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Table of Contents
CASE REPORT
Year : 2016  |  Volume : 4  |  Issue : 2  |  Page : 40-43

Chondroblastoma of proximal humerus: Case report and review of literature


1 Assistant Professor, Orthopaedics Department, Smt. B. K. Shah Medical Institute and Research Center, Sumandeep Vidyapeeth, Piparia, Waghodia, Vadodara, Gujarat, India
2 Resident, Orthopaedics Department, Smt. B. K. Shah Medical Institute and Research Center, Sumandeep Vidyapeeth, Piparia, Waghodia, Vadodara, Gujarat, India
3 Professor & HOD, Orthopaedics Department, Smt. B. K. Shah Medical Institute and Research Center, Sumandeep Vidyapeeth, Piparia, Waghodia, Vadodara, Gujarat, India

Date of Web Publication30-Aug-2018

Correspondence Address:
R J Soni
Assistant Professor, Orthopaedics Department, Smt. B. K. Shah Medical Institute and Research Center, Sumandeep Vidyapeeth, Piparia, Waghodia, Vadodara, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2347-6486.240201

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  Abstract 


Introduction: Chondroblastoma is a benign, epiphyseal bone tumor. It makes for approximately 1% of all bone tumors. In 1931, it was suggested to be a chondromatous variant of giant cell tumor by Codman. He reported these lesions in the region of proximal part of humerus. It is more common in second decade of life with male-to-female ratio of 2:1. It preferentially affectes the proximal part of tibia, distal part of femur, proximal humerus, and flat bones like the iliac bones.
Case report: We report case of a 15 year-old male who presented with pain over the right shoulder. Preoperative radiograph showed a large lytic tumor arising from proximal humerus interspersed with areas of calcification which was indicative of chondroblastoma on MRI and biopsy done later.
Conclusions: This patient had chondroblastoma with minimal symptoms of pain with no other abnormality. Chondroblastomas are typically benign, but progress locally or metastatise rarely. Early diagnosis and apt primary management prevents further surgeries and recurrences.

Keywords: Chondroblastoma, benign bone tumor, bone lytic lesion, proximal humerus


How to cite this article:
Soni R J, Patel A J, Merh A A, Golwala P P. Chondroblastoma of proximal humerus: Case report and review of literature. J Integr Health Sci 2016;4:40-3

How to cite this URL:
Soni R J, Patel A J, Merh A A, Golwala P P. Chondroblastoma of proximal humerus: Case report and review of literature. J Integr Health Sci [serial online] 2016 [cited 2022 Dec 4];4:40-3. Available from: https://www.jihs.in/text.asp?2016/4/2/40/240201




  Introduction Top


Chondroblastomas were first described in 1928 by Ewing. They were originally named as “epiphyseal chondroblastomatous giant cell tumors of the proximal humerus” by Codman in 1931.[1],[2],[3],[4] They are more common in males, mostly in the second decade of life. They usually arise from the epiphyseal plate. The most frequent sites of involement are the distal femur, proximal tibia, proximal humerus, and the iliac bones; however, rarely the talus, ribs and phalynx may also be affected. Although its a benign tumor, accounting for 1-2% of all benign bone tumors, it can be histologically aggressive with high recurrence (5-38%).[6] We present a case of Chondroblastoma of Proximal humerus in 15 year old male treated with extended curettage and bone grafting.


  Case Report Top


A 15 year old male came with the chief complaint of pain in right shoulder since last 6 months without any history of fall or trauma. Pain was dull in nature, none radiating, without any diurnal variation and not related to daily activities. Initially pain was low grade which was gradually increasing in intensity. Patient was taking on and off painkillers but pain was not relieved completely. There was no history of weight loss, fever, night pain, wasting and restricted range of motion.

On clinical examination: There was deep tenderness at proximal humerus without any neurovascular deficit and normal range of motion of right upper limb. There was no visible swelling, dilated vein, sinus or scar or any visible wasting of muscles.

Radiograph of the region showed expansile lesion at proximal humerus epiphysis with interspersed calcification [Figure 1]. MRI showed expansile bone lesion of the upper end of left humerus with areas of altered intensity suggestive of Chondroblastoma [Figure 2]. Under general anesthesia, lesion was treated with Extended curettage with phenol and a mechanical burr followed by autogenous cancellous bone grafting [Figure 3]. Biopsy was sent and it confirmed the diagnosis of chondroblastoma. Post operatively the limb was immobilised for 3 weeks , followed by gradual active range of motion exercises . At 4 months followup the graft was completely taken up. At final follow-up at 1 year the patient had complete functional recovery without any signs of recurrence [Figure 4],[Figure 5],[Figure 6].
Figure 1: Preoperation X ray

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Figure 2: Preoperation MRI

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Figure 3: X ray immediately after surgery

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Figure 4: X ray at final follow up

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Figure 5: Incision

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Figure 6: Movement at final followup

