DOCSLIB.ORG

Chondroblastoma of Ventral Skull Base: First Report of a Case

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Chondroblastoma of Ventral Skull Base: First Report of a Case ISSN: 2572-4193 Elkhatib et al. J Otolaryngol Rhinol 2018, 4:039 DOI: 10.23937/2572-4193.1510039 Volume 4 | Issue 1 Journal of Open Access Otolaryngology and Rhinology CASE REPORT Chondroblastoma of Ventral Skull Base: First Report of a Case Ahmad Elkhatib1, Paul Wakely Jr2, Luciano M Prevedello3, Ralph Abi Hachem1, Andre Beer-Furlan4, Daniel M Prevedello1,4 and Ricardo Carrau1,4* 1Department of Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, USA 2 Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, USA Check for 3Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, USA updates 4Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, USA *Corresponding author: Ricardo L Carrau, M.D, F.A.C.S, Professor, Department of Otolaryngology-Head & Neck Surgery, Di- rector of the Comprehensive Skull Base Surgery Program, The Ohio State University Wexner Medical Center, Starling Loving Hall - Room B221, 320 West 10th Avenue, Columbus, OH 43210, USA, Tel: 614-685-6778, E-mail: [email protected] Abstract Introduction Objective: Report of the first case of chondroblastoma in- Chondroblastoma is a rare neoplasm of the bone volving the sinonasal cavity and ventral skull base, offering constituting approximately 1% of all primary bone tu- a description of the puzzling diagnostic process followed mors. It is more common in men in their second or third by its management. We describe the main radiologic and histologic characteristics of chondroblastoma and compare decade of life and usually affects long bones. The skull them to those of frequently mistaken differential diagnoses. base undergoes a mixed membranous and endochon- dral ossification; thus, it is rarely affected by chondro- Design: Case report of a 19-years-old male patient with fi- nal diagnosis of chondroblastoma. blastomas. Nonetheless, they most commonly affect the temporal bone [1,2]. This report presents the first Results: A 19-years-old male patient presented with visu- al deterioration. Imaging revealed an expansile mass with case of a ventral skull base chondroblastoma. an epicenter in the planum sphenoidale extending both into the sphenoid sinus and intracranially. The patient was Case Report managed with partial resection via endoscopic endonasal For a period of two years, a 19-years-old healthy, Af- approach resulting in rapid recovery of vision. rican American male noticed progressive blurriness of Conclusion: Chondroblastoma of the skull base is an ex- his left eye with continual periods of aggravation associ- ceedingly rare tumor with varying prognosis. It is frequently ated with a pounding headache that would abate spon- confused with other bone tumors, such as chondrosarcoma and giant cell tumor. Meticulous radiological and histologi- taneously after one or two hours. However, the patient cal review with high level of expertise is crucial in the diag- did not seek medical attention until he suffered a motor nostic process. Complete resection is the mainstay treat- vehicle accident associated with loss of consciousness. ment; however, lesions of the skull base should always be The patient reported a history of migraine headaches tempered with potential complications. since childhood; however, he denied double vision, Keywords nosebleeds, nasal obstruction, or memory lapses and Chondroblastoma, Endoscopy, Skull base, Bone tumor his family denied any evidence of personality changes (before or after the accident). A brain and cervical spine computed tomography (CT) scans (Figure 1) showed a large expansile mass cen- tered in the planum sphenoidale extending both intra- Citation: Elkhatib A, Wakely Jr P, Prevedello LM, Hachem RA, Beer-Furlan A, et al. (2018) Chondroblas- toma of Ventral Skull Base: First Report of a Case. J Otolaryngol Rhinol 4:039. doi.org/10.23937/2572- 4193.1510039 Accepted: May 23, 2018: Published: May 25, 2018 Copyright: © 2018 Elkhatib A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduc- tion in any medium, provided the original author and source are credited. Elkhatib et al. J Otolaryngol Rhinol 2018, 4:039 • Page 1 of 5 • DOI: 10.23937/2572-4193.1510039 ISSN: 2572-4193 Figure 1: Preoperative CT scan A) Coronal; B) Sagittal (see