Intraoperative crush smear cytology of vertebral chondroblastoma: A diagnostic challenge

Abstract

Now-a-days intraoperative consultation plays an important role in proper management of patients. Intraoperative crush cytology is widely used in the rapid diagnosis of various tumors, but a very few reports describe the utility of intraoperative cytology for bone lesions. 7 Here, we report a case of vertebral chondroblastoma diagnosed on intraoperative crush smear cytology and later confirmed on histopathology. This case highlights the role of crush cytology in the rapid intraoperative diagnosis of bone tumors.In this brief report, we describe the cytological features of chondroblastoma and discuss its differential diagnosis. | C ASE H I STOR YA 17-year-old male presented with one-year history of back pain.He also complained of progressive weakness and numbness of both lower limbs for 1 month prior to the consultation. His routine investigations were within normal limits. Magnetic resonance imaging (MRI) spine revealed a well defined extradural mass measuring approx 6 cm 3 5 cm 3 3 cm involving predominantly right posterior segment of D 6-7 vertebrae with expansile soft tissue component (Figure 1). The mass showed an extradural intraspinal extension causing cord compression and edema. With a tentative radiological diagnosis of lymphoma, D 6-7 laminectomy was done and near total excision of the tumor was carried out. Postoperatively, the patient recovered well and was able to walk without difficulty. | Intraoperative crush cytologyThe tissue was relatively firm to make the smears. The smears showed dense tissue fragments with well spread cellular smears surrounding

Letter to the Editor concerning the article “Clinical outcomes of chondroblastoma treated using synthetic bone substitute: risk factors for developing radiographic joint degeneration”

“…Also, other factors that influence clinical outcomes in CB patients can bias the results. For example, in the study of recurrence, the authors did not consider that there may be different biological behaviors and clinical manifestations of CB at different sites, as indicated by reports that tumors located in the pelvis and proximal humerus are prone to recurrence after surgery [2,3], and that spinal CB has a higher recurrence rate compared with CB occurring in long bones [4,5].…”

Letter to Editor Regarding “Clinicopathologic Analysis of Chondroblastoma in Adults: A Single-Institution Case Series” by Negri et al

“…Second, the authors found that among CB patients in their institution, adult CB tended to involve the short bones and the local recurrence rate was similar to that of the young population, 1 whereas previous studies found that CB was most common in the epiphysis of long bones, 4 and the age of the patients was associated with CB recurrence. 7 Among patients with non-long bone CB, the prognosis of older patients is significantly better than that of younger patients, 7 and the unclosed epiphysis of young people is an important factor for CB recurrence.…”

“…However, we note that other factors that influence the clinical outcome of CB patients may bias the results. For example, in their study of recurrence, the authors did not consider the possible different biological behaviors and clinical manifestations of CB in different sites, as reported: tumors located in the proximal pelvis and humerus are prone to recurrence after surgery 2,3 ; spinal CB has a higher rate of recurrence and aggressiveness than CB occurring in the long bones, 4 and the local recurrence rate is even 100% if it involves the long bones. 5 Besides, the type of resection has an important impact on postoperative recurrence.…”

“…But it has been reported that chondroblasts, multinucleated osteoclast-like giant cells, and chondrocyte-like matrix are unique cytologic features for the diagnosis of CB. 4 Besides, in the absence of inflammatory cells, typical chondrocytes are sufficient for the diagnosis of CB even in the absence of a chondrocyte-like matrix, 8,9 and further investigation of these unique diagnostic cytological features may lead to more accessible, sensitive, and specific diagnostic markers in the future.…”

Prognostic Significance of Tumor-Associated Macrophages in Chondroblastoma and Their Association with Response to Adjuvant Radiotherapy

“…CB commonly involves the long bone epiphysis and accounts for less than 1% of all bone tumors. 1 Due to resistance to traditional chemotherapy, the current treatment of choice for CB mainly includes surgery and radiotherapy. 2 Although surgery is indicated for patients with neurological deficits, spinal instability and/or worsening symptoms caused by tumors, complete resection of CB lesion may be difficult due to its locally aggressive nature and proximity to important neurovascular structures.…”