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Gowda PC, Dunlap RH, Ahlawat S, Gross JM, Morris CD, Lyons GR. Recurrent chondromyxoid fibroma of the distal femur treated with percutaneous cryoablation. Skeletal Radiol 2023; 52:2497-2501. [PMID: 37544967 DOI: 10.1007/s00256-023-04414-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/28/2023] [Accepted: 07/24/2023] [Indexed: 08/08/2023]
Abstract
Chondromyxoid fibroma is a rare, benign tumor of the bone with excellent prognosis but a high rate of recurrence. We report a patient presenting with pain and a history of chondromyxoid fibroma of the distal left femur previously treated with multiple prior curettage and bone graft procedures. Magnetic resonance imaging and histopathology indicated a recurrence of tumor. Due to the small size of the tumor recurrence and challenges associated with prior open surgery, the patient underwent cryoablation of the lesion with computed tomography guidance. Follow-up 18 months later indicated a resolution of pain and improvement on magnetic resonance imaging, and no concerns after 20 months. To our knowledge, this is the first reported case of chondromyxoid fibroma treated with cryoablation. This case suggests cryoablation could be considered in the setting of recurrent chondromyxoid fibroma for local tumor control.
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Affiliation(s)
- Prateek C Gowda
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Interventional Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Robert H Dunlap
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Interventional Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Shivani Ahlawat
- Division of Musculoskeletal Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - John M Gross
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Carol D Morris
- Department of Orthopedic Surgery, Memorial-Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Gray R Lyons
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Interventional Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
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2
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Gómez-León N, Galán-González I, Moreno-Casado MJ, Benavides-de-Quirós C, Muñoz-Hernández P, Fernández-Rico P, Rodríguez-Laval V. Chondroid Tumors: Review of Salient Imaging Features and Update on the WHO Classification. Curr Probl Diagn Radiol 2023; 52:197-211. [PMID: 36797102 DOI: 10.1067/j.cpradiol.2023.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 11/17/2022] [Accepted: 01/18/2023] [Indexed: 01/26/2023]
Abstract
Chondrogenic tumors are typically well recognized on radiographs, but differentiation between benign and malignant cartilaginous lesions can be difficult both for the radiologist and for the pathologist. Diagnosis is based on a combination of clinical, radiological and histological findings. While treatment of benign lesions does not require surgery, the only curative treatment for chondrosarcoma is resection. This article (1) emphasizes the update of the WHO classification and its diagnostic and clinical effects; (2) describes the imaging features of the various types of cartilaginous tumors, highlighting findings that can help differentiate benign from malignant lesions; (3) presents differential diagnoses; and (4) provides pathologic correlation. We attempt to offer valuable clues in the approach to this vast entity.
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Affiliation(s)
- Nieves Gómez-León
- Department of Radiology, Princesa Hospital, Autónoma University, Madrid, Spain.
| | - Itxaso Galán-González
- Department of Radiology, University Hospital La Princesa, Madrid, Spain; Health Research Institute Princesa, Autonomous University of Madrid, Madrid, Spain
| | | | - Carmen Benavides-de-Quirós
- Department of Radiology, University Hospital La Princesa, Madrid, Spain; Health Research Institute Princesa, Autonomous University of Madrid, Madrid, Spain
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3
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Lodhia J, Goodluck G, Amsi P, Mremi A. Chondromyxoid fibroma: A rare benign tumor with potential for local recurrence. SAGE Open Med Case Rep 2023; 11:2050313X231152367. [PMID: 36744057 PMCID: PMC9893065 DOI: 10.1177/2050313x231152367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 01/03/2023] [Indexed: 01/29/2023] Open
Abstract
Chondromyxoid fibroma is one of the rarest benign cartilaginous tumors accounting for less than 0.5% of bone tumors and mostly found in the metaphysis of long bones. Diagnosis is by histology showing lobular pattern with stellate-shaped cells in a myxoid or chondroid background. Often they can be misdiagnosed as chondrosarcomas. Recommended treatment approach is surgically excision due to the high risk of malignancy. Although benign, local recurrence is common as presented from this case report.
