Background

This is most common cartilaginous tumor of bone. The key differentiating factor between this tumor and a malignant chondrosarcoma is whether there is growth over time. These tumors are stable and are benign while chondrosarcomas will grow slowly. Thus all clinical questions regarding the management of a cartilaginous lesion of the long bones centers upon this question. Serial radiographs and close clinical observation over several months will provide an answer with no compromise in the treatment of the lesion. The exception are tumors associated with Ollier's disease of the hand or in children. In these cases, a slow growth does not always indicate malignancy. The other key clinical point centers on symptoms. These tumors are non-growing and thus do not cause pain. Most patients have their tumors discovered as an incidental finding on radiographs or bone scans. The exception would be cases which are associated with a stress fracture which of course, may be associated with pain but not secondary to the growth of the lesion. True bone pain, of the type associated with a malignant bone tumor, is worse at night and not relieved by rest or immobilization.

AGE RANGE-MEDIAN

Younger 2-3rd decades

 

PATHOGENESIS	CHARACTERIZATION
Hamartomatous proliferations	Originates from epiphyseal plate which becomes entrapped in the medullary canal of the metaphysis or metadiaphysis These islands are subject to same growth factors as normal cartilage and cease to grow in adulthood

 

LABORATORY/RADIOLOGIC/ OTHER TESTS	CHARACTERIZATION
Radiographs	Well defined lytic lesions in the central portion of the metaphysis or metadiaphysis With age, these lesions calcify and ossify showing characteristic radiodense rings and stipples May show mild endosteal erosion but cortical erosion or cortical thickening is not present In long bones, these do not grow versus chondrosarcomas which grow slowly

 

GROSS APPEARANCE/CLINICAL VARIANTS	CHARACTERIZATION
General
VARIANTS
Tumors occurring in Ollier's disease	Tumors occur in the hands and feet Often painful and may cause cortical expansion Histologically may show chondrocytic atypia Only extreme cellular atypia and infiltration of adjacent soft tissue are unequivocal criteria for malignant behavior

 

HISTOLOGICAL TYPES	CHARACTERIZATION
General	Mature hyaline cartilage lobules of varying cellularity Cellular tumors may contain chondrocytes wth plump or double nuclei Myxoid change or focal necrosis may be present Cartilage lobules are usually separated by normal marrow and lobules are partially encased by mature lamellar bone
VARIANTS

 

DIFFERENTIAL DIAGNOSIS	KEY DIFFERENTIATING FEATURES
Low grade chondrosarcoma	May be more cellular with atypia Permeation of the bone marrow by cartilage, indicative of neoplastic growth

Pathol Case Rev 2001;6:8-13

Bone and Joint Tumors

Chondrosarcoma of the Bone

Last Updated 2/21/2001

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