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Chondroblastoma

  • At Boston Children's, we see many children with chondroblastoma, even though it's a rare tumor. Other institutions may see children with it just a few times a year. We're comfortable treating chondroblastoma because we see it so often.

    Megan Anderson, MD, orthopedic surgeon, Boston Children's Hospital

    If your teen or child has developed a chondroblastoma, it causes distress and disruption—for your child and the whole family. You’ll have concerns and questions about your child’s pain, treatment, length of recovery, long-term health and other issues. It may comfort you to know that Boston Children’s Hospital is a world leader in pediatric orthopedics, and we specialize in innovative, family-centered care that supports your family every step of the way.

    • Chondroblasts are specialized, cartilage-producing cells.

    • Sometimes, these cells can grow out of control and cause a benign (non-cancerous) tumor known as a chondroblastoma. The cause of this tumor is unknown and is being researched.

    • Chondroblastomas are usually found in the ends of long bones, such as the thigh bone (femur), upper arm bone (humerus) or shin bone (tibia). Sometimes they develop in the pelvis or hip socket. The vast majority of these tumors occur around the knee.

    • Although a chondroblastoma is considered a benign tumor, it has the potential to spread
      (metastasize) to the lungs. Metastasis is rare, occurring in less than 1 percent of cases.

    • The tumor can cause pain, inflammation, joint stiffness, limping and other symptoms.

    • It appears more often in boys than girls, usually during their teenage years.

    • Treatment is usually successful, and usually involves surgery. Kids typically feel better soon after treatment.

    • Chondroblastoma can recur; the rate of recurrence is up to 20 percent.


    How Boston Children’s Hospital approaches chondroblastoma

    The experts in our Bone and Soft Tissue Tumor Program are devoted to caring for children and teenagers with chondroblastoma. We take an in-depth, multidisciplinary approach to care that ensures that your child receives a personalized treatment plan—as well as supportive care before and after his treatment. For your child’s care, we draw on the expertise of specialists such as:

    • pediatric orthopedic and general surgeons who are nationally recognized for their expertise in removing bone and soft tissue tumors
    • pediatric experts from every needed medical subspecialty, including pathology, radiology physical therapy and bracing/casting
    • experienced pediatric nurses
    • Child Life specialists, psychologists, social workers and resource specialists

    Chondroblastoma: Reviewed by Megan Anderson, MD
    © Boston Children’s Hospital , 2011

    Contact Us

    Boston Children's Hospital
    300 Longwood Ave
    Fegan 2
    Boston MA 02115 

    617-355-6021
    fax: 617-730-0456 

  • At Boston Children’s Hospital, we understand that you may have a lot of questions if your child is diagnosed with a chondroblastoma. Will it affect my child long term? What do we do next? We’ve provided some answers to those questions on this site, and when you meet with our doctors, they can fully explain your child’s condition.
     

    What is chondroblastoma?

    Every child has chondroblasts—specialized, cartilage-producing cells. But sometimes, these cells can grow out of control and cause a benign (non-cancerous) tumor known as a chondroblastoma. These tumors are usually found in the ends of long bones, such as the thighbone, upper arm bone or shinbone. Sometimes they grow in the pelvis or the hip socket. While a chondroblastoma is considered a benign tumor, it does have the potential to spread (metastasize) to the lungs.
     

    How serious is chondroblastoma? Why is it a problem?

    Although benign and not life-threatening, chondroblastoma is a slow-growing tumor that weakens the bone and causes kids a lot of pain. Chondroblastoma is also hard to diagnose; it can cause teens and their families a great deal of frustration while doctors go through the process of ruling out other conditions with similar symptoms.
     

    Is chondroblastoma common?

    No, chondroblastoma is a very rare type of benign bone tumor. It appears more often in boys than girls and tends to occur during a child’s teenage years, around the time that the growth plates start to close.
     

    How do you diagnose chondroblastoma?

    Doctors use some combination of the following techniques to diagnose chondroblastoma:


    How do you treat chondroblastoma?

    Specialists usually treat chondroblastoma with surgery. The tumor often occurs near a joint, making it a challenge to remove.


    Does my child’s bone growth affect how you treat his chondroblastoma?

    The majority of kids who develop chondroblastomas are older teens whose growth plates are starting to close; so their growth plates are unlikely to be affected by surgery to remove the tumor. But with younger teens or children, surgeons take extra care not to disturb the growth plate when removing the tumor.
     

    How long after treatment will it take for my child to feel better, and heal?