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Affiliation(s)
- Jay Lodhia
- Department of General Surgery, Kilimanjaro Christian Medical Centre, Moshi, Tanzania,Faculty of Medicine, Kilimanjaro of Christian Medical University College, Moshi, Tanzania,Jay Lodhia, Department of General Surgery, Kilimanjaro Christian Medical Centre, P.O Box 3010, Moshi, Tanzania.
| | - Gregory Goodluck
- Department of General Surgery, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Patrick Amsi
- Faculty of Medicine, Kilimanjaro of Christian Medical University College, Moshi, Tanzania,Department of Pathology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Alex Mremi
- Faculty of Medicine, Kilimanjaro of Christian Medical University College, Moshi, Tanzania,Department of Pathology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
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4
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Jadaun G, Gupta H, Kharodia S, Gadhiya V. Rapidly expanding chondromyxoid fibroma of the mandible: A case report of rare entity. J Oral Maxillofac Pathol 2023; 27:S104-S108. [PMID: 37082290 PMCID: PMC10112688 DOI: 10.4103/jomfp.jomfp_351_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 01/04/2023] [Indexed: 03/14/2023] Open
Abstract
Chondromyxoid fibroma is an unusual, benign bone tumour that is usually sited in the metaphyseal region of the long bones. It accounts for less than 1% of all bone tumours. It manifests predominantly in males in their second and third decades of life. Rarely, it occurs in the bones of the craniofacial skeleton. For small, lesions enucleation and curettage and for larger lesions, resection followed by are the treatment modalities available. Here, we present a case of chondromyxoid fibroma with respect to the right side of the mandible which was managed by surgical resection followed by reconstruction under general anaesthesia. Resection followed by reconstruction provides satisfactory outcomes, especially in cases with large lesions. Chondromyxoid fibroma is an asymptomatic, benign, slow-growing lesion but can rapidly expand and involve the greater area of bone. Thus, its detection at an early stage and treatment at the proper time can lead to less morbidity associated with the lesion and improved quality of life of the patient.
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5
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Update of pediatric bone tumors-notochordal tumors, chondrogenic tumors, and vascular tumors of the bone. Skeletal Radiol 2022; 52:1101-1117. [PMID: 36369290 DOI: 10.1007/s00256-022-04235-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/04/2022] [Accepted: 11/06/2022] [Indexed: 11/12/2022]
Abstract
There are numerous bone tumors in the pediatric population, with imaging playing an essential role in diagnosis and management. Our understanding of certain bone tumors has rapidly evolved over the past decade with advancements in next-generation genetic sequencing techniques. This increased level of understanding has altered the nomenclature, management approach, and prognosis of certain lesions. We provide a detailed update of bone tumors that occur in the pediatric population with emphasis on the recently released nomenclature provided in the 5th edition of the World Health Organization Classification of Soft Tissue and Bone Tumours. In the current manuscript, we address notochordal tumors, chondrogenic tumors, and vascular tumors of the bone.
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6
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Hesni S, Ellatif M, Khodatars D, Lindsay D, Saifuddin A. Test yourself answer to question: a 69-year-old male presented with a 20-year history of left calf swelling that began following a fall from a tree. Skeletal Radiol 2022; 51:2235-2236. [PMID: 35412063 DOI: 10.1007/s00256-022-04048-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 02/02/2023]
Affiliation(s)
- Susan Hesni
- Department of Radiology, Royal National Orthopaedic Hospital (RNOH), Stanmore, UK.
| | - Mostafa Ellatif
- Department of Radiology, Royal National Orthopaedic Hospital (RNOH), Stanmore, UK
| | - Davoud Khodatars
- Department of Radiology, Royal National Orthopaedic Hospital (RNOH), Stanmore, UK
| | - Daniel Lindsay
- Department of Histopathology, Royal National Orthopaedic Hospital (RNOH), Stanmore , UK
| | - Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital (RNOH), Stanmore, UK
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7
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Li C, Li S, Hu W. Chondromyxoid fibroma of the cervical spine: A case report. World J Clin Cases 2022; 10:5748-5755. [PMID: 35979139 PMCID: PMC9258375 DOI: 10.12998/wjcc.v10.i17.5748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 03/14/2022] [Accepted: 04/04/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chondromyxoid fibroma (CMF) is an unusual benign tumour of cartilaginous tissues that may be confused with other malignant tumours. It is rarely seen in the cervical spine.
