Chondromyxoid fibroma excision and bone grafting: A case report

J. Mohan Kumar, Vivek

Department of orthopaedics, Kauvery Hospital, Bangalore

Abstract

Chondromyxoid fibroma (CMF) is a rare, benign bone tumor accounting for less than 1% of all primary bone neoplasms. It typically affects the metaphyseal region of long bones in young adults. Despite its benign nature, CMF exhibits locally aggressive behavior with a high recurrence rate if not adequately excised. Surgical excision with bone grafting is the preferred treatment to restore bone integrity and function. This article reviews the surgical approach, bone grafting techniques, and post-operative outcomes in CMF management in proximal tibia.

Introduction

Chondromyxoid fibroma (CMF) is a rare benign tumor of cartilaginous origin with occurrence of less than 0.5% of bone tumors and 2% of benign bone tumors.1 It usually affects the metaphysis of long bones, proximal tibia being the most common location.2 It is a slow-growing tumor of chondroblastic origin and has a raising concern for malignancy with characteristics of single lobular and eccentric lesion with expansion of the affected bone.3 CMF was first described in 1943 and said to be distinct from chondrosarcoma. They are usually asymptomatic at diagnosis but commonly cause local pain and rarely cause pathologic fractures.3 Herein, we present a case of recurrent CMF after multiple excision in a child.

CMF is characterized by lobulated histology with chondroid, myxoid, and fibrous components. It predominantly affects the tibia, femur, and pelvis. Clinical presentation includes localized pain, swelling, and, in rare cases, pathological fractures. Imaging studies such as X-ray, CT, and MRI aid in diagnosis, while histopathology confirms the tumor type.

Surgical Excision

Indications

  • Symptomatic lesions causing pain or functional impairment
  • Progressive growth detected on imaging
  • Risk of pathological fracture

Surgical Techniques

  1. Intralesional Curettage: Commonly performed but associated with a high recurrence rate (up to 25%).
  2. Wide Marginal Resection: Preferred for larger or recurrent lesions to minimize recurrence risk.
  3. En Bloc Resection: Reserved for aggressive or difficult-to-access tumors (e.g., pelvis, spine).

Bone Grafting

Following tumor excision, bone grafting is essential to restore structural integrity and facilitate bone healing. Options include:

  • Autografts (e.g., iliac crest): Provide osteoconductive, osteoinductive, and osteogenic properties but are limited by donor site morbidity.
  • Allografts: Avoid donor site complications but carry a risk of immune rejection and delayed integration.
  • Synthetic Bone Substitutes: Include hydroxyapatite and bioactive glass, which offer osteoconductive support.

Post-Operative Care and Outcomes

  • Rehabilitation: Weight-bearing restrictions depend on graft type and lesion location.
  • Complications: Include infection, graft failure, and recurrence.
  • Prognosis: With appropriate excision and reconstruction, recurrence rates decrease significantly. Long-term follow-up with imaging is necessary.

Case Presentation

A 15-year-old female presented to us with pain and swelling in right leg. Pain was insidious in onset, gradually progressive, aggravated on weight bearing.

Radiographic imaging showed lytic excentric metaphyseal lesion and sharply demarcated from adjacent bone in proximal tibia.

CT guided biopsy done, and revealed chondromyxoid fibroma, patient was advised excision of lytic lesion, curettage and bone grafting.

Thorough pre-op workup done, patient underwent above mentioned procedure. Intraop 5*3*3 cavity noted (fig b, c), intraregional curettage and bone grafting perfomed (fig d, e). Intra-op and post-op were uneventful. Limb was splinted, patient was advised non weight bearing walking with walker for 3 weeks follow-up dressings and check X-rays done (Fig h, i, j).

Patient improved symptomatically and was able to perform all the activities of daily routine within a span of 4 months.

Conclusion

CMF excision combined with bone grafting is an effective treatment strategy for managing this rare tumor. The choice of surgical technique and grafting material depends on tumor characteristics and anatomical location. Continued research into advanced biomaterials and regenerative techniques may further enhance outcomes.

References

  • Laitinen MK, Stevenson JD, Parry MC, et al. “Chondromyxoid Fibroma of Bone: A Multicenter Study of 278 Cases.” J Bone Joint Surg Am. 2021;103(14):1275-1283.
  • Lee FY, Yu J, Montgomery EA. “Chondromyxoid Fibroma: Clinicopathologic Features and Treatment Modalities.” Clin Orthop Relat Res. 2017;475(3):776-784.
  • De Mattos CB, Binitie O, Dormans JP. “Chondromyxoid Fibroma: A Rare and Challenging Diagnosis.” J Pediatr Orthop. 2013;33(2):156-162.
  • Murphey MD, Flemming DJ, Boyea SR, et al. “Imaging of Chondromyxoid Fibroma: Radiologic-Pathologic Correlation.” Radiographics. 1999;19(3):763-788.

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