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Year : 2002  |  Volume : 12  |  Issue : 4  |  Page : 531-532
Chondromyxoid fibroma of humerus


Mohan Dai Oswal Cancer Hospital, G.T. Road, Sherpur By Pass, Ludhiana, India

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Keywords: Chondroblastoma/DI, Shoulder Joint/RA, Bone Transplantation, Biopsy, Magnetic Resonance Imaging, Human, Male, Child, Case Report,

How to cite this article:
Singh J P, Shrimali R, Garg L, Setia V. Chondromyxoid fibroma of humerus. Indian J Radiol Imaging 2002;12:531-2

How to cite this URL:
Singh J P, Shrimali R, Garg L, Setia V. Chondromyxoid fibroma of humerus. Indian J Radiol Imaging [serial online] 2002 [cited 2020 Sep 22];12:531-2. Available from: http://www.ijri.org/text.asp?2002/12/4/531/28532

   Introduction Top


Chondromyxoid fibroma (CMF) is a rare, benign tumor of bone that represents fewer than 1% of all benign tumors of bone. The World Health Organization defines it as "A benign tumor characterized by lobulated areas of spindle-shaped or stellate cells with abundant myxoid or chondroid intercellular material separated by zones of more cellular tissue rich in spindle-shaped or rounded cells with a varying number of multinucleated giant cells of different sizes [1].


   Case Report Top


An Eight-year-old male child presented to the orthopaedics department with history of swelling in right upper arm of one-year duration. Physical examination revealed a globular non-tender swelling without any rise in overlying skin temperature.

A plain radiograph [Figure - 1] of the right shoulder joint showed an eccentric lytic area with marginal sclerosis in metadiaphyseal region of upper end of right Humerus. Epiphyses was not involved. There was possibility of cortical breach medially and periosteal reaction was seen laterally. On CT examination [Figure - 2] no cortical breach or soft tissue complex was visualized. The 'typical' periosteal reaction noted on plain radiograph was seen on CT to be an osseous/calcified linear structure with no definite contiguity with the Humerus; cortex on this aspect was also intact; this structure could be a post intervention phenomenon (a bone biopsy had already been done outside, before the patient presented to us). MRI showed a lesion hypointense on T1WI [Figure - 3], hyperintense on T2WI [Figure - 4] and Fat suppression [Figure - 5] sequences. Epiphyses was not involved and there was no extra medullary soft tissue component. Outside biopsy diagnosis was Chondroblastoma. Biopsy done at our institute showed multiple fragments of poorly cellular chondromyxoid tissue. There was no peripheral hypercellularity and a benign chondromyxoid fibroma was reported. Curettage and bone grafting was done and post-operative histopathological specimen confirmed the diagnosis of CMF.


   Discussion Top


Chondromyxoid fibroma is a benign primary bone neoplasm derived from cartilage and containing varying amounts of Chondroid, Fibrous and Myxoid tissue.CMF was first described in 1948 by Jaffe and Lichtenstein [2]. Most cases occur in patients younger than 30 years with the peak incidence in the second and third decades of life. A male predilection (1.5:1) has been noted. Although a minority of cases are asymptomatic, mild, intermittent local pain is present in the majority and some cases manifests a mass which may or may not be tender [3].

Feldman [4] found that 32% occurred in the tibia, often in the region of the tibial tubercle and 16.5% occurred in the femur. Less common sites included the pelvis, fibula, calcaneus and short tubular bones of the foot. The most common sites are on either side of the knee [5]. CMF in the humerus is a very rare site and Srivastava K.P. et al [6] reported the first Chondromyxoid fibroma involving the humerus. Treatment by curettage or local excision is usually successful. Recurrence of tumor after treatment is rare and is more likely to occur in patients under age 15 years. Very rarely, cases have been reported to have undergone chondrosarcomatous transformation [3].

Radiographically, CMF appears as a round or ovoid lytic area usually less than 5cm in greatest diameter, with the exception of lesions of innominate bones that may be considerably larger. Almost all CMF lesions in long bones are eccentric and metaphyseal, while centrally placed lesions are common in thin bones such as the fibulae, phalanges and ribs. The endosteal margin is usually well demarcated by a scalloped, sclerotic rim. Cortical thinning and / or "expansion" and a trabeculated appearance caused by ridging of the surrounding host bone are other common features. A few cases of CMF, usually in younger patients, appear purely lytic, with absence of a sclerotic border, reflecting the early, actively growing stage of the tumor. Matrix calcification, periosteal new bone production and pathological fracture rarely are associated with CMF [3].

Other conditions from which the tumor should be differentiated radiologically include simple bone cyst, aneurysmal bone cyst, benign chondroblastoma, fibrous dysplasia, enchondroma and giant cell tumor. Since there was no involvement of epiphyses in our case, the possibility of chondroblastoma and giant cell tumor was excluded CT and MRI revealed the lesion was solid and excluded the possibility of a simple cyst and aneurysmal bone cyst. Enchondroma and simple bone cyst are commonly associated with a pathological fracture. Because of all these considerations and in view of the patients age, imaging diagnosis given was Fibrous dysplasias / Chondromyxoid fibroma. The histopathological diagnosis came out as " benign Chondromyxoid fibroma".

In conclusion, although CMF is a rare tumor of bone and the humerus is an uncommon site of involvement yet, this diagnostic possibility should be considered in the case of a lytic, unmineralized, metadiaphyseal lesion in the humerus of a person less than 30 years of age, with radiographic features of an eccentric, scalloped, sclerotic margined, thinned and unbreached cortex, absence of periosteal new bone and solidity on CT and MR imaging.



 
   References Top

1.Wu CT, Inwards CY, O'Laughlin S, Rock MG, Beabout JW, Unni KK. Chondromyxoid fibroma of bone: A clinicopathologic review of 278 cases. Human Pathol 1998; 29 (5): 438-46.  Back to cited text no. 1    
2.White PG, Saunders L orr W, Friedman L. Chondromyxoid fibroma. Skeletal Radiol 1996; 25:79-81.  Back to cited text no. 2    
3.Tang J, Gold RH, Mirra JM. Case report 454. Skeletal Radiol 1987; 16:675-8.  Back to cited text no. 3  [PUBMED]  
4.Feldman F. Chondromyxoid fibroma. In: Ranniger K (ed). Bone tumors.Berlin, Springer- Verlag. 1977:158.   Back to cited text no. 4    
5.Mulder JD, Schutle HE, Kroon HM, Taconis WK. Radiologic atlas of bone tumors. Amsterdam:Elsevier 1993:475.  Back to cited text no. 5    
6.Srivastava KP, Chandra H, Srivastava VK, Bhatnagar VB. Chondromyxoid fibroma of humerus, International surgery 1976; 61 (1): 27-8.  Back to cited text no. 6    

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Correspondence Address:
J P Singh
Mohan Dai Oswal Cancer Hospital, G.T. Road, Sherpur By Pass, Ludhiana
India
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    Figures

[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5]

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