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  Discussion Top


Chondroblastoma is a benign, tumor involving bone epiphysis. It has a rare occurence, accounting for only about 1-2% of all bone tumors.[1],[2] Jaffe and Lichtenstein defined the differences between chondroblastoma and GCT in 1942 and also introduced the term “benign chondroblastoma”.[1],[5] Most chondroblastomas are benign bone tumour, but sometimes it may present with aggressive behaviour. It has a recurrence rate ranging from 2% to 10%; mostly due to inadequacy of primary surgery which can be taken care of by further surgical procedures.[3],[7] Pathologically, extension into cortical soft tissue is termed as ‘aggressive’.[9]

Researchers have theorized that intraosseus proliferation of tendon sheath cells give rise to chondroblastomas and have a predilection for chondroid formation. The typical site of origin of chondroblastomas is reported to be the epiphyses of tubular long bones. The most frequently involved sites are distal part of femur, proximal part of tibia and epiphysis of proximal humerus.[7],[8]

There are no known risk factors for chondroblastoma. Abnormalities of chromosomes 5, 8 and p53 mutations have been reported in this patients.11

Clinically, most commonly the patients present with pain at the site of lesion but rarely may be asymptomatic. Patients with benign chondroblastoma may have a limitation of activities due to pain.[2],[3],[6]

The basic microscopic features consist of the chondroblast, osteoclast type giant cells, with lower than four per high power field mitotic rate, interspersed with primitive chondroid and chicken-wire calcification islands.[1],[5]

In most cases, chondroblastomas are small in size with well-marginated boundaries that can be managed with intralesional curettage successfully; but in a small number of cases they may be much more aggressive. Bone grafting done following curettage leads to less chances of recurrence as compared to those without bone grafting.[1],[10]

Malignant chondroblastomas are extremely rare and have been reported to have poor prognosis. The long bone lesions have approximately 6-10% chances of local recurrence which is higher when flat bones are the site of origin of chondroblastomas, particularly if in the vicinity of triradiate cartilage.[8],[9],[10]

Springfield proposed that a less aggressive curettage done in order to avoid arrest of future growth may be the reason for higher recurrence rate in patients with open physeal plates.[4] Recurrences may respond to repeat curettage (which may or may not include bone graft or cementation), along with marginal excision of any soft-tissue component.[8] En-bloc resection and reconstruction can be used for more aggressive metastatic lesions where intralesional curettage would leave a large bony defect.[8],[10]


  Conclusion Top


Although most chondroblastomas are benign, rarely they may spread locally or metastasise. Recurrence is also common with these lesions. Early diagnosis and prompt adequate therapy can help to reduce events of recurrence and repeated surgeries.



 
  References Top

1.
Jaffe HL, Lichtenstein L. Benign chondroblastoma of bone: a reinterpretation of the so-called calcifying or chondromatous giant cell tumor. The American journal of pathology. 1942 Nov;18(6):969-91.  Back to cited text no. 1
    
2.
Dahlin DC, Ivins JC. Benign chondroblastoma. A study of 125 cases. Cancer. 1972 Aug 1; 30(2):401-13.  Back to cited text no. 2
    
3.
Schajowicz F, Gallardo H: Epiphyseal chondroblastoma of bone. A clinicopathological study of sixty-nine cases. J Bone Joint Surg [Br] 1970, 52(2):205-26.  Back to cited text no. 3
    
4.
Springfield DS, Capanna R, Gherlinzoni F, Picci P, Campanacci M. Chondroblastoma. A review of seventy cases. J Bone Joint Surg Am. 1985 Jun 1;67(5):748-55.  Back to cited text no. 4
    
5.
Unni KK. Benign chondroblastoma. In: Unni KK, editor. Dahlin’s bone tumors: general aspects and data on 11,087 cases. Philadelphia, PA: Lippincott-Raven; 1996. p. 47-57.  Back to cited text no. 5
    
6.
Kirchhoff C, Buhmann S, Mussack T, Muller- Hocker J, Schmitt-Sody M, Jansson V, Durr H. Aggressive scapular chondroblastoma with secondary metastasis-a case report and review of literature. European journal of medical research. 2006 Mar 27;11(3):128-34.  Back to cited text no. 6
    
7.
Harish K, Janaki MG, Alva NK. “ Primary” aggressive chondroblastoma of the humerus: a case report. BMC musculoskeletal disorders. 2004 Mar 17;5(1):9.  Back to cited text no. 7
    
8.
Erickson JK, Rosenthal DI, Zaleske DJ, Gebhardt MC, Cates JM. Primary Treatment of Chondroblastoma with Percutaneous Radio- frequency Heat Ablation: Report of Three Cases 1. Radiology. 2001 Nov;221(2):463-8.  Back to cited text no. 8
    
9.
Atalar H, Basarir K, Yildiz Y, Erekul S, Saglik Y. Management of chondroblastoma: retrospective review of 28 patients. Journal of Orthopaedic Science. 2007 Jul 1;12(4):334- 40.  Back to cited text no. 9
    
10.
Goldberg SN, Dupuy DE. Image-guided radiofrequency tumor ablation: challenges and opportunities—part I. Journal of vascular and interventional radiology. 2001 Sep 30;12(9):1021-32.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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