Spindle cell non-argyrophil carcinoma of the breast with neuroendocrine differentiation

Calcaneal chondroblastoma with pathologic fracture and recurrence

Chondroblastomas account for <2% of all bone tumors. The calcaneus is the fifth most common location of occurrence. Males in their second decade of life are most often affected, presenting with an insidious onset of localized pain, swelling, and tenderness. The finding of associated pathologic fracture has been rare. Imaging studies can aid in the formulation of the differential diagnosis and surgical plan. The definitive diagnosis requires histologic examination. Curettage and bone grafting is curative in >80% of cases. Local recurrence rates of ≤38% have been reported, most often because of inadequate resection, and have been associated with malignant conversion and metastasis. Adjuvant therapies can help minimize the incidence of local recurrence. Long-term follow-up examinations are recommended, given the protracted interval that can exist between recurrence and the potential for malignant conversion and metastasis. We present the case of a young, healthy, active male with a calcaneal chondroblastoma and associated pathologic fracture whose initial treatment consisted of curettage, hydrogen peroxide lavage, and allogeneic bone grafting. Recurrence developed at 15 months postoperatively and was treated with repeat curettage, high-speed burring, and reconstruction with steel Steinman pins and polymethylmethacrylate, resulting in no pain or recurrence at the 5-month follow-up point.

Knorpelbildende Tumoren

Primary cartilage-forming tumors of the bone are a large group among the rare bone tumors. The clinical and radiographic findings of the different entities show similar findings. Bone biopsy is still the most relevant examination in the final diagnosis of the lesion. The requirements for a correct biopsy and the main features of the macroscopic and histologic findings of cartilage tumors are presented from the viewpoint of the pathologist. Differentiation between benign enchondroma and grade I chondrosarcoma requires close interdisciplinary cooperation to avoid over-treatment and relapse. Rare low-grade malignant cartilage tumors such as clear-cell chondrosarcoma need to be diagnosed in specialized centres to arrive at the correct therapy. The morphologic features of mesenchymal chondrosarcoma, clear-cell chondrosarcoma and secondary chondrosarcoma in osteochondroma are demonstrated. The aim is to correlate the morphologic and radiographic features. The same applies to benign entities such as osteochondroma, chondroblastoma and chondromyxoid fibroma.

Metastatic chondroblastoma with elevated creatine kinase and paraneoplastic neurologic autoimmunity

A 17-year-old girl presented with chondroblastoma of the fibula and pulmonary metastases. Serum creatine kinase (CK) was elevated for a decade preoperatively and fell to near normal after tumor excision. An episode of aseptic meningitis 3 months later led to serologic detection of three antibody markers of paraneoplastic neurologic autoimmunity that in adult patients are characteristic of thymoma and lung carcinoma: muscle-type acetylcholine receptor (AChR) autoantibody (Ab), type 2 Purkinje cell cytoplasmic Ab (PCA-2), and collapsin response-mediator protein-5-IgG (CRMP-5-IgG). Locally recurrent chondroblastoma was excised 1 year later. Serum CK was elevated, CRMP-5-IgG was positive, PCA-2 was lower, and AChR Ab was undetectable. Three years after diagnosis she has stable pulmonary metastases, with elevated CK, higher PCA-2, positive CRMP-5-IgG, and undetectable AChR Ab. The association of metastatic chondroblastoma, elevated CK, and an evolving profile of paraneoplastic autoantibodies reveals a previously unrecognized immunobiologic dimension of chondroblastoma.

Primary treatment of chondroblastoma with percutaneous radio-frequency heat ablation: report of three cases

Chondroblastomas are benign cartilaginous lesions; however, intervention is necessary to stop progression and alleviate pain. The authors evaluated three patients in whom minimally invasive percutaneous radio-frequency heat ablation was used to treat pathologically proven chondroblastoma to determine whether this treatment demonstrated long-term success. The authors found that this approach may be an effective alternative to surgical intervention in some cases.