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Presented by Edward McCarthy, M.D. and prepared by Orin Buetens, M.D.
Case 2: A 35 year-old woman had pain and stiffness in her left shoulder for several months.
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Question 1 of 1
1. Question
Week 21: Case 2
A 35 year-old woman had pain and stiffness in her left shoulder for several months. The radiograph showed a scalloped radiolucency on the medial surface of the proximal humeral metaphysis. The scalloping resembles a crater and has a faint sclerotic rim./images/perioschond1.jpg
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/images/perioschond4.jpgCorrect
Answer: Periosteal chondroma
Histology: The radiograph is an important clue in a correct diagnosis of periosteal chondroma. These lesions are subperiosteal. A nodule of bland hyaline cartilage causes an erosion in the cortex. Occasionally, stippled calcifications are present. Histologically, periosteal chondromas consist of bland hyaline cartilage. On rare occasions chondrocyte atypia may be present.
Discussion: Radiologically, enchondromas are entirely confined to the medullary canal of the bone and frequently have a stippled calcification. Chondrosarcomas may also occur on the bone surface. However, these lesions are irregular and infiltrate the soft tissue. By contrast, periosteal chondroma is very sharply marginated. Synovial chondromatosis occasionally causes bone erosion. However, synovial chondromatosis primarily involves the synovial membrane. The stippled calcifications are centered on a joint or a bursal cavity. The principle distinction between a chondrosarcoma and periosteal chondroma is based on the smallness and location of the lesion.
Incorrect
Answer: Periosteal chondroma
Histology: The radiograph is an important clue in a correct diagnosis of periosteal chondroma. These lesions are subperiosteal. A nodule of bland hyaline cartilage causes an erosion in the cortex. Occasionally, stippled calcifications are present. Histologically, periosteal chondromas consist of bland hyaline cartilage. On rare occasions chondrocyte atypia may be present.
Discussion: Radiologically, enchondromas are entirely confined to the medullary canal of the bone and frequently have a stippled calcification. Chondrosarcomas may also occur on the bone surface. However, these lesions are irregular and infiltrate the soft tissue. By contrast, periosteal chondroma is very sharply marginated. Synovial chondromatosis occasionally causes bone erosion. However, synovial chondromatosis primarily involves the synovial membrane. The stippled calcifications are centered on a joint or a bursal cavity. The principle distinction between a chondrosarcoma and periosteal chondroma is based on the smallness and location of the lesion.
