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Chondroblastoma is a benign cartilage-forming neoplasm corresponding to approximately 1.8% of bone tumors.

Chondroblastoma

Condroblastoma da cabeça femoral – Lesão intra-articular – Pós operatório de 1 ano – Pós operatório de 8 anos
Chondroblastoma of the femoral head – Intra-articular lesion – 1 year after surgery – 8 years after surgery
Metástases Pulmonares assintomáticas.
Asymptomatic lung metastases.

Codman, in 1931, described it as a different form of manifestation of the “calcified giant cell tumor” of the proximal humerus. It was later found to be a tumor other than the gigantocellular tumor (GCT).

It preferentially affects the epiphysis of long bones, as a bone rarefaction lesion, with foci of calcification, in male patients, in the first and second decade of life, therefore with the growth plate open. Therefore, it affects the epiphyseal region of growing long bones (figs. 1 and 2) and, less frequently, the apophyseal portion (figs. 3 and 4).

Figura 1 condroblastoma epifisário do fêmur.
Figure 1 Epiphyseal chondroblastoma of the femur.
Figura 2 erosão da cartilagem articular.
Figure 2 erosion of articular cartilage.
Figura 3 condroblastoma da apófise do grande trocânter. Figura 4 – aumento significativo da lesão, com fratura arrancamento do grande trocânter.
Figure 3 Chondroblastoma of the apophysis of the greater trochanter. Figure 4 – significant increase in the injury, with tearing fracture of the greater trochanter.

This injury, as it occurs intra-articularly, can present a clinical picture similar to arthritis, when it causes reabsorption of the epiphysis (or apophysis), erosion of the cortical bone and joint invasion, leading to arthralgia, which can cause deformity and fracture and joint subsidence. It can, therefore, present local aggressiveness such as cortical erosion, growth plate erosion and joint invasion.

When there is radiographic manifestation of local aggressiveness, it is generally associated with areas of aneurysmal bone cyst. It presents differential diagnosis with simple bone cyst, aneurysmal, osteomyelitis, tuberculosis, arthritis, chondroma, giant cell tumor (osteoclastoma), early osteoid osteoma, pseudo-tumorous lesions, among others.

The treatment of chondroblastoma is surgical and must be carried out as soon as possible, as these lesions, despite being histologically benign, quickly progress to destruction of the local bone framework. It consists of intralesional curettage followed by local adjuvant (phenol, electrothermia, liquid nitrogen, etc.) and placement of a bone graft or cement (polymethylmethacrylate). 

In very advanced lesions, segmental resection followed by placement of a prosthesis or arthrodesis may be necessary. The best indication to avoid local recurrence is segmental resection.

However, due to the articular location of the chondroblastoma, it is preferable to provide adequate surgical access to each region, as in this example, which affects the posteromedial region of the femoral head (fig. 5 and 6).

Fig. 5- Condroblastoma da região medial da cabeça femoral direita.
Fig. 5- Chondroblastoma of the medial region of the right femoral head.
Fig. 6 – Lesão lítica posterior e medial na cabeça femoral direita.
Fig. 6 – Posterior and medial lytic lesion on the right femoral head.
We perform careful intra-lesional curettage, followed by local adjuvant, such as phenol, liquid nitrogen or electrothermia (figs. 7 and 8), to subsequently fill the cavity with autologous bone graft, restoring the anatomy of the region (fig. 9) and reestablishing the function (figs 10 and 11).
Fig. 7 – via de acesso à região póstero-medial da cabeça femoral.
Fig. 7 – access route to the posteromedial region of the femoral head.
Fig. 8 – curetagem intralesional, seguida de eletrotermia.
Fig. 8 – Intralesional curettage, followed by electrothermia.
Fig. 9 – enxerto ósseo autólogo já integrado. Fig. 10 – Função de flexão com carga dos quadris.
Fig. 9 – autologous bone graft already integrated. Fig. 10 – Load-bearing flexion function of the hips.
Fig. 11 Abdução do quadril, após um ano da cirurgia.
Fig. 11 Hip abduction, one year after surgery.
Chondroblastoma, despite being a benign lesion, in addition to local recurrence, can evolve into pulmonary metastases (figs. 12 and 13) which remain histologically benign, with the indication of additional chemotherapy being controversial, leaving only the excision of the metastases as treatment. as they do not respond to chemotherapy or radiotherapy.
Fig. 12 – radiografia do tórax, com múltiplos nódulos.
Fig. 12 – chest x-ray, with multiple nodules.
Fig. 13 – tomografia do tórax, com treze anos de evolução.
Fig. 13 – CT scan of the chest, with thirteen years of evolution.
In our experience we had two cases of osteoblastoma and one case of chondroblastoma with secondary lung disease. In this case of chondroblastoma, thoracotomy was performed and numerous pulmonary nodules were found, which persist to this day. This patient, at the time of diagnosis of metastases, presented with hypertrophic pulmonary osteopathy. He did not undergo any additional treatment and is asymptomatic to this day, thirteen years later (figs. 14 and ’15) and fifteen years after surgery (figs. 16 and 17).
Fig. 14 – Abdução apos 8 anos. Fig. 15 – Fexão com carga após 13 anos.
Fig. 14 – Abduction after 8 years. Fig. 15 – Loaded bending after 13 years.
Fig. 16 – Abdução após 15 anos. Fig. 17 Flexão com carga após quinze anos da cirurgia.
Fig. 16 – Abduction after 15 years. Fig. 17 Flexion with weight fifteen years after surgery.

Currently, the patient is well and asymptomatic, 24 years after surgery for the femoral injury and 22 years after the removal of some of the metastatic nodules.

The prognosis can be guarded for both local recurrence and orthopedic complications such as joint degeneration and growth deficit.

See the article published in 1995.

Author: Prof. Dr. Pedro Péricles Ribeiro Baptista

 Orthopedic Oncosurgery at the Dr. Arnaldo Vieira de Carvalho Cancer Institute

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