RADD 2712 Benign Cartilage Forming Tumors

RADD 2712 Benign Cartilage Forming Tumors - BENIGN...

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Unformatted text preview: BENIGN CARTILAGE FORMING TUMORS FORMING PRESENTED BY G. MICHAEL WHITEHEAD, B.S., D.C., G. D.A.C.B.R. D.A.C.B.R. OSTEOCHONDROMA OSTEOCHONDROMA PRESENTED BY G. MICHAEL WHITEHEAD, B.S., D.C., G. D.A.C.B.R. D.A.C.B.R. OSTEOCHONDROMA OSTEOCHONDROMA General Considerations: • Aka: Osteocartilaginous exostosis • Cartilaginous-capped bony growth off the surface of the bone the • M/C benign skeletal growth • Growth of osteochondromas continues to maturity OSTEOCHONDROMA OSTEOCHONDROMA General Considerations: • Growth of the osteochondroma continues to maturity. • Presentations: • Solitary osteochondroma • Multiple osteochondromas • HME (Hereditary multiple exostosis) • Pedunculated or sessile OSTEOCHONDROMA OSTEOCHONDROMA Signs and Symptoms: • M/C age at discovery 10-20 yoa M/C • Male to female 2:1 • Majority are asymptomatic • M/C complaint hard painless mass near a joint M/C • Fracture of the stalk pain and swelling Fracture • Pressure on nerves and vessels • Malignant degeneration to chondrosarcoma OSTEOCHONDROMA OSTEOCHONDROMA Skeletal Locations: • M/C locations: distal femur and proximal tibia • Humerus, scapula, pelvis, ribs, vertebrae and sacrum Humerus, are less common sites are • Long bones: metaphyseal • Spine: secondary centers of ossification OSTEOCHONDROMA OSTEOCHONDROMA Radiographic: • Pedunculated: • Osteocartilaginous cap on a long narrow stalk • M/C locations: knee, hip and ankle • Sessile: • Broad base with localized widening of shaft OSTEOCHONDROMA OSTEOCHONDROMA Radiographic: Radiographic: • Uninterrupted merging of the cortex and medullary Uninterrupted bone of the host bone with the osteochondroma bone • Cartilaginous cap may calcify extensively • Osteochondroma points away from the joint (coat Osteochondroma hanger exostosis) hanger OSTEOCHONDROMA OSTEOCHONDROMA Advanced Imaging: Advanced • Bone scintigraphy demonstrates uptake • CT and MRI are helpful in assessing the thickness of CT the cartilaginous cap the • CT and MRI are beneficial in suspected cases of CT malignant degeneration malignant OSTEOCHONDROMA OSTEOCHONDROMA Differential Diagnosis: • Supracondylar process • Enchondroma • Trevor’s Disease • Blount’s disease HEREDITARY MULTIPLE EXOSTOSIS HEREDITARY General Considerations: • Aka: HME, diaphyseal aclasia • Characterized by multiple osteochondromas mainly in Characterized the metaphysis the • Relatively common condition • Malignant degeneration to chondrosarcoma Malignant HEREDITARY MULTIPLE EXOSTOSIS HEREDITARY Signs and Symptoms: • M/C discovered between ages 2 and 10 • Males 2:1 over females • Hard, painless masses near joints • Bone deformity • Usually bilateral and symmetrical HEREDITARY MULTIPLE EXOSTOSIS HEREDITARY Signs and Symptoms: • Symptoms related to nerve and blood compromise Symptoms and joint movement. and • “Bayonet hand deformity” • Shortening of the ulna. • Outward bowing of radius. • Subluxation of radio-ulnar joint. HEREDITARY MULTIPLE EXOSTOSIS HEREDITARY Skeletal Locations: • Long bones especially of the lower extremity are m/c Long sites sites • Pelvis, ribs, scapula • Shortening of the metacarpals and phalanges occurs ENCHONDROMA ENCHONDROMA PRESENTED BY G. MICHAEL WHITEHEAD, B.S., D.C., G. D.A.C.B.R. D.A.C.B.R. ENCHONDROMA ENCHONDROMA General Considerations: • Aka: Chondroma • Benign tumor of cartilage • Originates from a cartilage rest displaced from the Originates epiphyseal plate