<<James C. Wittig, MD
Sarcoma Surgeon
Orthopedic Oncologist
GENERAL INFORMATION
Chondromyxofibroma
Rare, least common benign cartilage tumor
Chondromyxofibroma consists of lobules of spindle or stellate cells in an abundant myxoid and chondroid stroma. Giant cells may be present. The lobules are separated by fibrous type tissue containing spindle type cells and giant cells.
Most commonly arises in the lower extremity
Proximal Tibia is most common site
Ilium is second most common site
Hands and Feet (3rd most common site)
Young adults: 60% of patients are < 30 yrs. old
Rarely malignant transformation to Chondrosarcoma
Benign aggressive tumor with high propensity for local recurrence following intralesional curettage. Tumor actively grows and destroys bone.
CLINICAL PRESENTATION
Signs/Symptoms:
Usually painful and may have mild swelling
A tumor mass is rare
Prevalence:
Slight to moderate male predilection (2:1 male to female ratio)
CMF constitutes less than 1% of all bone tumors
Age:
Occurs in all ages
Most common between 10 and 30 years of age
Sites:
Usually in long bones
Proximal tibia is most common site
Flat bones (approximately 25% of cases)
Ilium is the most commonly affected flat bone
May also occur in tubular bones of hands, feet, vertebrae, ribs, femur
Radiology of Chondromyxoid Fibroma (CMF)
Imaging:
Geographic, Well Circumscribed Lesion with IA-IC margin
Eccentric metaphyseal location; can be cortical
Expansile remodeling of bone
Rare matrix mineralization requires CT/Tomography usually for detection
30% of cases show matrix mineralization/calcification
Often has an indolent, sclerotic medullary border and expansive blown out exterior border
Often has Internal Trabeculations
CT Scan: Useful for detecting minor calcifications and egg shell rim of calcification around soft tissue mass (periosteal reaction)
MRI:
TW1 images (similar or slightly lower intensity than T1W of muscle)
TW2 images (high signal intensity)
RADIOGRAPHIC PRESENTATION
Chondromyxofibroma of Proximal Tibia
Geographic, Eccentril Lesion
(Top arrow) Expansile Blown Out Border
(center) Indolent, Sclerotic Medullary Border
(Right arrow) Subtle Internal Trabeculations
Plain X-ray: Chondromyxofibroma of Right Posterior Ilium
Plain X-Ray: CMF of Posterior Ilium: Geographic, Expansile Lesion
MRI T2 CMF of Right Posterior Ilium
MRI T2: CMF of Right Posterior Ilium (High Signal Intensity)
CT Scan of Chondromyxofibroma of Right Posterior Ilium
(Top arrow) Subtle Mineralization
(Bottom arrow) Geographic Expansile Lesion
Plain X-ray: Chondromyxofibroma of Calcaneus
Plain X-ray: Chondromyxofibroma of Calcaneus
Typically an eccentrically located, metaphyseal lesion
May extend into epiphysis
Long axes parallel to bone
Usually sharply demarcated
Scalloped margins
Intralesional calcified matrix rare
MRI T1 Chondromyxofibroma of Calcaneus
Intermediate Signal Similar to Muscle
(Left arrow) Expansile Outer Border, Expanding Cortex
(Right arrow) Indolent Border, Sharp Zone of Transition
MRI T2: Chondromyxofibroma of Calcaneus (Cartilage Tumors are Often High Signal on T2 Weighted Images)
Plain X-ray: CMF of Distal Femur
MRI T1: CMF of Distal Femur (Eccentric, Expansile with Indolent Medullary Border)
Intermediate Signal
MRI T2: CMF of Distal Femur
High Signal
Plain X-ray: Chondromyxofibroma of Right Femoral Neck
Xray: Chondromyxofibroma of Right Femoral Neck
Plain X-ray: CMF of Femoral Neck
CT: CMF of Right Femoral Neck
CT: CMF of Femoral Neck
(Left arrow) Expansile Outer Border with Egg Shell Rim of Calcification
(Right arrow) Indolent Medullary Border Sharply Circumscribed
Plain X-ray: Chondromyxofibroma of Proximal Phalanx of Toe
(Left arrow) Expansile Lesion, Well Circumscribed, Geographic, No Mineralization Detected (Mineralization is not always detected in CMF)
(Right arrow) Sclerotic Medullary Border
CT Scan (sagittal): CMF of Proximal Phalanx of Big Toe
CT Scan (coronal): CMF of Proximal Phalanx of Big Toe
MRI T2: CMF of Proximal Phalanx of Big Toe (High Signal)
MRI T2: CMF of Proximal Phalanx of Big Toe
Specimen: Curettings
Tumor Cavity of Proximal Phalanx after Curettage
X-ray and CT Scan of CMF of Distal Humerus
(Elbow)
MRI T1 and T2 of CMF of Distal Humerus
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Plain X-Rays of CMF of Proximal Right Tibia
(arrows) Sclerotic/Indolent Medullary Border
CT Scan of CMF of Proximal Tibia
Calcifications within Lesion are Demonstrated
MRI T1 and T2 of CMF of Proximal Tibia
 T1 Weighted MRI |
 T2 Weighted MRI |
CMF of Radius
 Xray |
 T1 Weighted MRI |
 T2 Weighted MRI |
MRI of CMF of Proximal Tibia
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 T1 Weighted MRI
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 T2 Weighted MRI |
CT Scan of Proximal Tibia CMF
(Left arrow) Expansile Outer Border, Benign Appearance
(Center arrow) Minor Calcifications, Thin Internal Trabeculations
(Right arrow) Indolent Medullary Border
