Chondroblastomas are benign bone tumors. Children and adolescents are most commonly affected by the benign neoplasm. Treatment is by curettage.
What are chondroblastomas?
Bone tissue corresponds to particularly hard connective and supporting tissue and forms the human skeleton. Between 208 and 212 bones are found in the human body. All of them can be affected by disease. Some of these diseases are tissue neoplasms. These neoplasms correspond to either benign or malignant bone tumors. Chrondroblastoma is a benign bone tumor, also known as Codman tumor from medical literature. The benign tumor accounts for about five percent of all benign bone tumors. Usually, the symptoms of the tumor appear in the second decade of life. Most often, the tumor arises on the epiphysis of long tubular bones. The most common site of origin is the lower end of the femur. Closely related to chondroblastoma are chondromas of bone or cartilage tissue, which are also benign bone tumors.
Causes
Chrondroblastoma predominantly affects adolescents and young adults. It is basically a growth disorder that originates from the secondary ossification centers of the epiphyses within long tubular bones. The ossification centers of these bones develop prior to ossification of the growth plate and correspond to the tissue zones from which ossification later occurs. The centers are also referred to as bone nuclei. Bones usually bear multiple bone nuclei that start the ossification process at different times. As with all neoplasms, the cause of chondroblastoma is essentially a malfunction or misregulation of cell growth processes. Genetic predispositions play a decisive role in this. However, an internal genetic predisposition to the formation of a chondroblastoma does not necessarily lead to the actual formation. External factors, so to speak, first activate the actual growth processes.
Symptoms, complaints, and signs
Chondroblastomas are extremely slow-growing bone tumors that originate from the ossification centers of the long tubular bones. They preferentially arise on the femurs. Mostly adolescents develop chondroblastomas during the growth process. Until the second decade of life, the neoplasms usually do not cause any symptoms. The first symptoms often appear between the ages of 20 and 30. These complaints can correspond to pain, which in many cases is due to effusions in adjacent joints. The larger the tumor becomes, the more severe the joint impairment and with it the pain symptoms. At a certain point, the pain can be so severe that the patient’s motor function is impaired. Depending on the load, the pain symptoms intensify. For this reason, some sufferers adopt a protective posture while walking or standing. Growth-inhibiting processes may also be due to the tumor. Although chondroblastoma is essentially a benign tumor, metastases can occur despite this classification. Metastases from this type of tumor usually involve the lungs.
Diagnosis
After taking a history, the physician orders imaging of the skeleton if there are appropriate symptoms. All neoplasms can be seen on imaging, but often cannot be clearly classified as benign or malignant. Fine tissue examination is generally indicated for the classification of bone neoplasms. This classification usually requires a biopsy of the affected area. On examination, chondroblastoma appears as a sharply circumscribed tumor of chondroblast-like cells and giant cells. The prognosis for patients with chondroblastoma depends predominantly on whether metastases to the lungs are present.
When should you see a doctor?
If pain occurs around the joints that cannot be attributed to any specific cause, a physician must be consulted. Other warning signs that require medical clarification are motor disturbances and increasing relieving posture. Corresponding symptoms increase in the course of the disease and indicate a serious illness that must be diagnosed and treated in any case. The physician can determine whether chondroblastomas are involved by taking a medical history and using various diagnostic procedures.Appropriate therapy can then be started. If the disease remains untreated, the metastases increase in size and number and sometimes spread to the lungs. Unusual symptoms such as pain, restricted mobility or numbness in the limbs should therefore be investigated immediately. High-risk groups such as patients with genetic predispositions or people who have been exposed to increased radiation should consult a physician immediately. Because chondroblastomas usually form between the ages of twenty and thirty, additional screening is indicated during this period.
