Chondromyxoid fibroma of bone

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.

Chondromyxoid Fibroma of the Iliac Bone: A Case Report with Ultrastructural Observations

Ultrastructural findings in an unusual case of chondromyxoid fibroma are reported. The tumor was located in the iliac bone of a 42-year-old woman with left hip pain of 5 years duration.

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.

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.

Chondromyxoid fibroma of the calcaneus: two case reports and literature review

Chondromyxoid fibroma occurs primarily in the long tubular bones of the lower extremity, with the foot representing the second most frequent location after the knee. This benign cartilaginous tumor of bone is currently the rarest reported neoplasm of cartilaginous origin. This mass can mimic other benign and malignant bone tumors owing to its variable histologic features. We report 2 cases of chondromyxoid fibroma of the calcaneus with varying presentations. Initially, advanced imaging studies pointed to a diagnosis of a unicameral bone cyst. Pathologic examination is difficult but can be used to differentiate this lesion from more serious conditions. A quick and accurate diagnosis of chondromyxoid fibroma can prevent unnecessary treatment that could be harmful to the patient.

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.

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.

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.

Chondromyxoid fibroma of sphenoid sinus with unusual calcifications: case report with literature review

Chondromyxoid fibroma (CMF) is a rare benign primary tumor which usually affects the metaphyses of the long bone of the lower extremities in childhood and young adults. Rarely, CMF occurs in the skull base and parasinuses, which may be difficult to distinguish from chondrosarcoma or chordoma and other tumors in the head. It is composed of chondroid, myxoid, and fibrous tissue growth in a lobular pattern, infrequently with calcifications. We report one case of CMF involving the sphenoid sinus mimicking a chondrosarcoma. The tumor mass showed calcifications on images and histology.

Chondromyxoid fibroma of rib with a novel chromosomal translocation: a report of four additional cases at unusual sites

BACKGROUND

Chondromyxoid fibromas (CMFs) are rare benign chondroid/myxoid matrix-producing tumors that occur in metaphyses of long tubular bones, and very rarely in small bones of hands and feet. Flat bone involvement is even more uncommon. Prior cytogenetic analyses have identified complex abnormalities involving chromosome 6 in the majority of cases.

METHODS

A search for CMF over an 8-year period (1999-2006) from the surgical pathology files of our institution yielded 16 cases. Four cases occurred in relatively unusual regions, three from the small bones of distal extremities and one from the rib. The rib lesion was submitted for routine cytogenetic analysis.

RESULTS

Radiographic studies revealed that all four lesions were well-defined expansile radiolucent lesions which expanded the bony cortices with lobulated margins, sclerotic rim, septation, and no calcification. Morphologically, all four lesions showed typical features of CMF and had low proliferative index with Ki-67. Cytogenetic analysis on the rib lesion revealed a novel chromosomal translocation, t(1;5)(p13;p13). None of the four patients had a recurrence after a mean duration of follow-up of 24 months.

CONCLUSION

CMF originating in unusual locations should be distinguished from chondrosarcomas, especially on small biopsies, and should be included in the differential diagnosis. As previously noted in the literature, the cells can be positive for actin but unlike conventional chondroid neoplasms can be negative for S-100. To our knowledge, this is the first report describing a novel chromosomal translocation, t(1;5)(p13;p13) in CMF.

Chondromyxoid fibroma

Chondromyxoid fibroma is an uncommon benign cartilaginous tumor accounting for less than 1% of all bone tumors. The classic site of involvement is the metaphyseal region of long tubular bones, usually presenting in the second to third decades of life with nonspecific pain and swelling of the affected part. This case is an interesting incidental finding in a juvenile hallux abductovalgus deformity with no prodrome, eccentrically located in the diaphysis of the first metatarsal. Early detection and complete surgical resection are valuable in preventing recurrence in the affected bone. ACFAS Level of Clinical Evidence: 4.

