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Presented by Dr. John Gross and prepared by Dr. Yembur Ahmad
This case talks about a 13-year-old male with knee pain.
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This is a 13-year-old male with knee pain.
Diagnosis:
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Chondromyxoid fibroma is a rare benign cartilage tumor typically affecting young adults and presenting as a metaphyseal, eccentric, and well-defined lesion on radiographs. Chondromyxoid fibroma is composed of bland spindle to stellate cells growing in a background chondromyxoid matrix. The tumor tends to condense into macro- or microlobular pattern and may grow in cords and trabeculae. This low power diagnosis showing a peripheral condensation with central hypocellularity is important two recognize for this diagnosis. Fibrous dysplasia is benign bone tumor which often shows a ground glass radiographic appearance which may expand or deform the bone and shows well defined margins. Histologically, fibrous dysplasia shows randomly arranged trabeculae of woven bone with inconspicuous osteoblastic rimming. The fibrous stroma is bland without cytologic atypia and may grow in a storiform pattern. Non-ossifying fibroma often shows a similar radiographic appearance as chondromyxoid fibroma with a well-defined lesion in metaphysis at an eccentric location. Histologically, non-ossifying fibroma shows bland spindle cells, osteoclast-type giant cells, hemosiderin laden macrophages, and variable amounts of hemorrhage and reactive woven bone. Finally, myofibroma may rarely occur as a primary intraosseous neoplasm and has a predilection for craniofacial sites. If a myofibroma were to occur as a lytic, eccentric mass with sclerotic borders in the metaphysis of a young patient, the radiographic appearance could mimic a chondromyxoid fibroma; however, histologically, myofibromas do not show the same lobulated pattern and instead grow in a more sheet-like or fascicular architecture and have cells with eosinophilic “myoid” cytoplasm with plump oval to spindled nuclei with fine chromatin and tiny, dot-like nucleoli.
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Chondromyxoid fibroma is a rare benign cartilage tumor typically affecting young adults and presenting as a metaphyseal, eccentric, and well-defined lesion on radiographs. Chondromyxoid fibroma is composed of bland spindle to stellate cells growing in a background chondromyxoid matrix. The tumor tends to condense into macro- or microlobular pattern and may grow in cords and trabeculae. This low power diagnosis showing a peripheral condensation with central hypocellularity is important two recognize for this diagnosis. Fibrous dysplasia is benign bone tumor which often shows a ground glass radiographic appearance which may expand or deform the bone and shows well defined margins. Histologically, fibrous dysplasia shows randomly arranged trabeculae of woven bone with inconspicuous osteoblastic rimming. The fibrous stroma is bland without cytologic atypia and may grow in a storiform pattern. Non-ossifying fibroma often shows a similar radiographic appearance as chondromyxoid fibroma with a well-defined lesion in metaphysis at an eccentric location. Histologically, non-ossifying fibroma shows bland spindle cells, osteoclast-type giant cells, hemosiderin laden macrophages, and variable amounts of hemorrhage and reactive woven bone. Finally, myofibroma may rarely occur as a primary intraosseous neoplasm and has a predilection for craniofacial sites. If a myofibroma were to occur as a lytic, eccentric mass with sclerotic borders in the metaphysis of a young patient, the radiographic appearance could mimic a chondromyxoid fibroma; however, histologically, myofibromas do not show the same lobulated pattern and instead grow in a more sheet-like or fascicular architecture and have cells with eosinophilic “myoid” cytoplasm with plump oval to spindled nuclei with fine chromatin and tiny, dot-like nucleoli.