Background:Chondroblastoma is a relatively rare benign bone tumor that develops from immature cartilage cells (chondroblasts). It occurs in the epiphyses of long bones. It is a tumor that mainly affects children and males. Its onset in older age groups is rare. The most common locations are the proximal humerus, femoral condyles, and proximal tibia. Radiological and anatomopathological staging divides the tumor into three stages. Most lesions are stage 2, meaning they are active, symptomatic. Stage 3 presentation is when there is involvement of the adjacent joint and destruction of the growth plate with passage into the metaphysis.Malignant transformation of chondroblastoma is quite rare. Very rare cases of pulmonary metastasis have also been reported.Purpose of the study:The aim of the study is to compare the functional, clinical, and radiological results of children with chondroblastoma treated at our center with the results presented in the literature. Materials and methods: This is an observational, retrospective study conducted on a group of 22 patients treated between 2014 and 2025 at the Orthopedic Clinic of Padua. Demographic, functional, clinical, and radiographic data were collected and analyzed for comparison with cases reported in the literature. Results:Twenty-two patients were treated between 2014 and 2025. The male-to-female ratio was 6:1. The average age at diagnosis was 16 years (range 2-30). The distribution of tumour location was as follows: femur 11 patients, humerus 5 patients, tibia 4 patients, patella 2 patients. All patients presented with significant pain as an initial symptom. Radiological diagnostic imaging associated with clinical and histological staging according to the criteria: no patients had latent neoplasia, 14 patients had active neoplasia and the remaining 8 patients had aggressive neoplasia. Eleven patients underwent surgical treatment with curettage and filling with bone grafts; four patients underwent curettage only; four patients were treated with curettage and filling with cement/cerament G and one patient underwent curettage and filling with both grafts and cement; One patient required en bloc resection of the bone segment and massive grafting with stabilisation using synthesis devices. One patient underwent en bloc resection and prosthetic joint replacement. In 13 cases, intraoperative phenol was applied to the curetted cavity. The mean follow-up was 5.5 years (range 1-11 years). Five patients had minor post-operative complications and one had major surgical complications. There were no infectious complications. Dysmetria of more than 1 cm in the affected limb due to altered skeletal growth was observed in 3 patients. The recurrence rate was 1% (2 cases). No patients in the study group presented lung metastases or malounding bone tissue.ignant transformation of the neoplasm. Conclusions:The diagnosis, treatment and follow-up of chondroblastoma is characterised by a high degree of clinical complexity that requires considerable experience and a dedicated centre. Low incidence, age of onset and uncertain behaviour make both diagnosis and treatment choice difficult. The results of the study are consistent with those in the literature, demonstrating that chondroblastoma is a disease that predominantly affects young males. The definitive diagnosis must be made prior to surgery by means of a biopsy performed under fluoroscopic guidance. The treatment of choice remains curettage combined with phenol lavage of the tumour cavity and filling with bone grafts. The use of phenol as an intraoperative adjuvant could reduce the risk of local recurrence and thus avoid secondary surgery, but as it is a toxic substance with possible long-term effects such as genetic mutations, further protocols are needed.
Introduzione :Il condroblastoma è un tumore osseo benigno piuttosto raro che deriva da cellule cartilaginee immature (condroblasti). Predilige le localizzazioni alle epifisi delle ossa lunghe. Interessa prevalentemente la popolazione pediatrica e il sesso maschile. L’insorgenza nell’età più avanzata è rara. La localizzazione più frequente è l’omero prossimale, condili femorali e tibia prossimale. La stadiazione radiologica ed anatomopatologica prevede la suddivisione in tre stadi. La maggior parte delle lesioni sono stadio 2 quindi attive. Stadio 3 quando vi è un interessamento dell'articolazione adiacente e distruzione della cartilagine di accrescimento con passaggio nella metafisi e coinvolgimento dei tessuti ossei circostanti. La trasformazione maligna di un condroblastoma è rara. Sono stati riportati inoltre rarissimi casi di metastasi polmonari. Scopo dello studio: L’obiettivo dello studio è confrontare i risultati funzionali, clinici e radiologici dei pazienti affetti da condroblastoma e trattati presso il nostro centro con i risultati presentati nella letteratura. Materiali e metodi: Si tratta di uno studio osservazionale, retrospettivo condotto su un gruppo di 22 pazienti trattati tra il 2014 e il 2025 presso la Clinica Ortopedica di Padova. I dati demografici, funzionali, clinici e radiografici sono stati raccolti e analizzati per il confronto delle casistiche presenti nella letteratura. Risultati: Sono stati i 22 pazienti trattati tra il 2014 e il 2025. Rapporto maschi/femmine era 6:1. Età media alla diagnosi era di 16 anni (range 2-30). La distribuzione della localizzazione del tumore: femore 11 pazienti, omero 5 pazienti, tibia 4 pazienti, rotula 2 pazienti. Tutti i pazienti presentavano dolore importante come sintomo all'esordio. All’imaging diagnostico radiologico associato alla clinica e stadiazione istologica secondo i criteri: nessun paziente presentava neoplasia latente, 14 pazienti presentavano neoplasia attiva ei restanti 8 pazienti presentavano neoplasia aggressiva. 