Chondromyxoid fibroma of the calcaneus

Chondromyxoid fibroma is a rare, benign, aggressive bone tumor whose localization in the calcaneus is even rarer. We report a case of chondromyxoid fibroma in the calcaneus of a 10-year-old Iranian boy who was treated with extended curettage. After 3 years of follow-up, the patient had experienced no recurrence.

[Chondromyxoid fibroma. A case report of location in the phalanx of the thumb]

Chondromyxoid Fibroma is a rare benign osseous tumor especially in the hand, because the hand represents less than 3% of all osseous locations. It can causes problems of differential diagnosis with several types of tumors and in particular with chondrosarcoma, for which the management is totally different. We report a case of location of a chondromyxoid fibroma in a phalanx of the thumb, which caused problems of differential diagnosis with chondroma and chondrosarcoma. There were 2 recurrences after local excision. A wide resection with massive cancellous aotograft prevented further recurrence and the patient is disease free with a follow up of 7.5 years.

Spinal chondromyxoid fibroma of C2

Chondromyxoid fibroma of bone (CMF) is a rare benign primary bone neoplasm accounting for less than 0.5% of all primary bone neoplasms. The spine is an uncommon site for this tumour, with forty-two cases reported in the modern English literature. They have clinical features similar to CMF arising at other sites. Local recurrence is well documented. We report an incidentally discovered lytic lesion of the C2 vertebra. The patient underwent stereotactic CT guided trans-oral curettage of the lesion with iliac bone graft and anterior fusion of C2 and C3. Microscopic examination of the surgical specimen demonstrated CMF. This is the second reported case of this rare tumour in this location. We review the literature and the unique radiological and pathological features and management of spinal CMF. Local recurrence of spinal CMF and its management is also discussed in light of the five previously reported cases of local spinal recurrence.

Periosteal chondromyxoid fibroma: A case study using imprint cytology

Bone surface is an exceptional location for chondromyxoid fibroma. Only 14 cases of juxtacortical chondromyxoid fibroma have been reported to date and, to our knowledge, none of these cases are documented with imprint cytology. We report a case of periosteal chondromyxoid fibroma located in the distal tibial metaphysis of a 4-yr-old boy. The clinical diagnosis was metaphyseal fibrous defect. Cytologic examination revealed a mixoid matrix, with stellate and spindle-shaped cells seen singly, focus of chondroid material, and epithelioid cells. Multinucleate giant cells were not seen. The diagnosis of periosteal chondromyxoid fibroma can be made by fine-needle aspiration or imprint cytology with clinico-radiologic correlation.

Chest wall tumors: radiologic findings and pathologic correlation: part 1. Benign tumors

Benign chest wall tumors are uncommon lesions that originate from blood vessels, nerves, bone, cartilage, or fat. Chest radiography is an important technique for evaluation of such tumors, especially those that originate from bone, because it can depict mineralization and thus indicate the diagnosis. Computed tomography (CT) and magnetic resonance (MR) imaging are helpful in further delineating the location and extent of the tumor and in identifying tumor tissues and types. Although the radiologic manifestations of benign and malignant chest wall tumors frequently overlap, differences in characteristic location and appearance occasionally allow a differential diagnosis to be made with confidence. Such features include the presence of mature fat tissue with little or no septation (lipoma), the presence of phleboliths and characteristic vascular enhancement (cavernous hemangioma), evidence of neural origin combined with a targetlike appearance on MR images (neurofibroma), well-defined continuity of cortical and medullary bone with the site of origin (osteochondroma), or fusiform expansion and ground-glass matrix (fibrous dysplasia). Both aneurysmal bone cysts and giant cell tumors typically manifest as expansile osteolytic lesions and occasionally show fluid-fluid levels suggestive of diagnosis.

Chondromyxoid fibroma of the cervical spine: case report

OBJECTIVE AND IMPORTANCE

The clinical, pathological, and imaging findings in a patient with a chondromyxoid fibroma involving the C2 vertebra are reported. Seven cases that involve the cervical spine have previously been reported in the literature; the posterior vertebral body and posterior elements are the most frequently involved. To our knowledge, this is the first reported case of C2 involvement and craniocervical instability.

