Click here to learn What's New at our website. Page views in 11, Cite this page: Pernick N. Accessed June 4th, Rare Painful, often causes joint effusions and restricts joint mobility Sites: distal femur, proximal humerus, proximal tibia, pelvis, ribs, feet, scapula; usually epiphysis open or apophysis such as iliac crest; may extend into metaphysis; also skull in older patients Course: usually benign, but commonly recurs often with atypia , rarely invades locally; rarely pulmonary metastases occur after surgical manipulation of primary tumor; patients survive after removal of localized metastases but not if multiple.
|Published (Last):||22 January 2018|
|PDF File Size:||2.57 Mb|
|ePub File Size:||1.58 Mb|
|Price:||Free* [*Free Regsitration Required]|
Chondroblastoma is a rare, giant cell-rich, benign neoplasm of bone. Since the past few decades fine needle aspiration cytology FNAC has gained momentum in preoperative diagnosis of bone lesions. At cytology, other giant cell-rich tumors and tumorlike lesions such as aneurysmal bone cyst ABC , giant cell tumor, and chondromyxoid fibroma fall under the differential diagnosis of chondroblastoma. Due to the difference in the treatment protocol and prognosis, preoperative diagnosis is mandatory.
We describe the cytomorphology in two cases of chondroblastoma diagnosed at FNAC and confirmed by histopathology. At cytology, the presence of giant cells, chondroid matrix, mononuclear cells with nuclear indentation, and grooving along with glassy, vacuolated cytoplasm are characteristic of chondroblastoma.
In addition to this, the presence of chicken wire calcification is a useful clue to the accurate diagnosis of chondroblastoma at FNAC. However, unusual sites of presentation such as patella, talocalcaneal, and temporomandibular joint has been reported. It is necessary to differentiate chondroblastoma from other giant cell-rich lesions, as chondroblastoma exhibits predominantly benign behavior, though recurrences and metastasis are on record.
Simple curettage with bone grafting is the mode of treatment. Here, we report cytomorphology in two cases of chondroblastoma confirmed by histopathology with a brief review of literature.
A year-old male presented with pain and diffuse swelling on the knee joint since 2 months. There was no history of trauma. The overlying skin was unremarkable. X ray showed typically lytic, centrally placed, sharply demarcated lesion with sclerotic border in the epiphysis. A year-old male presented with diffuse swelling on the shoulder joint of 1-month duration. X ray showed typically lytic, centered in the epiphysis. FNAC was performed by the nonaspiration technique in the first patient using a 24 gauge needle while for the second case, ultrasound-guided aspiration was done because the lesion was deep-seated.
Cytology smears in both the cases showed similar findings. Smears were highly cellular, polyhedral cells arranged in sheets and small clusters, giving a pebble stone pattern appearance. The individual cells were monomorphic with a well-defined cell membrane, glassy cytoplasm at places showing microvacuolation.
Nucleus showed indentation with nuclear grooving. At surgery, curettage and bone grafting was performed. Grossly, the specimen consisted of multiple irregular grey-brown tissue bits with areas of hemorrhage. Histopathology in both the cases showed sheets of polygonal cells with thick cell membranes and fine pale vacuolated cytoplasm.
The nucleus showed fine chromatin and occasional nuclear grooving. Additionally seen were osteoclast-type giant cells seen scattered throughout the tumor. Areas of cartilage formation and chicken wire calcification were noted [ Figure 1d ].
Unusual sites of location include pelvis, patella, talus, calcaneum, and temporomandibular joint. Metastases are unusual but occur in the lungs at the time of recurrence.
This, compounded with nonconforming radiological features, leads to the tragic delay in diagnosis. Though the age of the patient and location of the lesion in the given bone are key pieces of information, accurate and early diagnosis is a must for planning appropriate treatment. The past decade has witnessed the impressive use of FNAC in the diagnosis of bone tumors. Despite this, we have a limited case series describing FNAC findings in chondroblastoma.
