Chondroblastoma is a rare benign cartilaginous tumor typically seen in long bones, especially femur, tibia and proximal humerus. Extracortical soft tissue invasion or metastasis is rarely seen. We report here a unique case of chondroblastoma of the fibula with extracortical soft tissue invasion. Differential diagnosis on cytology is discussed. Patella, pelvis, fibula, small bones of hands and feet, ribs, skull, mandible, maxillae, vertebrae, scapulae and sternum are considered as atypical localizations.
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Chondroblastoma is a rare benign cartilaginous tumor typically seen in long bones, especially femur, tibia and proximal humerus. Extracortical soft tissue invasion or metastasis is rarely seen. We report here a unique case of chondroblastoma of the fibula with extracortical soft tissue invasion.
Differential diagnosis on cytology is discussed. Patella, pelvis, fibula, small bones of hands and feet, ribs, skull, mandible, maxillae, vertebrae, scapulae and sternum are considered as atypical localizations. Although fine needle aspiration cytology FNAC is gaining acceptance as very convenient and reliable method for the rapid diagnosis of bone lesions, very few cases of chondroblastoma diagnosed on cytology have been reported in the literature.
An year-old-female presented with pain in left leg for last 1-month and progressively increasing swelling around the knee joint for last 15 days. There was no history of trauma. On examination, the patient had restricted left knee joint movements with tenderness. Radiograph showed a lytic lesion in the head and upper shaft of the fibula. Various investigations like routine blood and urine examination, serum acid and alkaline phosphatase, serum calcium and phosphorus were within normal limits.
Magnetic resonance imaging of leg showed abnormal marrow infiltration in medullary cavity of head and upper shaft of fibula hypo-intense on T1-weighted T2-weighted sequences and hypo-to hyper-intense on short tau inversion recovery STIR sequence, the vertical length being 8 cm approximately. There was cortical destruction with extra-osseous extension of abnormal marrow signals abutting soft tissue and musculature namely peroneal, extensor digitorum longus, flexor hallucis longus, tibialis anterior and posterior, and soleus muscle.
The extra-osseous component was large and measured 7. Tibialis anterior vessels and deep peroneal nerve were encased. Tibia and femur were normal [ Figure 1 ]. Magnetic resonance imaging knee joint short tau inversion recovery Coronal reveals abnormal hyperintense medullary marrow signal in the head of fibula epiphysis extending inferiorly into upper shaft of the fibula.
There is associated cortical destruction with sotissue components. The FNAC smears, stained with giemsa stain, showed neoplastic mononucleated and binucleated chondroblasts, multinucleated osteoclast-like giant cells, and chondromyxoid matrix fragments representing early cartilage in hemorrhagic background.
The chondroblasts were distributed singly in smears, had round to oval nuclei with indentation and lobulation, and fine evenly distributed chromatin. Their cytoplasm was dense with rounded well-defined borders. Many binucleated forms were also present along with multinucleated osteoclast-like giant cells. Characteristic magenta colored fragments of chondroid matrix were seen [ Figure 2b ].
Diagnosis of chondroblastoma was made on cytology. Subsequent intralesional curetting was done with bone autografting. Histopathology revealed tumor composed of sheets of polyhedral chondroblasts with round to ovoid, indented and lobulated nuclei and thick sharply defined cell membrane. At places, multinucleated giant cells were seen.
Thin network chicken-wire like to dense obvious deposits of calcification was evident. Histopathology confirmed the diagnosis of chondroblastoma. There was no recurrence observed on 2-year follow-up of the case. The histological diagnosis of typical chondroblastoma is not difficult due to their characteristic appearance with rounded or polygonal chondroblasts, multinucleated giant cells and eosinophilic chondroid extracellular matrix with focal chicken-wire calcification.
Although aspiration cytology is very convenient and reliable method for the rapid diagnosis of bone lesions, the failure rate is high. High failure rate of aspiration cytology in bone tumors is mainly due to the hardness and fibrous nature of the tumors and if they are guarded by thick cortex leading to difficulty in piercing the needle.