text). Figure 2: Preoperative MRI A) T1 sagittal MRI; B) T2 coronal MRI (see text). cranially and into the sphenoid sinus with involvement scopic endonasal approach (EEA). Intraoperative find- of the left anterior clinoid process. The outer margins ings included a very large fibro-osseous lesion invading of the mass demonstrated cortical bone that appeared the sphenoid sinus, involving the sella and suprasellar predominantly intact except in a few areas of disconti- space, and extending into the anterior skull base overly- nuity. The mass measured 4.9 × 3.0 × 4.2 cm and had a ing the planum sphenoidale. In the context of a benign soft tissue density center with Hounsfield Units varying lesion, a subtotal extradural resection was done decom- from 8 to 115 (average of 55) as well as several areas of pressing 270° of the left optic nerve canal and avoiding amorphous calcifications peripherally. a CSF leak (Figure 3). The skull base defect was recon- MRI showed that the central component of the le- structed using a right pedicled nasoseptal flap, which sion was isointense to hypointense on T1-weighted served to reline and protect the left optic nerve and in- images relative to gray matter and heterogeneous on ternal carotid artery. T2-weighted images. There were areas of extremely The patient was discharged with no complaints one low T2 signal intermixed with cystic-appearing areas. day after surgery already noticing visual improvement. Following intravenous administration of gadolinium, He followed an uneventful postoperative course and the lesion demonstrated heterogeneous but predomi- his left eye vision regained normal function within two nantly avid enhancement. The mass extended upwards weeks. The patient returned to his daily activity and into the intracranial fossa with mild displacement of the continued doing well at 2 months of postoperative fol- inferior portion of the left frontal lobe. No significant low-up. After discussion of further treatment alterna- signal abnormality was noted in the adjacent brain pa- tives, the patient agreed to follow the residual tumor renchyma (Figure 2). with imaging and monitor his vision with periodic neu- A preliminary diagnosis of an osseous lesion with a ro-ophthalmologic examinations. high suspicion for an ossifying fibroma was made, and Histopathology the patient was subsequently referred to us for further management. This included a subtotal resection of the The specimen consisted of multiple bony tissue frag- tumor with left optic nerve decompression via endo- ments that measured 4.5 cm in greatest dimension. Elkhatib et al. J Otolaryngol Rhinol 2018, 4:039 • Page 2 of 5 • DOI: 10.23937/2572-4193.1510039 ISSN: 2572-4193 Figure 3: Post-operative CT scan showing resection of the center of the lesion with overall preservation of the peripheral osseous rim A) Sagittal; B) Coronal. Figure 4: A) A solid sheet of mononuclear cells displays uniform cells with ovoid and reniform nuclei, discrete cells borders, occasional giant cells, and minimal matrix. H&E stain, x40; B) A large amount of extracellular stromal matrix is present in the upper half of this image causing a wide separation of cells. The lower half imitates the cells seen in figure 1A. H&E stain. x20. Light microscopic examination showed a solid prolifera- fibromas and aneurysmal bone cysts, while malignant tion of polygonal cells infiltrating among bone trabecu- lesions include chondrosarcoma and osteosarcoma [2]. lae. Proliferating cells had uniform rounded, ovoid and Chondroblastomas can be confused with chondrosarco- reniform hypochromic nuclei, evenly dispersed nuclear ma when there is an excessive chondroid matrix with hy- chromatin with occasional nuclear grooves but lacking percellularity, while ossification of the matrix may mimic nucleoli, a moderate amount of cytoplasm, and sharp osteoblastoma. Sinonasal ossifying fibromas typically cell borders. Mitotic figures were conspicuously infre- present as a lesion with a fibrous center and a thick pe- quent, and necrosis was absent. Eosinophilic stromal ripheral osseous rim. Intermediate to low T1 signal along matrix varied among tissue fragments with some being with mixed T2 signal composed of low signal intensity ar- almost completely cellular (Figure 4A) while other frag- eas (calcification or ossification) and high signal intensity ments contained an excessive