Chondroma differential diagnosis: Difference between revisions
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[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Chondroma]] | |||
{{CMG}};{{AE}} {{Rohan}} | {{CMG}};{{AE}} {{Rohan}} | ||
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======Low-grade Chondrosarcoma====== | ======Low-grade Chondrosarcoma====== | ||
*When differentiating an enchondroma from a chondrosarcoma, the radiographic image may be equivocal. However, [[periostitis]] is not usually seen with an uncomplicated enchondroma. | *When differentiating an enchondroma from a [[chondrosarcoma]], the [[Radiography|radiographic]] image may be equivocal. However, [[periostitis]] is not usually seen with an uncomplicated enchondroma. | ||
======Chondroblastoma====== | ======Chondroblastoma====== | ||
*Presence of bone marrow [[edema]] frequently seen surrounding chondroblastomas is helpful, as it is not a usual feature of | *Presence of [[bone marrow]] [[edema]] frequently seen surrounding chondroblastomas is helpful, as it is not a usual feature of [[Chondromyxoid fibroma|chondromyxoid fibromas]], [[giant cell]] [[tumors]], or enchondromas.<ref name="pmid11687691">{{cite journal| author=Erickson JK, Rosenthal DI, Zaleske DJ, Gebhardt MC, Cates JM| title=Primary treatment of chondroblastoma with percutaneous radio-frequency heat ablation: report of three cases. | journal=Radiology | year= 2001 | volume= 221 | issue= 2 | pages= 463-8 | pmid=11687691 | doi=10.1148/radiol.2212010262 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11687691 }} </ref> | ||
======Fibrocartilaginous dysplasia====== | ======Fibrocartilaginous dysplasia====== | ||
* | *[[Fibrous dysplasia]] is seen with an extensive [[Cartilage|cartilagenous]] differentiation that results in a picture that mimics enchondroma. | ||
*Cellular [[atypia]] in the surrounding [[stroma]] helps in the differentiation.<ref name="pmid16329546">{{cite journal| author=Muezzinoglu B, Oztop F| title=Fibrocartilaginous dysplasia: a variant of fibrous dysplasia. | journal=Malays J Pathol | year= 2001 | volume= 23 | issue= 1 | pages= 35-9 | pmid=16329546 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16329546 }} </ref> | *Cellular [[atypia]] in the surrounding [[stroma]] helps in the differentiation.<ref name="pmid16329546">{{cite journal| author=Muezzinoglu B, Oztop F| title=Fibrocartilaginous dysplasia: a variant of fibrous dysplasia. | journal=Malays J Pathol | year= 2001 | volume= 23 | issue= 1 | pages= 35-9 | pmid=16329546 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16329546 }} </ref> | ||
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======Bone Infarcts====== | ======Bone Infarcts====== | ||
*Differentiating an enchondroma from a bone infarct on plain film may be difficult. | *Differentiating an enchondroma from a [[Bone infarction|bone infarct]] on plain film may be difficult. | ||
*An enchondroma usually causes endosteal scalloping while an [[infarct]] will not. | *An enchondroma usually causes endosteal scalloping while an [[infarct]] will not. | ||
*An infarct usually has a well-defined, sclerotic serpentine border, whereas an | *An [[infarct]] usually has a well-defined, [[Sclerosis|sclerotic]] serpentine border, whereas an endochondroma does not have a well defined border. | ||
===Periosteal Chondroma=== | ===Periosteal Chondroma=== | ||
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======Periosteal chondrosarcoma====== | ======Periosteal chondrosarcoma====== | ||
*Chondrosarcomas are generally greater in size and occur in older patients more than 50 years of age. | *[[Chondrosarcoma|Chondrosarcomas]] are generally greater in size and occur in older patients more than 50 years of age. | ||
*They may extend into the soft tissue. | *They may extend into the [[soft tissue]]. | ||
*Periosteal chondrosarcoma shows popcorn calcifications on radiographs, which present as a collection of scalloped radiolucencies and with a sclerotic margin. | *[[Chondrosarcoma|Periosteal chondrosarcoma]] shows popcorn [[Calcification|calcifications]] on [[Radiograph|radiographs]], which present as a collection of scalloped radiolucencies and with a sclerotic margin. | ||
======Periosteal osteosarcoma====== | ======Periosteal osteosarcoma====== | ||
*Periosteal osteosarcomas are slow-growing, and primarily arise beneath the periosteum, inducing new bone formation. | *[[Osteosarcoma|Periosteal osteosarcomas]] are slow-growing, and primarily arise beneath the periosteum, inducing new bone formation. | ||
*It seen as a radiolucent lesion on the bone surface with perpendicular striae and a peripheral Codman’s triangle on radiography. | *It seen as a radiolucent lesion on the [[bone]] surface with perpendicular striae and a peripheral [[Codman's triangle|Codman’s triangle]] on [[radiography]]. | ||
======Osteochondroma====== | ======Osteochondroma====== | ||
*Osteochondromas are more commonly seen in adolescents, in contrast with periosteal chondromas, which typically occur in young adults. | *[[Osteochondroma|Osteochondromas]] are more commonly seen in adolescents, in contrast with [[Periosteal chondroma|periosteal chondromas]], which typically occur in young adults. | ||
*Osteochondromas may also be distinguished by the presence of a dense osteoid formation in the cortex and medulla of the mass, and by the continuation with its originating bone. | *[[Osteochondroma|Osteochondromas]] may also be distinguished by the presence of a dense [[osteoid]] formation in the [[cortex]] and [[medulla]] of the mass, and by the continuation with its originating [[bone]]. | ||
Latest revision as of 22:28, 20 February 2019
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Rohan A. Bhimani, M.B.B.S., D.N.B., M.Ch.[2]
Overview
Enchondroma must be differentiated from low-grade chondrosarcoma, fibrocartilaginous dysplasia, bone islands and bone infarcts. Periosteal chondroma must be differentiated from juxtacortical chondrosarcoma, osteochondroma and periosteal osteosarcoma.
