Chondroblastoma: Difference between revisions

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== Medical Management (current best evidence)  ==
== Medical Management (current best evidence)  ==


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Most patients undergo curettage and bone grafting surgery when the tumor is present, high speed burring can also be included in the surgery5. Other treatments vary in the type of replacement after the curettage. These types of fillings can include polymethylmethacrylate, and fat implantation. Long term follow-up is needed because of the tumors ability for late recurrence3. <br>
 
Radiofrequency ablation is also used to treat this type of tumor. According to the Mayo Clinic radiofrequency ablation is a treatment in which the doctor inserts a thin needle through the skin and into the tumor, guided by imaging techniques. High-frequency electrical energy delivered through this needle heats and destroys the tumor. Months after the procedure, dead cells turn into a harmless scar.<br>


== Physical Therapy Management (current best evidence)  ==
== Physical Therapy Management (current best evidence)  ==

Revision as of 23:12, 4 April 2012

Welcome to PT 635 Pathophysiology of Complex Patient Problems This is a wiki created by and for the students in the School of Physical Therapy at Bellarmine University in Louisville KY. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Original Editors - Drew Cecil & Chance Chadwick from Bellarmine University's Pathophysiology of Complex Patient Problems project.

Lead Editors - Your name will be added here if you are a lead editor on this page.  Read more.

Definition/Description[edit | edit source]

Chondroblastoma refers to a benign bony tumor that is caused by the rapid division of chondroblast cells which are found in the epiphysis of long bones. They have been described as calcified chondromatous giant cell tumors1. The most frequently involved body regions are the hip, knee, and shoulder. Although usually benign, chondroblastoma metastasizes on rare occasions, with fatal results3.

Prevalence[edit | edit source]

Chondroblastoma is a relatively rare, benign cartilaginous tumor, accounting for approximately 1% of the benign tumors of bone. The peak incidence is in the second decade of life and is slightly more common in males than females. In addition to long bones, chondroblastoma also occurs in the acetabular region of the pelvis, scapula, spine, and ribs. It can also occur in the patella, tarsal bones, and occasionally in craniofacial bones.

Metaphyseal origin is rare but has been reported. Rare cases of multifocal chondroblastoma with synchronous involvement of several typical sites have also been documented. A small number of cases have reported chondroblastomas that are exclusively found in soft tissue2.

Recurrence of the tumor happens in about 20% of cases, and seems to depend on the location of the initial tumor and the surgical intervention selected to treat it6. Recurrence is most common in tumors of the hip and lumbar spine6.

Characteristics/Clinical Presentation[edit | edit source]

Clinically, patients present with the following signs and symptoms in early stages of tumor development4:

  • Pain
  • Swelling around the joint
  • Limited range of motion secondary to pain 
  • Palpable mass at the sight of the lesion
  • Antalgic gait patterns secondary to pain and decreased range of motion3


In later stages of tumor development the following signs and symptoms may become evident:

  • Synovitis
  • Joint effusion
  • Periostitis


Histologically, the tumour is built up of round or polygonal chondroblasts surrounded by reticulin fibers. The matrix is pinkstained chondroid, with occasional focal calcification. Scattered osteoclast-type multi-nucleated cells are often present4. Dystrophic (chicken-wire) calcification is occasionally present but is not necessary for a diagnosis5.

Associated Co-morbidities[edit | edit source]

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Medications[edit | edit source]

There is currently no evidence that supports the pharmacological management of chondroblastoma. Over the counter medications such as nonsteroidal anti-inflammatory drugs (Ibuprofen) and acetaminophen (Tylenol) are commonly used for the management of pain as needed.