amount of hyalinized ma- areas (fibrous tissue) are commonly described. Areas of trix (Figure 4B). Osteoclastic giant cells were scattered ossification tend to increase in size with patient’s age in throughout the tissue. Immunostain results showed ossifying fibromas [3]. Ossifying fibromas may be indis- rare S-100 staining and diffuse positivity with vimentin. tinguishable from sinonasal fibrous dysplasia, particularly when fibrous areas are more prominent, although the Discussion classic ground-glass appearance centrally would favor Chondroblastomas are rare benign neoplasms af- the latter. Another differentiating feature is that ossifying fecting any bone with endochondral ossification. Most fibromas are typically monostotic whereas
Load more

Recommended publications
  • Infiltrating Myeloid Cells Drive Osteosarcoma Progression Via GRM4 Regulation of IL23
    Published OnlineFirst September 16, 2019; DOI: 10.1158/2159-8290.CD-19-0154 RESEARCH BRIEF Infi ltrating Myeloid Cells Drive Osteosarcoma Progression via GRM4 Regulation of IL23 Maya Kansara 1 , 2 , Kristian Thomson 1 , Puiyi Pang 1 , Aurelie Dutour 3 , Lisa Mirabello 4 , Francine Acher5 , Jean-Philippe Pin 6 , Elizabeth G. Demicco 7 , Juming Yan 8 , Michele W.L. Teng 8 , Mark J. Smyth 9 , and David M. Thomas 1 , 2 ABSTRACT The glutamate metabotropic receptor 4 (GRM4 ) locus is linked to susceptibility to human osteosarcoma, through unknown mechanisms. We show that Grm4 − / − gene– targeted mice demonstrate accelerated radiation-induced tumor development to an extent comparable with Rb1 +/ − mice. GRM4 is expressed in myeloid cells, selectively regulating expression of IL23 and the related cytokine IL12. Osteosarcoma-conditioned media induce myeloid cell Il23 expression in a GRM4-dependent fashion, while suppressing the related cytokine Il12 . Both human and mouse osteosarcomas express an increased IL23:IL12 ratio, whereas higher IL23 expression is associated with worse survival in humans. Con- sistent with an oncogenic role, Il23−/− mice are strikingly resistant to osteosarcoma development. Agonists of GRM4 or a neutralizing antibody to IL23 suppressed osteosarcoma growth in mice. These fi ndings identify a novel, druggable myeloid suppressor pathway linking GRM4 to the proinfl ammatory IL23/IL12 axis. SIGNIFICANCE: Few novel systemic therapies targeting osteosarcoma have emerged in the last four decades. Using insights gained from a genome-wide association study and mouse modeling, we show that GRM4 plays a role in driving osteosarcoma via a non–cell-autonomous mechanism regulating IL23, opening new avenues for therapeutic intervention.
    [Show full text]
  • Primary Ewing Sarcoma/Primitive Neuroectodermal Tumor of the Kidney: the MD Anderson Cancer Center Experience
    cancers Article Primary Ewing Sarcoma/Primitive Neuroectodermal Tumor of the Kidney: The MD Anderson Cancer Center Experience Nidale Tarek 1,2,*, Rabih Said 3, Clark R. Andersen 4, Tina S. Suki 1, Jessica Foglesong 1,5 , Cynthia E. Herzog 1, Nizar M. Tannir 6, Shreyaskumar Patel 7, Ravin Ratan 7, Joseph A. Ludwig 7 and Najat C. Daw 1,* 1 Department of Pediatrics, the University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; [email protected] (T.S.S.); [email protected] (J.F.); [email protected] (C.E.H.) 2 Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut 1107, Lebanon 3 Department of Investigational Cancer Therapeutics, the University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; [email protected] 4 Department of Biostatistics, the University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; [email protected] 5 Division of Hematology, Oncology, Neuro-Oncology & Stem Cell Transplant, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA 6 Department of Genitourinary Medical Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; [email protected] 7 Department of Sarcoma Medical Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; [email protected] (S.P.); [email protected] (R.R.); [email protected] (J.A.L.) * Correspondence: [email protected] (N.T.); [email protected] (N.C.D.); Tel.: +1-713-792-6620 (N.C.D.) Received: 27 August 2020; Accepted: 5 October 2020; Published: 11 October 2020 Simple Summary: The Ewing sarcoma family of tumors (ESFT)s rarely originate in the kidneys and their treatment is significantly different from the other common kidney tumors.
