Chondromyxoid fibromas (CMFs) are extremely rare, benign cartilaginous neoplasms that account for <1% of all bone tumours.
The majority of cases occur in the second and third decades, with ~75% of cases occurring before the age of 30 years 1,12-15. There is no recognised gender predilection 18. However, examples have been seen in patients up to the age of 75 years. In some series, there is a male predilection, whilst in others, no such distribution is found 2,12.
Typically patients present with progressive pain, often long-standing and/or bony swelling and restricted range of movement in affected limb 3,12. The latter is most often the case in bones with little overlying soft tissues (e.g. short tubular bones of the hands and feet).
The tumour comprises of a variable combination of chondroid, myxoid, and fibrous tissue components organised in a pseudolobulated architecture 20.
On gross examination, they are typically seen as solid glistening tan-gray intraosseous masses.
Occasional osteoclast-like giant multinucleated cells are encountered particularly at the periphery. Most cells are morphologically bland, and mitotic figures are rare or absent 13.
Most chondromyxoid fibromas are located in the metaphyseal region of long bones (60%), and may extend to the epiphyseal line and even rarely abut the articular surface 3,12. They are almost never just epiphyseal 3.
The classical site is the upper one-third of the tibia, which accounts for 25% of all cases, with the small tubular bones of the foot, the distal femur and pelvis being other relatively common locations 12.
- often seen as a lobulated, eccentric radiolucent lesion
- long axis parallel to long axis of long bone
- no periosteal reaction (unless a complicating fracture present)
- geographic bone destruction: almost 100%
- well defined sclerotic margin: ~85%
- presence of septations (pseudotrabeculation): ~60% 2
- presence of matrix calcification in small proportion cases: 12.5% 1
MR features are often not particularly specific. Signal characteristics include:
- T1: low signal
T1 C+ (Gd)
- the majority (~70%) tend to show peripheral nodular enhancement
- ~30% diffuse contrast enhancement and this can be either homogeneous or heterogeneous 19
- T2: high signal
Treatment and prognosis
They are benign lesions and malignant degeneration is rare. They are usually treated with curettage which however have a high recurrence rate of 25%. As such if an en-bloc resection is possible this is advisable 14.
History and etymology
It is thought to have been initially described by H L Jaffe and L Lichtenstein in 1948 7.
General imaging differential considerations include:
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- 19. Kim HS, Jee WH, Ryu KN et-al. MRI of chondromyxoid fibroma. Acta Radiol. 2011;52 (8): 875-80. Acta Radiol (full text) - doi:10.1258/ar.2011.110180 - Pubmed citation
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The differential diagnosis for bone tumours is dependent on the age of the patient, with a very different set of differentials for the paediatric patient.
- bone-forming tumours
- cartilage-forming tumours
- chondromyxoid fibroma
- fibrous bone lesions
- bone marrow tumours
- other bone tumours or tumour-like lesions
- aneurysmal bone cyst
- benign fibrous histiocytoma
- giant cell tumour of bone
- Gorham massive osteolysis
- haemophilic pseudotumour
- intradiploic epidermoid cyst
- intraosseous lipoma
- musculoskeletal angiosarcoma
- musculoskeletal haemangiopericytoma
- primary intraosseous haemangioma
- simple bone cyst
- impending fracture risk