CASE SUMMARY A 24-year-old young woman was admitted to the hospital because of neck and shoulder pain. Computed tomography, magnetic resonance imaging, X-ray and other imaging examinations of the cervical spine and laboratory-related indicators combined with intraoperative pathology revealed that the patient had cervical CMF. We performed total resection of the vertebral body and intervertebral disc, and internal fixation was performed to simultaneously maintain the stability of the entire spine. The clinical results from extensive resection were satisfactory. At the 2-year follow-up, the patient's symptoms had not recurred.
CONCLUSION CMF is a benign primary bone tumour that is rarely located in the vertebral bone. Accurate initial diagnosis of these tumours is important for appropriate treatment. En bloc surgical resection of the tumour is the cornerstone of treatment.
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Affiliation(s)
- Cheng Li
- Fifth Clinical Medical College, Guilin Medical University, Guilin 541002, Guangxi Zhuang Autonomous Region, China
| | - Sen Li
- Fifth Clinical Medical College, Guilin Medical University, Guilin 541002, Guangxi Zhuang Autonomous Region, China
| | - Wei Hu
- Fifth Clinical Medical College, Guilin Medical University, Guilin 541002, Guangxi Zhuang Autonomous Region, China
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8
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Zeinoddini A, Bezold A, Ezzeldin O, AL Jadiry H. Radiological manifestations of chondromyxoid fibroma in the zygoma: A case report and literature review. BJR Case Rep 2021; 7:20210008. [PMID: 35047203 PMCID: PMC8749392 DOI: 10.1259/bjrcr.20210008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/26/2021] [Accepted: 04/16/2021] [Indexed: 11/05/2022] Open
Abstract
Chondromyxoid fibroma (CMF) is a rare benign bone tumor of cartilaginous origin, with an extremely rare craniofacial occurrence. Considering its rarity, craniofacial CMF presents a diagnostic challenge for radiologists. To our knowledge, only seven cases of zygomatic CMF have been described in the literature, only one of which was in the paediatric age group. Furthermore, none of the currently reported cases include MRI findings of zygomatic CMF. Here, we present a paediatric case of CMF of the zygoma with a comprehensive literature review of the reported cases, focusing on their radiological features and its differential diagnosis.
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Affiliation(s)
- Atefeh Zeinoddini
- Neuroradiology Division, Department of Radiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Amy Bezold
- Neuroradiology Division, Department of Radiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Obadah Ezzeldin
- Neuroradiology Division, Department of Radiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Huda AL Jadiry
- Neuroradiology Division, Department of Radiology, University of Texas Medical Branch, Galveston, TX, USA
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9
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Jiménez AA, Prall F, Saß M, Weber MA. [Rare cause of nonspecific symptoms in the area of the right knee joint]. Radiologe 2021; 61:942-946. [PMID: 34160644 DOI: 10.1007/s00117-021-00871-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Alba Antón Jiménez
- ESOR Visiting Scholar, European School of Radiology (ESOR), Wien, Österreich.,Hospital Universitari Vall d'Hebron Barcelona, Barcelona, Spanien
| | - Friedrich Prall
- Institut für Pathologie, Universitätsmedizin Rostock, Rostock, Deutschland
| | - Marko Saß
- Klinik für Unfall- und Wiederherstellungschirurgie, Universitätsmedizin Rostock, Rostock, Deutschland
| | - Marc-André Weber
- Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland.
