3. Rare benign tumor.
Epiphysis.
CODMAN’S TUMOR – first described by Codman 1931.
<1% of all primary bone tumors.
Develops from – Cartilage germ cells.
Reticulohistiocytes – according to Valls.
4. Age:
Active epiphysial plate growth
Range: 3-73 yrs.
Teenagers – before obliteration of growth plates.
90% in 5 – 25 yrs. of age.
Sex
Male : Female 2 : 1
5. Site:
EPIPHYSIAL region of long bones and occasionally to adjacent
metaphysis.
Common occurrence:
Lower extremity (72% of cases), in which 50% of the
chondroblastomas occur around the knee.
Prox. Humerus 18% > Prox. Tibia 17% > Distal femur 16%
> Prox. Femur 16% > Ankle bones 9%
Size: 1- 6 cm.
6. Clinical features:
Non-specific and vague.
Pain & swelling – several months.
May be referred to nearest joint
Some loss of joint function & muscle wasting.
Joint effusion esp. around knee.
Pathological fractures – rare.
7. Mortality/Morbidity:
Without surgical excision, the tumor may extend
into the adjacent soft tissues or synovium and
metastasize to distant organs.
Metastasis, when it occurs,
most frequently involves the lungs and
tends to occur at the time of primary tumor recurrence.
Widespread metastases and death have been reported.
8. Radiological features:
X – RAYS:
Lytic area –
Oval or round
< ½ of epiphysial area.
Thin rim of sclerosis
Punctate or streaky
calcification.
9. Usually open growth plates.
In metaphysial extension,
crossing growth plate results
in – Eccentric location &
bulging expansion of cortex.
20. Uptake of the bone-seeking
agent may be due to –
regional hyperemia of the
tumor.
21. Pathology:
Gross:
Usually well demarcated lesions.
Capsule – thin, easily disruptable
Soft, reddish –purple, friable, focally fritty tissue.
Cystic spaces and haemorrhages may be seen.
22. Microscopic:
Islands of chondroblasts within
uniform polyhedral closely
packed cells.
Background of fibrous stroma
cells within the islands –
PAVING STONE
APPEARANCE.
23. Cells – round, plump and active.
Pericellular lattice-like fine calcification – “CHICKEN WIRE” or
“PICKET FENCE” pattern.
Small granular purplish areas of micro calcification.
Multinucleated Giant cells – scattered in stroma.
Often prominent, dilated blood vessels at centre & periphery.
26. Treatment & prognosis:
Curettage and autologous bone grafting – high recurrence rate
(10 – 35%).
Close follow up & observation till skeletal maturity – when
potential growth remaining & lesion abuts epiphysial plate.
Marginal extra capsular excision – when growth plate not
at all at risk, low recurrence rate.
Defect – Autologous bone grft.
27. Methacrylate adjunct – when excision impractical &
intra capsular curettage is of high risk of recurrence due to
surgical inaccessibility.
Curettage followed by cryosurgery:
In case of recurrence or when associated with ABC.
Yields consistent good results with a high cure rate when entire
tumor is adequately frozen by liquid nitrogen.
