eMedicine Specialties > Radiology > Musculoskeletal
Chondromyxoid Fibroma: Imaging
Updated: Mar 17, 2009
Radiography
Radiograph of the proximal tibia of a 16-year-old boy reveals a large, lucent, slightly expansile, eccentric, metaphyseal lesion with thin sclerotic borders. Pathologic analysis helped confirm a diagnosis of chondromyxoid fibroma.
Anteroposterior radiograph of the distal femur of a 14-year-old girl reveals a large, expansile, bubbly, eccentric, metadiaphyseal lesion. Pathologic analysis helped confirm a diagnosis of chondromyxoid fibroma.
Radiograph of the proximal tibia obtained 5 years after the radiograph in Multimedia Image 5 was obtained. The lucent metaphyseal lesion has grown and currently extends into the proximal tibial epiphysis. Pathologic analysis helped confirm a diagnosis of chondromyxoid fibroma.
Radiograph of the tibia of a 15-year-old girl reveals a lucent, slightly expansile, diaphyseal lesion. Pathologic analysis helped confirm a diagnosis of chondromyxoid fibroma.
Radiograph of the first metatarsal of a 16-year-old boy reveals a bubbly, expansile, lytic lesion in the distal metadiaphysis. Pathologic analysis helped confirm a diagnosis of chondromyxoid fibroma.
Radiograph of the right sacroiliac joint of a 20-year-old woman reveals a bubbly lucent lesion of the medial right ilium with sclerotic margins. Pathologic analysis helped confirm a diagnosis of chondromyxoid fibroma.
Findings
On conventional radiographs, a chondromyxoid fibroma (CMF) usually appears as a well-marginated, expansile, eccentric, lucent medullary lesion in the metaphysis of a long bone, ranging in length from 3-10 cm (see Image 1). The tumor may extend into the diaphysis (see Image 2) or, uncommonly, into the epiphysis (see Image 6). CMF may rarely be purely diaphyseal (see Image 10), but it is never solely epiphyseal. The tumor may replace the bulk of a smaller bone. Smaller CMFs may appear to arise from the cortex of bone, and juxtacortical (exophytic) tumors have been reported.
Smaller tumors are usually round with a thin sclerotic margin (see Image 5) and uncommonly contain visible calcification or trabeculation. In larger lesions, remnants of cortical bone reinforcing the tumor at the periphery can appear on radiographs as trabeculation (see Image 23). These osseous ridges along the periphery are also responsible for the bubbly cystic radiographic appearance of CMF (see Image 22). A sclerotic scalloped border is typical. Compared with other cartilaginous tumors, the matrix of CMF uncommonly appears calcified on conventional radiographs (see Image 18).
Degree of Confidence
An eccentric, medullary, bubbly-appearing, metaphyseal lesion with scalloped sclerotic borders should prompt the radiologist to consider CMF in the differential diagnosis, particularly if the lesion is found in the proximal tibia; however, diagnosing CMF with a high degree of confidence by using imaging studies may be difficult because of the rarity of the tumor. An analysis of a biopsy specimen is always necessary for a definitive diagnosis.
Computed Tomography
Scout image from a CT examination of the legs of a 15-year-old girl reveals a lucent diaphyseal lesion with sclerotic margins; this lesion represents a chondromyxoid fibroma in this patient (same patient as in Image 10 in Multimedia).
CT scan of the legs of a 15-year-old girl reveals replacement of the normal fatty marrow by a chondromyxoid fibroma (same patient as in Images 10-11 in Multimedia). Trabeculation is evident.
CT scan of the distal tibia of a 16-year-old boy reveals calcific matrix in a chondromyxoid fibroma (same patient as in Image 18 in Multimedia).
CT scan of the pelvis of a 20-year-old woman reveals a right iliac chondromyxoid fibroma (same patient as in Image 23 in Multimedia). Trabeculation is evident.
Findings
After conventional radiography, CT scans may be used to further study the nature and extent of the suspected CMF (see Images 11-12). CT is the best imaging modality for detecting sclerotic margins and ridges (see Image 24) and matrix mineralization (see Image 19), and CT findings can depict the cortical integrity of the lesion. CT scans may show calcification within the tumor that is not visible on conventional radiographs.
Degree of Confidence
CT findings may reveal calcifications within the lesion that are not apparent on conventional radiographs; therefore, CT findings may increase the suspicion that a lesion is cartilaginous. Otherwise, CT scans add little to the diagnosis.
Magnetic Resonance Imaging
T1-weighted transverse MR image of the proximal tibia of a 37-year-old man (same patient as in Images 5-6 in Multimedia). The eccentric lesion with low signal intensity situated in the anterior tibia corresponds to the location of the chondromyxoid fibroma in this patient.
Fat-saturated T1-weighted transverse MR image of the proximal tibia of a 37-year-old man obtained after the intravenous administration of gadolinium (same patient as in Images 5-7 in Multimedia). The chondromyxoid fibroma is heterogeneously enhancing.