    [Show full text]
  • Pathogenesis and Current Treatment of Osteosarcoma: Perspectives for Future Therapies
    Journal of Clinical Medicine Review Pathogenesis and Current Treatment of Osteosarcoma: Perspectives for Future Therapies Richa Rathore 1 and Brian A. Van Tine 1,2,3,* 1 Division of Medical Oncology, Washington University in St. Louis, St. Louis, MO 63110, USA; [email protected] 2 Division of Pediatric Hematology and Oncology, St. Louis Children’s Hospital, St. Louis, MO 63110, USA 3 Siteman Cancer Center, St. Louis, MO 63110, USA * Correspondence: [email protected] Abstract: Osteosarcoma is the most common primary malignant bone tumor in children and young adults. The standard-of-care curative treatment for osteosarcoma utilizes doxorubicin, cisplatin, and high-dose methotrexate, a standard that has not changed in more than 40 years. The development of patient-specific therapies requires an in-depth understanding of the unique genetics and biology of the tumor. Here, we discuss the role of normal bone biology in osteosarcomagenesis, highlighting the factors that drive normal osteoblast production, as well as abnormal osteosarcoma development. We then describe the pathology and current standard of care of osteosarcoma. Given the complex hetero- geneity of osteosarcoma tumors, we explore the development of novel therapeutics for osteosarcoma that encompass a series of molecular targets. This analysis of pathogenic mechanisms will shed light on promising avenues for future therapeutic research in osteosarcoma. Keywords: osteosarcoma; mesenchymal stem cell; osteoblast; sarcoma; methotrexate Citation: Rathore, R.; Van Tine, B.A. Pathogenesis and Current Treatment of Osteosarcoma: Perspectives for Future Therapies. J. Clin. Med. 2021, 1. Introduction 10, 1182. https://doi.org/10.3390/ Osteosarcomas are the most common pediatric and adult bone tumor, with more than jcm10061182 1000 new cases every year in the United States alone.
    [Show full text]
  • View Presentation Notes
    When is a musculoskeletal condition a tumor? Recognizing common bone and soft tissue tumors Christian M. Ogilvie, MD Assistant Professor of Orthopaedic Surgery University of Pennsylvania University of Pennsylvania Department of Orthopaedic Surgery Purpose • Recognize that tumors can present in the extremities of patients treated by athletic trainers • Know that tumors may present as a lump, pain or both • Become familiar with some bone and soft tissue tumors University of Pennsylvania Department of Orthopaedic Surgery Summary • Introduction – Pain – Lump • Bone tumors – Malignant – Benign • Soft tissue tumors – Malignant – Benign University of Pennsylvania Department of Orthopaedic Surgery Summary • Presentation • Imaging • History • Similar conditions –Injury University of Pennsylvania Department of Orthopaedic Surgery Introduction •Connective tissue tumors -Bone -Cartilage -Muscle -Fat -Synovium (lining of joints, tendons & bursae) -Nerve -Vessels •Malignant (cancerous): sarcoma •Benign University of Pennsylvania Department of Orthopaedic Surgery Introduction: Pain • Malignant bone tumors: usually • Benign bone tumors: some types • Malignant soft tissue tumors: not until large • Benign soft tissue tumors: some types University of Pennsylvania Department of Orthopaedic Surgery Introduction: Pain • Bone tumors – Not necessarily activity related – May be worse at night – Absence of trauma, mild trauma or remote trauma • Watch for referred patterns – Knee pain for hip problem – Arm and leg pains in spine lesions University of Pennsylvania
    [Show full text]
  • A Rare Case of Peripheral Primitive Neuroectodermal Tumor in Palate
    Surgery and Rehabilitation Case Report ISSN: 2514-5959 A rare case of peripheral primitive neuroectodermal tumor in palate Rajul Ranka1*, Anuj Jain2, Amol Gadbail3 and Minal Chaudhary1 1Oral Pathology and Microbiology, Sharad Pawar Dental College and Hospital, Sawangi(M), Wardha, India 2Department of Trauma and Emergency Medicine, All India Institute of Medical Sciences, Bhopal, India 3Department of Dentistry, Indira Gandhi Government Medical College, Nagpur, India Abstract Primitive Neuroectodermal Tumor (PNET) is an aggressive round cell malignant tumor which belongs to Ewing’s Sarcoma family. Peripheral PNET is rare in head and neck region and even rare in palate with handful of cases reported till date. A case of Peripheral PNET of palate in a 32-year-old female pa tient along with its clinico-pathologic, radiologic and immunohistologic features as well as its management is reported here. We emphasize the need of histopathology and immunohistochemistry (IHC) for early diagnosis of such aggressive tumors to improve the prognosis of patient by providing timely management. Introduction Case report A neuroectodermal tumor is a tumor of the central or peripheral A thirty-two years old female patient of Indian origin reported nervous system. They are divided into two categories viz. Group to the Out-Patient Department of our institute with a complaint of (I) tumors, such as the pituitary adenomas and carcinoid tumors, painful ulcer on her palate since five months. The ulcer was gradually represent tumors that show predominantly epithelial differenti ation. progressive but has now suddenly increased in size since few days. It Group (II) tumors, which incorporate malignant melanoma, olfactory was associated with dull aching, intermittent and localized pain which neuroblastoma, Ewing’s sar coma (EWS) and primitive neuroectodermal aggravated on mastication and relieved with time.
