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Chondrogenic Lesions of the Skeletal System Using Radiographs, CT and MRI

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Author(s): Akbar Bonakdarpour

Journal: Iranian Journal of Radiology
ISSN 1735-1065

Volume: 8;
Issue: S1;
Start page: 64;
Date: 2011;
Original page

Keywords: Keyword

ABSTRACT
Benign Tumors: Chondroma, chondroblastoma,"nchondromyxoid fibroma, osteochondroma"nChondroma"n1. Enchondroma"n2. Periosteal Chondroma"n3. Enchondromatosis"n4. Metachondromatosis"nEnchondroma is a benign metaphyseal tumor. The"nmajor differential diagnoses are bone infarct and"nchondrosarcoma. Calcification in enchondroma"nhas a popcorn appearance and on radiographs and"nCT they may be counted. Calcified bone infarct"nhas an appearance similar to rotten metal. Central"nchondrosarcoma shows cortical erosion more than"ntwo thirds of the thickness of cortex and also periosteal"nreaction. Pain and growth of lesion in adulthood raises"nthe possibility of malignant transformation."nPeriosteal chondroma: This lesion arises from the"nperiosteum without involving the medullary bone."nThe most common location is the upper humerus."nEnchondromatosis reveals multiple enchondromas,"npredominantly involving one side of the skeleton."nMalignant transformation is the major complication"nof enchondromatosis. In malignant transformation,"nMRI shows that perichondrium is more than 1 cm"nthick in adults and more than 3 cm thick in children."nIn the hands and feet, enchondromatosis should not"nbe confused with fibrous dysplasia. Mafucci syndrome"nis enchondromatosis associated with cavernous"nhemangiomas with a prognosis worse than enchondr"nomatosis."nMultiple hereditary cartilaginous exostoses: This is"nof metaphyseal origin and pedunculated forms grow"naway from the adjacent joint. Sessile osteochondromas"nare broad based; if their surface is irregular they are"nsuspicious of malignancy. Pain and growth of the"nlesion after closure of the epiphyseal plate are warning"nsigns of malignant transformation. In malignant"ntransformation MRI shows that perichondrium is"nmore than 1 cm thick in adults and more than 3 cm"nthick in children."nChondroblastoma: This is a benign tumor, seen before"nclosure of epiphyseal plate, with a sclerotic border."n30 to 50% show calcification. CT and MRI confirm"nradiographic findings. The tumor is hypodense in T1"nand hyperdense in T2 and post gadolinium injection"nfat suppressed T1 images. CT and MRI confirm"nradiographic findings."nChondromyxoid Fibroma-A benign, eccentric, ovoid,"nmetaphyseal tumor with recurrent tendency. It rarely"nshows calcification. The tumor is hypodense on T1 and"nIran J Radiol 2011, 8 (Supp.1) S65"nhyper dense on T2 and post gadolinium studies show"nhyperintensity beyond the tumor. It has a tendency"nfor recurrence. Non-ossifying fibroma is a self healing"nmetaphyseal fibrous defect and not a tumor, diamond"nshaped in one of the perpendicular radiographs."nMetaphyseal fibrous defect is usually subcortical, but"nit may be small and intracortical. CT and MRI confirm"nradiographic findings."nSynovial chondrometaplasia. (synovial"nosteochondromatosis) is an arthritis resulting"nfrom chondro (or osteochondro) metaplasia of the"nsynovium. They may form osteocartilaginous bodies"nin the joint. In advanced cases they may cause erosion of"nthe articular surface and malignant transportation has"nbeen reported. Radiographs may demonstrate chondroosseous"nbodies in the joints, but CT demonstrates them"nbetter. MRI shows joint fluid and filling defects in the"nfluid. Erosion may be demonstrated by these three"nmodalities."nChondrosarcoma:"nConventional Chondrosarcoma: central, peripheral"nand juxtacortical."nVariants of chondrosarcoma: clear cell, mesenchymal"nand dedifferentiated. Chondrosarcoma can be"ndifferentiated from enchondroma by the presence"nof cortical erosion more than two thirds of the"ncortical diameter and periosteal reaction. Most"nchondrosarcomas discussed here are of low grade"nmalignant potential. Mesenchymal chondrosarcoma"nare high grade. Clear cell chondrosarcoma is similar"nto chondroblastoma, but it is a low grade malignant"ntumor seen in older patients.

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