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2012, Volume 28, Number 2, Page(s) 172-174
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DOI: 10.5146/tjpath.2012.01119
Periosteal Chondroma of the Ischium; An Unusual Location
Bülent AKANSU1, Esin ATİK2, Süleyman ALTINTAŞ3, Aydıner KALACI4, Şerefettin CANDA2
1Department of Pathology, M.H. Diyarbakır Education and Research Hospital, Dİyarba kır, TURKEY
2Department of Pathology, Mustafa Kemal University, Faculty of Medicine, HATAY, TURKEY
3 Department of Pathology, M. H. Kahramanmaraş State Hospital, KAHRAMANMARAŞ, TURKEY
4Department of Orthopedics and Traumatology, Mustafa Kemal University, Faculty of Medicine, HATAY, TURKEY
Keywords: Chondroma, Ischium, Chondrosarcoma
Abstract
Periosteal chondroma is a rare benign tumor of hyaline cartilage. Periosteal chondroma arising in the ischium is an extremely rare event. By presenting this case report, we aim to remind that differential diagnosis of these lesions should be carefully performed especially for unusual locations.

A 51-year-old man visited the orthopedics clinic with the complaints of left pelvic mass and pain lasting about one year. Computed tomography showed a solid mass with abundant specks of calcification that was 4x5 cm in diameter and associated with the ischium of the left pelvic bone. There was no evidence of penetration into the medullary cavity and cortical sclerosis. No radiological aggressive appearance was observed. The lesion was removed with the covering periosteum. Microscopically, there were lobules of hyaline cartilage composed of chondrocytes with foci of endochondral ossification and calcification. The case was reported as ‘periosteal chondroma’.

In conclusion, this case report presents a case of periosteal chondroma, a rare tumor, which occurred in an unusual location and age range. The differential diagnosis of periosteal chondroma from malignant lesions is necessary for avoiding aggressive and inappropriate treatment.

Introduction
Periosteal chondroma is a relatively rare benign cartilage tumor that arises from the periosteum. Although periosteal chondromas account for less than 2% of all chondromas, they can occur both in adults and children1-3.

They predominate in patients younger than 30 years of age, with the highest frequency in the second decade3-5. The most common location for periosteal chondromas is the metaphyses of long tubular bones, particularly the proximal humerus, although small tubular bones of hands and feet can also be involved1,2,5. We report a case of periosteal chondroma in the ischium which is an unusual location. The older than expected age of the patient is also another remarkable finding.

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  • Abstract
  • Introduction
  • Case Presentation
  • Disscussion
  • References
  • Case Presentation
    A 51-year-old man visited the orthopedics clinic with the complaints of left pelvic mass and pain lasting about one year. Physical examination revealed a palpable and fixed mass in the ischium. The family and past histories were not contributory. X-ray findings were not clear because of overlapping of the tumor and ischium (Figure 1). Computed tomography showed a solid tumor that was 4x5 cm in diameter and associated with the left pelvic bone with abundant specks of calcification (Figure 2). Magnetic resonance imaging revealed a lobular heterogenous mass arising from the ischium and extending anteriorly, that was hypointense on T1-weighted images, hyperintense on T2-weighted images and showed no enhancement after gadolinium (Figure 3). There was no evidence of penetration into the medullary cavity and cortical sclerosis. No radiological aggressive appearance was observed. Perioperatively, the tumor was noted to be surrounded by an intact fibrous capsule and to originate from the anterior aspect of the left ischium. The lesion was removed with the covering periosteum. On pathologic examination, a cauliflower-like lesion composed of soft tissue and cartilaginous areas that was 6x5x4 cm in diameter was seen macroscopically. Microscopically, there were lobules of hyaline cartilage composed of chondrocytes with foci of endochondral ossification and calcification (Figure 4).


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    Figure 1: X-ray findings are not clear because of overlapping of tumor and ischium.


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    Figure 2: Computed tomography showing a solid tumor associated with the left pelvic bone.


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    Figure 3: Magnetic resonance imaging revealing a lobular heterogeneous mass arising from the ischium.


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    Figure 4: Lobules of hyaline cartilage composed of chondrocytes with endochondral ossification (H&E, x200).

    The lesion was hypercellular but cytological atypia was not seen. There was no penetration to the medullary cavity and surrounding soft tissues. The case was diagnosed as ‘periosteal chondroma’.

