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| OJHAS Vol. 20, Issue 3:
(July-September 2021) |
Case Report
Soft Tissue Chondromas - Study of Five Cases
Authors:
Roopak Agarwal, Associate Professor, Department of Pathology, University of Medical Sciences, Saifai,
Etawah, Uttar Pradesh,
Srijan Srivastav, Assistant Professor, Department of Pathology, School of Medical Sciences and Research, Veer Chandra Singh Garhwali Govt. Institute of Medical Sciences and Research, Srinagar, Uttarakhand,
Jyoti Mishra, Associate Professor, Department of Pathology, School of Medical Sciences and Research, Sharda Hospital, Greater Noida, Uttar Pradesh,
Sarita Devdhar, Professor, Department of Pathology, Noida International Institute of Medical Sciences, Greater Noida, Uttar Pradesh,
Varun Prasad, Assistant Professor, Department of Anaesthesia, Veer Chandra Singh Garhwali Govt. Institute of Medical Sciences and Research, Srinagar, Uttarakhand.
Address for Correspondence
Dr. Jyoti Mishra,
Associate Professor,
Department of Pathology,
School of Medical Sciences and Research,
Greater Noida
Uttar Pradesh
E-mail: drm714@gmail.com.
Citation
Agarwal R, Srivastav S, Mishra J, Devdhar S, Prasad V. Soft Tissue Chondromas - Study of Five Cases. Online J Health Allied Scs.
2021;20(3):19. Available at URL:
https://www.ojhas.org/issue79/2021-3-19.html
Submitted: Aug 30,
2021; Accepted: Oct 3, 2021; Published: Oct 31, 2021 |
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Abstract: Extraskeletal soft tissue chondroma is a rare benign neoplasm predominantly composed of mature hyaline cartilage. It develops in the soft tissues without any connection to bone cortex, intra-articular synovium, or periosteum. It could have atypical features both radiological and histopathological simulating malignant tumors. We herein report 5 cases of soft tissue chondromas with their histopathological and radiological features and review the literature.
Key Words: Extraskeletal chondroma, benign, soft tissue |
Introduction:
Chondromas are classified according to their location as enchondroma, periosteal chondroma and the extraskeletal soft tissue chondroma. Extraskeletal soft tissue chondroma is a rare slowly growing benign tumour with predilection for hands and feet [1]. It affects both sexes equally with peak incidence between 30-60 years of age. It may arise from the synovial sheath of the long tendons, paratendinous soft tissues or the para-articular tissues [2].
Extraskeletal chondromas are composed of hyaline cartilage with focal calcification and some may show worrying radiological and histological pictures simulating chondrosarcoma [3]. The clinical, radiological and cytological triad is important for the correct diagnosis of soft tissue chondroma despite worrying cellular atypia. Approximately 10% of soft tissue chondromas contain epitheloid histiocytes and multinucleated giant cells [4].
Case Reports:
Case 1
A 32 year old woman had a progressive swelling of the right calcaneum for a year. Physical examination revealed a large, firm and tender mass on the calcaneum. There were no other subcutaneous masses. Plain radiograph revealed an anteroposterior soft tissue mass, with dense in homogenous calcification. There was no bone erosion or periosteal reaction (Figure No.1a) Fine needle aspiration cytology of the mass reveal chondrocytes in a cartilaginous matrix with mild insignificant cellular atypia (Figure No.1b). The overall picture was suggestive of neoplasm of cartilaginous origin. The swelling was excised completely. Histological assessment of the resected specimen confirmed a soft tissue chondroma characterized by chondrocytes in hyaline matrix with occasional cells showing mild focal cellular atypia (Figure No.1 c).
Case 2
A 12 year old boy had a fixed hard lump in the 2nd metatarsal of the right foot for 6 months. An X- ray of the anterior-posterior and lateral view showed a normal bony skeleton of the foot. There was a soft tissue mass with focal incomplete calcification and no bony involvement. The periosteum was intact (Figure No.2a). Fine needle aspiration cytology of the mass was suggestive of cartilaginous neoplasm (Figure No.2b). A 2.5 cm mass with an osseous core completely separate from the adjacent bone was excised. Histopathological examination showed a peripheral shell of hyaline cartilage merging with fibrous tissue. Partly infracted cancellous lamellar bone was present at the centre (Figure No.2c).