T1-weighted transverse MR image of the proximal tibia of a 36-year-old man reveals a chondromyxoid fibroma with low signal intensity (same patient as in Images 13-15 in Multimedia).
T2-weighted transverse MR image of the tibia of a 36-year-old man reveals a chondromyxoid fibroma with high signal intensity (same patient as in Images 13-16 in Multimedia).
Findings
MRI may be used in the management of CMF to observe the true extent of the lesion, so that complete resection may be planned and potential recurrence may be avoided.7,8
MRI findings of CMF are nonspecific. The tumor typically demonstrates low signal intensity on T1-weighted images (see Image 7, Image 16) and heterogeneous high signal intensity on T2-weighted images (see Image 26). Smaller lesions, as well as some larger lesions, may demonstrate a homogeneously bright signal on T2-weighted images, often with a hypointense rim (see Image 17). Enhancement following intravenous administration of gadolinium is typically heterogeneous (see Image 8), often most prominent along the vascular borders of the tumor. Heterogeneity is believed to be the result of varying amounts of chondroid, myxoid, and fibrous tissues in the tumor, as well as any underlying cystic and/or hemorrhagic components.
Gadolinium-based contrast agents (gadopentetate dimeglumine [Magnevist], gadobenate dimeglumine [MultiHance], gadodiamide [Omniscan], gadoversetamide [OptiMARK], gadoteridol [ProHance]) have been linked to the development of nephrogenic systemic fibrosis (NSF) or nephrogenic fibrosing dermopathy (NFD). For more information, see the eMedicine topic Nephrogenic Fibrosing Dermopathy. The disease has occurred in patients with moderate to end-stage renal disease after being given a gadolinium-based contrast agent to enhance MRI or MRA scans.
NSF/NFD is a debilitating and sometimes fatal disease. Characteristics include red or dark patches on the skin; burning, itching, swelling, hardening, and tightening of the skin; yellow spots on the whites of the eyes; joint stiffness with trouble moving or straightening the arms, hands, legs, or feet; pain deep in the hip bones or ribs; and muscle weakness. For more information, see the FDA Public Health Advisory or Medscape.
Degree of Confidence
MRI findings of CMF are nonspecific and typically do not alter the degree of confidence in the diagnosis. The primary role of MRI is in preoperative planning (ie, evaluation of the extent of the tumor).
Nuclear Imaging
Angiographic phase images from a bone scan of a 16-year-old boy reveal increased flow to the site of the chondromyxoid fibroma in the distal right tibia (same patient as in Images 18-19 in Multimedia).
Delayed bone scan image reveals increased activity in the distal right tibia, corresponding to a chondromyxoid fibroma (same patient as in Images 18-20 in Multimedia).
Delayed bone scan image of the pelvis (posterior view) of a 20-year-old woman (same patient as in Images 23-26 in Multimedia). Activity at the right sacroiliac joint is slightly increased, corresponding to a chondromyxoid fibroma in this patient.
Findings
Although increased radionuclide activity is demonstrated in CMFs on bone scans (see Image 21), nuclear medicine procedures are of limited use in the diagnosis or management of these lesions. The typically eccentric location of a CMF may be evident if the lesion is relatively small (see Image 15). Smaller lesions may be subtle if located adjacent to a growing physis or joint that typically accumulates radiotracer (eg, sacroiliac joint) (see Image 27). Increased flow may be apparent on the angiographic portion of a 3-phase study (see Image 20). Bone scintigraphy may be used to exclude the possibility of multiple lesions, which are highly uncharacteristic of CMF (see Image 4).9
Degree of Confidence
Nuclear medicine studies add little to the degree of confidence in the diagnosis, although multiple lesions on a bone scan is highly uncharacteristic of a CMF.
Angiography
Findings
Angiography is of limited use in the diagnosis of CMF. Angiographic appearances are nonspecific, with the tumor demonstrating either minimal neovascularity or no internal vascularity, with or without surrounding vascular tissue. Angiography may be used to define surrounding vasculature or for planning embolization (uncommon).
Degree of Confidence
Angiography typically does not alter the degree of confidence in the diagnosis, but it may be used as a preoperative study.
More on Chondromyxoid Fibroma |
| Overview: Chondromyxoid Fibroma |
 Imaging: Chondromyxoid Fibroma |
| Follow-up: Chondromyxoid Fibroma |
| Multimedia: Chondromyxoid Fibroma |
| References |
| Further Reading |
| « Previous Page | Next Page » |
References
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Further Reading
Related eMedicine topics
Chondromyxoid Fibroma (from Orthopedic Surgery)
Fibroma
Aneurysmal Bone Cyst
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Histology of Bone
Keywords
chondromyxoid fibroma, CMF, fibromyxoid chondroma, myxofibrous chondroma, primary osseous neoplasm, benign bone tumor, osseous tumor, lower extremity tumor
