Juxta-cortical chondromas, also known as periosteal chondromas, are rare benign chondral tumours that arise from the periosteum of tubular bones. They are thought to account for ~2% of benign bone tumours.
They tend to present around the 2nd to 4th decades. There is a recognised male predilection 1.
Typical sites include 3:
- proximal humerus and distal femur 70%
- phalanges 25%
- may be seen as a saucerisation of the adjacent bony cortex with a sclerotic periosteal reaction
- distinct soft tissue mass may be difficult to identify
- matrix calcification may be seen is ~50% of cases; as with all chondroid lesions, this tends to be ring and arc
- most lesions are <3 cm in size 1
Typically seen has a soft tissue lesion abutting the cortex and may better demonstrate evidence of pressure erosion of neighbouring bone. Often has a lobulated configuration. Tends to lack associated medullary bone or soft tissue oedema.
Signal characteristics include 8:
- T1: typically iso to low signal relative to muscle
- T2/T2*: high signal but with low signal areas representing calcification
- T1 C+ (Gd): heterogeneous and tends to show peripheral predominant contrast enhancement
Treatment and prognosis
They are benign lesions, however may be similar in imaging and histopathologic appearance to juxtacortical chondrosarcomas. Local excision is often the treatment of choice. Once resected lesions usually do not recur.
Imaging differential considerations include:
- periosteal osteosarcoma: lobulated margins and high T2 chondral nodules of periosteal chondroma are absent
- non-epiphyseal chondroblastoma: typically associated with reactive marrow edema on MR
- juxtacortical chondrosarcoma: often larger than 3 cm (mean size 5.5 cm)
- bizarre parosteal osteochondromatous proliferation (Nora lesion): for phalangeal lesions
- cortical desmoid: for the posteromedial distal femoral lesions
- giant cell tumour of tendon sheath: for phalangeal lesions
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