Diz çevresi kondroblastom

Özet

Kondroblastom çoğunlukla iskelet olgunlaşması tamamlanmamış ergenlerde, uzun kemiklerin epifiz veya apofizinde gelişen benign fakat yerel olarak agresif bir tümördür. Diz çevresinde distal femur ya da proksimal tibia epifizinde coğrafi litik odak, ince sklerotik kenar ve bazen kıkırdak matriksi kalsifikasyonları görülebilir. BT lezyondaki litik yıkımı ve varsa kalsifikasyonu gösterebilir; MR'da lezyon çevresindeki ödem değerlendirilir. Lezyonun yaşa ve fizise göre yanlış konumlandırılması dev hücreli tümör gibi farklı biyolojiye sahip bir tanıyla karışmasına yol açabilir.

Faz ve pencere

Kontrastsız tanısal

Epifiz veya apofiz merkezli coğrafi litik odak, ince sklerotik kenar, küçük noktasal/bulutsu mineralizasyon ve kortikal incelme ya da ekspansiyon aranır.

Kemik algoritması tanısal

BT'de lezyonun litik yıkımı, sklerotik sınırı ve varsa intralezyonel kalsifikasyonları değerlendirilebilir.

Önerilen pencereler: Kemik (G 1800 / M 400), Yumuşak doku (G 400 / M 40).

BT bulguları

• Epifiz/apofiz odağı — distal femur veya proksimal tibia kemiğinin ekleme yakın kemikleşen ucunda merkezlenir.
• Coğrafi litik morfoloji — dar geçişli, ince sklerotik kenarlı ve yaklaşık %56 oranında lobüle yapıda kemik kaybı görülür.
• Sklerotik çevre — yavaş büyüyen sınır boyunca ince reaktif kemik çizgisi bulunabilir.
• Noktasal matriks mineralizasyonu — küçük bulutsu kalsifikasyonlar kondroid matriksi destekler, ancak zorunlu değildir.
• Fizis ilişkisi — bazı olgularda epifiz plağında tutulum bildirilmiştir.
• Kortikal bütünlük — bazı olgularda kortekste devamlılık kaybı görülebilir.
• Eklem içi eşlik — efüzyon veya lezyonla ilişkili patolojik kırık görülebilir.

Normalde

Lezyon değerlendirilirken epifizdeki litik alanı, ince sklerotik kenarı, varsa matriks kalsifikasyonunu ve lezyon çevresindeki ödemi gözden geçirin.

Ayırıcı tanı

Dev hücreli tümör

çoğunlukla fizis kapandıktan sonra epifiz-metafizi subkondral kemiğe kadar doldurur; belirgin sklerotik çevresi genellikle yoktur.

Anevrizmal kemik kisti

ekspansiyon ve ince septalar baskındır; sıvı-sıvı seviyeleri BT'de görülebilse de MRI daha duyarlıdır.

Brodie apsesi, subakut osteomiyelitin lokalize biçimidir; bir distal femur olgusunda iyi kortike litik odak ve MRI’da penumbra işareti bildirilmiştir.

Tuzaklar

• Epifiz odağını fizis açıklığından bağımsız okumayın; yaş ve iskelet olgunluğu dev hücreli tümör ayrımını değiştirir.
• Küçük kondroid kalsifikasyon yokluğunu dışlama ölçütü saymayın; bu mineralizasyon her lezyonda seçilmez.
• İnce sklerotik sınırı benign davranışın garantisi gibi yorumlamayın; korteksin delinmesi ve kırık ayrıca aranmalıdır.
• Kondroblastom değerlendirmesinde MR'da eklem efüzyonu ve lezyon çevresindeki ödem de incelenebilir.

Kendini dene

1. Açık fizisli 12 yaşındaki ergende distal femur epifizinde dar geçişli, ince sklerotik kenarlı litik odak ve küçük noktasal kalsifikasyonlar görülüyor. En olası tanı hangisidir?

   • Kondroblastom
   • Dev hücreli tümör
   • İntraosseöz ganglion
   • Unikameral kemik kisti
   Cevabı göster

   Kondroblastom. Açık fizisli ergende epifiz/apofiz merkezli, dar geçişli ve ince sklerotik kenarlı litik odak kondroblastomu destekler; noktasal kondroid mineralizasyon da tanıyı destekleyebilir. Dev hücreli tümör çoğunlukla iskelet olgunluğu tamamlanmış kişilerde görülür.

2. Fizisi kapanmış 35 yaşındaki erişkinde distal femurda epifiz-metafiz boyunca subkondral kemiğe uzanan ve belirgin sklerotik çevresi olmayan litik lezyon hangi tümörü en çok düşündürür?

   • Dev hücreli tümör
   • Kondroblastom
   • İntraosseöz ganglion
   • Osteoid osteoma
   Cevabı göster

   Dev hücreli tümör. İskelet olgunluğu tamamlanmış erişkinde epifiz-metafiz boyunca subkondral kemiğe uzanan, çoğunlukla eksantrik ve belirgin sklerotik sınırı olmayan litik lezyon dev hücreli tümörle uyumludur. Kondroblastom genç hastalarda epifiz/apofiz merkezlidir; osteoid osteoma ise 15 mm'den küçük, çevresinde reaktif sklerozis içeren bir nidusa sahip kemik yapıcı lezyondur.

Kaynaklar

Bu sayfadaki 34 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 13 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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