Differential Diagnosis
Enchondroma
Enchondroma must be differentiated from the following:[1][2]
Low-grade Chondrosarcoma
- When differentiating an enchondroma from a chondrosarcoma, the radiographic image may be equivocal. However, periostitis is not usually seen with an uncomplicated enchondroma.
Chondroblastoma
- Presence of bone marrow edema frequently seen surrounding chondroblastomas is helpful, as it is not a usual feature of chondromyxoid fibromas, giant cell tumors, or enchondromas.[1]
Fibrocartilaginous dysplasia
- Fibrous dysplasia is seen with an extensive cartilagenous differentiation that results in a picture that mimics enchondroma.
- Cellular atypia in the surrounding stroma helps in the differentiation.[2]
Bone Islands
- Small focus of compact bone within the cancellous bone.
- No cortical destruction or involvement of the surrounding soft tissues.
Bone Infarcts
- Differentiating an enchondroma from a bone infarct on plain film may be difficult.
- An enchondroma usually causes endosteal scalloping while an infarct will not.
- An infarct usually has a well-defined, sclerotic serpentine border, whereas an endochondroma does not have a well defined border.
Periosteal Chondroma
Periosteal chondroma must be differentiated from the following:[3][4][5][6]
Periosteal chondrosarcoma
- Chondrosarcomas are generally greater in size and occur in older patients more than 50 years of age.
- They may extend into the soft tissue.
- Periosteal chondrosarcoma shows popcorn calcifications on radiographs, which present as a collection of scalloped radiolucencies and with a sclerotic margin.
Periosteal osteosarcoma
- Periosteal osteosarcomas are slow-growing, and primarily arise beneath the periosteum, inducing new bone formation.
- It seen as a radiolucent lesion on the bone surface with perpendicular striae and a peripheral Codman’s triangle on radiography.
Osteochondroma
- Osteochondromas are more commonly seen in adolescents, in contrast with periosteal chondromas, which typically occur in young adults.
- Osteochondromas may also be distinguished by the presence of a dense osteoid formation in the cortex and medulla of the mass, and by the continuation with its originating bone.
References
- ↑ 1.0 1.1 Erickson JK, Rosenthal DI, Zaleske DJ, Gebhardt MC, Cates JM (2001). "Primary treatment of chondroblastoma with percutaneous radio-frequency heat ablation: report of three cases". Radiology. 221 (2): 463–8. doi:10.1148/radiol.2212010262. PMID 11687691.
- ↑ 2.0 2.1 Muezzinoglu B, Oztop F (2001). "Fibrocartilaginous dysplasia: a variant of fibrous dysplasia". Malays J Pathol. 23 (1): 35–9. PMID 16329546.
- ↑ Singh AP, Singh AP, Mahajan S (2008). "Periosteal chondroma of the sacrum". Can J Surg. 51 (5): E105–6. PMC 2556540. PMID 18841229.
- ↑ Agrawal A, Dwivedi SP, Joshi R, Gangane N (2005). "Osteochondroma of the sacrum with a correlative radiographic and histological evaluation". Pediatr Neurosurg. 41 (1): 46–8. doi:10.1159/000084865. PMID 15886513.
- ↑ Akansu B, Atık E, Altintaş S, Kalaci A, Canda S (2012). "Periosteal chondroma of the ischium; an unusual location". Turk Patoloji Derg. 28 (2): 172–4. doi:10.5146/tjpath.2012.01119. PMID 22627638.
- ↑ Sulzbacher I, Puig S, Trieb K, Lang S (2000). "Periosteal osteoblastoma: a case report and a review of the literature". Pathol Int. 50 (8): 667–71. PMID 10972867.