Chondroblastoma and clear cell chondrosarcoma: radiological and MRI characteristics with histopathological correlation

Abstract

Objective: To analyze and compare the radiological and magnetic resonance imaging (MRI) appearances of chondroblastoma and clear cell chondrosarcoma with histopathological correlation. Design and patients: Twelve patients with histologically proven chondroblastoma and of another four patients with clear cell chondrosarcoma were investigated by radiographs and MRI (T1-, T2-weighted sequences, intravenous gadolinium application). Additionally, the clinical and radiologic data of seven cases of clear cell chondrosarcoma without available MRI were considered. The localization, calcification of tumor matrix, periosteal reaction, cortical bone and patterns of bone destruction were analyzed according to the Lodwick radiological grading system (LRGS). The signal intensity on T1-and T2-weighted sequences, characteristics of contrast enhancement, associated bone marrow edema, soft tissue reaction and joint involvement were evaluated. Histopathological specimens were available in all cases. Results: The age of patients with chondroblastoma (range 15-59 years, mean 22.3 years) was lower than that of those with clear cell chondrosarcoma (range 19-61 years, mean 36.6 years), and the lesions were smaller in the chondroblastoma group (range 1-4 cm, mean 2.3 cm) than in patients with clear cell chondrosarcoma (range 3-7.5 cm, mean 5.2 cm). The chondroblastomas were more confined to the epiphysis (10/12) than the clear cell chondrosarcomas. All chondroblastomas and clear cell chondrosarcomas except one were classified as grade 1A or 1B according to the LRGS; one clear cell chondrosarcoma was judged as grade 2. Signal intensity of the tumors on MRI was very heterogeneous in both groups. High signal intensity on T2-weighted MR images in chondroblastoma mostly corresponded to areas with aneurysmal bone cyst components and in clear cell chondrosarcoma to islands of hyaline cartilage. Contrast enhancement occurred in all tumors and tended to be more intense with clear cell chondrosarcoma. Chondroblastoma was more frequently associated with bone marrow edema (11/12), periosteal reaction (10/12), soft tissue reaction (7/12) and synovitis (3/12). Conclusion: Chondroblastoma occurs in younger patients, is smaller than clear cell chondrosarcoma and is more confined to the epiphysis. The overlap of signal intensity and contrast enhancement patterns does not allow a reliable differentiation of the two tumors by MRI. Chondroblastomas are typically associated with bone marrow edema, periosteal reaction and soft tissue reaction.

Expression of cyclooxygenase-2 in chondroblastoma: immunohistochemical analysis with special emphasis on local inflammatory reaction

“…Bone-marrow edema extending to the circumference of the tumor is observed in 82-92% of cases on MRI, and soft-tissue edema is also found in 58-82% of cases [15,16,23]. Approximately 30% of cases are associated with joint effusion as demonstrated by MRI [15,16,25]. In our study, the frequency of inflammatory reaction was similar to previously reported data.…”

“…A thick-solid or layered-type periosteal reaction distant from the lesion itself has been found in 20-90% of cases of chondroblastoma on radiography or MRI [2,3,4,8,12,13,15,16,23,25]. Bone-marrow edema extending to the circumference of the tumor is observed in 82-92% of cases on MRI, and soft-tissue edema is also found in 58-82% of cases [15,16,23]. Approximately 30% of cases are associated with joint effusion as demonstrated by MRI [15,16,25].…”

“…Osteoid osteoma is a typical example of such a benign tumor [17,18]. Recent imaging advances, especially MRI, have revealed that other benign tumors, e.g., chondroblastomas, demonstrate tissue reactions around them [3,12,16,23,25].…”

Hip Pain in an 18-year-old Man

“…Radiographically, giant cell tumors differ from chondroblastomas as purely radiolucent lesions without the intralesional calcification present in chondroblastomas. Additionally, the flare phenomenon found in chondroblastomas is less prominent in giant cell tumors [13,17,24]. Histologically, the main differentiating characteristic is cartilage matrix.…”

Surface-based chondroblastoma of the tibia: a unique presentation

“…Histologically, approximately one-third of cases have foci of secondary aneurysmal bone cyst (ABC) [6], which may present as areas of fluid signal-intensity or fluid-fluid levels within the tumor on MRI [12,13]. Pain is the presenting symptom in most patients, with swelling, limp, joint stiffness, and a soft tissue mass also reported [14].…”