Intervention
The therapy of choice is extended surgical curettage and packing with a bone graft or polymethylmethacrylate (PMMA). In skeletally immature patients, filling of the defect with PMMA is recommended because the polymer agent may allow continued skeletal growth — a concern in young patients — while residual tumor cells are destroyed. In older patients in whom skeletal growth is not an issue, bone grafting is recommended for smaller lesions. For large lesions, excision and cementation or reconstruction may be required.
PMMA packing is recommended over bone grafting after the removal of recurrent lesions or lesions that are likely to recur. If a secondary aneurysmal bone cyst is present, the use of phenol or cryosurgery should be considered because of the higher local recurrence rate that has been reported with these lesions.
Angiographic embolotherapy has no role in cases of chondroblastomas, although image-guided percutaneous therapy for difficult surgical cases may become more common in the future.
Medicolegal Pitfalls
- Although a chondroblastoma has nonspecific findings, if any, at physical examination, the imaging findings of chondroblastomas are often straightforward when a nonaggressive epiphyseal lesion is identified in a child or adolescent patient.
- From an imaging standpoint, pitfalls reflect a lack of detection of the lesion or a misinterpretation of the radiologic findings.
- Fortunately, chondroblastomas are generally slow-growing and benign lesions, although delays in diagnosis delay treatment and conceivably increase the risk of one of the aforementioned complications (see Mortality/Morbidity).
- Occasionally, a chondroblastoma may be mistaken for one of the entities listed in the Differentials and Other Problems to Be Considered sections. However, these other entities are almost never confined to the epiphysis, with the exception of degenerative cysts, avascular necrosis, and clear cell chondrosarcomas (which usually occur in older patients), and infection (which usually occurs in patients with fever, leukocytosis, and an elevated erythrocyte sedimentation rate [ESR]).
- Confusion may arise if the chondroblastoma extends across the physis and mimics a metaphyseal lesion or if it arises in an atypical location such as the pelvis.
- If the chondroblastoma crosses the physis, it may be mistaken for either a chondromyxoid fibroma or a giant cell tumor (which typically occurs in a slightly older patient population, generally has no mineralization, and usually has nonsclerotic borders). (Also see the eMedicine Radiology articles Chondromyxoid Fibroma and Giant Cell Tumor.)
- If the chondroblastoma occurs in the pelvis, it may mimic either fibrous dysplasia or a nonossifying fibroma, both of which are often multifocal "don't touch" lesions. (Also see the eMedicine Radiology articles Fibrous Dysplasia and Fibrous Cortical Defect and Nonossifying Fibroma.)
- An eosinophilic granuloma is frequently multifocal and only rarely confined to the epiphysis.
- Hemangiomas may also involve the epiphysis, but these lesions are rarely confined to this location.
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References
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Further Reading
Keywords
Codman tumor, cartilage-containing giant cell tumor, calcified giant cell tumor, epiphyseal chondromatous giant cell tumor, epiphyseal tumors, benign cartilaginous neoplasms, chondroclasts