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10
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Al-Qassab S, Lalam R, Botchu R, Bazzocchi A. Imaging of Pediatric Bone Tumors and Tumor-like Lesions. Semin Musculoskelet Radiol 2021; 25:57-67. [PMID: 34020468 DOI: 10.1055/s-0041-1723965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
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.
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Affiliation(s)
- Sinan Al-Qassab
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, United Kingdom
| | - Radhesh Lalam
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, United Kingdom
| | - Rajesh Botchu
- The Royal Orthopaedic Hospital, Birmingham, United Kingdom
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11
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Engel H, Herget GW, Füllgraf H, Sutter R, Benndorf M, Bamberg F, Jungmann PM. Chondrogenic Bone Tumors: The Importance of Imaging Characteristics. ROFO-FORTSCHR RONTG 2020; 193:262-275. [PMID: 33152784 DOI: 10.1055/a-1288-1209] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Chondrogenic tumors are the most frequent primary bone tumors. Malignant chondrogenic tumors represent about one quarter of malignant bone tumors. Benign chondrogenic bone tumors are frequent incidental findings at imaging. Radiological parameters may be helpful for identification, characterization, and differential diagnosis. METHODS Systematic PubMed literature research. Identification and review of studies analyzing and describing imaging characteristics of chondrogenic bone tumors. RESULTS AND CONCLUSIONS The 2020 World Health Organization (WHO) classification system differentiates between benign, intermediate (locally aggressive or rarely metastasizing), and malignant chondrogenic tumors. On imaging, typical findings of differentiated chondrogenic tumors are lobulated patterns with a high signal on T2-weighted magnetic resonance imaging (MRI) and ring- and arc-like calcifications on conventional radiography and computed tomography (CT). Depending on the entity, the prevalence of this chondrogenic pattern differs. While high grade tumors may be identified due to aggressive imaging patterns, the differentiation between benign and intermediate grade chondrogenic tumors is challenging, even in an interdisciplinary approach. KEY POINTS · The WHO defines benign, intermediate, and malignant chondrogenic bone tumors. · Frequent benign tumors: osteochondroma and enchondroma; Frequent malignant tumor: conventional chondrosarcoma. · Differentiation between enchondroma versus low-grade chondrosarcoma is challenging for radiologists and pathologists. · Pain, deep scalloping, cortical destruction, bone expansion, soft tissue component: favor chondrosarcoma. · Potential malignant transformation of osteochondroma: progression after skeletal maturity, cartilage cap thickness (> 2 cm adult; > 3 cm child). · Potentially helpful advanced imaging methods: Dynamic MRI, texture analysis, FDG-PET/CT. CITATION FORMAT · Engel H, Herget GW, Füllgraf H et al. Chondrogenic Bone Tumors: The Importance of Imaging Characteristics. Fortschr Röntgenstr 2021; 193: 262 - 274.
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Affiliation(s)
- Hannes Engel
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Georg W Herget
- Department of Orthopaedics and Traumatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Hannah Füllgraf
- Institute for Surgical Pathology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Reto Sutter
- Department of Radiology, Balgrist University Hospital, Zurich, Switzerland; Faculty of Medicine, University of Zurich, Switzerland
| | - Matthias Benndorf
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Fabian Bamberg
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Pia M Jungmann
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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12
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Grewal AM, Singh M, Vishwajeet V, Thakur U, Das A, Gupta P. Primary chondromyxoid fibroma of the orbit: An orbital mass with calcification. Indian J Ophthalmol 2020; 67:2110-2113. [PMID: 31755478 PMCID: PMC6896519 DOI: 10.4103/ijo.ijo_1275_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Primary orbital chondromyxoid fibroma is a rarely reported entity. A 34-year-old lady presented with painless, non-axial proptosis of the left eye of 6 months duration. Orbital imaging showed a supero-temporal mass with calcific foci and bone erosion. The mass caused globe compression resulting in choroidal folds. Anterior orbitotomy with complete mass excision was performed. The histopathology revealed a chondromyxoid fibroma. At 12-months follow-up, the patient is doing fine with no clinical recurrence. Chondromyxoid fibroma is an important differential diagnosis for bony orbital tumors.
