cartilage tumors
DESCRIPTION
radiologyTRANSCRIPT
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Benign and Malignant Benign and Malignant Tumors Tumors
ofofCartilaginous OriginCartilaginous Origin
C.Pierre-Jerome,M.D.PhDC.Pierre-Jerome,M.D.PhD
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General ApproachGeneral Approach Patient:Patient: Age / Gender Age / Gender Clinical History:Clinical History: Painful Solitaire Multiple Painful Solitaire Multiple Slow or Fast Growing Slow or Fast Growing History of trauma? History of trauma?
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General ApproachGeneral Approach
Radiologically: L.E.D.SRadiologically: L.E.D.S LocationLocation: Epi Meta Diaphysis : Epi Meta Diaphysis Medullary or CorticalMedullary or Cortical ExtensionExtension: To Soft Tissues: To Soft Tissues DensityDensity: Lytic /Blastic/ Mixte : Lytic /Blastic/ Mixte /Ca+ /Ca+ Solitaire or MultipleSolitaire or Multiple MRI MRI Contrast Enhancement (?)Contrast Enhancement (?)
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ClassificationClassification BENIGNBENIGN 1.1. EnchondromaEnchondroma 2. Osteochondroma2. Osteochondroma 3. Chondroblastoma3. Chondroblastoma 4. ChondroMyxoid Fibroma 4. ChondroMyxoid Fibroma
(CMF)(CMF) 5. PeriOsteal Chondroma5. PeriOsteal Chondroma
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ClassificationClassificationMalignant Malignant ChondrosarcomasChondrosarcomas
1. Primary (de novo)1. Primary (de novo) 2. Secondary2. Secondary
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1. Enchondroma1. Enchondroma General Features:General Features: Benign Intramedullary TuBenign Intramedullary Tu. of . of
hyaline cartilagehyaline cartilage 10% of all Benign Bone Tumors10% of all Benign Bone Tumors Solitaire LesionSolitaire Lesion Multiple (enchondromatosis) Multiple (enchondromatosis)
is is rarerare
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1. Enchondroma1. EnchondromaClinical FeaturesClinical Features In Children and young AdultsIn Children and young Adults 60% between ages of 15 – 40 y.60% between ages of 15 – 40 y. Males = FemalesMales = Females Usually Asymptomatic Usually Asymptomatic
(incidental finding) (incidental finding)
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1. Enchondroma1. Enchondroma Clinical FeaturesClinical FeaturesIt becomesIt becomes Painful: Painful: - Pathological fracture- Pathological fracture - - Malignant DegenerationMalignant Degeneration Radiol. Radiol. GrowthGrowth / Cortical / Cortical DisruptionDisruption Loss of marginal definitionLoss of marginal definition Local periosteal reactionLocal periosteal reaction
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EnchondromasEnchondromasEnchondromas Enchondromas
a. a. In short bonesIn short bones (lytic) (lytic) metacarpals, phalanges metacarpals, phalanges
b. b. In long bonesIn long bones (+calcifications) (+calcifications) metaphysis….humerus,femur,tibia metaphysis….humerus,femur,tibia
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1. Enchondroma1. Enchondroma Sites: Short bonesSites: Short bonesAbout About 50% in Hands50% in Hands and and FeetFeet phalangesphalanges metacarpalsmetacarpals metatarsalsmetatarsals
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1. Enchondroma1. Enchondroma Radiographic FINDINGS:Radiographic FINDINGS: Radiolucent, intramedullaryRadiolucent, intramedullaryShort bone ……DiaphysisShort bone ……DiaphysisMayMay expand the bone (phalanges) expand the bone (phalanges) Thinning of Cortex….Fracture? Thinning of Cortex….Fracture?
