dr james c wittig, orthopedic oncologist, new york, new jersey
About Dr. Wittig
Periosteal Chondroma

General Information

  • Benign neoplasm
  • Composed of mature hyaline cartilage
  • Arises from surface of bone from inner layer of periosteum
  • Erodes the outer table of the cortex
  • Does not grossly extend into medullary cavity
  • Also known as juxtacortical chondroma
  • More cellular than an enchondroma

Clinical Presentation

Signs/Symptoms:

  • Incidental radiographic findings
  • Possible symptomatic mass
    • Mildly painful
    • Long duration of symptoms
    • Mechanical symptoms

Prevalence:

  • Very uncommon
    • Accounts for ~0.66% of bone tumors
    • 3 times as common as juxtacortical chondrosarcoma
  • 2 to 1 male predilection

Age:

  • All ages; usually <30 years
  • Most commonly in second or third decades of life

Sites:

  • Almost all in appendicular skeleton
    • Proximal humerus-Most common
    • Femur, tibia, phalanges are common sites
    • Pelvis, ribs, vertebrae less common
  • Occasionally multiple lesions occur
  • Difficult to differentiate from periosteal chondrosarcoma (periosteal chondrosarcomas are usually
  • greater than 6cm and periosteal chondromas are usually less than 6 cm)

Radiographic Presentation

Roll over the images for more information
Radiographic presentation, Periosteal Chondroma CT Scan: Periosteal Chondroma
CT Scan: Periosteal Chondroma X-ray: Distal Femur Periosteal Chondroma

Gross Pathology

  • Well circumscribed
  • Appears to be embedded in underlying cortical bone
  • Typically covered by a thin shell of reactive, often ossified periosteum
  • Medullary cavity not grossly invaded
  • Cross-section
    • Blue-gray to white
    • Translucent hyaline cartilage
      • Often formed as lobules
    • Calcification occasionally noticeable
      • Yellow-white, gritty foci

Microscopic Pathology

  • Lobulated, obviously hyaline cartilage tumor
    • Cartilaginous lobules separated by fibrous connective tissue or well-formed lamellar bone
      • Calcium deposition occasionally present
    • Necrosis absent
  • Innermost margin of lesion usually demarcated by rim of lamellar bone
  • Considerable interlesional variation in cellularity and pleomorphism
    • Many consist of normocellular benign hyaline cartilage
    • Binucleated chondrocytes are invariably present
    • May be more cellular than an enchondroma with myxoid change of matrix
  • About 2/3 of tumors display
    • Nuclear enlargement
    • Hypercellularity with hyperchromasia
    • Or myxoid change of the matrix
Roll over the images for more information
Microscopic Pathology: Periosteal Chondroma

Biological Behavior

  • No metastasis
  • No malignant change
  • Exceedingly rare recurrence
  • Non aggressive

Treatment & Prognosis

  • Marginal excision without removal of surrounding tissue
    • Occasional rare recurrence
  • En bloc excision
    • Invariable curative
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