Treatment and therapy
Symptomatic therapy with analgesics is not indicated for chondroblastomas. The therapy of choice for bone tumors corresponds to curettage of the tumor tissue. This surgical mechanical scraping or excavation of the bone is performed by the surgeon using a sharp-edged instrument shaped for the anatomical area of use within the bones. Using this curette, the surgeon removes the tumor tissue as completely as possible and then fills the resulting tissue defect with cancellous bone. In some cases, he also uses a temporary cement plug to stabilize the defect in the bone tissue. The plug allows early detection and repair of possible recurrences. Since chondroblastoma usually affects patients of growing age and is particularly often located in the immediate vicinity of a joint, the surgeon often has to remove any cement that may have been used after two years at the latest. This requires a second operation in which the plug is removed and the bone hole is filled with cancellous bone. Since recurrences occur in ten to thirty percent of all cases, control examinations should be performed after the operation. As long as the soft tissues are not affected, an en bloc resection is performed to treat possible recurrences. En-bloc resection is the term used for procedures that remove not only the actual tumor but also the adjacent tissue in one piece with the tumor in the same surgical procedure. On the other hand, if the recurrences are accompanied by soft tissue involvement, the widest possible tumor resection is used. In the case of metastases to the lungs, drug therapy is an option for many patients with chondroblastoma. Depending on the metastases in each individual case, the treating physician decides between drug therapy and invasive removal of the metastatic foci.
Outlook and prognosis
In chondroblastoma, the prognosis is based on the stage of the disease and the location of any metastases. Individual tumors can usually be permanently removed by surgery. Sometimes radiation therapy or chemotherapy is also possible. In the case of a larger tumor, the prognosis depends on whether organs are affected. The complete removal of a chondroblastoma is often associated with the removal of bone fragments or entire limbs. In addition, growth disorders or organ damage that have already occurred can usually no longer be corrected. Although the prospect of a symptom-free life is given, there may nevertheless be restrictions in the quality of life. Particularly in children and adolescents before puberty and in older patients, the disease itself is associated with risks, as is the treatment. If tumors have already penetrated the lungs, the prognosis is rather poor. The patient must immediately undergo radiation or chemotherapy, which is an enormous strain on the body. After treatment, recurrences may form or the original chondroblastoma may cause further symptoms. Close monitoring by a physician is required in all cases.
Prevention
For chondroblastomas and other neoplasms, genetic predisposition plays a role that should not be underestimated. Although external factors are also involved in tumor formation, neither the internal nor the external factors can be eliminated to the full extent. In case of a predisposition, control examinations of the skeleton should be perceived. However, these controls expose the skeleton to radiation, which may promote bone tumors as an external factor.
Follow-up
Aftercare following surgical removal of a chondroblastoma includes physical treatment. This is used to strengthen the muscles and restore the original function of the affected joint. There is often a tendency for local recurrence.For this reason, regular control examinations must be carried out. These reveal at an early stage whether a new infestation is emerging. The sooner the doctor recognizes this, the better he can combat the tumor. En bloc resection is usually used as part of the follow-up treatment. If cement was used in the immediate vicinity of the joint during surgery on individuals who are still growing, it must be removed after two years at the latest to prevent malformations. After that, the doctor fills the defect with cancellous bone. Depending on the severity of the disease, patients can live symptom-free after the operation. However, risks are to be expected, especially during the growth phase. There is also a risk of complications for older individuals. In the course of the subsequent therapy, overloading of the joint must be avoided. Here it is immanently important to follow the exact recommendations of the doctor and physiotherapist. For the holistic well-being of patients, psychotherapy may also be useful.
What you can do yourself
In the case of chondroblastoma, the most important self-help measure is immediate clarification of the warning signs. A visit to the doctor is indicated as soon as bone pain, limited mobility, and similar symptoms are noticed. Once the disease has been diagnosed, the patient must undergo comprehensive treatment. Since chemotherapy and radiotherapy place a considerable strain on the body, rest is indicated. Especially in the first weeks and months, strenuous physical activities should be avoided. Under certain circumstances, various homeopathic remedies can be used. However, this should first be discussed with the doctor. Accompanying this, it can be useful to change the diet. Depending on the physician’s instructions, irritating foods, among other things, must be eliminated from the diet. It is also advisable to avoid certain foods that could promote tumor growth. The individual diet is best put together in consultation with a specialist or a nutritionist. After treatment is stopped, the individual should consult a physician on a regular basis. Chrondroblastomas have a relatively high risk of recurrence. These must be detected and treated to avoid serious complications.