History

Pain is the most common presenting symptom of a chondroblastoma. It typically is mild and gradually progressive and initially may be attributed to a minor injury. If the lesion is juxta-articular, the patient may complain of joint swelling or diminished range of motion. Usually, constitutional symptoms are lacking. In their series of 70 patients, Turcotte et al found the average duration of symptoms in patients with chondroblastoma to be 20 months.^[15]

Physical Examination

The physical examination is remarkable for localized tenderness in most patients. Soft-tissue swelling, mass, or joint effusion is present in about 20% of cases. Muscular atrophy or decreased joint motion is less common.

Differential Diagnoses

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. 2006 Sep. 450:12-6. [Medline].
Jaffe HL, Lichtenstein L. Benign Chondroblastoma of Bone: A Reinterpretation of the So-Called Calcifying or Chondromatous Giant Cell Tumor. Am J Pathol. 1942 Nov. 18 (6):969-91. [Medline]. [Full Text].
Mii Y, Miyauchi Y, Morishita T, Miura S, Honoki K, Aoki M, et al. Ultrastructural cytochemical demonstration of proteoglycans and calcium in the extracellular matrix of chondroblastomas. Hum Pathol. 1994 Dec. 25 (12):1290-4. [Medline].
Aigner T, Loos S, Inwards C, Perris R, Perissinotto D, Unni KK, et al. Chondroblastoma is an osteoid-forming, but not cartilage-forming neoplasm. J Pathol. 1999 Dec. 189 (4):463-9. [Medline].
Brien EW, Mirra JM, Ippolito V. Chondroblastoma arising from a nonepiphyseal site. Skeletal Radiol. 1995 Apr. 24 (3):220-2. [Medline].
Sailhan F, Chotel F, Parot R, SOFOP. Chondroblastoma of bone in a pediatric population. J Bone Joint Surg Am. 2009 Sep. 91 (9):2159-68. [Medline].
Romeo S, Hogendoorn PC, Dei Tos AP. Benign cartilaginous tumors of bone: from morphology to somatic and germ-line genetics. Adv Anat Pathol. 2009 Sep. 16 (5):307-15. [Medline].
Sjögren H, Orndal C, Tingby O, Meis-Kindblom JM, Kindblom LG, Stenman G. Cytogenetic and spectral karyotype analyses of benign and malignant cartilage tumours. Int J Oncol. 2004 Jun. 24 (6):1385-91. [Medline].
WHO Classification of Tumours Editorial Board, eds. WHO Classification of Tumours: Soft Tissue and Bone Tumours. 5th edition. Lyon, France: IARC; 2020.
Springfield DS, Capanna R, Gherlinzoni F, Picci P, Campanacci M. Chondroblastoma. A review of seventy cases. J Bone Joint Surg Am. 1985 Jun. 67 (5):748-55. [Medline].
Lehner B, Witte D, Weiss S. Clinical and radiological long-term results after operative treatment of chondroblastoma. Arch Orthop Trauma Surg. 2011 Jan. 131 (1):45-52. [Medline].
Kyriakos M, Land VJ, Penning HL, Parker SG. Metastatic chondroblastoma. Report of a fatal case with a review of the literature on atypical, aggressive, and malignant chondroblastoma. Cancer. 1985 Apr 15. 55 (8):1770-89. [Medline].
Ostrowski ML, Johnson ME, Truong LD, Hicks MJ, Smith FE, Spjut HJ. Malignant chondroblastoma presenting as a recurrent pelvic tumor with DNA aneuploidy and p53 mutation as supportive evidence of malignancy. Skeletal Radiol. 1999 Nov. 28 (11):644-50. [Medline].
Farfalli GL, Slullitel PA, Muscolo DL, Ayerza MA, Aponte-Tinao LA. What Happens to the Articular Surface After Curettage for Epiphyseal Chondroblastoma? A Report on Functional Results, Arthritis, and Arthroplasty. Clin Orthop Relat Res. 2017 Mar. 475 (3):760-766. [Medline].
Turcotte RE, Kurt AM, Sim FH, Unni KK, McLeod RA. Chondroblastoma. Hum Pathol. 1993 Sep. 24 (9):944-9. [Medline].
Hmada YA, Bernieh A, Morris RW, Lewin J, Allen T. Chondroblastoma-like Osteosarcoma. Arch Pathol Lab Med. 2020 Jan. 144 (1):15-17. [Medline].
Maheshwari AV, Jelinek JS, Song AJ, Nelson KJ, Murphey MD, Henshaw RM. Metaphyseal and diaphyseal chondroblastomas. Skeletal Radiol. 2011 Dec. 40 (12):1563-73. [Medline].
Kennedy N, Demos TC, Lomasney LM. Radiologic case study. Chondroblastoma with geographic bone destruction and a sclerotic rim. Orthopedics. 2009 Aug. 32 (8):542. [Medline].
Daugaard S, Christensen LH, Høgdall E. Markers aiding the diagnosis of chondroid tumors: an immunohistochemical study including osteonectin, bcl-2, cox-2, actin, calponin, D2-40 (podoplanin), mdm-2, CD117 (c-kit), and YKL-40. APMIS. 2009 Jul. 117 (7):518-25. [Medline]. [Full Text].
