eMedicine Specialties > Orthopedic Surgery > Neoplasms

Chondroblastoma: Follow-up

Author: Hannah D Morgan, MD, Consulting Staff, Connecticut Orthopaedic Specialists
Coauthor(s): Timothy A Damron, MD, David G Murray Endowed Professor, Department of Orthopedic Surgery, Professor, Orthopedic Oncology and Adult Reconstruction, Vice Chair, Department of Orthopedics, State University of New York Upstate Medical University at Syracuse
Contributor Information and Disclosures

Updated: Jul 18, 2007

Follow-up

Further Outpatient Care

  • Due to a 10% risk of local recurrence, patients should be monitored for at least several years.
  • Monitor patients with open physes at the time of treatment for premature physeal closure.
  • At follow-up, patients should be evaluated with a thorough history and physical examination and with appropriate radiographs.

Inpatient & Outpatient Medications

  • Pain medications should be administered as needed.

Complications

  • In addition to recurrence, many complications can occur following treatment of chondroblastomas. These include the following:
    • Infection
    • Development of degenerative joint changes
    • Fracture through the lesion
    • Failure of osteoarticular allografts, if used
    • Premature physeal closure and subsequent limb-length discrepancy or angular deformity of the limb
    • Malignant transformation or development of a postradiation sarcoma as late as 18 years after diagnosis (in rare cases in which radiation therapy is used)

Prognosis

  • Local recurrence in long bone lesions is approximately 10% and is higher for chondroblastomas arising in flat bones, especially those lesions arising in the vicinity of the triradiate cartilage. Average time to recurrence is 34 months following initial treatment. Most authors have not reported any significant difference in recurrence rates for tumors, regardless of the age or sex of the patient, size of the lesion, amount of calcification or vascular invasion seen on histologic examination, duration of follow-up, or method of treatment. Springfield attributed a higher recurrence rate in patients with open physeal plates to a less aggressive curettage performed in an effort to avoid future growth arrest.8 Recurrences may be treated with repeat curettage, with or without bone graft or cementation, and with marginal excision of any soft-tissue component.
  • While most chondroblastomas are small, well-marginated lesions that are successfully treated with intralesional curettage, a small subset of chondroblastomas behave in a much more aggressive fashion. Some of these tumors retain their benign microscopic features but nonetheless become very large or have the capability of metastasizing to the lungs and soft tissues. Metastases may be synchronous or metachronous, occurring concurrently with the primary bone tumor or up to 33 years later. Metastases can occur even without surgical manipulation or local recurrence of the primary tumor. These more aggressive lesions may be treated with en bloc resection and reconstruction where intralesional curettage would leave a large, bony defect. Pulmonary implants or soft-tissue metastases should be resected, especially if they are progressive.
  • Another rare subset of chondroblastomas may become frankly malignant even though no prior radiation therapy was used. Kyriakos and colleagues used the term malignant chondroblastoma to describe tumors that continue to grow or disseminate, not just those that metastasize.9 Malignant transformation usually occurs many years (usually >10 y) following treatment of the initial benign lesion. Pulmonary metastases may develop along with the malignant bony lesion. Microscopic examination of the malignant bone lesion shows features similar to the original lesion (along with other areas with nuclear pleomorphism), abundant and abnormal mitotic figures, tumor necrosis, and intravascular thrombi. Ostrowski and colleagues reported a patient with malignant transformation of a recurrent pelvic chondroblastoma with a p53 mutation.10 Frankly malignant chondroblastoma tends to be resistant to surgery, radiation, and chemotherapy, and patients with these tumors have had dismal prognoses.

Patient Education

  • Educate patients regarding the nature of the disease, available treatment, risks of treatment and recurrence, and prognosis.

Miscellaneous

Medicolegal Pitfalls

  • Failure to recognize the lesion
  • Failure to recommend surgical treatment
  • Failure to recognize metastatic or multicentric disease
  • Failure to monitor patients for several years after surgery
 


More on Chondroblastoma

Overview: Chondroblastoma
Differential Diagnoses & Workup: Chondroblastoma
Treatment & Medication: Chondroblastoma
Follow-up: Chondroblastoma
Multimedia: Chondroblastoma
References
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References

  1. Codman EA. The classic: epiphyseal chondromatous giant cell tumors of the upper end of the humerus. Surg Gynecol Obstet.1931;52:543. Clin Orthop Relat Res. Sep 2006;450:12-6. [Medline].

  2. Jaffe HL, Lichtenstein L. Benign chondroblastoma of bone: a reinterpretation of the so-called calcifying or chondromatous giant cell tumor. Am J Pathol. 1942;18:969-91.

  3. Mii Y, Miyauchi Y, Morishita T, et al. Ultrastructural cytochemical demonstration of proteoglycans and calcium in the extracellular matrix of chondroblastomas. Hum Pathol. Dec 1994;25(12):1290-4. [Medline].

  4. Aigner T, Loos S, Inwards C, et al. Chondroblastoma is an osteoid-forming, but not cartilage-forming neoplasm. J Pathol. Dec 1999;189(4):463-9. [Medline].