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T2W image + Fat sat
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T1W + Contrast
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EnchondromasEnchondromas
In long bones (+ calcifications):In long bones (+ calcifications): MetaphysisMetaphysis Humerus Humerus (proximal)(proximal) FemurFemur (proximal or distal) (proximal or distal) Tibia, fibula Tibia, fibula Also in: Also in: Pelvis, Vertebrae, Ribs (rare)Pelvis, Vertebrae, Ribs (rare)
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1. Enchondroma1. Enchondroma Radiographic FINDINGS:Radiographic FINDINGS:In long tubular bones….In long tubular bones….MetaphysisMetaphysis Do not expand the boneDo not expand the bone Little (or no) cortical erosion Little (or no) cortical erosion
Presence of Ca+ Presence of Ca+ in the matrixin the matrix
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1. Enchondroma1. Enchondroma MRIMRI Lobulated Lobulated intramedullaryintramedullary lesion lesionLow signal ----T1W Low signal ----T1W High signal----T2W /with Fat SatHigh signal----T2W /with Fat SatScattered areas of low signal---Ca+Scattered areas of low signal---Ca+ Contrast---Enhances(heterogeneously)Contrast---Enhances(heterogeneously)
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DYNAMIC STUDY
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1. Enchondroma1. Enchondroma Treatment / PrognosisTreatment / Prognosis Most are treated by Most are treated by CurettageCurettage with of without Bone Graftingwith of without Bone Grafting
Recurrence rate is Recurrence rate is less than 5%less than 5%
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1. Enchondroma1. Enchondroma EnchondromatosisEnchondromatosis (Multiple) (Multiple) 1. 1. Ollier’s DiseaseOllier’s Disease Rare, Nonhereditary disorderRare, Nonhereditary disorder Usually in ExtremitiesUsually in Extremities Unilateral – shortening- deformityUnilateral – shortening- deformity 30-50% develop Sarcoma30-50% develop Sarcoma
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1. Enchondroma1. Enchondroma EnchondromatosisEnchondromatosis (Multiple) (Multiple)2. Mafucci Syndrome2. Mafucci Syndrome Rare, Nonhereditary, congenitalRare, Nonhereditary, congenital Presence of Presence of HemangiomasHemangiomas Cavernous, Uni/bilateralCavernous, Uni/bilateral Presence of Phleboliths (X-Rays)Presence of Phleboliths (X-Rays) May developMay develop Malignancy Malignancy
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ClassificationClassificationBENIGNBENIGN 1.1. EnchondromaEnchondroma
2. 2. OsteochondromaOsteochondroma3. 3. ChondroblastomaChondroblastoma 4. 4. ChondroMyxoid Fibroma (CMF)ChondroMyxoid Fibroma (CMF) 5. PeriOsteal Chondroma5. PeriOsteal Chondroma
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2. Osteochondroma2. Osteochondroma General Features:General Features: Also called Also called ExostosisExostosisBony protuberance Bony protuberance with cortical and with cortical and
medullary continuity / cartilage cap.medullary continuity / cartilage cap.
It It arises in childhoodarises in childhood and continues to grow and continues to grow until fusion of the closest epiphyseal lineuntil fusion of the closest epiphyseal line
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2. Osteochondroma2. Osteochondroma Clinical Features:Clinical Features: Males twice as FemalesMales twice as Females Presence of Mass of long durationPresence of Mass of long duration AsymptomaticAsymptomaticBecomes SymptomaticBecomes Symptomatic::
By compression of nervesBy compression of nerves Interfers with Joint FunctionInterfers with Joint Function Malignant DegenerationMalignant Degeneration
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2. Osteochondroma2. Osteochondroma Clinical Features:Clinical Features: Rapid Growth Rapid Growth Development of Localized PainDevelopment of Localized Pain suggest suggest Malignant DegenerationMalignant Degeneration “ “MRI recommended” MRI recommended” to see the cartilage capto see the cartilage cap
