Chondromyxoid Fibroma of Radius: A Case Report

Abstract

A 37-year-old female presented with swelling over right elbow since 2 years, which was gradually increasing in size and was associated with pain since 8 months. There was no history of trauma. On examination, a diffuse swelling was noted over the lateral aspect of elbow extending from lateral epicondyle to proximal part of forearm. On palpation swelling was tender and firm in consistency. Supination and pronation movements were restricted.Radiographs of right elbow revealed an expansile lytic lesion involving the radial head and proximal shaft of radius with breach in the cortex with soft tissue extension and sclerosis of distal margin suggestive of benign bone tumour [Table/ Fig-1]. MRI of right elbow revealed T2W hyperintense and T1W hypointense expansile lytic lesion with multiple thick septations involving the meta-epiphyseal region of radius, extending to the articular surface with its breach and elevation of cortex and presence of Codman's triangle features suggestive of neoplastic lesion-giant cell tumour [Table/ Fig-2]. Complete blood count showed HB of 13.5 gm/dl, total leucocyte count of 8400 cells/cumm and platelet count was 2.4 lacs/cumm. Routine biochemical investigations showed RBS of 110 mg/dl, serum alkaline phosphatase was 90 IU/L, HIV and HBsAg test were negative. Wide local excision of proximal radius along with radial head was done and the specimen was sent for histopathological examination.On gross examination the specimen showed multiple firm irregular reddish white tissue bits all together weighing 50 gm along with 3 ml of mucoid gelatinous material. Also, received was radial head measuring 3x2x1 cm with glistening white external surface. A cavity was noted on radial head measuring 1.5x1.5 cm with reddish friable material inside the cavity. Multiple sections were given and slides were stained with H&E stain. Chondromyxoid fibroma (CMF) is a rare benign cartilaginous tumour accounting to less than 1% of bone tumours. It is most commonly seen in lower extremity involving tibia. CMF of radius is rare. We report a rare case of CMF of proximal radius in a 37-year-old female who presented with swelling and pain over right elbow. Wide local excision of proximal radius along with radial head was done and above elbow POP slab was applied for one month. Elbow range of movement exercises started after one month. Keywords: Bone tumour, Cartilage, TibiaOn microscopic examination, multiple sections were studied which showed tumour tissue arranged in varying sized lobules. Centre of the lobule was hypocellular with peripheral hypercellular areas [ Elbow range of movement exercises were started after one month and patient was followed up for 3 months.Patient had a good range of painless functional movements and was able to carry out her day today activity without any assistance.

Radiological evaluation of a Chondromyxoid Fibroma

“…Malignant transformation is very rare [3]. The tumor occurs most commonly in young adults and adolescents in the second and third decade of life, with an age range between the ages of 10 to 30 [1]. However, cases have been previously reported outside this range.…”

“…However, cases have been previously reported outside this range. Clinical presentation is characterized by pain, swelling, and edema; most commonly noted in the proximal metaphysis of the tibia [1]. The proximal femur is also commonly affected [3].…”

“…Rarer locations include the ibula, scapula, vertebrae and ribs [3]. Occasionally clinical presentation may be absent and the tumor may be discovered incidentally during radiography [1]. Tumors located in the distal extremities such as the hands or feet may only present clinically with signs of painless swelling [5].…”

“…Chondromyxoid ibroma is a very rare benign cartilaginous tumor representing less than 0.5% of all bone tumors while also being the rarest cartilaginous bone tumor [1]. The most commonly affected area is the metaphysial region of the proximal tibia and the distal femur [2].…”

Radiological Evaluation of a Chondromyxoid Fibroma

“…Chondromyxoid fibroma is a very rare benign cartilaginous tumor representing less than 0.5% of all bone tumors while also being the rarest cartilaginous bone tumor [1,2]. The most commonly affected area is the metaphysial region of the proximal tibia and the distal femur [3].…”