    Teens and children often feel better almost immediately after surgery, which usually involves bone grafting. It takes about two to three months for a knee or leg graft to heal, and kids usually use crutches for much of that time. Arms heal a bit faster, since the body puts less physical stress on the arm.
     

    Is there a risk of early arthritis when my child grows up?

    Even with successful surgery to remove the chondroblastoma, if the tumor involved the bones of a joint there’s still some risk of early arthritis (joint inflammation) when a child reaches adulthood.
     

    Will my child be OK?

    Your child’s long-term health outlook after surgery for chondroblastoma is very good, although the condition can recur. It may require multiple operations to eventually be free of the tumor, but it helps to remember that this is a benign tumor, and that with timely treatment it won’t spread.

    At Children’s, our research into bone problems means that we can provide your child with the most innovative care available. The overwhelming majority of children treated for chondroblastoma at Children’s have corrections that enable their bones to grow and function normally—so they can walk, play, grow and live active lives.


    How can Boston Children’s Hospital help?

    The team in our Bone and Soft Tissue Tumor Program is known for innovative treatments and a research-driven approach. Boston Children’s is home to the world’s most extensive pediatric research enterprise, and we partner with elite health care and biotech organizations around the globe. But as specialists in family-centered care, our doctors never forget that your child is precious, and not just a patient.
     

    Causes

    Chondroblasts are specialized cells found at the end of bones that normally produce cartilage. Sometimes, these cells can grow out of control and cause a benign tumor known as a chondroblastoma. The cause of this condition is unknown and is being researched.
     

    Signs and symptoms

    While symptoms may vary from child-to-child, the most common include:

    • ongoing pain, usually severe, in the affected area
    • swelling
    • joint stiffness
    • decreased range of motion
    • limping
       

    The symptoms of chondroblastoma may resemble those of other medical problems. So, it’s important that your child be evaluated by a doctor to obtain an accurate diagnosis.
     

    When to seek medical advice

    A bone tumor should be treated quickly and correctly—the sooner a chondroblastoma is diagnosed and treated, the better the chances for a successful removal of the tumor. Consult your pediatrician immediately if your child has:

    • ongoing pain, usually severe, in the affected area
    • swelling
    • joint stiffness
    • decreased range of motion
    • limping
       

    Who’s at risk

    The teenage years are when kids are more likely to develop chondroblastoma. Boys are slightly more likely than girls to develop the tumor. Beyond these factors, there’s no way to predict who’s at risk for developing a chondroblastoma.                                             


    Complications

    Although complications after surgery for chondroblastomas are relatively uncommon, they can occur and can include:

    • post-surgery complications, including:
      • infection
      • damage to blood vessels or nerves
    • early arthritis
    • premature growth plate closure (for children with open growth plates)
       

    Long-term outlook

    Our research into bone tumors means that we can provide your child with the most innovative care available. As a result, the overwhelming majority of children treated for chondroblastoma at Children’s have treatment that enables their bones to grow and function normally—so they can walk, play, grow and live active lives.
     

    For teens

    If you’re teen with a chondroblastoma, you have a lot to cope with. Besides the typical issues any teenager faces—from social acceptance to body changes and more—you’ll also have to deal with medical appointments and procedures, and with limiting your activities while you get better.

    If you’re usually active, sitting on the sidelines for a while as you heal can be frustrating. If you feel down, angry or anxious through this important time in your life, speak to your doctor, parent or counselor to get help—they’re all on your team, and they want to help. And remember that Children’s Bone and Soft Tissue Tumor Program is always here for you, too.
     

    Prevention

    Since there’s no way to predict who’s at risk for developing a chondroblastoma, there’s also no known way to prevent one from developing.
     

    Chondroblastoma glossary

    • benign: non-cancerous; word is primarily used to describe a non-cancerous tumor, such as chondroblastoma
       
    • biopsy: tissue sample from the tumor: provides definitive information about the type of tumor; in chondroblastoma, this is collected during surgery
       
    • The Center for Families at Children’s: gateway to services and amenities at Children’s; dedicated to helping families find the information, services and resources they need to understand their child’s medical condition and take part in their care
       
    • cartilage: smooth, rubbery tissue that cushion the bones at the knee joint, between the vertebrae and other areas; allows the bones to move easily without pain
       
    • chondroblastoma: a benign bone tumor that results from chondroblast cells (see below) that grow out of control
       
    • chondroblasts: specialized, cells that normally develop into chondrocytes, the cells that make cartilage
       
    • computed tomography (CT, CAT) scan: a non-invasive procedure that uses X-ray equipment and powerful computers to create detailed, cross-sectional images of your child’s body. The CT scanner is a large machine that looks like a big doughnut.
       