These cells have well-defined cell margins, glassy cytoplasm, and nucleus with indentation and grooving. However, errors in the FNAC diagnosis of this rare tumor are known to occur, with the major pitfalls being its association with aneurysmal bone cyst ABC leading to a nonrepresentative aspirate and the occurrence of a plethora of giant cell-rich lesions in the differentials.
In one large series of 12 cases of chondroblastoma, the authors described the cytomorphology of this tumor in detail. Radiology was not supportive in most of the cases. In eight cases, diagnosis was rendered preoperatively. In three cases, the diagnosis was missed on FNAC, among which, one was associated with ABC and in another case an erroneous diagnosis of a giant cell tumor was made.
The cause of misdiagnosis in one case was due to its association with ABC, leading to nonrepresentative aspirate. In the second case, due to the location of the tumor in preauricular region, cartilaginous stroma aspirated was misinterpreted as chondroid stroma of pleomorphic adenoma in the salivary gland. All the giant cell containing lesions fall under the differential diagnosis of chondroblastoma.
Most common of these are giant cell tumor, ABC, and chondromyxoid fibroma. In giant cell tumor, the mononuclear cells are spindle-shaped and occur in clusters.
In chondromyxoid fibroma, the smears are sparsely cellular and lack the mononuclear cell component. Instead, stellate cells with pleomorphism are noted.
Differentiation of chondroblastoma from solid ABC is a challenge as well. In addition to chondroblastoma, ABC can occur secondarily in giant cell tumor and osteosarcoma. Hence, multiple aspirations from different sites and awareness of the associations are important. Chondroblastoma is a rare bone tumor, the cytomorphology of which is very characteristic.
This report reiterates the cytomorphologic findings in chondroblastoma and its differential diagnosis from other giant cell containing lesions of bone. The collective application of the knowledge of the cytomorphological features of this rare bone tumor would aid in accurate preoperative diagnosis even in the absence of typical clinical and radiologic presentations. National Center for Biotechnology Information , U. Journal List J Cytol v.
J Cytol. Author information Copyright and License information Disclaimer. Address for correspondence: Dr. E-mail: moc. This article has been cited by other articles in PMC.
Abstract Chondroblastoma is a rare, giant cell-rich, benign neoplasm of bone. Case Report Case 1 A year-old male presented with pain and diffuse swelling on the knee joint since 2 months. Case 2 A year-old male presented with diffuse swelling on the shoulder joint of 1-month duration.
Open in a separate window. Figure 1. Conclusion Chondroblastoma is a rare bone tumor, the cytomorphology of which is very characteristic. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. References 1. Benign chondroblastoma. A study of cases. Diagnostic pitfalls in fine-needle aspiration cytology of temporomandibular chondroblastoma: Report of two cases.
Diagn Cytopathol. Sterling G, Wilson A. Chondroblastoma of the talus: A case report. J Foot Ankle Surg. Bone tumors. Sternberg's Diagnostic Surgical Pathology. New York: Wolters Kluwer; Fine needle aspiration cytology of chondroblastoma of bone.
Fine needle aspiration cytology of chondroblastoma of the fibula
Chondroblastoma is a rare benign cartilaginous tumor typically seen in long bones, especially femur, tibia and proximal humerus. Extracortical soft tissue invasion or metastasis is rarely seen. We report here a unique case of chondroblastoma of the fibula with extracortical soft tissue invasion. Differential diagnosis on cytology is discussed.
Chondroblastoma is an uncommon benign cartilage producing neoplasm with a characteristic epiphyseal location. This report documents the cytological features of two cases of chondroblastomas diagnosed by cytology. One of the two cases had an unusual location in the temporomandibular region and the other was located in the epi-metaphyseal region of the right humerus. Smears characteristically revealed chondroblasts and osteoclast-like giant cells. The cytologic diagnosis of chondroblastoma was confirmed on both cases by histopathology.