DX: Chondroblastoma of the hand

Ok sorry for the delay. Here is the reason:

I knew that this patient went to ressection of the hand mass because I found this image:

Later on, I compared with previous hand x-ray prior to biopsy 11 years ago.

We see here an expansile mass with predominantly chondroid matrix. Bening appeareance, but age favors malignancy in bone tumors. So a biopsy was conducted and it revealed : Chondroblastoma

Patient was given a conservative treatment but 10 years later the mass continued to cause pain. This is the radiography control.

Pathological specimen (seen above) revealed: Osteochondroma.

That was the issue. I went to pathologist and the Department decided to conduce a revision of the case. And I was part of the discussion. Imaging findings are clearly narrowing the scope of differentials to a chondroid, benign, slow growing mass with no soft tissue involvement and some diffuse calcifications. STIR and T2 sequences are useful to show the hyperintensity of the lesion due to cartilaginous tissue wich is rich in water content. They reviewed the biopsy with the specimen and concluded that it is a Chondroblastoma.

Either way, this is still a rare lesion in the hand and more rarer in this group age (>50y).

Chondroblastomas most frequently arise in the epiphyses of long bones, with 70% occurring in the humerus (most frequent), femur and tibia 9. ~ 10% are found in the hands and feet wich is this case.

They are seen as well defined lytic lesions, with either smooth or lobulated margins with a thin sclerotic rim, arising in the epiphysis or apophysis of long tubular bone such as the femur, humerus, or tibia. Internal calcifications can be seen in up to 40 - 60% of cases 7,9. A joint effusion is seen in ~1/3 of patients. They range in size from 1 - 10cm, with most being 3 - 4cm at diagnosis.

Approximately 92% of patients presenting with chondroblastoma are younger than 30 years. However, chondroblastomas have been reported to arise in patients as young as 2 years and as old as 83 years. In several large series, most patients were diagnosed in the second decade of life.

Thank you for the patience in this case. Hope is useful.