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Figure 1a. X-ray (Lateral view, Right foot) showing extraskeletal inhomogeneous calcification with no bony involvement, black arrow 1b. Chondrocytes in cartilaginous matrix (H&E;40 x) 1c. lobules of mature chondrocytes lying in lacunae (H&E;10X). Figure 2a. X-ray (Lateral view, Right foot) soft tissue mass showing incomplete calcification, black arrow 2b. FNAC shows mature chondrocytes in a chondroid background (H&E; 10X). 2c. Lobules of hyaline cartilage with adjacent fibrous tissue and dilated vessels (H&E; 10X). |
Case 3
A 19 year old man had a 4- month history of swelling in his right great toe. Physical examination revealed a tender, firm nodule in the subcutaneous tissue just proximal to interphalangeal joint. X-ray showed a small, calcified lesion proximal to interphalangeal joint. A 0.8x 0.6 cm well circumscribed lesion was excised, displaying a firm, gritty, grey. The cut surface was glistening grey. Microscopic examination showed confluent lobules of hyaline cartilage including solid groups of 10-15 chondrocytes (Figure No.3). There were areas of geographic calcification in the periphery of the tumor.
Case 4
A 30 years old female presented with a lump over right thumb for last 3 months and history of pain in it for last 15 days. There was no history of trauma. X-ray revealed a soft tissue mass in right thumb with no bony involvement (Figure No.4a) Excision was done. Gross revealed a 1 cm circumscribed soft tissue mass greyish white in color. Microscopic examination revealed lobules of mature hyaline cartilage with surrounding fibrous tissue and without any areas of calcification or atypia (Figure No.4b).
Case 5
A 19 years old female presented with swelling over left toe for last 5 months. On palpation the swelling was tender. There was no history of trauma. X-ray revealed a soft tissue mass in left toe with no bony involvement. Excision was performed. Gross revealed approximately 3 cm circumscribed soft tissue mass greyish white in color. Microscopic examination revealed lobules of mature hyaline cartilage with surrounding fibrous tissue and without any areas of calcification or atypia (Figure No. 5 a, b, c).
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Figure 3: Section shows confluent lobules of mature chondrocytes lying in lacunae (H& E 40X).Figure 4a. X-ray (AP view, Right hand) shows soft tissue mass with no underlying bony involvement. 4b. Mature cartilaginous tissue with surrounding fibrous tissue (H& E 10X). Figure 5a, b & c. Mature lobulated cartilage with focal fibrosis. |
Conclusion:
Extraskeletal Chondromas is a benign lesion that sometimes could have atypical features simulating malignant tumors. Thus, it is important that a pathologist should be aware of these features to arrive at the correct diagnosis.
References:
- Cardia R, Favazzi CM, Fenga D, Rosa MA, Ieni A. A Large Extraskeletal Chondroma: An Unusual Location in the Lower Extremity, Huge Extraskeletal Chondroma: An Unusual Localization in the Leg. J Orthop Case Rep. 2019;9(1):74-77.
- Kedhaier A, Maala R, Ennouri N, Regaya N. Soft tissue chondroma of the hand: A report of five cases. Acta Orthop Belg. 2007;73:458-61
- Singh A, Kumar P, Chandrasekhar SH, Kumar A. Unravelling chloroma: review of imaging findings. Br J Radiol. 2017; 90(1075):20160710.
- Yu T, Xu G, Xu X, Yang J, Ding L. Myeloid sarcoma derived from the gastrointestinal tract: A case report and review of the literature. Oncol Lett. 2016;11(6):4155-9.
- Zhao J, Niu X, Wang Z, Lu H, Lin X, Lu Q. Histiocytic sarcoma combined with acute monocytic leukemia: a case report. Diagn Pathol. 2015; 10:110.
- Pileri SA, Ascani S, Cox MC, Campidelli C, Bacci F, Piccioli M, Piccaluga PP et al. Myeloid sarcoma: clinico-pathologic, phenotypic and cytogenetic analysis of 92 adult patients. Leukemia. 2007; 21(2):340-50.
- Corpechot C, Lemann M, Brocheriou I, Mariette X, Bonnet J, Daniel MT et al. Granulocytic sarcoma of the jejunum: a rare cause of small bowel obstruction. Am J Gastroenterol 1998; 93:2586-7.
- Alexiev BA, Wang W, Ning Y et al. Myeloid sarcomas: a histologic, immunohistochemical, and cytogenetic study. Diagn Pathol 2007; 2:42.
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