Discussion Author: James H Flint
Periosteal chondroma was first reported in the literature by Lichtenstein in 1952(1), although earlier descriptions of similar lesions have been found(2). It is a benign bone lesion, seen most commonly in the second and third decades, with a male to female predilection of approximately 2 to 1(3,4). Of all the chondromas, periosteal chondroma accounts for less than 2% of cases(5). The most common locations for this lesion are the metaphysis or diaphysis of the proximal humerus and distal femur(2-4).
Periosteal chondroma presents as a well demarcated, ossific mass in a juxtacortical position, with or without sclerotic borders and not continuous with the medullary cavity(2,4). Periosteal chondroma exhibits a characteristic saucerization of the underlying cortex(3). T1 weighted MRI imaging typically reveals a hypointense signal, and T2 weighted imaging shows a hyperintense signal. In addition, MR imaging reveals that this lesion does not show soft tissue involvement or continuity with the medullary cavity(6).
Histologically, periosteal chondroma appears as a lobulated fibrocartilaginous matrix on low power. Higher power reveals lobules of chondrocytes, sometimes showing atypia such as binucleation (2,4,7). Ossification and calcification may also be present.
Surgical excision is the treatment of choice(2,4,7), primarily due to the similarity to malignant lesions like osteosarcoma and chondrosarcoma. In addition, it may cause symptoms in the hand such as restricted range of motion or local pain and tenderness. Periosteal chondroma typically has a low rate of recurrence, particularly when excising the underlying periosteal tissue and any suspicious appearing cortex(2,3,8).
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