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2. Osteochondroma2. Osteochondroma RadiographicRadiographic Findings: Findings:MRIMRICartilage Cap:Cartilage Cap: 1 cm or less ----Benign Lesion1 cm or less ----Benign Lesion 2 cm or more---Suspicion of 2 cm or more---Suspicion of
Malignant Malignant DegenerationDegeneration
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2. Osteochondroma2. Osteochondroma RadiographicRadiographic Findings: Findings: MRI --MRI -- Low to Intermediate-----T1WLow to Intermediate-----T1W Intermediate to High-----T2W Intermediate to High-----T2W
and Fat Sat imagesand Fat Sat imagesThe periphery of the lesion is The periphery of the lesion is
covered bycovered by Hyaline Cartilage cap Hyaline Cartilage cap
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2. Osteochondroma2. Osteochondroma RadiographicRadiographic Findings: Findings: In the metaphysis of long bones.In the metaphysis of long bones. Points away from the nearby Points away from the nearby
articulationarticulation Most in---lower Femur Most in---lower Femur ---upper Humerus, Tibia ---upper Humerus, Tibia
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2. Osteochondroma2. Osteochondroma OsteochondromatosisOsteochondromatosis (Multiple) (Multiple) A familial disorder, Autosomal A familial disorder, Autosomal
dominant.dominant. Males/Females ratio= 7 to 3Males/Females ratio= 7 to 3Deformity of forearm,wrist,knee… Deformity of forearm,wrist,knee… 5-25% develop Malignancies5-25% develop Malignancies
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ClassificationClassificationBENIGNBENIGN 1. 1. EnchondromaEnchondroma
22. . OsteochondromaOsteochondroma
3. Chondroblastoma3. Chondroblastoma 4. ChondroMyxoid Fibroma 4. ChondroMyxoid Fibroma
(CMF)(CMF) 5. PeriOsteal Chondroma5. PeriOsteal Chondroma
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3. Chondroblastoma3. Chondroblastoma General / Clinical Features:General / Clinical Features: Benign Cartilaginous TumorBenign Cartilaginous Tumor Age between Age between 5 and 25 years5 and 25 years most cases most cases in teenagersin teenagers Slight Slight Male PredominanceMale Predominance
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3. Chondroblastoma3. Chondroblastoma General / Clinical Features:General / Clinical Features: Pain – most common symptomPain – most common symptom (several months or years)(several months or years) 1/3 Patients have have:1/3 Patients have have: Joint effusion, swelling, Joint effusion, swelling, limitation of motionlimitation of motion
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3. Chondroblastoma3. Chondroblastoma RadiographicRadiographic FINDINGS: FINDINGS: 98% located in Epiphysis or 98% located in Epiphysis or Apophysis Apophysis
of a long boneof a long bone OsteolyticOsteolytic, well-defined, well-defined Ca+ in less than 50% of casesCa+ in less than 50% of cases
Sites: Sites: distal femur, proximal tibia, proximal distal femur, proximal tibia, proximal humerus humerus
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3. Chondroblastoma3. Chondroblastoma RadiographicRadiographic FINDINGS: FINDINGS:MRI:MRI:Low signal------T1WLow signal------T1WIntermediate signal---T2W/fat satIntermediate signal---T2W/fat sat Hyaline cartilage + Hemorrage-Hyaline cartilage + Hemorrage- High signal-------T2WHigh signal-------T2W
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3. Chondroblastoma3. Chondroblastoma RadiographicRadiographic FINDINGS: FINDINGS:MRIMRI** Periosteal Thickening** Periosteal Thickening Bone Marrow EdemaBone Marrow Edema Adjacent Soft Tissue EdemaAdjacent Soft Tissue Edema Scattered Ca+ Scattered Ca+
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Chondroblastoma
in
Humeral Head
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3. Chondroblastoma3. Chondroblastoma Treatment and Prognosis:Treatment and Prognosis: 90% 90% of Chondroblastomas are of Chondroblastomas are
treated by treated by curettage curettage and and bone chip bone chip grafting.grafting.
