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Presented by Edward McCarthy, M.D. and prepared by Natasha Rekhtman, M.D., Ph.D.
Case 3: A 15 year-old boy had pain in his leg for a year.
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1. Question
Week 243: Case 3
A 15 year-old boy had pain in his leg for a year. A radiograph demonstrated a well-defined lytic lesion in the metaphyseal portion of his femur.images/oct 24 2005 case 3 1.jpg
images/oct 24 2005 case 3 2.jpg
images/oct 24 2005 case 3 3.jpg
images/oct 24 2005 case 3 4.jpgCorrect
Answer: Chondromyxoid fibroma
Histology: none provided
Discussion: A chondromyxoid fibroma is a benign lesion made up of fetal cartilage tissue. There is a chondroid background and cells with stellate or spindly nuclei. Often there is cellular atypia without abnormal mitotic figures. The cellular atypia can be misdiagnosed as a chondrosarcoma.
The lesion is not an enchondroma. Although there is a chondroid flavor to this lesion, mature hyaline cartilage is not present.
The lesion is not a chondroblastoma. Chondroblastomas are lesions which always involve the epiphyseal area of bone. Although chondroblastomas are also composed of fetal cartilage, the myxoid stroma is not a feature of chondroblastomas.
The lesion is not a chondrosarcoma. Despite the chondroid flavor and the cellular atypia, the radiograph is indicative of a benign lesion. It is extremely well circumscribed. In addition, the degree of atypia in this lesion would require that the lesion be considered a high grade chondrosarcoma. If this were the case, mitotic figures would be present.
Incorrect
Answer: Chondromyxoid fibroma
Histology: none provided
Discussion: A chondromyxoid fibroma is a benign lesion made up of fetal cartilage tissue. There is a chondroid background and cells with stellate or spindly nuclei. Often there is cellular atypia without abnormal mitotic figures. The cellular atypia can be misdiagnosed as a chondrosarcoma.
The lesion is not an enchondroma. Although there is a chondroid flavor to this lesion, mature hyaline cartilage is not present.
The lesion is not a chondroblastoma. Chondroblastomas are lesions which always involve the epiphyseal area of bone. Although chondroblastomas are also composed of fetal cartilage, the myxoid stroma is not a feature of chondroblastomas.
The lesion is not a chondrosarcoma. Despite the chondroid flavor and the cellular atypia, the radiograph is indicative of a benign lesion. It is extremely well circumscribed. In addition, the degree of atypia in this lesion would require that the lesion be considered a high grade chondrosarcoma. If this were the case, mitotic figures would be present.