    • diagnosis, diagnostics: identifying disease or injury through examination, testing and observation
       
    • femur: thigh bone (upper leg); the longest and strongest of your child’s bones; one of the three long bones in the leg
       
    • growth plate (physis): areas of cartilage at either end of a bone from which growth occurs. As key components of a child’s developing skeletal system, growth plates largely turns to bone (ossify) as a child grows.
       
    • humerus: long bone of the upper arm
       
    • internal fixation: metal screws and pins surgically inserted inside the bone to hold bone fragments in place to allow alignment and healing
       
    • MRI (magnetic resonance imaging): produces detailed images of organs and structures within the body; best for looking at soft/non-bone tissues such as ligaments, tendons, muscle, and cartilage.
       
    • non-surgical (non-operative) treatments: alternatives to surgery
       
    • orthopedic surgeon, orthopedist: a physician specializing in surgical and non-surgical treatment of the spine, skeletal system and associated muscles, joins and ligaments
       
    • orthopedics: the medical specialty concerned with diagnosing, treating, rehabilitating and preventing disorders and injuries to the spine, skeletal system and associated muscles, joints and ligaments
       
    • physis, physes: growth plate(s) at both ends of a bone; the source of bone growth
       
    • post-operative (post-op): after surgery
       
    • pre-operative (pre-op): before surgery
       
    • skeletally immature: in pre-pubescent or early-adolescent children, the bones of the skeleton haven’t yet fully grown
       
    • x-ray (radiograph): common, diagnostic radiology; shows the dense structures, including bones, inside your child’s body. X-rays are fast, non-invasive and easy to take, making them particularly useful for emergency diagnoses.


  • At Boston Children’s Hospital, we know that the first step in treating your child’s chondroblastoma is to form an accurate and complete diagnosis.

    During a physical exam, the doctor obtains a complete medical history of your child, and conducts neurologic function tests for:

    • reflexes
    • muscle strength
    • eye and mouth movement
    • coordination
    • alertness
       

    Other diagnostic tests may include:

    • x-rays: produce images of internal tissues, bones, and organs onto film
    • MRI (magnetic resonance imaging): produces detailed images of organs and structures within the body; especially useful for assessing soft tissue around injured joints and bones
    • computed tomography scan (CT, CAT scan): uses a combination of x-rays and computer technology to produce 3-D cross-sectional images (slices), both horizontally and vertically, of the affected area—including bones, fat, soft tissue
    • bone scan: detects bone diseases and tumors; can determine the cause of bone pain or inflammation
    • biopsy or tissue sample from the tumor: provides definitive information about the type of tumor; this is collected during surgery
       

    After we complete all necessary tests, our experts meet to review and discuss what they have learned about your child's condition. We then meet with you and your family to discuss the results and outline the best treatment options.
     


  • At Boston Children's Hospital, we know how stressful a diagnosis of a chondroblastoma can be, both for your child and for your whole family. That's why our physicians are focused on family-centered care: From your first visit, you'll work with a team of professionals committed to supporting all of your family's physical and emotional needs.

    Your child's physician will determine a specific course of treatment based on several factors, including:

    • your child's age, overall health and medical history
    • the location and size of the tumor (including whether a joint is involved)
    • the risk of fracture from bone weakness
    • whether the disease has recurred
       

    Prompt medical attention and aggressive therapy are important in minimizing any possibility of the tumor spreading. Continuous follow-up care is essential because chondroblastomas have up to a 20 percent chance of recurring after successful removal.


    Surgical options
    Treatment aimed at removing the tumor and preventing damage to the end of the affected bone usually involves a surgical procedure, such as:

    • curettage and bone grafting: This is the most common treatment for chondroblastomas. During this procedure, the tumor is scraped out of the bone with a special instrument called a curette that has a scoop, loop or ring at its tip. The remaining cavity is usually filled with donor bone tissue (allograft), bone chips taken from another bone in the child's body (autograft). The graft takes two or three months to heal into the bone.
    • biopsy: During the operation, doctors will take a tissue sample of the tumor so that they can confirm the diagnosis under a microscope.
    • extended curettage: In some cases, our orthopedic surgeons perform an “extended” curettage using a special instrument to remove additional layers of cells around the chondroblastoma. This is done to reduce the risk of recurrence.
    • en bloc resection: Doctors may need to surgically remove bone containing the tumor if the tumor is located in the pelvis or certain other sites. They may insert pins and other hardware (internal fixation) to restore the structural integrity of the bone.
       