Diagnostic Tests/Lab Tests/Lab Values[edit | edit source]

Radiographic Imaging
The appearance of chondroblastomas in radiographic imaging are reflected by the benign, slow-growing nature of the lesions. They are usually revealed as round or oval, lucent lesions with sharply marginated borders. Radiographs may also be useful in differentiating chondroblastoma from other benign bony tumors when periostitis is present.7

Computed Tomography
CT scanning is rarely used as a diagnostic tool in patients with chondroblastoma. This imaging modality is usually reserved for more severe or recurrent tumors. CT scans can depict matrix mineralization, extension of the tumor into soft tissue, and erosion of cortical bone. Coronal and sagittal reconstructions can be used to assess extension of the tumor across the epiphyseal plate into the metaphysis of the bone.

Magnetic Resonance Imaging
MRI can be useful in depicting the extent of the tumor when a chondroblastoma extends to the metaphysis of long bones. The stroma of the bony tumor provides a low signal intensity on T1-weighted images and variable signal intensity on T2-weighted images. The signal intensities of other bony tumors (endochondromas, osteochondromas, etc.) tend to be very high in T2 weighted images, a characteristic that is not seen in chondroblastomas. In some cases, MRI and radiographic images may have contradicting results. In this situation, the diagnosis of chondroblastoma should be made based off of radiographic images.

Nuclear Imaging
Nuclear imaging involves the uptake of a radionuclide agent that is absorbed by the bone. This type of imaging has proven to be useful as the agent is absorbed by the highly vascularized area surrounding the tumor. Nuclear imaging is not typically used to diagnose chondroblastoma, rather, it can be used to rule in other bony tumors that are typically multifocal in nature such as endochondromas and osteochondromas.

Angiography
Angiography is not typically used as a diagnostic intervention, however, it can be useful in planning for surgical removal of the tumor. Angiograms rarely reveal any serious vascular abnormality, but there have been reports of vascular displacement in cases where large tumors are present. Periosteal reactions and neovascularization of nearby cortical bone have been reported in some angiographic imaging cases.

Biopsy
In cases that appear to be atypical upon imaging, a needle or incisional biopsy of the tumor may be required before further surgical intervention can take place.

Etiology/Causes[edit | edit source]

Chondroblastomas occur when a single chondroblast cell begins to divide at an abnormally high rate. This typically occurs in the epiphyseal region of long bones. The cause of the high rate of cell division is unknown. There is currently no evidence that links chondroblastoma to a faulty or abnormal gene. Chondroblastoma has also been found to have no association with repeated joint trauma.

Systemic Involvement[edit | edit source]

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Medical Management (current best evidence)[edit | edit source]

Most patients undergo curettage and bone grafting surgery when the tumor is present, high speed burring can also be included in the surgery5. Other treatments vary in the type of replacement after the curettage. These types of fillings can include polymethylmethacrylate, and fat implantation. Long term follow-up is needed because of the tumors ability for late recurrence3.

Radiofrequency ablation is also used to treat this type of tumor. According to the Mayo Clinic radiofrequency ablation is a treatment in which the doctor inserts a thin needle through the skin and into the tumor, guided by imaging techniques. High-frequency electrical energy delivered through this needle heats and destroys the tumor. Months after the procedure, dead cells turn into a harmless scar.

Physical Therapy Management (current best evidence)[edit | edit source]

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Alternative/Holistic Management (current best evidence)[edit | edit source]

There is currently no evidence related to alternative or holistic approaches in the management of chondroblastoma.

Differential Diagnosis[edit | edit source]

Differential diagnosis is important for both the physician and the physical therapist. The physician must differentiate between different bony tumor disease processes using appropriate imaging and histological findings. The physical therapist, especially in a direct access situation, must be able to rule out articular or soft tissue injuries in order to refer the patient to the proper practitioner. Below, is a list of possible differential diagnoses seen with chondroblastoma:


  • Giant cell tumor
  • Chondrosarcoma
  • Endochondroma
  • Osteochondroma
  • Osteoarthritis
  • Rheumatoid Arthritis
  • Juvenile Rheumatoid Arthritis
  • Periarticular Soft Tissue Injury

Case Reports/ Case Studies[edit | edit source]

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Resources
[edit | edit source]

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Recent Related Research (from Pubmed)[edit | edit source]

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References[edit | edit source]

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