    [Show full text]
  • A Rare Case of Chondromyxoid Fibroma of the Scapula Jay B
    A Case Report & Literature Review A Rare Case of Chondromyxoid Fibroma of the Scapula Jay B. Jani, MD, Kathleen S. Beebe, MD, Meera Hameed, MD, and Joseph Benevenia, MD hondromyxoid fibroma (CMF) is a rare benign Plain radiography (Figures 1A, 1B) and computed tumor, apparently derived from cartilage-forming tomography (CT) scan (Figure 2) revealed an expansile connective tissue. The name is highly descriptive lesion of the right scapula with central calcification sug- of this distinctive tumor and has gained accep- gesting chondroid-type matrix. There was some thinning Ctance.1 The entity was first described in 1948 by Jaffe and of the cortex but no obvious cortical breach or associated Lichtenstein,2 who presented 8 cases and emphasized the soft-tissue mass. MRI (Figure 3) revealed a 5×3×2.5- danger of mistaking this benign neoplasm for a malignant cm expansile lesion involving the inferior border of the lesion, chondrosarcoma in particular. Approximately two scapula. T2-weighted images showed a heterogeneous thirds of the recorded cases of this tumor have been in the mass with bright signal intensity. There was considerable long tubular bones and one third in the proximal tibia.1,3,4 A edema in the teres minor and subscapularis muscle bel- scapular origin of this tumor is exceedingly rare.1,5-10 lies. No fluid–fluid levels were seen. Additional workup We report the case of a 13-year-old girl with chondro- included a chest CT scan and a whole-body bone scan. myxoid fibroma of the scapula. This case is of interest The bone scan revealed increased focal uptake to the right because of the rarity and unusual location of the tumor.
    [Show full text]
  • Craniofacial Chondrosarcomas: Imaging Findings in 15 Untreated Cases
    165 Craniofacial Chondrosarcomas: Imaging Findings in 15 Untreated Cases Ya-Yen Lee1 Radiographic findings of 15 untreated chondrosarcomas of the cranial and facial Pamela Van Tassel bones were reviewed. These tumors have a propensity to occur in the wall of a maxillary sinus, at the junction of sphenoid and ethmoid sinuses and vomer, and at the undersur­ face of the sphenoid bone. Because of its slow-growing nature, chondrosarcomas tend to be large, multi lobulated, and sharply demarcated when detected. Frequent bone changes are a combination of erosion and destruction, with sharp transitional zones and absent periosteal reaction. Tumor matrix calcifications, not necessarily chondroid, are almost always present. Both CT and MR may be necessary for thorough evaluation of tumor extent. Chondrosarcoma, a malignant but usually slow-growing cartilaginous tumor, constitutes approximately 11 % of malignant bone tumors [1] but rarely occurs in the craniofacial region . Because of its propensity to occur in the deep facial structures or base of the skull, the true extent and origin of the tumor may be overlooked if not properly evaluated radiographically. We review a relatively large series of craniofacial chondrosarcomas and discuss the differential diagnosis and choice of imaging technique. Materials and Methods This retrospective radiologic review was based on the pretreatment radiographic studies of 15 patients with craniofacial chondrosarcomas seen at our institution over a period of 40 years , excluding three intracranial dural chondrosarcomas, which are to be reported sepa­ rately. An attempt was also made to correlate the radiographic findings with the hi stologic grades of the tumors. The ages of the patients ranged from 10 to 73 years , with a mean of 40 years.