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Affiliation(s)
- Aditi Mehta Grewal
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manpreet Singh
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikarn Vishwajeet
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Umang Thakur
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashim Das
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Gupta
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
RATIONALE Chondromyxoid fibroma (CMF) is a rare form of benign bone tumor and easily misdiagnosed as fibrosarcoma. Hence, to explore the clinical manifestations, diagnostic tests, and therapeutic procedures for temporal bone cartilage myxoid fibroma, it is important to optimize patient treatment and avoid overtreatment. Previous research has discussed cases of CMF, but this paper presents a systematic, complete, and comprehensive introduction of this disease based on this case and related literature. PATIENT CONCERNS A 52-year-old male patient presented with pain in his right ear for 2 years and hearing loss in his right ear with tinnitus for 1 year. The patient had a history of hypertension for 9 years and it was well-controlled. DIAGNOSIS A computed tomography (CT) scan of the temporal bone showed an expansive growth on the right temporal bone plate and tympanic plate, presenting as a cloud-like ground glass opaque shadow involving the temporom and ibular joint, middle skull base, and small auditory bones. A magnetic resonance imaging (MRI) of the temporal bone showed a large and irregular soft tissue mass shadow on the right temporal bone plate. The right temporal bone plate was occupied by the lesion, consistent with a bone origin. From the results of the imaging examination of the patient, a lesion occupying the temporal bone in the right ear and mastoiditis in the right middle ear was initially diagnosed. INTERVENTIONS Right ear temporal bone tumor resection and abdominal fat extraction were conducted. OUTCOMES Postoperative pathological results demonstrated myxoid fibroma of the temporal bone cartilage. No recurrence or severe complications were observed in 8 months of follow-up. LESSONS A finding of myxoid fibroma of the temporal bone cartilage is rare in the clinic. The growth of such tumors is slow. The temporal bone CT and inner ear MRI were helpful in diagnosis. Surgery was the principal treatment.
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Affiliation(s)
- Tao Liu
- Department of Otorhinolaryngology, Affiliated Hospital of Jining Medical University
| | - Jing Yao
- Department of Pharmacology, Jining Medical University, Jining
| | - Xiaoyu Li
- Department of Otorhinolaryngology, Affiliated Hospital of Jining Medical University
| | - Xinmeng Qi
- Department of Otorhinolaryngology, Beijing Tongren Hospital
| | - Pengyun Zhao
- Department of Otolaryngology, Beijing Shuangqiao Hospital, Beijing, the People's Republic of China
| | - Zhiqiao Tan
- Department of Otorhinolaryngology, Affiliated Hospital of Jining Medical University
| | - Jie Wang
- Department of Otorhinolaryngology, Beijing Tongren Hospital
| | - Yongxin Li
- Department of Otorhinolaryngology, Beijing Tongren Hospital
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Zhong J, Si L, Geng J, Xing Y, Hu Y, Jiao Q, Zhang H, Yao W. Chondromyxoid fibroma-like osteosarcoma: a case series and literature review. BMC Musculoskelet Disord 2020; 21:53. [PMID: 31996205 PMCID: PMC6990471 DOI: 10.1186/s12891-020-3063-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 01/13/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Chondromyxoid fibroma-like osteosarcoma (CMF-OS) is an exceedingly rare subtype of low-grade central osteosarcoma (LGCO), accounting for up to 10% of cases and making it difficult to diagnose. CMF-OS is frequently misdiagnosed on a radiological examination and biopsy, even after the initial operation. Its treatment is a controversial issue due to its low-grade classification and actual high-grade behavior. CASE PRESENTATION We retrospectively reviewed the medical charts of more than 2000 osteosarcoma patients between 2008 and 2019; 11 patients with CMF-OS were identified, of which six patients were treated by our institution with complete clinical characteristics, including treatment and prognosis, radiological and pathological features were reviewed. Three males and three females with a median age of 46 (range 22-56) years were pathologically proven to have CMF-OS. The radiological presentation of CMF-OS is variable, thus radiological misdiagnoses are common. However, one must not ignore a malignant radiologic appearance. The most distinctive pathological feature conferring the diagnosis of CMF-OS is the presence of osteoid production directly by the tumor cells under a chondromyxoid fibroma (CMF)-like background. Differential diagnoses based on comprehensive data from CMF, LGCO, chondrosarcoma (CHS), conventional osteosarcoma (COS), etc., are needed. All patients were treated with an operation and chemotherapy, and one patient received additional radiotherapy. Nevertheless, recurrence and metastasis are common in CMF-OS patients. Relatively invasive biological behavior of CMF-OS is against the low-grade classification of this disease. CONCLUSIONS It is important to recognize CMF-OS and distinguish it from CMF, CHS, COS and other LGCOs. CMF-OS has a relatively poor prognosis despite its low-grade classification.
