Chondromyxoid Fibroma 

  • Author: Hannah D Morgan, MD; Chief Editor: Harris Gellman, MD   more...
 
Updated: Jul 20, 2010
 

Background

Chondromyxoid fibroma (CMF) is a rare, slow-growing bone tumor of chondroblastic derivation.[1, 2, 3, 4] Jaffe and Lichtenstein first described the condition in 1943.[5] They differentiated this benign lesion from chondrosarcoma, a much more common, but malignant, tumor.

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Pathophysiology

Grossly, CMFs are firm, grayish-white masses that are sharply demarcated; they are lobulated or pseudolobulated. Their appearance can mimic fibrous tissue or hyaline cartilage. The lesions can destroy trabecular bone and may thin the cortex. Some CMFs may have areas of hemorrhage or cystic degeneration. A liquid, mucinous appearance may increase the suggestion of chondrosarcoma.

Many chondromyxoid fibromas display morphologic features that resemble different stages of chondrogenesis.[6, 7]

A study by Romeo and colleagues examined the DNA microarray of chondromyxoid fibroma (as well as that of chondroblastoma).[8] The authors found that the differential expression of adhesion and extracellular matrix molecules, including CD166, versican, perlecan, and Col4A2, may interfere with cartilaginous differentiation.

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Epidemiology

Frequency

United States

CMF accounts for less than 1% of primary bone tumors.

International

As of 2000, approximately 500 cases of CMF had been described in the world literature.[9]

Mortality/Morbidity

Local symptoms of CMF may cause a reduction in activity. CMF may recur locally, especially following a marginal excision. In addition, it may behave in an active or aggressive fashion, but malignant conversion is extremely rare and is difficult to distinguish from misdiagnosed de novo chondrosarcoma. Consequently, mortality from true benign CMF is essentially nonexistent.

Race

No racial predilection has been reported.

Sex

According to most reports, males and females are affected equally, although a few series have reported a male predominance.[10]

Age

CMF primarily affects young adults in their second and third decades of life. Eighty percent of patients are younger than 36 years. The youngest reported patient was aged 3 years at the time of diagnosis, and the oldest patient was aged 87 years at the time of diagnosis.

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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: Lippincott, Williams, and Wilkins Royalty Editing/writing textbook; Genentech Grant/research funds Clinical research; Orthovita Grant/research funds Clinical research; National Institutes of Health Grant/research funds Clinical research

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

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

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.

References

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  3. Schutt PG, Frost HM. Chondromyxoid fibroma. Clin Orthop Relat Res. 1971;78:323-9. [Medline].

  4. White PG, Saunders L, Orr W, et al. Chondromyxoid fibroma. Skeletal Radiol. Jan 1996;25(1):79-81. [Medline].

  5. Jaffe HL, Lichtenstein L. Chondromyxoid fibroma of bone: a distinctive benign tumor likely to be mistaken especially for chondrosarcoma. Arch Path. 1943;19:541-51.

  6. Baker AC, Rezeanu L, O'Laughlin S, et al. Juxtacortical chondromyxoid fibroma of bone: a unique variant: a case study of 20 patients. Am J Surg Pathol. Nov 2007;31(11):1662-8. [Medline].

  7. Romeo S, Hogendoorn PC, Dei Tos AP. Benign cartilaginous tumors of bone: from morphology to somatic and germ-line genetics. Adv Anat Pathol. Sep 2009;16(5):307-15. [Medline].

  8. Romeo S, Oosting J, Rozeman LB, et al. The role of noncartilage-specific molecules in differentiation of cartilaginous tumors: lessons from chondroblastoma and chondromyxoid fibroma. Cancer. Jul 15 2007;110(2):385-94. [Medline].

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  13. Yasuda T, Nishio J, Sumegi J, Kapels KM, Althof PA, Sawyer JR, et al. Aberrations of 6q13 mapped to the COL12A1 locus in chondromyxoid fibroma. Mod Pathol. Nov 2009;22(11):1499-506. [Medline].

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  23. Bergman S, Madden CR, Geisinger KR. Fine-needle aspiration biopsy of chondromyxoid fibroma: an investigation of four cases. Am J Clin Pathol. Nov 2009;132(5):740-5. [Medline].

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  25. Konishi E, Nakashima Y, Iwasa Y, Nakao R, Yanagisawa A. Immunohistochemical analysis for Sox9 reveals the cartilaginous character of chondroblastoma and chondromyxoid fibroma of the bone. Hum Pathol. Oct 2 2009;[Medline].

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Radiograph showing the "bite" out of the metaphyseal cortex that is a diagnostic feature of chondromyxoid fibroma.
Magnetic resonance imaging (MRI) scan of chondromyxoid fibroma (T1 image).
Close-up of a lobule of a chondromyxoid fibroma.
 
 
 
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