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  • Abstract
  • Introduction
  • Case Presentation
  • Disscussion
  • References
  • Discussion
    Periosteal chondroma is a very rare benign tumor of hyaline cartilage accounting for less than 2% of all chondromas1. It is a slow-growing lesion, generally of small size (1-3 cm), developing at the periosteal region, frequently eroding the cortex. The lesion is predominantly seen in patients younger than 30 years of age with the highest frequency in the second decade and with equal sex distribution2-5. However, our patient is a 51-year-old man. The metaphyses of long bones, particularly the proximal humerus, and small tubular bones of hands and feet are the most common locations1,2,5. A few cases have been reported in the spine, clavicula and costochondral margin2,6,7 whereas, to our knowledge, there is only one reported case on periosteal chondroma of the ischium in the English literature8.

    Common roentgenographic features are cortical erosion surrounded by periosteal reaction producing peripheral buttressing, and a thin margin of cortical sclerosis underlying the base of the lesion. Focal calcification or ossification may be present within the soft-tissue mass9. Histopathologically, periosteal chondromas show a lobulated configuration of hyaline cartilage covered by periosteum3,10,11. They are usually hypocellular, but occasionally may show increased cellularity with nuclear pleomorphism, binucleation, and multinucleation2,4,5. They may sometimes be misdiagnosed as chondrosarcoma because of hypercellularity and nuclear atypia12. The differential diagnosis of periosteal chondroma includes juxtacortical chondrosarcoma and periosteal osteosarcoma. Histologically, it may be difficult to distinguish low-grade chondrosarcoma from a chondroma. Juxtacortical chondrosarcoma shows popcorn calcifications on radiographs, whereas a periosteal osteosarcoma is expected to demonstrate perpendicular spicules of calcification13. Both periosteal chondrosarcoma and osteosarcoma are common in the pelvis, while this is an unusual location for periosteal chondromas.

    In conclusion, this case demonstrates the characteristic radiological and histological features of periosteal chondroma, a rare tumor, which occurred at an unusual location and age. The differential diagnosis of periosteal chondroma from malignant lesions is necessary for avoiding aggressive and inappropriate treatment.

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  • Abstract
  • Introduction
  • Case Presentation
  • Discussion
  • References
  • References

    1) Brien EW, Mirra JM, Luck JV Jr: Benign and malignant cartilage tumors of bone and joint: their anatomic and theoretical basis with an emphasis on radiology, pathology and clinical biology. II. Juxtacortical cartilage tumors. Skeletal Radiol 1999, 28:1-20. [ PubMed ]

    2) Lewis MM, Kenan S, Yabut SM, Norman A, Steiner G: Periosteal chondroma. A report of ten cases and review of the literature. Clin Orthop Relat Res 1990, (256):185-192. [ PubMed ]

    3) Molto FL, Lluch DJB, Perales VM: Childhood periosteal chondroma. Arch Ortop Trauma Surg 2000, 120:605-608. [ PubMed ]

    4) Boriani S, Bacchini P, Bertoni F, Campanacci M: Periosteal chondroma. A review of twenty cases. J Bone Joint Surg Am 1983, 65:205-212. [ PubMed ]

    5) Bauer TW, Dorfman HD, Latham JT Jr: Periosteal chondroma. A clinicopathologic study of 23 cases. Am J Surg Pathol 1982, 6:631-637. [ PubMed ]

    6) Peidro L, Suso S, Alcantara E, Ramon R: Periosteal chondroma of the clavicle. Skeletal Radiol 1996, 25:406-408. [ PubMed ]

    7) Fahim DK, Johnson KK, Whitehead WE, Curry DJ, Luerssen TG, Jea A: Periosteal chondroma of the pediatric cervical spine. J Neurosurg Pediatr 2009, 3:151-156. [ PubMed ]

    8) Rockwell MA, Saiter ET, Enneking WF: Periosteal chondroma. J Bone Joint Surg Am 1972, 54:102-108. [ PubMed ]

    9) DeSantos LA, Spjut HJ: Periosteal chondroma: a radiographic spectrum. Skeletal Radiol 1981, 6:15-20. [ PubMed ]

    10) Varma DG, Kumar R, Carrasco CH, Guo SQ, Richli WR: MR imaging of periosteal chondroma. J Comput Assist Tomogr 1991, 15:1008-1010. [ PubMed ]

    11) Woertler K, Blasius S, Brinkschmidt C, Hillmann A, Link TM, Heindel W: Periosteal chondroma: MR characteristics. J Comput Assist Tomogr 2001, 25:425-430. [ PubMed ]

    12) Nojima T, Unni KK, McLeod RA, Pritchard DJ: Perisoteal chondroma and perisoteal chondrosarcoma. Am J Surg Pathol 1985, 9:666-677. [ PubMed ]

    13) Inoue S, Fujino S, Kontani K, Sawai S, Tezuka N, Hanaoka J: Periosteal chondroma of the rib: report of two cases. Surg Today 2001, 31:1074-1078. [ PubMed ]

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  • Abstract
  • Introduction
  • Case Presentation
  • Discussion
  • References
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