Recurrences may develop within 3 Recurrences may develop within 3 years---years---
99% of99% of them are cured by a second them are cured by a second CurettageCurettage
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ClassificationClassificationBENIGNBENIGN
11.. EnchondromaEnchondroma 2. Osteochondroma2. Osteochondroma 3. Chondroblastoma3. Chondroblastoma
4. ChondroMyxoid Fibroma 4. ChondroMyxoid Fibroma (CMF)(CMF)
5. PeriOsteal Chondroma5. PeriOsteal Chondroma
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4. 4. ChondroMyxoidFibromaChondroMyxoidFibroma General / Clinical Features:General / Clinical Features: Least commonLeast common Diagnosed in 2d. and 3Diagnosed in 2d. and 3rdrd decade decade Male predominace 2:1Male predominace 2:1Predilection for Metaphysis of long Predilection for Metaphysis of long
Tubular BonesTubular Bones
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ChondroMyxoidFibromaChondroMyxoidFibroma General / Clinical Features:General / Clinical Features: 25%25% in flat bones, in flat bones, mainly Iliummainly Ilium PainPain is the presenting symptom is the presenting symptom15% of cases are incidental 15% of cases are incidental
radiographic findingsradiographic findings
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ChondroMyxoidFibromaChondroMyxoidFibroma RadiographicRadiographic FINDINGS: FINDINGS: Eccentric Metaphyseal Eccentric Metaphyseal Lesion Lesion
with with Cortical ExpansionCortical ExpansionCoarse TrabeculationCoarse TrabeculationEndosteal ScallopingEndosteal Scalloping/ Sclerosis/ Sclerosis
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ChondroMyxoidFibromaChondroMyxoidFibroma RadiographicRadiographic FINDINGS: FINDINGS: MRIMRILow to Intermediate signal---Low to Intermediate signal---T1WT1WIntermediate to High signal---Intermediate to High signal--- T2W /Fat satT2W /Fat sat ContrastContrast:Inhomogeneous :Inhomogeneous
enhancement enhancement
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ClassificationClassification
BENIGNBENIGN 1. 1. EnchondromaEnchondroma 2. Osteochondroma2. Osteochondroma 3. Chondroblastoma3. Chondroblastoma 4. ChondroMyxoid Fibroma (CMF)4. ChondroMyxoid Fibroma (CMF)
5. PeriOsteal Chondroma5. PeriOsteal Chondroma
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5. PeriOsteal Chondroma5. PeriOsteal Chondroma
General / Clinical Features:General / Clinical Features: UncommonUncommon All ages are affectedAll ages are affected Usually diagnosed Usually diagnosed under age 30under age 30 Slight Male predominanceSlight Male predominance Mild PainMild Pain (1-5 years) (1-5 years)
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5. PeriOsteal Chondroma5. PeriOsteal Chondroma
RadiographicRadiographic FINDINGS: FINDINGS: At Metaphysis At Metaphysis of long Bones and of long Bones and
HandsHands Soft tissue Mass Soft tissue Mass Erosion of Adjacent CortexErosion of Adjacent Cortex Periosteal reaction Periosteal reaction
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5. PeriOsteal Chondroma5. PeriOsteal Chondroma RadiographicRadiographic FINDINGS: FINDINGS: MRIMRI Low signal -----T1WLow signal -----T1W High signal -----T2WHigh signal -----T2W Ca+ ----intratumoralCa+ ----intratumoral
Contrast:Contrast: Peripheral Enhancement Peripheral Enhancement TypicalTypical
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ClassificationClassification BenignBenign
Malignant Malignant ChondrosarcomasChondrosarcomas 1. Primary (de novo)1. Primary (de novo) 2. Secondary2. Secondary
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ChondrosarcomasChondrosarcomas Second most commonSecond most common primary primary
sarcoma of bone sarcoma of bone Males + often than Females Males + often than Females
(2:1)(2:1)Peak age: 5Peak age: 5thth – 7 – 7thth decades (I) decades (I) 44thth – 5 – 5thth ‘’ (II) ‘’ (II)
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ChondrosarcomasChondrosarcomas
Occur in the Occur in the diaphysisdiaphysis or or metaphysis metaphysis
Calcifications Calcifications with ring-like with ring-like patternpattern
Ill-defined borders Ill-defined borders
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ChondrosarcomasChondrosarcomas Location within the bone: Location within the bone: Central, Peripheral, Central, Peripheral,
Juxtacortical (periosteal)Juxtacortical (periosteal) Sites:Sites: Pelvic bonesPelvic bones prox. femurprox. femur prox. humerus Scapula, Ribs prox. humerus Scapula, Ribs
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ConclusionsConclusions 11. Benign. Benign:: Enchondromas….complicationsEnchondromas….complications Osteochondromas….Osteochondromas…. cartilage cap > 3cm(?)cartilage cap > 3cm(?) 2. 2. MalignantMalignant Primary or Secondary Primary or Secondary 3. 3. MRI indicationsMRI indications (contrast,cap,fracture) (contrast,cap,fracture) 4. Skip lesion (s) on MR images4. Skip lesion (s) on MR images
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ConclusionsConclusions
Good LookGood Look at the imagesat the images
andand
Good Luck !!!Good Luck !!!
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HAPPY NEW YEAR HAPPY NEW YEAR
2007 2007
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Enchondroma
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