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Presented by Edward McCarthy, M.D. and prepared by Sharon Swierczynski, M.D., Ph.D.
Case 1: A 12-year-old boy had a painless swelling beneath his left knee for many years.
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1. Question
Week 152: Case 1
A 12-year-old boy had a painless swelling beneath his left knee for many years. A radiograph demonstrated a fusiform enlargement of the metaphysis of the fibula.images/092203case1fig1.jpg
images/092203case1fig2.jpg
images/092203case1fig3.jpgCorrect
Answer: Osteochondroma
Histology: Osteochondromas are often pedunculated and shaped like a piece of broccoli with a stalk and a broad cartilaginous cap. However, some osteochondromas are sessile and have a very broad base. In this case, the broad base wraps around the fibula producing a very large swelling. The lesion has a discrete cartilage cap without chondrocyte atypia.
Discussion: The lesion is not an enchondroma because there is no cartilage within the medullary canal of the bone.
The lesion is not a surface chondrosarcoma because the cartilage cap is thin and extremely well emarcated. There is no atypia present in the cartilage, and the cartilage does not infiltrate the soft tissues.
Although bone cysts cause fusiform expansion in the metaphyseal portion of bone, this lesion is not a bone cyst because it does not have a medullary cyst with a lining. This differential diagnosis is primarily radiographic.
Incorrect
Answer: Osteochondroma
Histology: Osteochondromas are often pedunculated and shaped like a piece of broccoli with a stalk and a broad cartilaginous cap. However, some osteochondromas are sessile and have a very broad base. In this case, the broad base wraps around the fibula producing a very large swelling. The lesion has a discrete cartilage cap without chondrocyte atypia.
Discussion: The lesion is not an enchondroma because there is no cartilage within the medullary canal of the bone.
The lesion is not a surface chondrosarcoma because the cartilage cap is thin and extremely well emarcated. There is no atypia present in the cartilage, and the cartilage does not infiltrate the soft tissues.
Although bone cysts cause fusiform expansion in the metaphyseal portion of bone, this lesion is not a bone cyst because it does not have a medullary cyst with a lining. This differential diagnosis is primarily radiographic.