Wootton-Gorges SL. MR imaging of primary bone tumors and tumor-like conditions in children. Magn Reson Imaging Clin N Am. 2009 Aug. 17 (3):469-87, vi. [Medline].
Kilgore WB, Parrish WM. Calcaneal tumors and tumor-like conditions. Foot Ankle Clin. 2005 Sep. 10 (3):541-65, vii. [Medline].
de Silva MV, Reid R. Chondroblastoma: varied histologic appearance, potential diagnostic pitfalls, and clinicopathologic features associated with local recurrence. Ann Diagn Pathol. 2003 Aug. 7 (4):205-13. [Medline].
Fang Z, Chen M. Chondroblastoma associated with aneurysmal cyst of the navicular bone: a case report. World J Surg Oncol. 2013 Feb 28. 11:50. [Medline]. [Full Text].
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. 2010 Feb. 41 (2):208-13. [Medline].
Santiago FR, Del Mar Castellano García M, Montes JL, García MR, Fernández JM. Treatment of bone tumours by radiofrequency thermal ablation. Curr Rev Musculoskelet Med. 2009 Mar. 2 (1):43-50. [Medline]. [Full Text].
Rybak LD, Rosenthal DI, Wittig JC. Chondroblastoma: radiofrequency ablation--alternative to surgical resection in selected cases. Radiology. 2009 May. 251 (2):599-604. [Medline].
Christie-Large M, Evans N, Davies AM, James SL. Radiofrequency ablation of chondroblastoma: procedure technique, clinical and MR imaging follow up of four cases. Skeletal Radiol. 2008 Nov. 37 (11):1011-7. [Medline].
Yang X, Yang ZJ, Liu FX, Zeng K, Qian MQ, Chen G, et al. Inhibition of mTOR and HIF pathways diminishes chondro-osteogenesis and cell proliferation in chondroblastoma. Tumour Biol. 2013 Oct. 34(5):3111-9. [Medline].
Suster DI, Kurzawa P, Neyaz A, Jarzembowski JA, Lozano-Calderon S, Raskin K, et al. Chondroblastoma Expresses RANKL by RNA In Situ Hybridization and May Respond to Denosumab Therapy. Am J Surg Pathol. 2020 Aug 20. [Medline].
Xu H, Nugent D, Monforte HL, Binitie OT, Ding Y, Letson GD, et al. Chondroblastoma of bone in the extremities: a multicenter retrospective study. J Bone Joint Surg Am. 2015 Jun 3. 97 (11):925-31. [Medline].
Cho HS, Park YK, Oh JH, Lee JH, Han I, Kim HS. Proximal Tibia Chondroblastoma Treated With Curettage and Bone Graft and Cement Use. Orthopedics. 2016 Jan 1. 39 (1):e80-5. [Medline].
Ebeid WA, Hasan BZ, Badr IT, Mesregah MK. Functional and Oncological Outcome After Treatment of Chondroblastoma With Intralesional Curettage. J Pediatr Orthop. 2019 Apr. 39 (4):e312-e317. [Medline].
Lehner B, Witte D, Weiss S. Clinical and radiological long-term results after operative treatment of chondroblastoma. Arch Orthop Trauma Surg. 2011 Jan. 131 (1):45-52. [Medline].
Mashhour MA, Abdel Rahman M. Lower recurrence rate in chondroblastoma using extended curettage and cryosurgery. Int Orthop. 2014 May. 38 (5):1019-24. [Medline].
Sailhan F, Chotel F, Parot R, SOFOP. Chondroblastoma of bone in a pediatric population. J Bone Joint Surg Am. 2009 Sep. 91 (9):2159-68. [Medline].
Strong DP, Grimer RJ, Carter SR, Tillman RM, Abudu A. Chondroblastoma of the femoral head: management and outcome. Int Orthop. 2010 Mar. 34 (3):413-7. [Medline]. [Full Text].
Riedel B, Franklin C, Seal A, Stevanovic M. Free vascularized fibula graft to treat chondroblastoma of the hip. Orthopedics. 2012 Feb 17. 35 (2):e259-61. [Medline].
Lalam RK, Cribb GL, Tins BJ, Cool WP, Singh J, Tyrrell PN, et al. Image guided radiofrequency thermo-ablation therapy of chondroblastomas: should it replace surgery?. Skeletal Radiol. 2014 Apr. 43 (4):513-22. [Medline].
Rajalakshmi P, Srivastava DN, Rastogi S, Julka PK, Bhatnagar S, Gamanagatti S. Bipolar radiofrequency ablation of tibialchondroblastomas: A report of three cases. World J Radiol. 2012 Jul 28. 4 (7):335-40. [Medline].
Zoccali C, Teori G, Salducca N, Di Paola B, Adriani E. Arthroscopic guided biopsy and radiofrequency thermoablation of a benign neoplasm of the tibial spines area: a treatment option. BMC Musculoskelet Disord. 2012 Apr 4. 13:52. [Medline]. [Full Text].
Xie C, Jeys L, James SL. Radiofrequency ablation of chondroblastoma: long-term clinical and imaging outcomes. Eur Radiol. 2015 Apr. 25 (4):1127-34. [Medline].