    [Show full text]
  • Bone and Soft Tissue Sarcomas
    Bone and Soft Tissue Sarcomas Changes to Pathology Codes in the 4th Edition of the World Health Organisation Classification of Bone and Soft Tissue Sarcomas September 2013 Page 1 of 17 Authors Mr Matthew Francis Cancer Analysis Development Manager, Public Health England Knowledge & Intelligence Team (West Midlands) Dr Nicola Dennis Sarcoma Analyst, Public Health England Knowledge & Intelligence Team (West Midlands) Ms Jackie Charman Cancer Data Development Analyst Public Health England Knowledge & Intelligence Team (West Midlands) Dr Gill Lawrence Breast and Sarcoma Cancer Analysis Specialist, Public Health England Knowledge & Intelligence Team (West Midlands) Professor Rob Grimer Consultant Orthopaedic Oncologist The Royal Orthopaedic Hospital NHS Foundation Trust For any enquiries regarding the information in this report please contact: Mr Matthew Francis Public Health England Knowledge & Intelligence Team (West Midlands) Public Health Building The University of Birmingham Birmingham B15 2TT Tel: 0121 414 7717 Fax: 0121 414 7712 E-mail: [email protected] Acknowledgements The Public Health England Knowledge & Intelligence Team (West Midlands) would like to thank the following people for their valuable contributions to this report: Dr Chas Mangham Consultant Orthopaedic Pathologist, Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust Professor Nick Athanasou Professor of Musculoskeletal Pathology, University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences Copyright @ PHE Knowledge & Intelligence Team (West Midlands) 2013 1.0 EXECUTIVE SUMMARY Page 2 of 17 The 4th edition of the World Health Organisation (WHO) Classification of Tumours of Soft Tissue and Bone which was published in 2012 contains notable changes from the 2002 3rd edition. The key differences between the 3rd and 4th editions can be seen in Table 1.
    [Show full text]
  • What Is New in Orthopaedic Tumor Surgery?
    15.11.2018 What is new in orthopaedic tumor surgery? Marko Bergovec, Andreas Leithner Department of Orhtopaedics and Trauma Medical University of Graz, Austria 1 15.11.2018 Two stories • A story about the incidental finding • A scary story with a happy end The story about the incidental finding • 12-year old football player • Small trauma during sport • Still, let’s do X-RAY 2 15.11.2018 The story about the incidental finding • Panic !!! • A child has a tumor !!! • All what a patient and parents hear is: – bone tumor = death – amputation – will he ever do sport again? • Still – what now? 3 15.11.2018 A scary story with a happy end • 12-year old football player • Small trauma during sport • 3 weeks pain not related to physical activity • “It is nothing, just keep it cool, take a rest” 4 15.11.2018 A scary story with a happy end • A time goes by • After two weeks of rest, pain increases... • OK, let’s do X-RAY 5 15.11.2018 TUMORS benign vs malign bone vs soft tissue primary vs metastasis SARCOMA • Austria – cca 200 patients / year – 1% of all malignant tumors • (breast carcinoma = 5500 / year) 6 15.11.2018 Distribution of the bone tumoris according to patients’ age and sex 250 200 150 100 broj bolesnika broj 50 M Ž 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 80+ dob 7 15.11.2018 WHO Histologic Classification of Bone Tumors Bone-forming tumors Benign: Osteoma; Osteoid osteoma; Osteoblastoma Intermediate; Aggressive (malignant) osteoblastoma Malignant: Conventional central osteosarcoma; Telangiectatic osteosarcoma; Intraosseous well
    [Show full text]
  • Giant Cell Tumor of Bone
    GIANT CELL TUMOR OF BONE Definition. First described by Jaffe et al. 1, giant cell tumor of bone is a locally aggressive primary neoplasm of bone that is composed of proliferation of bland looking oval to polyhedral mononuclear cells, admixed with evenly distributed, osteoclast-type giant cells. The tumor is typically located with the epiphysis of long tubular bones or the epiphyseal equivalent in other bones 2-4. In the most current WHO classification of bone tumors, giant cell tumor of bone is classified as a locally aggressive, rarely metastasizing neoplasm 3. General features. Accounts for approximately 6% of primary bone tumors and 20% of benign bone tumors 5. Previously, it was believed that the giant cells were formed by the fusion of the mononuclear neoplastic cells and it was assumed that the giant cells might also be neoplastic. Currently, giant cell tumor of bone is considered a neoplastic process derived from mononuclear cells exhibiting osteoblastic phenotype that express RANK-ligand (RANKL), which induces the formation of the osteoclast-type giant cells, from which the tumor derives its name. Most giant cell tumors of bone arise de-novo but can also arise in bones affected by Paget disease of bone. Clinical features. Most patients are skeletally mature at the time of diagnosis (usually between the age of 20-40 years); it rarely arises in skeletally immature individuals; less than 10% arise in patients under the age of 18 years 6. Females are affected more common than males. It is more common in the Chinese population accounting for approximately 20% of primary bone tumors 7.