epiphyseal • Lesions located near the axial skeleton have greater Lesions potential for malignant degeneration potential • M/C benign tumor of the hand ENCHONDROMA ENCHONDROMA Signs and Symptoms: • Incidence greatest between 2nd and 5th decade • M=F • Usually asymptomatic in short tubular bones and Usually discovered incidentally or after pathologic fracture discovered • Pain or pathologic fracture in long bones ENCHONDROMA ENCHONDROMA Skeletal Locations: M/C site: short tubular bones of hands • Humerus, femur Humerus, • Toes, metatarsals, tibia, fibula, ulna • Rare sites include ribs, sternum, pelvis ENCHONDROMA ENCHONDROMA Radiographic: • Metaphyseal origin with apparent migration down the Metaphyseal shaft shaft • May extend into epiphysis after the plate closes • Usually involves the middle and distal aspects of Usually metacarpals and proximal aspect of the phalanges metacarpals • Central or slightly of axis location within the medullary Central cavity cavity ENCHONDROMA ENCHONDROMA Radiographic: • Well marginated geographic lesion • Thin cortex or thickened cortex, endosteal scalloping • Often are expansile • No cortical breakthrough • Matrix calcification sparse or very heavy Matrix • Bone scintigraphy demonstrates uptake ENCHONDROMA ENCHONDROMA Treatment and Prognosis: • Most lesion require no treatment • Symptomatic lesions require careful curettage, Symptomatic cryosurgery and bone chips cryosurgery • Irradiation is contraindicated • Potential for malignant degeneration ENCHONDROMA ENCHONDROMA Differential Diagnosis: • Medullary bone infarct • Chondrosarcoma • Epidermoid inclusion cyst MULTIPLE MULTIPLE ENCHONDROMATOSIS • General Considerations: • Aka: Ollier’s disease • Osseous dysplasia characterized by hypertrophic Osseous cartilage that has not been resorbed or ossified normally. normally. • Usually discovered before 10 years of age MULTIPLE MULTIPLE ENCHONDROMATOSIS Signs and Symptoms: • Marked shortening of the extremities • Severe deformity, deforming masses, and facial Severe asymmetry asymmetry • Maffucci syndrome: • Enchondromas • Cavernous hemangiomatosis MULTIPLE MULTIPLE ENCHONDROMATOSIS Radiographic: • Rounded or linear radiolucencies in metaphyses and Rounded shafts of tubular bones shafts • Lesions are expansile with or without matrix Lesions calcification calcification • Bone shortening and deformity due to eccentric Bone growth growth CHONDROBLASTOMA CHONDROBLASTOMA General Considerations: • Aka: Codman’s tumor • Uncommon bone tumor originating from Uncommon chondroblasts in the epiphyseal cartilage plate chondroblasts • Usually seen before epiphyseal plate closure CHONDROBLASTOMA CHONDROBLASTOMA Signs and Symptoms: • Peak age range is 10-25; Range 8-59 Peak • Joint pain, tenderness, heat, swelling • Limitation of motion • Weakness, numbness and muscle atrophy CHONDROBLASTOMA CHONDROBLASTOMA Skeletal Locations: • Arises in epiphyseal cartilage plate, extends into the Arises epiphysis epiphysis • M/C sites: distal femur, proximal tibia, upper M/C humerus, femoral head and greater trochanter, distal tibia tibia CHONDROBLASTOMA CHONDROBLASTOMA Radiographic: • Well demarcated, oval or round radiolucency • Most are eccentric and may expand the cortex Most • Matrix calcification on occasion • Thin, sharply demarcated sclerotic margin is Thin, characteristic characteristic CHONDROBLASTOMA CHONDROBLASTOMA Differential Diagnosis: • Giant-cell tumor Complications: • • Formation of secondary ABC Malignant degeneration after radiation treatment ...
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