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Periosteal Chondroma: (Juxta Cortical Chondroma)

- Discussion:
    - cartilaginous tumor that arises from surface of cortex deep to the periosteum producing broad based cartilaginous mass that may extend into soft tissues;
    - often develops after adolescence (in contrast to osteochondroma)
    - persists as mass of mature cartilage w/o calcification or ossification (in contrast to chondrosarcoma);
    - tumor is does not infiltrate the adjacent soft tissue but may increase in size;

- Location:
    - over 50% of these tumors are found in lateral cortex of proximal humerus just proximal to insertion of deltoid muscle;
    - other lesions are evenly dispersed thru out the long bones;

- Clinical Manifestation:
    - pts may complain of pain at tumor site;
    - often can be palpated & is nontender, hard mass, fixed to bone;

- Radiographs:
    - consists of small surface mass ( < 3 cm) & appears as radiolucent oval or oblong defect on periphery of underlying cortex;
    - lesion is underlined by a thin, distinct cortical reaction.
    - has little or no calcification but may have spicules of mineralization radiating from the cortex, providing a "sunburst" appearance (in contrast to chondrosarcoma);
    - occassionally there is intralesional calcifications & minimal periosteal rxn;
    - radiographic diff dx:
            - osteochondroma in younger patients;
            - juxtacortical chondrosarcoma;
            - parosteal and periosteal osteosarcomas;
    - CT scan:
            - CT is used to demonstrate extent of cortical involvement and identify density of cartilage;

- Histology:
    - low power view shows lobulated hyaline masses that are well circumscribed;
    - lesion is usually hypocellular and well circumscribed;
    - isolated areas of increased cellularity may be seen;
    - lesion is composed of benign cartilage but it looks more active than an enchondroma;
    - this lesion may be confused with chondrosarcoma;

- Treatment:
    - most of these lesions present in stage 2 & require en bloc marginal excision to prevent recurrence;
           - wide excision including underlying cortex is treatment of choice;
    - its important to remove entire tumor w/o rupturing tumor capsule;
    - risk of recurrence after bloc marginal excision is < 10%, & more aggressive excision or adjuvant chemo & XRT are not indicated

Tumors: Periosteal Chondroma. A Report of Ten Cases and Review of the Literature.

Periosteal chondroma. A review of twenty cases.