Recurrent chondromyxoid fibroma of the humerus

Case contributed by Dr Mohammad A. ElBeialy

Presentation

13 years old boy with right upper arm pain and swelling. History of previous curettage of the bony mass lesion.

Patient Data

Age: 13 years
Gender: Male
Modality: X-ray

A well-defined right proximal humeral diametaphyseal expansile, multilocular lesion with a geographic pattern of bone destruction and sclerotic margin. The lesion has narrow zone of transition with no matrix calcification. No definite periosteal reaction.   

Modality: MRI

An expansile mildly lobulated and septated lesion is seen within the proximal humeral metadiaphysis. The lesion shows low to intermediate T1 and high T2/STIR signal intensity with T1/T2 hypointense sclerotic rim. The lesion measures 11 X 3 X 3 cm in its main CC,TS and AP diameters. The lesion shows endosteal scalloping with sclerosed margin and narrow zone of transition. Focal cortical destruction is noted with small extra-osseous soft tissue component at the anterolateral aspect of the lesion. No fluid / fluid levels are seen. The lesion shows heterogenous post-contrast enhancement with enhancing septa.

Case Discussion

Recurrent chondromyxoid fibroma of the proximal humerus.

The differential diagnosis is :

  • Aneurysmal bone cyst (ABC):  fluid/fluid level, periosteal reaction, no matrix mineralization. Chondromyxoid fibroma with 2ry ABC is not uncommon. 
  • Fibrous dysplasia: central location, no internal septation or periosteal reaction. Ground glass attenuation is typical.
  • Adamantinoma: older patient, mostly in the upper tibia, cortical destruction with aggressive periosteal reaction. 
  • Fibrous cortical defect (FCD) and non-ossified fibroma (NOF): Fibroxanthomas: No cortical expansion or destruction, no periosteal reaction. 
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Case Information

rID: 26416
Case created: 20th Dec 2013
Last edited: 16th Dec 2015
Inclusion in quiz mode: Included

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