11 pazienti sono stati sottoposti a trattamento chirurgico con curettage e riempimento con innesti ossei; in 4 pazienti è stato eseguito solo il curettage; 4 pazienti sono stati trattati con curettage e riempimento con cemento/cerament G e 1 paziente curettage e riempimento sia con innesti che cemento; in 1 paziente è stata necessaria la resezione en bloc del segmento osseo e innesto massivo con stabilizzazione mediante mezzi di sintesi. 1 paziente è stato sottoposto a resezione en bloc e sostituzione protesica dell’articolazione. In 13 casi è stato applicato fenolo intraoperatorio nella cavità curettata. Follow up medio è stato di 5.5anni (range 1-11anni). 5 pazienti hanno presentato complicanze post operatorie minori e 1 complicanze chirurgiche maggiori. Non si è verificata alcuna complicanza di tipo infettivo. Dismetria di più di 1 cm all’arto affetto per alterata crescita scheletrica, si è stata evidenziata in 3 pazienti. Il tasso di recidive è stato 1% (2 casi). Nessun paziente del gruppo di studio ha presentato metastasi polmonari e trasformazione maligna della neoplasia. Conclusioni: La diagnosi, trattamento e follow up di condroblastoma è caratterizzato da una complessità clinica elevata che richiede molta esperienza e un centro dedicato. Bassa incidenza, età di esordio e comportamento incerto rendono difficili sia la diagnosi che la scelta terapeutica. I risultati dello studio sono concordanti con quelli della letteratura, dimostrando che il condroblastoma è una patologia che predilige giovane età e sesso maschile. La diagnosi definitiva deve essere posta prima dell'intervento tramite biopsia eseguita sotto guida scopica. Il trattamento di prima scelta rimane il curettage associato al lavaggio con fenolo della cavità tumorale.
IL CONDROBLASTOMA: ESPERIENZA DELLA CLINICA ORTOPEDICA DI PADOVA E REVISIONE DELLA LETTERATURA.
STROJNA, ALEKSANDRA
2022/2023
Abstract
Background:Chondroblastoma is a relatively rare benign bone tumor that develops from immature cartilage cells (chondroblasts). It occurs in the epiphyses of long bones. It is a tumor that mainly affects children and males. Its onset in older age groups is rare. The most common locations are the proximal humerus, femoral condyles, and proximal tibia. Radiological and anatomopathological staging divides the tumor into three stages. Most lesions are stage 2, meaning they are active, symptomatic. Stage 3 presentation is when there is involvement of the adjacent joint and destruction of the growth plate with passage into the metaphysis.Malignant transformation of chondroblastoma is quite rare. Very rare cases of pulmonary metastasis have also been reported.Purpose of the study:The aim of the study is to compare the functional, clinical, and radiological results of children with chondroblastoma treated at our center with the results presented in the literature. Materials and methods: This is an observational, retrospective study conducted on a group of 22 patients treated between 2014 and 2025 at the Orthopedic Clinic of Padua. Demographic, functional, clinical, and radiographic data were collected and analyzed for comparison with cases reported in the literature. Results:Twenty-two patients were treated between 2014 and 2025. The male-to-female ratio was 6:1. The average age at diagnosis was 16 years (range 2-30). The distribution of tumour location was as follows: femur 11 patients, humerus 5 patients, tibia 4 patients, patella 2 patients. All patients presented with significant pain as an initial symptom. Radiological diagnostic imaging associated with clinical and histological staging according to the criteria: no patients had latent neoplasia, 14 patients had active neoplasia and the remaining 8 patients had aggressive neoplasia. Eleven patients underwent surgical treatment with curettage and filling with bone grafts; four patients underwent curettage only; four patients were treated with curettage and filling with cement/cerament G and one patient underwent curettage and filling with both grafts and cement; One patient required en bloc resection of the bone segment and massive grafting with stabilisation using synthesis devices. One patient underwent en bloc resection and prosthetic joint replacement. In 13 cases, intraoperative phenol was applied to the curetted cavity. The mean follow-up was 5.5 years (range 1-11 years). Five patients had minor post-operative complications and one had major surgical complications. There were no infectious complications. Dysmetria of more than 1 cm in the affected limb due to altered skeletal growth was observed in 3 patients. The recurrence rate was 1% (2 cases). No patients in the study group presented lung metastases or malounding bone tissue.ignant transformation of the neoplasm. Conclusions:The diagnosis, treatment and follow-up of chondroblastoma is characterised by a high degree of clinical complexity that requires considerable experience and a dedicated centre. Low incidence, age of onset and uncertain behaviour make both diagnosis and treatment choice difficult. The results of the study are consistent with those in the literature, demonstrating that chondroblastoma is a disease that predominantly affects young males. The definitive diagnosis must be made prior to surgery by means of a biopsy performed under fluoroscopic guidance. The treatment of choice remains curettage combined with phenol lavage of the tumour cavity and filling with bone grafts. The use of phenol as an intraoperative adjuvant could reduce the risk of local recurrence and thus avoid secondary surgery, but as it is a toxic substance with possible long-term effects such as genetic mutations, further protocols are needed.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/93109