Condroblastom

Condroblastomul is a bone tumor, usually benign, which has approximately 1% of bone tumors.
Complications associated with pathological fractures and rarely include condroblastomul malignant transformation. Fractures are uncommon and occur in large tumors. Surgical excision without tumor may extend to adjacent soft tissue or synovium and metastasize to distant organs. Metastasis occurs when affecting the lungs and tends to occur when the primary tumor recurrence.Patients with benign condroblastom limit activities because of pain may occur. Condroblastoamele malignant, which may occur several years after the primary lesion are very rare and are associated with adverse prognosis. Condroblastomului symptoms and signs are nonspecific and include local pain, tenderness, swelling and muscle emanciere. Pain symptom onset is most common. It is light and progressive, initially attributed to minor trauma. Constitutional symptoms usually missing. He reported a high rate of tumor for condroblastoame appellant.
There are no data on spontaneous remission condroblastoamelor so surgical treatment is indicated. The surgical procedure most used is curettage with or without bone grafting. Other techniques used are filling the defect with PMMA, cryotherapy, marginal resection, cauterization chemical. Because 10% risk of recurrent tumor patients should be monitored for several years.
Pathogenesis condroblastomuluiThere are several theories on the origin condroblastoamelor. It was concluded that the tumors are of condrogenica. Condroblastomul typically occurring utbulare epiphysis of long bones. Distal femoral and proximal tibial Eifizele are most commonly affected, followed by proximal humerus.
Condroblastomul is composed of chondroblasts, oval or round primitive cells of the epiphyseal cartilage plate containing intense cytoplasmic eosinophilia. Cell areas are surrounded by variable amounts of eosinophilic matrix and may contain calcifications.Mitotic and atypical cellular elements are rare. Cystic changes may simulate those of a cyst, aneurysm, especially if the tumor occurs in the patella, talus or calcaneum.
Condroblastoamele epiphysis and apophyses occur in long tubular bones and the tumor is limited to the epiphysis in 40% of cases. In other cases adjacent tumor extends to metaphysics.Condroblastoamele rarely occur less frequently in the shaft of metaphysics. The region is most affected leg and 50% of tumors occur in the knee. Femur is involved in 33% of cases, humerus and tibia 18% 20%. The lesions appear mainly on the proximal femur than the femoral head, greater trochanter. 90% of lesions occur in the humeral head of the humerus.
10% of small condroblastoame appear in the hand and foot bones, talus and calcaneum are most affected. Other rare locations include unnamed bone, ribs, skull, jaw, jaw, vertebrae, scapula, sternum and patella.
Signs and symptomsCondroblastomului symptoms and signs are nonspecific and include local pain, tenderness, swelling and muscle emanciere.Epensamentele joints occur in 30% of patients. Symptoms vary in duration before diagnosis: months, years.Pain symptom onset is most common. It is light and progressive, initially attributed to minor trauma. If the lesion is juxta-articular joint swelling, the patient can accuse or limitation of movement.Constitutional symptoms usually missing.He reported a high rate of tumor appellant for condroblastoame: 10-35%. Risk factors for recurrence include large size of the lesion side and location of aneurysm bone cyst in the proximal femur or pelvis.
Condroblastomului Complications include infection, development of degenerative joint changes, pathologic fracture and malignant transformation or the development of post irradiation sarcoma.Fractures are uncommon and occur in large tumors. Surgical excision without tumor may extend to adjacent soft tissue or synovium and metastasize to distant organs. Metastasis occurs when the lungs and affects momemntul tend to occur in primary tumor recurrence.Evolution condroblastomului:Local Recurrence is 10% and is higher for tumors of flat bones.The average duration of recurrence is 34 months after initial treatment. It can be repeatedly treated by curettage with or without bone graft or cement and by marginal excision of tissue component.
While most condroblastoamelor are small, well-limited and successfully treated by intralesional curettage, a small subset behaves differently. They remain very benign but then develops microscopic or metastable in the lungs. Metastasis can be synchronous or metachrony. These lesions can be treated by aggressive bloc resection and reconstruction. Another subset of condroblastoame become malignant even without irradiation.Malignant transformation occurs many years after the initial injury treatment. Pulmonary metastases may develop near the malignant lesion.
Diagnostic condroblastomImaging Studies:The methods are preferred for assessing condroblastoamelor standard radiography and computed tomography or magnetic resonance imaging. X-rays can miss condroblastoamele. CT scanning is useful in defining cortical erosion and matrix mineralization.Radiography showed benign nature, slow-growing condroblastoamelor. Tumors occur in epiphyses of long bones in the lower extremities. They are round or oval, geographic, bright with sharp edges. The outer ring may be sclerotic, sclerotic nonsclerotic or incomplete. Most lesions were 1-4 cm in diameter.40% are limited to the epiphysis, the remainder of this expansion.Condroblastoamele shows different models of matrix mineralization. 40% and 60% are uniformly bright opaque shows calcifications and sevens.By increasing the size of the metaphysical and extend condroblastoamele cause endosteal erosion, expressing the underlying cortex and periosteala reaction.
MRI is reserved for aggressive or recurrent tumor assessment.Can lead to matrix mineralization, soft tissue extension and cortical erosion.Angiography can be used to create a vascular map for surgical planning. Periostiala and cortical surface reaction neovascularizarea synovium adjacent or near the tumor are present.The differential diagnosis is with other bone tumors: Chondrosarcoma, osteosarcoma, osteoblastoma, cyst aneurysms, condromixoid fibroids, bone giant cell tumor, osteocondromul.
Treatment condroblastomuluiTherapy of choice is surgical curettage expanded plastic or artificial bone graft. Skeletally immature patients is recommended to fill the bone defect with polymethylmethacrylate, this skeletal growth while allowing the tumor cells are destroyed. In older patients where skeletal development is not a problem bone grafting is recommended for small lesions. For large lesions and cement reconstruction is necessary.Filling the defect with PMMA is recommended after removal of recurrent lesions. If an aneurysm secondary bone cyst is currently considered the use of phenol and cryosurgery, due to the high rate of local recurrence of these lesions.