Introduction
The periosteum is a strong layer of connective tissue that covers the outer surface of bones. This structure has a lot of blood vessels and nerves and is very important for connecting bones to the tissues around them. A chondroma is a benign growth made up of cartilage tissue. This disease usually happens in bones or soft tissues and is characterized by the unusual growth of cartilage cells. Chondromas are usually not cancerous but can make one uncomfortable and limit function.
What Is Periosteal Chondroma?
A periosteal chondroma is an infrequent, non-malignant tumor comprised of cartilaginous tissue that develops either beneath or within the periosteum, which is the connective tissue covering the outer surface of cortical bone. This tumor is made of cartilage tissue and usually causes pain and swelling in the localized area.
This condition is most often found in patients under 30 years old, with the highest occurrence between 10 and 20 years of age. It usually shows up in the growing parts of long bones, especially in the upper arm bone and the long bones in the hands. The common sites where the periosteal chondroma occurs are the proximal humerus, distal femur, phalanges, tibia, radius, and ulna. The periosteal chondroma is also known as the juxtacortical chondroma.
The exact cause of periosteal chondromas needs to be better understood. Certain things like genetic changes, injuries, and pressure on the bone may cause periosteal chondromas to develop. However, these factors are not always found in every case, and the exact cause is still unknown.
What Are the Symptoms of Periosteal Chondroma?
Periosteal chondromas can present with various clinical features, though they often share some common characteristics. The most common sites for these tumors to develop are the hands and feet, particularly the fingers and toes.
The clinical presentation may include:
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Localized pain at the tumor site is a common symptom. The pain may be mild to moderate and can be aggravated by physical activity or pressure on the affected area.
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Periosteal chondromas often lead to swelling in the affected region. This swelling may be associated with tenderness at the tumor site.
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In cases where the tumor develops near a joint, it can restrict the joint's range of motion.
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A broken bone
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Occasionally, a palpable mass or lump can be felt under the skin at the tumor's location. This mass is typically firm and non-mobile.
How Is a Periosteal Chondroma Diagnosed?
Diagnosing a periosteal chondroma involves a combination of clinical evaluation, radiological imaging, and, in some cases, histopathological examination.
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The doctor will assess the patient's medical history, perform a physical examination, and evaluate the presenting symptoms.
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X-rays are often the initial imaging modality used to visualize the bone lesion. Periosteal chondromas appear as well-circumscribed, radiolucent masses on X-ray images.
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Magnetic resonance imaging (MRI) and computed tomography (CT) scans may be ordered to provide more detailed information about the tumor's size, location, and relation to adjacent structures.
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A biopsy or a needle biopsy may be necessary to confirm the diagnosis. In a biopsy, a tiny tissue sample is extracted from the tumor and scrutinized under a microscope for analysis.
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The histopathological analysis can distinguish periosteal chondromas from other bone conditions.
How Is Periosteal Chondroma Treated?
The treatment of periosteal chondromas primarily depends on factors like the tumor's location, size, symptoms, and the patient's health.
The main treatment options for periosteal chondromas are as follows:
Observation: In some cases, especially when the tumor is small, asymptomatic, and not causing functional impairment, a conservative observation approach may be chosen. Regular follow-up appointments and imaging can monitor the tumor's progression.
Surgical Excision: Surgical removal of the periosteal chondroma is the most common treatment approach. The tumor is carefully excised during the surgery while preserving the surrounding healthy tissue. This method can provide complete resolution of symptoms and prevent recurrence. Intraoperative adjuvants like cryotherapy (using liquid nitrogen), phenol (a chemical), or cauterization (burning the tumor bed) may be used to eliminate microscopic tumor cells.
Curettage: Curettage involves scraping or scooping out the tumor tissue from the bone. After curettage, the area may be filled with bone graft or cement to promote healing and structural stability.
Amputation: In cases where the tumor is extensive or located near critical structures, amputation of the affected digit or limb may be considered a last resort.
What Are the Differential Diagnoses of Periosteal Chondroma?
When diagnosing periosteal chondroma, it is important to differentiate it from similar conditions.
Some similar conditions to periosteal chondroma and their differences include:
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Chondrosarcoma: Typically larger, found in older patients, and may extend into soft tissues.
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Osteochondroma: More common in adolescent bones, with distinct dense bone formation within the mass and a connection to the originating bone.
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Periosteal Chondrosarcoma: Shows popcorn-like calcifications on X-rays with scalloped radiolucencies.
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Periosteal Osteosarcoma: Tends to grow slowly under the periosteum, creating a radiolucent lesion with perpendicular striae. It may contain lace-like, malignant osteoids.
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Soft Tissue Chondroma: Soft tissue chondromas appear as distinct, clearly defined masses on radiological examination. They are differentiated from adjacent bone structures and exhibit the presence of calcifications.
What Is the Prognosis of Periosteal Chondroma?
The prognosis for periosteal chondroma is usually good. These tumors are not harmful and usually do not spread to other body parts. After a successful treatment, most patients feel better, and their symptoms completely disappear. They can use the affected body parts normally again.
Periosteal chondroma's recurrence after surgery is uncommon, but it can happen. Continued observation after surgery is important to catch any signs of the problem coming back, and more treatment might be needed if that happens.
Conclusion
Periosteal chondroma is not common, but it has a good outcome for people with it. This non-cancerous bone tumor mostly affects young individuals. Due to improvements in medical knowledge and treatments, periosteal chondroma can usually be successfully treated. Whether patients are observed or have surgery, they can feel better and return to living pain-free lives.