  5. Brien EW, Mirra JM, Ippolito V. Chondroblastoma arising from a nonepiphyseal site. Skeletal Radiol. Apr 1995;24(3):220-2. [Medline].

  6. Turcotte RE, Kurt AM, Sim FH, et al. Chondroblastoma. Hum Pathol. Sep 1993;24(9):944-9. [Medline].

  7. Sjögren H, Orndal C, Tingby O, et al. Cytogenetic and spectral karyotype analyses of benign and malignant cartilage tumours. Int J Oncol. Jun 2004;24(6):1385-91. [Medline].

  8. Springfield DS, Capanna R, Gherlinzoni F, et al. Chondroblastoma. A review of seventy cases. J Bone Joint Surg Am. Jun 1985;67(5):748-55. [Medline].

  9. Kyriakos M, Land VJ, Penning HL, et al. Metastatic chondroblastoma. Report of a fatal case with a review of the literature on atypical, aggressive, and malignant chondroblastoma. Cancer. Apr 15 1985;55(8):1770-89. [Medline].

  10. Ostrowski ML, Johnson ME, Truong LD, et al. Malignant chondroblastoma presenting as a recurrent pelvic tumor with DNA aneuploidy and p53 mutation as supportive evidence of malignancy. Skeletal Radiol. Nov 1999;28(11):644-50. [Medline].

  11. Dahlin DC, Ivins JC. Benign chondroblastoma. A study of 125 cases. Cancer. Aug 1972;30(2):401-13. [Medline].

  12. Dorfman HD, Czerniak B. Cartilage Tumors. In: Bone Tumors. St Louis, Mo: Mosby; 1998:317.

  13. Fanning CV, Sneige NS, Carrasco CH, et al. Fine needle aspiration cytology of chondroblastoma of bone. Cancer. Apr 15 1990;65(8):1847-63. [Medline].

  14. Jambhekar NA, Desai PB, Chitale DA. Benign metastasizing chondroblastoma: a case report. Cancer. Feb 1998;82(4):675-8. [Medline].

  15. Jee WH, Park YK, McCauley TR, et al. Chondroblastoma: MR characteristics with pathologic correlation. J Comput Assist Tomogr. Sep-Oct 1999;23(5):721-6. [Medline].

  16. Khalili K, White LM, Kandel RA, et al. Chondroblastoma with multiple distant soft tissue metastases. Skeletal Radiol. Aug 1997;26(8):493-6. [Medline].

  17. Kurt AM, Turcotte RE, McLeod RA, et al. Chondroblastoma of bone. Orthopedics. Jul 1990;13(7):787-90. [Medline].

  18. Kurt AM, Unni KK, Sim FH, et al. Chondroblastoma of bone. Hum Pathol. Oct 1989;20(10):965-76. [Medline].

  19. Mermelstein LE, Friedlaender GE, Katz LD. Cystic chondroblastoma. Orthopedics. Jan 1997;20(1):69-71. [Medline].

  20. Mirra JM, Ulich TR, Eckardt JJ, et al. "Aggressive" chondroblastoma. Light and ultramicroscopic findings after en bloc resection. Clin Orthop Relat Res. Sep 1983;(178):276-84. [Medline].

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  22. Ramappa AJ, Lee FY, Tang P, et al. Chondroblastoma of bone. J Bone Joint Surg Am. Aug 2000;82-A(8):1140-5. [Medline].

  23. Rodgers WB, Mankin HJ. Metastatic malignant chondroblastoma. Am J Orthop. Dec 1996;25(12):846-9. [Medline].

  24. Swarts SJ, Neff JR, Johansson SL, et al. Significance of abnormalities of chromosomes 5 and 8 in chondroblastoma. Clin Orthop Relat Res. Apr 1998;(349):189-93. [Medline].

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Further Reading

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Keywords

CB, bone tumor, giant cell tumor, GCT, benign chondroblastoma, Codman's tumor, Codman tumor, bone-forming neoplasm, malignant chondroblastoma, aneurysmal bone cyst

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Contributor Information and Disclosures

Author

Hannah D Morgan, MD, Consulting Staff, Connecticut Orthopaedic Specialists
Hannah D Morgan, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and American Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Timothy A Damron, MD, David G Murray Endowed Professor, Department of Orthopedic Surgery, Professor, Orthopedic Oncology and Adult Reconstruction, Vice Chair, Department of Orthopedics, State University of New York Upstate Medical University at Syracuse
Timothy A Damron, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Medical Association, Children's Oncology Group, Connective Tissue Oncology Society, Musculoskeletal Tumor Society, Orthopaedic Research Society, and Society for Experimental Biology and Medicine
Disclosure: Nothing to disclose.

Medical Editor

Howard A Chansky, MD, Associate Professor, Department of Orthopedics and Sports Medicine, University of Washington Medical Center
Howard A Chansky, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Sean P Scully, MD, PhD, Professor, Department of Orthopedics, University of Miami
Sean P Scully, MD, PhD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, International Society on Thrombosis and Haemostasis, and Society of Surgical Oncology
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD, Consulting Surgeon, Broward Hand Center, Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami School of Medicine
Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society
Disclosure: Nothing to disclose.

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