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Presented by Edward McCarthy, M.D. and prepared by Orin Buetens, M.D.
Case 1: A 40 year-old man had pain in his pelvis for 2 months.
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Question 1 of 1
1. Question
Week 14: Case 1
A 40 year-old man had pain in his pelvis for 2 months.
Correct
Answer: Chondromyxoid fibroma
Histology: Radiographic examination reveals a well-defined lytic lesion in the wing of the ilium that measured 4 cm in greatest dimension. There is no matrix mineralizations in the lesion.
Histologically, the lesion consists of lobules of basophilic chondroid material that contains spindle cells and stelate-shaped cells. Thin fibrous bands, some of which contain multinucleated giant cells, separate the lobules.Discussion: The radiologic features are critical in determining that the behavior of this lesion is that of a slowly growing neoplasm. The margins are well defined. That radiologic picture, coupled with a lesion with a chondroid background containing spindle cells and stelate-shaped cells, is indicative of a chondromyxoid fibroma. Chondromyxoid fibromas often show atypia. However, mitotic figures are almost never present. The absence of mitoses helps distinguish this lesion from a chondrosarcoma. Chondrosarcomas, by contrast, usually show some matrix mineralization on the radiograph and are poorly defined. While they may contain spindle cells as in a chondromyxoid fibroma, these spindle cells are usually condensed around the periphery of the lobules. Enchondromas are composed of mature hyaline cartilage with little or no atypia. Usually enchondromas are partially mineralized or ossified. This matrix calcification is apparent on plain radiographs. Chondroblastic osteosarcoma can mimic true cartilage neoplasms. However, there will be areas of neoplastic osteoid being made by atypical cells.
Incorrect
Answer: Chondromyxoid fibroma
Histology: Radiographic examination reveals a well-defined lytic lesion in the wing of the ilium that measured 4 cm in greatest dimension. There is no matrix mineralizations in the lesion.
Histologically, the lesion consists of lobules of basophilic chondroid material that contains spindle cells and stelate-shaped cells. Thin fibrous bands, some of which contain multinucleated giant cells, separate the lobules.Discussion: The radiologic features are critical in determining that the behavior of this lesion is that of a slowly growing neoplasm. The margins are well defined. That radiologic picture, coupled with a lesion with a chondroid background containing spindle cells and stelate-shaped cells, is indicative of a chondromyxoid fibroma. Chondromyxoid fibromas often show atypia. However, mitotic figures are almost never present. The absence of mitoses helps distinguish this lesion from a chondrosarcoma. Chondrosarcomas, by contrast, usually show some matrix mineralization on the radiograph and are poorly defined. While they may contain spindle cells as in a chondromyxoid fibroma, these spindle cells are usually condensed around the periphery of the lobules. Enchondromas are composed of mature hyaline cartilage with little or no atypia. Usually enchondromas are partially mineralized or ossified. This matrix calcification is apparent on plain radiographs. Chondroblastic osteosarcoma can mimic true cartilage neoplasms. However, there will be areas of neoplastic osteoid being made by atypical cells.