    Alternative to surgery

    • percutaneous radiofrequency ablation: If the tumor is in a hard-to-reach location, doctors may prefer to perform this procedure, in which radio frequency waves  pass through a probe to kill the tumor cells by heating them to a high temperature. This procedure has the benefits of being minimally invasive and requiring less recovery time.


    Care after surgery
    Your child may need physical therapy after surgery to help him restore strength and function in the affected limb. If his leg was affected, he may need crutches for some part of the two to three months of healing time.


    Follow-up care
    Chondroblastomas can return after treatment up to 20 percent of the time. To monitor the possibility of recurrence, we see children for follow-up care after surgery and treatment every three months for the first two years after treatment.

    A typical follow-up visit may include:

    • a physical exam
    • x-rays
    • imaging scans
       

    A recurrent chondroblastoma is usually treated using the same techniques described above, although your child's orthopedic surgeon may opt for a more aggressive treatment to prevent further recurrence.
     

    Long-term outlook
    The long-term outlook for a child who's been treated for chondroblastoma depends in part on:

    • the extent of the disease
    • the presence or absence of metastasis to the lungs
    • the size and location of the tumor
    • the tumor's response to therapy
    • the age and overall health of your child
    • your child's tolerance for specific medication, procedures or therapies


    Generally, surgery usually successfully treats a chondroblastoma that is caught before metastasis (spreading). Prompt medical attention, aggressive therapy, and regular follow-up care are important for the best long-term outlook. With these, your child should be able to walk and run normally, and to engage in sports and physical activities.


    Coping and support

    A hospital visit can be difficult. So, we offer many amenities to make your child's—and your own—hospital experience as pleasant as possible. Visit The Center for Families for all you need to know about:

    • getting to Children's
    • accommodations
    • navigating the hospital experience
    • resources that are available for your family
       

    In particular, we understand that you may have a lot of questions when your child is diagnosed with chondroblastoma. Will my child need surgery? How long will his recovery take? Will it affect my child long term? What should we do at home? Children's can help you connect with extensive resources to help you and your family through this stressful time, including:

    • patient education: From doctor's appointments to treatment to recovery, our nurses and physical therapists will be on hand to walk you through your child's diagnosis, treatment and healing. And once your child is home, we'll help you coordinate and continue the care and support he received at Children's.

       
    • parent-to-parent: Want to talk with someone whose child has been treated for a chondroblastoma? We can often put you in touch with other families who've been through the same experience that you and your child are facing.

       
    • faith-based support: If you're in need of spiritual support, we'll connect you with the Children's chaplaincy. Our program includes nearly a dozen clergy—representing Protestant, Jewish, Muslim, Catholic and other faith traditions—who will listen to you, pray with you and help you observe your own faith practices during your child's hospital experience.

       
    • social work: Our social workers and mental health clinicians have helped many other families in your situation. We can offer counseling and assistance with issues such as coping with your child's diagnosis, stresses relating to coping with illness and dealing with financial issues.
       

  • For more than a century, orthopedic surgeons and investigators at Boston Children’s Hospital have played a vital role in the field of musculoskeletal research, pioneering major treatment approaches for many conditions.

    Bone and Soft Tissue Tumor Research
    The main objective of our research program is to improve the understanding of bone and soft tissue cancers and develop new ways to treat children with these conditions. We are actively pursuing our own research initiatives, as well as participating in those directed by the Boston Children’s Oncology Group, an international research collaboration.

    Translational research. Children’s is a world leader in opening new avenues of "translational research"—bringing laboratory advances to the bedside and doctor's office as quickly as possible. All of our senior medical staff members of the Bone and Soft Tissue Tumor Program participate in clinical research activities. Our program director, Carlos Rodriguez-Galindo, MD, is also the co-director of our new Clinical and Translational Investigation Program, which aims to dramatically improve translational research in pediatric hematology and oncology.

    Boston Children’s Oncology Group
    Dana-Farber/Boston Children’s Cancer and Blood Disorders Center is the New England Phase I Center of the Children's Oncology Group. If your child has a progressive or recurrent bone or soft tissue tumor, he may be eligible for a number of experimental therapies available through these groups, or through one of our independent clinical investigators.

    The Boston Children's Oncology Group is a consortium of cancer treatment centers across the United States, Canada, and other countries, that conduct studies of Ewing’s sarcoma, osteosarcoma, rhabdomyosarcoma and other soft tissue sarcomas. Our participation in the Children’s Oncology Group gives children with bone and soft tissue tumors unparalleled access to the newest clinical trials.

    Research
    In addition to a wide variety of clinical trials, Boston Children’s also conducts extensive laboratory research to identify new treatments and improve therapies for bone and soft tissue tumors.
     


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