CHONDROMA (chondroma; Greek chondros a cartilage + - from) — the benign tumor which is characterized by education mature, usually hyaline, a cartilage.
Most often bones are surprised, but sometimes the chondroma comes to light in soft tissues without any communication with bones. The chondroma which is localized in the central departments of a bone is called an enchondroma, and in peripheral — an ecchondroma. In most cases the chondroma is located in the central departments of a bone (in spongy substance or in a marrowy cavity) and less often out of a bone, but in close connection with its compact substance (periosteal, or yuksta-cortical, a chondroma). Enchondromas more often happen single, but can be found at the same time in several or even in many bones. At Ollye's disease enchondromas of several bones on one side of a body come to light (see the Chondromatosis of bones).
Chondroma make apprx. 10 — 12% of all new growths of a skeleton. Are found in adults (average age of sick 35 years) more often. Preferential localization — tubular bones of a brush. A chondroma develop also in tubular bones of foot, femoral, humeral, fibular bones. Unlike a chondrosarcoma (see) the chondroma rather seldom meets in flat bones. A chondroma of soft tissues are located, as a rule, in distal departments of extremities, striking first of all brushes and feet.
Macroscopically the chondroma of a bone consists of segments of various size and a form of bluish-white color with yellowish sites of calcification, the red centers of secondary bone formation and sometimes sites of a myxomatous look. Segments of a tumor often merge among themselves and extend in a marrowy cavity. The contour of a bone in a zone of a tumor, especially at damage of short tubular bones of a brush or groans, is a little expanded as a result of an erosion and thinning of an endosteal surface. Destruction of compact substance (a cortical layer) with spread of a tumor out of limits of a bone can testify to its malignancy.
The periosteal (yukstakortikal-ny) chondroma is located eccentric peri-or parostalno, erodes cortical substance of a bone with education in it saucer-shaped defect. The tumor seldom towers more than on 2 — 3 cm over the surface of a bone.
Microscopically the tumor is formed by cartilaginous cells of the usual sizes with one or occasionally two small round kernels. Kernels of cells are located in the typical lacunas divided by large or smaller amount of the main substance of the hyaline type creating segments of various sizes.
The chondroma of soft tissues on the structure significantly does not differ from a chondroma of a bone.
At an uncomplicated current the chondroma gives few wedge, symptoms that is connected with its very slow growth. Knotty deformation of affected areas of bones can be noted, pains, as a rule, are absent. The pain syndrome is characteristic only at localization of a chondroma in the field of a sacroiliac joint. At hondroma of long tubular bones are quite often noted patol. changes. Existence of the pain which is not connected with patol. a change, shall guard in respect of a possible malignancy.
In diagnosis hondry plays an important role rentgenol. research. The enchondroma comes to light as the site of destruction of a bone tissue of a spherical or oval shape. The multiple nature of defeat with deformation of a bone prevails. At defeat of an epiphysis also joint crack is deformed that is shown clinically by restriction of mobility in a joint. Tumoral nodes are located is central or is excentric, consist of cartilaginous tissue, transparent for x-ray emission, may contain small islands, tochechka or specks of deposits of salts of calcium or substance of a bone. Nek-ry tumoral nodes represent a conglomerate of salts of calcium, a little transparent for x-ray emission, bone and cartilaginous fabrics. In tumoral nodes bone partitions and semi-partitions come to light. At a solitary arrangement the tumor is delimited from a surrounding bone by a dense and equal sclerous border. At a multiple enchondroma separate tumors merge in the conglomerate divided scarcely noticeable, clearer bone partitions. Periosteal reaction can vary from scarcely noticeable to sharply expressed with intensive tape-like stratifications.
The ecchondroma is defined as consolidation with equal, sometimes by hilly contours (fig.), in soft tissues, adjacent to the affected bone. In a tumor sites of calcification and ossification can be visible various size. In nek-ry cases limited structural changes in cortical substance of a bone — reorganization of a bone tissue, small bone defects or sites of an osteosclerosis are observed (see).
Differential diagnosis is carried out by hl. obr. with a chondrosarcoma (see). At the same time are based on results rentgenol. and morfol. researches. During the carrying out the last it is necessary to consider that nek-ry sites of a chondroma can be very rich with cells, sometimes with the phenomena of myxomatosis. A chondroma of short tubular bones of a brush and foot differ in polymorphism of cells that it is not necessary to take for a sign of a malignancy, especially considering that chondrosarcomas of short tubular bones of a brush and tables meet exclusively seldom. However the specified signs revealed in hondroma of long tubular bones of a hand or leg testify to a possible malignancy.
Treatment operational. At localization of a chondroma in phalanxes of fingers make broad excision of a tumor. In cases of an enchondroma of a long tubular bone method of the choice is the segmented resection of a bone with plastics of defect an allokost or endonrotezy, and at an okhondroma of the same bones the regional resection is possible.
The forecast at a solitary chondroma favorable, however after operation a recurrence is possible. At multiple defeats danger of a malignancy, edge, io given various researches,
Fig. increases. The roentgenogram of a knee joint and proximal part of a shin at an ecchondroma of a tibial bone (a direct projection): consolidation in soft tissues with equal contours (/), a limited zone of reorganization of a bone tissue with signs of an osteosclerosis in the field of a metaphysis of a tibial bone (2).
it is observed approximately in 15 — 20% of cases.
Bibliography: Vinogradova T. P. Tumors of bones, page 69, M., 1973; L and at N the island and I. G. Tumors of a skeleton, M., 1962; Pathoanatomical diagnosis of tumors of the person, under the editorship of N. A. Krayevsky, etc., page 405, M., 1982; Reynbergs. A. Radiodiagnosis of diseases of bones and joints, book 2, page 397, M., 1964; Sh and y about in and the p F. and d river. Histologic classification of bone tumors, page 34, Geneva, WHO, 1974; d e S a n t about s L. A. a. S r j u t H. J. Periosteal chondroma, radiographic spectrum, Skeletal Radiol., v. 6, p. 15, 1981; Schajowicz F. Tumors and tumorlike lesions of bone and joints, p. 110, N. Y. a. o., 1981.
BB. H. Nightingales; And. II. Korolyuk (rents.).