CLINICAL PRESENTATION

A 20-year-old man presented with intermittent neck pain resulting from a fall 4 years earlier. X-rays and magnetic resonance imaging demonstrated a lytic lesion in the body of C2, as well as instability at C1-C2.

INTERVENTION

Preoperative transcatheter angiography and embolization were performed. An expansile tumor of the C2 vertebral body was resected via a transoral approach. Because of craniocervical instability, fusion from the occiput to posterior elements of C1 through C4 was performed.

CONCLUSION

Chondromyxoid fibroma is a rare benign bone tumor that is uncommonly found in the spine and may mimic other lesions, particularly radiographically. We report the first known involvement of C2 by this tumor in the modern English-language literature. The patient has had excellent clinical and radiographic resolution of the prior instability with no neck pain, instability, or local recurrence.

Chondromyxoid fibroma of the nasal bone with extension into the frontal and ethmoidal sinuses: report of one case and a review of the literature

Chondromyxoid fibroma is a rare benign tumor that usually occurs in the long bones. A 50-year-old patient presented with chondromyxoid fibroma of the nasal bone with extension into the frontal and ethmoidal sinuses. This is the fourth case reported to date in the literature. The clinical manifestations of the tumor were very limited, and the appearance at rhinoscopy was misleading. Radiologic imaging showed a soft tissue lesion invading the adjacent bony structures and the dura mater. Surgery was performed by a combined team of otorhinolaryngologists and neurosurgeons, and total excision of the tumor was achieved. The histologic diagnosis of this tumor is difficult because of its similarities to chondrosarcoma. [Editorial comment: The authors concisely review management of this rare tumor, emphasizing that complete surgical excision, rather than curettage, is required for long term control.]

Chondromyxoid fibroma of the distal phalanx of the great toe: a tumor with unusual histological findings

Chondromyxoid fibroma (CMF) rarely arises in the distal phalanx of the foot and less than 20 cases have been reported in the literature. It has also been known to show a wide spectrum of histology mimicking other primary bone tumors. An unusual case of CMF arising in the distal phalanx of the left great toe is reported because of its unique anatomic site of origin and histology. A 53-year-old female presented with a slow growing, painful great toe of the left foot which she had had for 3 years. She had first noticed the mass 25 years ago. On admission, plain X-ray revealed an osteolytic mass with a sclerotic margin expanding to the distal phalanx of the great toe. Interestingly, the lesion was microscopically composed of hypercellular chondromyxoid lobules separated by hypocellular fibrous tissue, which is in contrast to the typical histology of CMF. In addition, the lesion showed an aggregate of tumor cells with pleomorphic multinucleate or giant nuclei within the chondromyxoid matrix, which were not similar to the osteoclast-like type. Perhaps these unusual histological findings may be associated with its long duration and presenting location.

Chondromyxoid fibroma of the ala of the sacrum presenting as a cause of lumbar pain in an adolescent

We report a case of chondromyxoid fibroma of the ala of the sacrum: its presentation, diagnosis, treatment, and resolution. Although this tumor is admittedly rare, our case demonstrates the need for careful evaluation of pack pain in an adolescent.

Fibroma condromixóide da coluna torácica: Relato de caso e revisão da literatura

Os autores relatam caso de compressão medular torácica por lesão da quinta articulação costovertebral à direita. O diagnóstico pré-operatório, com mielotomografia, foi de processo expansivo intrarraquidiano extradural ao nível de T5. Feita a abordagem cirúrgica por laminectomia, com ressecção apenas da lesão intrarraquidiana. O diagnóstico de fibroma condromixóide somente foi definido com o estudo histopatológico. A paciente teve importante melhora neurológica. Decidiu-se pelo acompanhamento clínico e radiológico. Após dois anos houve recidiva do processo para dentro do canal raquidiano. Desta vez, foi realizada abordagem posterolateral à direita, por costotransversectomia e retirada da lesão. O diagnóstico histopatológico foi o mesmo. A paciente evoluiu com melhora neurológica e está sendo feito o seguimento há dois anos. Chamamos a atenção para a raridade do caso e discutimos a conduta.