    [Show full text]
  • A Case of Thoracic Vertebral Chondroblastoma, Treated with 3-D Image Guided Resection and Reconstruction
    KISEP J Korean Neurosurg Soc 37 : 154-156, 2005 Case Report A Case of Thoracic Vertebral Chondroblastoma, Treated with 3-D Image Guided Resection and Reconstruction Yoon Ho Lee, M.D., Dong Ah Shin, M.D., Keung Nyun Kim, M.D., Do Heum Yoon, M.D. Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea We present a case of chondroblastoma in the thoracic vertebra. A 40-year-old patient with upper back pain and lower extremity weakness was admitted to our clinic. On neurological examination, the patient exhibited lower extremity spastic paraparesis. Magnetic resonance imaging revealed a mass infiltrating the 7th thoracic vertebra and its adjacent structures with concomitant compression of the epidural space. After right upper lung tuberculoma was resected through the transthoracic approach, T7 total corpectomy was done with anterior stabilization using a MESH cage and T7 rib bone graft. Two weeks after the first operation, remained part of vertebra was removed and posterior stabilization was performed using a pedicle screw fixation and cross linkage bar with the assistance of the navigation system. The final pathologic diagnosis of the vertebral lesion was benign chondroblastoma. KEY WORDS : Chondroblastoma·Thoracic vertebra·Spine tumor. Introduction hondrobalsoma is a benign C bone tumor arising most often in the epiphysis of long bones. The vertebra is a rare pri- mary site of origin for chondro- blastomas. We report a 40-years old woman with chondroblastoma A B C of the 7th thoracic vertebral body and the adjacent structures. In Fig. 1. Preoperative T1-weighted enhanced axial(A) and sagittal(B) magnetic resonance images and computed tomography(C) scan demonstrating tumor involvement of the T7 vertebra with spinal addition, the use of an intraop- cord compression.
    [Show full text]
  • Pelvic Chondroblastoma in an Adolescent. New Treatment Approach
    www.medigraphic.org.mx Acta Ortopédica Mexicana 2011; 25(6): Nov.-Dec: 388-394 Clinical case Pelvic chondroblastoma in an adolescent. New treatment approach Rico-Martínez G,* Linares-González L,** Delgado-Cedillo E,** Cerrada-Moreno L,*** Clara-Altamirano M,*** Pichardo-Bahena R**** National Rehabilitation Institute. Mexico, D.F. ABSTRACT. Surgical management of tumors RESUMEN. Los tumores que están localizados located in the spine and the pelvis involves greater en la columna vertebral y en la pelvis tienen aso- diffi culty. Moreover, these tumors are usually very ciada una mayor difi cultad para el manejo quirúr- large and vascularized. Preoperative embolization gico. Además, estos tumores son habitualmente de of the internal iliac artery is a relatively safe pro- gran tamaño y ricamente vascularizados. La em- cedure that may reduce the risk of bleeding and lo- bolización prequirúrgica arterial de la arteria ilía- cal recurrence in the case of benign tumors. Chon- ca interna tiene la bondad de ser un procedimiento droblastoma is a tumor that is rarely located in the relativamente seguro que puede reducir el riesgo pelvis; its more frequent location is the triradiate de sangrado y de recidiva local en tumores benig- cartilage. We describe a case of a chondroblasto- nos. El condroblastoma es un tumor raro en la pel- ma with a relapsing aneurysmal cystic component vis y la localización más frecuente es en el cartílago in the acetabulum of an adolescent patient. Treat- trirradiado. Se presenta un caso de condroblasto- ment consisted of embolization of the internal iliac ma con componente quístico aneurismático recidi- artery, fl uid hyperthermia, hydrogen peroxide and vante en el acetábulo de un paciente adolescente.
    [Show full text]