Department of Orthopaedics and Rehabilitation, State University of New York Downstate Medical Center, 450 Clarkson Avenue-Box 30, Brooklyn, NY 11203, USA.
Skeletal Radiol. 2011 Dec;40(12):1563-73. doi: 10.1007/s00256-011-1227-y. Epub 2011 Jul 20.
Epiphyseal/apophyseal locations are important diagnostic radiological features of chondroblastomas (CB). Although the tumor may secondarily involve the metaphysis, reports of primary metaphyseal or diaphyseal CB without any epiphyseal or apophyseal involvement are exceptionally rare and frequently present as a diagnostic dilemma. The purpose of this study was to present seven cases of pure metaphyseal and/or diaphyseal CB along with a review of pertinent literature.
A retrospective review of databases at two major referral centers revealed 390 cases of CB between 1960 and 2009. Out of these, seven histologically proven CB cases (1.8%) were found to be radiologically located in metaphysis and/or diaphysis, without involving the epiphysis and/or apophysis, and formed the study cohort.
There were four males and three females (age range 2-25 years). Locations included proximal femur (n = 1), distal femur (2), proximal humerus (2), clavicle (1), and proximal radius (1). All lesions showed marginal sclerosis. A periosteal reaction was seen in five cases (71%), cortical expansion in four cases (57%), and chondroid matrix in four cases (57%). A CT (two cases) demonstrated a matrix in both cases. An MR (one case) showed extensive perilesional edema. Bone scan (one case) showed intense uptake.
Pure metaphyseal and/or diaphyseal CB are exceedingly rare. A presumptive diagnosis may be considered in the appropriate age group in the presence of chondroid matrix, perilesional edema, periosteal reaction, and marginal sclerosis. Regardless of all the diagnostic possibilities, biopsy may still be required. However, knowledge of this entity will help make the final diagnosis and guide the correct treatment.
骺板/突骺位置是成软骨细胞瘤（CB）的重要放射学诊断特征。尽管肿瘤可能继发累及干骺端，但报告显示无骺板或突骺累及的原发性干骺端或骨干 CB 极为罕见，且常引起诊断难题。本研究的目的是报告 7 例单纯骨干和/或干骺端 CB，并复习相关文献。
对两个主要转诊中心的数据库进行回顾性研究，发现 1960 年至 2009 年间有 390 例 CB 病例。其中，7 例经组织学证实的 CB 病例（1.8%）影像学上位于干骺端和/或骨干，无骺板和/或突骺累及，构成研究队列。
男 4 例，女 3 例（年龄 2-25 岁）。病变部位包括股骨近端（n=1）、股骨远端（2）、肱骨近端（2）、锁骨（1）和桡骨近端（1）。所有病变均显示边缘硬化。5 例（71%）可见骨膜反应，4 例（57%）可见皮质膨胀，4 例（57%）可见软骨基质。2 例 CT 显示均有基质，1 例 MR 显示广泛的瘤周水肿。1 例骨扫描显示摄取增加。
单纯骨干和/或干骺端 CB 极为罕见。在存在软骨基质、瘤周水肿、骨膜反应和边缘硬化的情况下，可考虑在适当的年龄组做出推测性诊断。无论所有的诊断可能性如何，仍可能需要活检。但是，了解该实体将有助于做出最终诊断并指导正确的治疗。