Media Gallery

Radiograph of epiphyseal lesion (hip).
Radiograph demonstrating tumor on both sides of physis (humerus).
Bone scan.
Magnetic resonance image of a hip showing lobular pattern of chondroblastoma.
Histology of chondroblastoma.
Chondroblastoma histology demonstrating chicken-wire calcifications.
Axial computed tomography scan of the pelvis demonstrates a lesion of the femoral head without noticeable internal matrix production. The epiphyseal location of the lesion is a clue to the correct diagnosis.
Plain film of the hip shows a femoral head with a lytic lesion with surrounding sclerosis in the epiphysis of the proximal femur. Internal matrix formation is not present, but that finding can be a feature of this tumor.
Coronal T1-weighted sequence shows a lesion of the epiphysis with medium signal intensity. Small islands of matrix are noted.
Low-power photomicrograph demonstrates islands of hyaline-type cartilage, which can often be seen in chondroblastomas.
Medium-power photomicrograph with lobules of chondroid matrix. In these lesions, the cartilage can be eosinophilic, with superficial resemblance to osseous matrix. Correlation with the radiologic studies is often helpful when in doubt.
Medium-power photomicrograph demonstrates secondary cystic changes, which can often accompany chondroblastomas. Careful sampling of the tumor will show the correct etiology for the changes noted here.
Giant cells are a component of this tumor, and in areas that are rich in giant cells, sampling will show the chondroblastomatous portions of the tumor.
Immunohistochemistry for S100 is positive in chondroblastomas and is often helpful, especially when the tissue sample is small.

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Author

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, Society for Experimental Biology and Medicine

Disclosure: Received research grant from: National Institutes of Health NIAMS; Orthopaedic Research and Education Foundation; Stryker; Cempra; Wright Medical<br/>Received income in an amount equal to or greater than $250 from: Stryker, Inc (Educational travel to Stryker sponsored meetings)<br/>Received royalty from Lippincott, Williams, and Wilkins for editing/writing textbook; Received grant/research funds from Genentech for clinical research; Received grant/research funds from Orthovita for clinical research; Received grant/research funds from National Institutes of Health for clinical research; Received royalty from UpToDate for update preparation author; Received grant/research funds from Wright Medical, Inc. for clinical research.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Omohodion (Odion) Binitie, MD Medical Director, Assistant Member, Department of Sarcoma, Section Head, Orthopedics, Adolescent/Young Adult and Pediatric Orthopedic Oncology, Medical Director, Physical Therapy, Speech Therapy, and Rehabilitation Services, Assistant Fellowship Program Director, Musculoskeletal Oncology, Moffitt Cancer Center; Assistant Professor, Department of Oncologic Sciences, Department of Ortho and Sports Medicine, University of South Florida Morsani College of Medicine

Omohodion (Odion) Binitie, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Children's Oncology Group, Florida Orthopaedic Society, Musculoskeletal Tumor Society

Disclosure: Nothing to disclose.

Additional Contributors

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.

Francis H Gannon, MD Associate Professor of Pathology and Orthopedic Surgery, Director of Residency and Fellowship Programs, Department of Pathology, Baylor College of Medicine; Staff Pathologist, Department of Pathology, Texas Children's Hospital, Ben Taub General Hospital and Debakey Veterans Affairs Medical Center

Francis H Gannon, MD is a member of the following medical societies: American Society for Bone and Mineral Research, International Academy of Pathology, International Skeletal Society, Texas Medical Association

Disclosure: Nothing to disclose.

Michael J Klein, MD Professor of Pathology and Laboratory Medicine, Weill Cornell Medical College; Pathologist-in-Chief, Director, Department of Pathology and Laboratory Medicine, Hospital for Special Surgery; Consultant in Orthopedic Pathology, Memorial Sloan-Kettering Cancer Center and Memorial Hospital for Cancer and Allied Diseases

Michael J Klein, MD is a member of the following medical societies: American Society for Clinical Pathology, College of American Pathologists, International Skeletal Society, United States and Canadian Academy of Pathology

Disclosure: Nothing to disclose.

Acknowledgements

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.

Chondroblastoma Clinical Presentation

History

Physical Examination

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