Chondromyxoid fibroma of the nasal bone with extension into the frontal and ethmoidal sinuses

Chondromyxoid fibroma is a rare benign tumour whose histological appearance may easily be misinterpreted as chondrosarcoma. It has a tendency to recur locally unless completely excised. A rare case of the tumour affecting the nasal bone with extension into the frontal and ethmoidal sinuses and impingement on the cribiform plate is presented. Complete excision was achieved by the craniofacial resection approach.

Unusual presentation of a chondromyxoid fibroma of the mandible. Report of a case and review of the literature

Chondromyxoid fibromas are uncommon central bone tumors that are most often found at the proximal metaphyses of long bones. Chrondromyxoid fibromas of the jaws are very rare with only 18 reported cases in the literature. This article reports on a recurrent chondromyxoid fibromas of the mandible in a 10-year-old boy. In addition, a literature review of the clinical and histologic features, as well as the diagnostic pitfalls and recommended modalities of treatment are presented.

Chondromyxoid fibroma: a fine-needle aspiration diagnosis

A 25-yr-old female presented with a slowly progressive swelling, occurring over an 8-yr period, in the right lower leg. The swelling was tender and fixed to the underlying bone. Clinical and radiological diagnosis was giant cell tumor (GCT) of the bone. Aspiration cytology smears were cellular showing an admixture of chondroid, stellate, and fibrocytic cells against a chondroid background. On cytomorphology, a diagnosis of chondromyxoid fibroma (CMF) was made. It was confirmed on histologic examination.

Case report 713. Chondromyxoid fibroma of the third metatarsal

In the case presented, the imaging features are those of an aggressive benign or less aggressive malignant lesion. The differential diagnosis radiographically included aneurysmal bone cyst with or without an accompanying lesion, giant cell tumor synovial sarcoma, and other mesenchymal sarcomas. Indeed, at times it is difficult to be certain whether the process originated in the bone or soft tissue. Pathological examination of the resected specimen showed the typical features of chondromyxoid fibroma. Grossly, the tumor was well demarcated and firm and composed of tan, translucent tissue that destroyed cortex but was confirmed by periosteum. Histologically, the tumor consisted of myxoid, chondroid, and fibrous elements. The tumor lobules were composed of predominately myxoid matrix containing stellate cells. Variable chondroid elements were present with immature appearing chondrocytes, containing eosinophilic cytoplasm and irregularly shaped nuclei.

Chondromyxoid fibroma of bone: thirty-six cases with clinicopathologic correlation

A series of 36 cases of chondromyxoid fibroma (CMF) of bone, a rare benign tumor that may be confused with chondrosarcoma, is presented to aid in correctly identifying and diagnosing these neoplasms. In this series, CMFs were found in patients of all age groups, with no predominance between sexes. Long bone tumors were more common in young patients, while small and flat bone lesions were more common in older patients. Radiographically, long, flat, and small bone lesions were well-defined and benign-appearing. Tumors in the vertebrae had a more aggressive appearance, with marked bone destruction. The histologic picture was of a pseudolobulated tumor with myxoid and chondroid regions. Tumor cells were at times bizarre, pleomorphic, and binucleate, but rarely contained mitoses. Curettage with or without bone grafting and en bloc resection were the most common modes of treatment. The majority of recurrences were seen in patients treated by curettage alone. Radiation therapy was associated with the development of sarcoma in one case. No cases of malignant transformation were found in this series, but unusually aggressive recurrences were noted in CMFs involving a phalanx, the cervical vertebra, and the sacrum.