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Affiliation(s)
- Jingyu Zhong
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 Xian Xia Road, Shanghai, 200050, China
| | - Liping Si
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 Xian Xia Road, Shanghai, 200050, China
| | - Jia Geng
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yi Shan Road, Shanghai, 200233, China
| | - Yue Xing
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yi Shan Road, Shanghai, 200233, China
| | - Yangfan Hu
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yi Shan Road, Shanghai, 200233, China
| | - Qiong Jiao
- Department of Pathology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yi Shan Road, Shanghai, 200233, China
| | - Huizhen Zhang
- Department of Pathology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yi Shan Road, Shanghai, 200233, China
| | - Weiwu Yao
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 Xian Xia Road, Shanghai, 200050, China.
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15
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Zheng YM, Wang HX, Dong C. Chondromyxoid fibroma of the temporal bone: A case report and review of the literature. World J Clin Cases 2018; 6:1210-1216. [PMID: 30613685 PMCID: PMC6306630 DOI: 10.12998/wjcc.v6.i16.1210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 11/15/2018] [Accepted: 11/24/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Chondromyxoid fibroma (CMF) is a rare benign bone tumour of cartilaginous origin, which usually affects the metaphysis of the long bone. Involvement of the temporal bone is extremely rare. Patients with CMF in the temporal bone can present some neurological deficits due to involvement of surrounding neural structures.
CASE SUMMARY We present the first case of histopathologically proven CMF originating in the temporal bone and involving the hypoglossal canal in a 40-year-old woman. Hypoglossal nerve paralysis was identified on the cranial nerve examination. The patient underwent surgical excision and was neurologically normal except for mild left facial palsy on 5-mo follow-up examination after surgery. In the current report, the major characteristics and computed tomography/magnetic resonance imaging features of the lesion are discussed. Furthermore, previous literature regarding this pathology is reviewed.
CONCLUSION The current study presents the first case of temporal bone CMF involving the hypoglossal canal.
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Affiliation(s)
- Ying-Mei Zheng
- Health Examination Center, the Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - He-Xiang Wang
- Department of Radiology, the Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Cheng Dong
- Department of Radiology, the Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
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Xie BS, Zhong JW, Wang AJ, Zhang ZD, Zhu X, Guo GH. Duodenal variceal bleeding secondary to idiopathic portal hypertension treated with transjugular intra-hepatic porto-systemic shunt plus embolization: A case report. World J Clin Cases 2018; 6:1217-1222. [PMID: 30613686 PMCID: PMC6306627 DOI: 10.12998/wjcc.v6.i16.1217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/20/2018] [Accepted: 11/23/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Duodenal varices are a lesser-known complication with non-cirrhotic portal hypertension. We report a circuitous route from missed diagnosis of duodenal varices to correction. An extremely rare case of duodenal variceal bleeding secondary to idiopathic portal hypertension (IPH) is expounded in this study, which was controlled by transjugular intra-hepatic porto-systemic shunt (TIPS) plus embolization. CASE SUMMARY A 46-year-old woman with anemia for two years was frequently admitted to the local hospital. Upon examination, anemia was attributed to gastrointestinal tract bleeding, which resulted from duodenal variceal bleeding detected by repeated esophagogastroduodenoscopy. At the end of a complete workup, IPH leading to duodenal varices was diagnosed. Portal venography revealed that the remarked duodenal varices originated from the proximal superior mesenteric vein. TIPS plus embolization with coils and Histoacryl was performed to obliterate the rupture of duodenal varices. The anemia resolved, and the duodenal varices completely vanished by 2 mo after the initial operation. CONCLUSION TIPS plus embolization may be more appropriate to treat the bleeding of large duodenal varices.
