Chondromyxoid Fibroma Workup

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

Laboratory Studies

CMF does not cause any laboratory abnormalities.

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Imaging Studies

  • Radiographs[18, 19]
    • CMFs are well-defined, eccentric, elongated, radiolucent lesions that usually occur in the metaphysis of long bones. A diagnostic feature, when present, is a nearly hemispherical "bite" from the cortical margin without periosteal reaction. The greatest dimension of CMFs is typically 1-10 cm. The margins are often sclerotic with scalloped borders and may demonstrate mild cortical expansion. The lesions can extend into the diaphysis or epiphysis but do not cross the open physeal plate. Radiograph showing the "bite" out of the metaphyseRadiograph showing the "bite" out of the metaphyseal cortex that is a diagnostic feature of chondromyxoid fibroma.
    • Trabeculations within the tumor, which reflect bony ridges formed around a lobulated tumor periphery, may be visible on radiographs.
    • Matrix calcifications are unusual, appearing in only 2-13% of lesions.[20]
    • When CMF involves the vertebrae (in approximately 8% of cases), radiographs may reveal a more aggressive appearance, with cortical destruction and extension into soft tissue.[21]
    • Lesions of the small bones of the hands or feet are more typically central and expansile.
    • CMFs may have associated secondary ABCs, visible on radiographs.
  • Computed tomography (CT) scans
    • Mild cortical expansion may be observed on CT scans, and the lesions have a density greater than fluid throughout, except in areas affected by a secondary ABC.
    • CT scans can also reveal the characteristic lack of mineralization within the lesions.
  • Magnetic resonance imaging (MRI) scans[22]
    • The chondroid and myxoid tissues, as well as any normal hyaline cartilage within the lesion, have an intermediate to high signal on proton-density and T2-weighted images and have a low signal on T1-weighted images. The fibrous tissue components have a variable appearance, depending on their vascularity.
    • Because of their diverse tissue components, CMFs have a heterogeneous appearance. They are typically solid but can have cystic areas as well.
    • Secondary ABCs have typical septations and, in many cases, fluid-fluid levels reflecting the blood-filled vascular channels. MRI scans may demonstrate soft-tissue or bone marrow edema extending well beyond the lesion and are helpful in preoperative planning. Magnetic resonance imaging (MRI) scan of chondromyMagnetic resonance imaging (MRI) scan of chondromyxoid fibroma (T1 image).
  • Bone scans - CMFs usually have increased activity on bone scintigraphy.
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Procedures

Biopsy is used for histologic examination.[23] A generous tissue sample is required for an accurate diagnosis, because small biopsies may not be representative.

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Histologic Findings

Microscopically, CMFs are lobulated or pseudolobulated, with peripheral condensation of more cellular tissue within the lobules. Composed of myxoid or chondroid tissue, the center of each lobule is hypocellular. The surrounding stroma is denser, with spindle-shaped cells, blood vessels, and occasional multinucleate giant cells. Tumor nuclei may be hyperchromatic, are of moderate size, and may lie in chondroid lacunae. Nuclear atypia can be observed, but mitoses are rare or absent. Microcalcification is present in 15-20% of cases, with an increased incidence in older patients.

Close-up of a lobule of a chondromyxoid fibroma. Close-up of a lobule of a chondromyxoid fibroma.

Scattered areas of hyalinization, xanthomatous changes, cholesterol clefts, and cystic degeneration may be noted, including secondary ABCs. The tumors have a heterogeneous immunohistochemical staining pattern, with the central chondroid areas staining positively for S-100 protein and the peripheral, hypercellular tissue staining diffusely for muscle and smooth muscle actin.[24, 25] None of the cells express desmin.

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Staging

Local staging typically includes plain radiographs and an MRI or CT scan. Because CMF does not metastasize, there is no need for routine chest radiographs or other systemic staging studies. A total skeletal bone scan is generally advisable during the initial evaluation to assess local activity and to ensure the solitary nature of the tumor.

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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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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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