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Presented by Edward McCarthy, M.D. and prepared by Natasha Rekhtman, M.D., Ph.D.
Case 2: A 30 year-old man had pain in his shoulder.
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Question 1 of 1
1. Question
Week 243: Case 2
A 30 year-old man had pain in his shoulder. A radiograph demonstrated a surface lesion in the proximal humerus.images/oct 24 2005 case 2 1.jpg
images/oct 24 2005 case 2 2.jpg
images/oct 24 2005 case 2 3.jpg
images/oct 24 2005 case 2 4.jpgCorrect
Answer: Periosteal chondroma
Histology: The radiographic features are typical of a periosteal chondroma with a surface lesion causing a trough beneath the periosteum. There is faint mineralization in the lesion consistent with cartilage. It is extremely well defined. Histologic features show a cartilage with a little atypia and no mitotic figures. There is some endochondral bone formation typical of all cartilage lesions.
Discussion: The lesion is not a surface chondrosarcoma because the radiographic features indicate an extremely well-defined lesion with no evidence of invasion of the surrounding soft tissues or bone marrow. Also, there is no cartilaginous atypia.
The lesion is not an enchondroma because it is not located in the medullary canal of the bone.
The lesion is not synovial chondromatosis. Although the lesion is fairly close to the shoulder joint, this lesion is entirely unassociated with synovial or basal tissues. It lacks the nodular arrangement of synovial chondromatosis.
Incorrect
Answer: Periosteal chondroma
Histology: The radiographic features are typical of a periosteal chondroma with a surface lesion causing a trough beneath the periosteum. There is faint mineralization in the lesion consistent with cartilage. It is extremely well defined. Histologic features show a cartilage with a little atypia and no mitotic figures. There is some endochondral bone formation typical of all cartilage lesions.
Discussion: The lesion is not a surface chondrosarcoma because the radiographic features indicate an extremely well-defined lesion with no evidence of invasion of the surrounding soft tissues or bone marrow. Also, there is no cartilaginous atypia.
The lesion is not an enchondroma because it is not located in the medullary canal of the bone.
The lesion is not synovial chondromatosis. Although the lesion is fairly close to the shoulder joint, this lesion is entirely unassociated with synovial or basal tissues. It lacks the nodular arrangement of synovial chondromatosis.