Solitary lucent epiphyseal lesions in children

We evaluated retrospectively the varying radiographic appearances of 15 solitary lucent epiphyseal lesions occurring in children. Imaging modalities used included plain films, conventional tomography, nuclear scintigraphy, and computed tomography. Forty percent of the lesions (6) were due to osteomyelitis. The remaining lesions included tuberculosis (1), foreign body granuloma (1), chondroblastoma (2), chondromyxoid fibroma (1), enchondroma (1), osteoid osteoma (2), and eosinophilic granuloma (1). Although the radiographic appearances of such lesions may be particularly characteristic, pathologic correlation is frequently necessary. The high incidence of osteomyelitis in our cases emphasizes its importance as a cause for a lucent epiphyseal lesion.

Parasellar chondromyxofibroma with ipsilateral total internal carotid artery occlusion

A case of parasellar chondromyxofibroma with ipsilateral total internal carotid artery occlusion is presented. Its radiological appearance and its pathological characteristics are discussed and compared with previously published reports. The rare association with total internal carotid artery occlusion is reviewed.

Chondromyxoid fibroma

A brief review of the literature concerning chondromyxoid fibroma is presented. 7 previous cases and the present case of the tumor in the jaws are described. Parallels to the extra oral lesions are drawn and in the light of previously published data, distinctive diagnostic features are discussed. The importance of close cooperation between the surgeon, the radiologist and the pathologist is stressed to avoid a misdiagnosis and radical treatment of the malignant counterpart of a rare benign tumor.

Chondromyxoid fibroma of the maxilla. Electron microscopic findings and review of the literature

A case of chondromyxoid fibroma of the anterior maxilla is presented. The light and electron microscopic appearances of this tumor are described. A review of chondromyxoid fibromas of the jaws is performed, with a discussion of the appropriate therapy.

Sacral chondromyxoid fibroma

A 15-year-old girl with a limp and weakness and wasting of the left leg, was found to have a large chondromyxoid fibroma of the sacrum. The lesion presented difficulties in diagnosis because of its unusual site, neurological presentation, large size and extensive extension into the soft tissues of the pelvis and buttock.

Chondromyxoid fibroma of bone

Chondromyxoid fibroma is a rare benign neoplasm of bone with a predominant incidence in the second and third decades of life. The commonest site is on either side of the knee joint. There is often endosteal sclerosis, well-defined scalloping and other benign features, although the cortex may be destroyed. It is commonly eccentric and rarely shows radiological evidence of calcification. The radiological features of 31 histologically confirmed cases are described and the literature is reviewed. Chondromyxoid fibroma may be mistaken radiologically for other lesions, particularly when it does not occur in a characteristic site; the differential diagnosis is discussed.

Chondromyxoid fibroma of the jaws

A new case of chondromyxoid fibroma of the jaws is reported, and the current world literature on chondromyxoid fibroma is reviewed. Chondromyxoid fibroma is a rare tumor arising from cartilage-forming mesenchymal tissue. In the long bones, it has frequently been confused with chondrosarcoma or benign chondroblastoma. When it occurs in the jaws, apparent confusion with myxomas of myxofibromas may result. In the jaws the neoplasm typically occurs in the mandible. Initial symptoms are pain or a slowly growing expansile mass. After evaluation of the natural history of these lesions, a conservative approach to surgical therapy is advocated.

Cranial chondromyxoid fibroma. Case report

A case of chondromyxoid fibroma of the frontal bone in a 15-year-old girl is presented. This is a benign tumor, but should be excised widely enough to include a rim of normal bone, otherwise it may recur or even undergo malignant transformation.

Chondromyxoid fibroma of the mandible. Case report

Chondromyxoid fibroma in the jaws is an extremely rare, benign tumor. The lesion is relatively more common in the long bones and mainly occurs in adolescents and young adults. The treatment of choice is local resection of the tumor. Recurrences are not uncommon, especially when curettage was the method of treatment. Differentiation from chondrosarcoma is mandatory as treatment and prognosis are dissimilar.

Chondromyxoid fibroma of the petrygo-palatine space

A patient who for five years had obstinate unilateral facial pain, difficult to interpret, was found to have an expanding process in the left retromaxillary space. Histological examination of a biopsy specimen revealed chondromyxoid fibroma. This tumour is rarely seen in the bones of the face and has never before been described in this area. The clinical and histological findings are described and discussed.