangeal mass protruding into the interphalangeal joint of the hand, which had been labeled mistakenly as a soft tissue mass preoperatively. These cases illustrated that chondromyxoid fibromas have various the manifestations and should be included in the differential diagnosis of an osteolytic lesion or an exophytic mass in the small bones.

Imaging of Pediatric Bone Tumors and Tumor-like Lesions

Bone lesions are commonly seen when reporting pediatric skeletal imaging. Distinguishing aggressive from nonaggressive lesions is essential in making the diagnosis. Not all aggressive lesions are neoplastic; indeed, osteomyelitis frequently presents with aggressive appearances and is far more commonly seen in the pediatric population than neoplastic lesions. In this article, we discuss an approach for the diagnosis of pediatric bone tumors and tumor-like conditions. The most common pediatric benign and malignant bone tumors are discussed in more detail.

Subperiosteal chondromyxoid fibroma: a rare case involving the humeral diaphysis

Initially described, in 1948, as a tumor that could be mistaken with chondrosarcoma at histopathology, chondromyxoid fibroma is now a well-recognized entity. Surface-type chondromyxoid fibroma, however, remains an extremely rare occurrence. We present a case of a 55-year-old woman, who experienced right arm pain for 5 years. After unsuccessful treatment for presumed thoracic outlet syndrome, MRI revealed a large mass abutting the anteromedial cortex of the distal humeral diaphysis in a subperiosteal location. Further characterization was made with radiography, CT, and bone scan, which were followed by ultrasound-guided biopsy. Although histopathologic features were suggestive of chondromyxoid fibroma, the diagnosis remained somewhat uncertain initially due to the very unusual location involving the diaphysis of the humerus. Surgical resection was performed, and subsequent histopathologic analysis confirmed the diagnosis of chondromyxoid fibroma. Despite being a rare entity, surface-type chondromyxoid fibroma would need to be considered in the differential when dealing with expansile surface diaphyseal lesions.

Surface-type chondromyxoid fibroma in an elderly patient: a case report and literature review

Chondromyxoid fibroma (CMF) is a rare benign bone neoplasm that typically occurs in young adults. Juxtacortical or surface-type CMF are rarer still and we present the case of a surface-type CMF in a 78-year-old woman, with only one other case described in a patient of a similar age previously. This patient was an otherwise healthy woman who presented for evaluation of a palpable lump in the anterior proximal tibia. Initial radiographs obtained demonstrated a focal soft tissue fullness immediately anterior to the anterior cortex of the proximal tibia, which contained faint chondroid-like matrix internally. There was associated scalloping of the anterior tibial cortex. MRI confirmed the presence of a juxtacortical, enhancing lesion. Subsequent excisional biopsy was performed and histopathology demonstrated features, which was consistent with surface-type CMF. At a 6-month follow-up the patient remained free of recurrence. In a patient of this age, paraosteal chondrosarcoma should be excluded. Surface-type CMF, although rare, has been described in older patients and while it is unlikely to feature in a list of differential considerations on initial imaging, awareness of the entity is important.