Many times, chondroblastoma is mistaken as giant cell tumor on aspiration cytology. FNAC of giant cell tumor also shows two population of cells; dominant histiocytoid mononuclear cells and multinucleated giant cells.
Presence of chondroid matrix is believed to be the decisive feature to differentiate chondroblastoma from giant cell tumor, which is seen better in Giemsa-stained smears than in Papanicolaou-stained smears. Another entity to differentiate from chondroblastoma is Langerhan's cell histiocytosis LCH. Cytologically histiocytes of LCH are like chondroblasts of chondroblastoma but not associated with any type of matrix production.
Fine needle aspiration cytology provides a simple, quick, easy and reliable method of preoperative diagnosis of chondroblastoma and can be used as a substitute of surgical biopsy. The cytologic features of the chondroblasts and chondroid matrix are the diagnostic hallmarks of chondroblastoma. Source of Support: Nil. Conflict of Interest: None declared.
National Center for Biotechnology Information , U. Journal List J Cytol v. J Cytol. Kamal Malukani , Shirish S. Nandedkar , Prashant Yeshwante , and Preeti Rihal. Shirish S. Author information Copyright and License information Disclaimer. Address for correspondence: Dr. E-mail: moc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3. Abstract Chondroblastoma is a rare benign cartilaginous tumor typically seen in long bones, especially femur, tibia and proximal humerus.
Keywords: Bone tumor, chondroblastoma, fibula, fine needle aspiration cytology. Case Report An year-old-female presented with pain in left leg for last 1-month and progressively increasing swelling around the knee joint for last 15 days.
Open in a separate window. Figure 1. Figure 2. Conclusion Fine needle aspiration cytology provides a simple, quick, easy and reliable method of preoperative diagnosis of chondroblastoma and can be used as a substitute of surgical biopsy. References 1. Aggressive scapular chondroblastoma with secondary metastasis: A case report and review of literature.
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Am J Pathol. BMC Musculoskelet Disord. Coleman SS. Benign chondroblastoma with recurrent soft-tissue and intra-articular lesions. J Bone Joint Surg Am. Fine needle aspiration cytology in the management of tumors and tumor like lesions of bone. JK Sci. Chondrobastoma in fine needle aspirates. Arch Putti Chir Organi Mov. Benign and malignant cartilage tumors of bone and joint: Their anatomic and theoretical basis with an emphasis on radiology, pathology and clinical biology.
The intramedullary cartilage tumors. Skeletal Radiol. Ultrastructure of cartilaginous tumors and S protein in the tumors. With reference to the histogenesis of chondroblastoma, chondromyxoid fibroma and mesenchymal chondrosarcoma.
Fine needle aspiration cytology of chondroblastoma of the fibula
Click here to learn What's New at our website. Page views in 11, Cite this page: Pernick N. Accessed June 4th, Rare Painful, often causes joint effusions and restricts joint mobility Sites: distal femur, proximal humerus, proximal tibia, pelvis, ribs, feet, scapula; usually epiphysis open or apophysis such as iliac crest; may extend into metaphysis; also skull in older patients Course: usually benign, but commonly recurs often with atypia , rarely invades locally; rarely pulmonary metastases occur after surgical manipulation of primary tumor; patients survive after removal of localized metastases but not if multiple. Radiology description. Extremely well circumscribed tumor of epiphysis with spotty calcifications in patient with open epiphysis.
Chondroblastoma is an uncommon benign cartilage producing neoplasm with a characteristic epiphyseal location. This report documents the cytological features of two cases of chondroblastomas diagnosed by cytology. One of the two cases had an unusual location in the temporomandibular region and the other was located in the epi-metaphyseal region of the right humerus. Smears characteristically revealed chondroblasts and osteoclast-like giant cells. The cytologic diagnosis of chondroblastoma was confirmed on both cases by histopathology. The radiologic appearance and differential diagnosis in both cases are discussed. Kilpatrick SE, Romeo S.