#A. Afifi, *S. Boujraf, **A. Elmrini, $S. Atmani, #K. Demni, #Y. Bouabdallah

#Department of Pediatric Surgery, University Hospital Hassan II, Fez
*Department of Biophysics and Clinical MRI Methods, Faculty of Medicine and Pharmacy, University of Fez
*Department of Radiology, University Hospital Hassan II, Fez
**Department of Orthopedic and Traumatic Surgery, University Hospital Hassan II, Fez
$Department of Pediatrics, University Hospital Hassan II, Fez

Address for Correspondence
Prof. Dr. Saïd Boujraf
Biophysics and Clinical MRI Methods Department
Faculty of Medicine and Pharmacy, University of Fez
BP. 1893; Km 2.200, Sidi Hrazem Road, Fez 30000; Morocco
Phone: 00 212 67 780 442, Fax: 00 212 55 619 321
E-mail: sboujraf@hotmail.com

The chondroblastoma is a rare cartilaginous tumor; it represents less than 1 % of all bone tumors. It is mostly localized at the level of the epiphysis of long bones length. Metaphysial localizations are very exceptional. We report a case of metaphysial-diaphysia chondroblastoma in 14 year old patient with chondroblastoma of Femoral metaphysis.
Key words: infant, chondroblastoma, metaphysis

J.Orthopaedics 2006;3(4)e14

Introduction:

The chondroblastoma is a very rare benign cartilaginous tumor; it represents less than 1 % of all bone tumors (1, 2). It is mostly localized at the level of the epiphysis of long bones and it might extend to the metaphysis. Pure metaphysial localizations without epiphysis affection are very exceptional.

Observation 

Our female patient was 14 years old. Three months prior consultation, she presented pains at the inferior limb with neither particular expansion nor limitation in the knee movements.
The clinical examination found a painless tumefaction of the inferior extremity of the thigh at palpation, no inflammatory signs were observed. The radiology showed a metaphysial-diaphysia gap of 7cm in the main line direction, it had well subscribed internal limits with a bowled over aspect of the cortical and without any periost reaction (Figure 1).
The biopsy of the tumoural mass recognizes a benign chondroblastoma. The patient was operated using external access in front of the tumor, she benefited of curettage of the tumoural mass with osseous transplant; this last one was obtained from the iliac bone. The evaluation was favorable with absence of recurrence in one year recession.

Discussion :

Chondroblastoma is a rare benign bone tumor; it represents about 1 % of all osseous tumors (1, 2). It is also adolescence tumor, generally occurring between the ten and the twenty years old and affects mostly male in 60% of reported cases (3). The favorite site of this tumor is the superior humeral epiphysis, superior and inferior femoral, superior humeral of the tibia (1, 3). The metaphyseal and metaphyseal diaphysia localization are very rare and exceptional; it only occurs in 2 to 5% of reported series of chondroblastoma (4, 5). Definitely, about twenty cases were reported since the earliest description in the literature. The Radiography shows chondroblastoma as geographic gap, round or oval, regular and well-delimited, it could squall the bone but it doesn’t destroy the cortical. A cortico-periost reaction could be noticed in half of cases (3). The positive diagnosis is established using immunohistochemistry and histological studies (6). The treatment of these tumors is surgical and consists of curettage of the tumor followed by an osseous grafting. Reports indicated also the curettage association with thermic or chemical cauterization using a the phenol or salty serum (7).

The evolution of the chondroblastoma is mainly dominated by risk of local recurrence which varies between 5 and 38 % (7). This recurrence is often accessible for a new curettage-transplant treatment approach. However, sometimes it is associated to a tumoural extension in the joint or to adjacent morrow; which require a less conservative and more extensive surgery, this would also weight on the functional prognosis.

Reference :

1. Corsat JP, Tomeno B, Forest M, Vinh TH : chondroblastomes bénins:    une    revue de 30 cas; Revue de chirurgie orthopédique, 1989, 75, 179-187

2. Clipatrick SE, Parisen M, Bridge JA (2002) chondroblastoma in: Fletcher   CDM, Unni KK, Mertens F : world health organisation classification of   tumors; Pathology and genetics of tumors of soft tissue and bonne: IARC Press, Lyon, pp 241-2

3. Ch. bonard, B de courtivron: chondroblastome bénin, in les tumeurs     osseuses béningnes de l’enfant 1996, 65,69.

4. Dwaik M, Devlin PB.: case report: metadiaphyseal chondroblastoma; clin. Radiol. 1992 feb; 42 (2): 131-3

5. Pierre Maroteaux, Martine Le merrer: tumeurs osseuses et processus pseudo- tumoraux bénin, in  M aladies osseuses de l'enfant, 4° edition 2002, 572-610

6. RE, Kurt AM, Sim FH, Unni KK, Mcleod RA, chondroblastoma,  Hum pathol, 1993, 24, 944 – 949F.

7. accadbled , A brouchet, F. salmeron, P. davodes, J. P. cahuzac, J. salesde gauzy. Récidive de chondrobastome agressif, à propos de 2 cas et revue de la littérature, revue de chirurgie orthopédique 2001; 87, 718-723

This is a peer reviewed paper 

Please cite as : A. Afifi: Exceptional Metaphyseal Diaphysia Localization of Chondroblastoma

J.Orthopaedics 2006;3(4)e14

URL: http://www.jortho.org/2006/3/4/e14

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