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Affiliation(s)
- Bu-Shan Xie
- Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Jia-Wei Zhong
- Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - An-Jiang Wang
- Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Zhen-Dong Zhang
- Department of Pathology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Xuan Zhu
- Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Gui-Hai Guo
- Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
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Sono T, Ware AD, McCarthy EF, James AW. Chondromyxoid Fibroma of the Pelvis: Institutional Case Series With a Focus on Distinctive Features. Int J Surg Pathol 2018; 27:352-359. [PMID: 30580642 DOI: 10.1177/1066896918820446] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Chondromyxoid fibroma (CMF) is a relatively uncommon benign bone tumor of cartilaginous differentiation. The primary pitfall in the histopathologic diagnosis of CMF is confusion with a high-grade chondrosarcoma, owing to the atypical stellate and spindled cells set within a chondromyxoid background. CMF is particularly challenging to diagnose within the pelvis, where clinical suspicion for chondrosarcoma is high and benign lesions may grow to a large size to occupy the pelvic bones. In our practice, we noted this difficulty in several consecutive cases, especially when older patients presented with CMF within the pelvis. This prompted an institutional retrospective case review of all CMF within the pelvis. In 10 cases, we found overall that CMF of pelvis occurred in an older age range (mean age = 48.6 years), was larger in size (mean size = 6.0 cm), and showed a higher rate of soft tissue extension (50%) as compared with prior reports of nonpelvic CMF. Typical histologic features of CMF were seen in all cases; however, a high frequency of dystrophic calcification (50%) and necrosis (30%) was observed. Of interest, these aggregate demographic, radiologic, and histologic findings are all consistent with a benign neoplasm that has grown undetected within the pelvis over a long period of time. Recognition of these differences between pelvic CMF and tumors involving other sites will aid in avoiding misdiagnosis of this uncommon entity.
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Gholamrezanezhad A, Basques K, Kosmas C. Peering beneath the surface: Juxtacortical tumors of bone (part I). Clin Imaging 2018; 51:1-11. [PMID: 29414518 DOI: 10.1016/j.clinimag.2018.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 01/06/2018] [Accepted: 01/16/2018] [Indexed: 12/18/2022]
Abstract
Juxtacortical or surface tumors of bone are neoplasms arising from or just outside the cortex, and are composed of different histologic types. Although the imaging appearances of these lesions have similarities to their intramedullary counterparts, their location alters their radiographic and MR characteristics, creating difficulties in diagnosis. Meanwhile, several non-neoplastic lesions, such as stress reaction/stress fracture and indolent infectious processes, compound the differential diagnosis. Neoplastic juxtacortical lesions of bone have been classified into five categories: cartilaginous, fibrous, lipomatous, osseous, and metastatic tumors. Our goal in part one of this review is to illustrate the characteristic radiographic, CT and MR imaging features of various juxtacortical neoplasms, including pathognomonic imaging findings that can aid in diagnosis, and to develop an appropriate differential diagnosis for surface lesions based on imaging characteristics, lesion location and patient age.
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Affiliation(s)
- Ali Gholamrezanezhad
- Departments of Emergency Radiology and Musculoskeletal Imaging, Keck School of Medicine, University of Southern California (USC), 1520 San Pablo St, Los Angeles, CA 90033, USA.
| | - Kyle Basques
- Department of Radiology, Cleveland Medical Center, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA
| | - Christos Kosmas
- Department of Radiology, Cleveland Medical Center, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA
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