loader
Home/
Journal of General Surgery

Full Text


Case Report

Intra-Capsular Chondroma of the knee: A Case Report

Essekkal M, Hammani Y, El hayane M, Marzouki A, Boutayeb F

Correspondence Address :

Essekkal Mohamed
Department of Trauma and Orthopedic Surgery A Hassan II Teaching Hospital
Faculty of Medicine and Pharmacy Sidi Mohammed Ben Abdellah University Fez
Morocco, Afirca
Tel: +33659249533 [1]
Email: essekkalmohamed@gmail.com

Received on: July 29, 2017, Accepted on: September 14, 2017, Published on: September 21, 2017

Citation: Essekkal M, Hammani Y, El hayane M, Marzouki A, Boutayeb F (2017). Intra-Capsular Chondroma of the knee: A Case Report

Copyright: 2017 Essekkal Mohamed, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

  • Abstract

  • Fulltext

  • References

  • Tables & Figures

  • Download PDF

Abstract
Intra-capsular chondroma of the knee is a rare benign cartilaginous tumor resulting from extra synovial  etaplasia. Typically located at the lower part of the patella Some authors view this mentit as a late form of Hoffa disease. This would explain the similar localization of these two pathologies.
We describe clinical, paraclinical and perioperative images of an intracapsular chondroma of the right knee evolving for 2 years in a young patient of 35 years. The standard radiographs of the right knee face and profil showed an opacity in the infra-patellar soft parts, well limited in comparison with the patellar tendon, without any associa Ted bone lesions.
MRI showed the cartilaginous nature of the lesion and indicated its intimate relationship with the patellar tendon which is pushed out. The tumor is in hypo-signal in T1 and hypersignal in T2.
Internal parapatellar excision revealed a very limited cartilaginous tumor extra synovial within the hoffa and adherent to the patellar tendon. The diagnosis of intracapsular chondroma was confirmed by pathological examination.
The postoperative sequences were simple.
Keywords: Chondroma, knee, Magnetic Resonance Imaging
Fulltext
Introduction
Intra-capsular chondroma of the knee is a rare benign cartilaginous tumor resulting from extra synovial metaplasia [1]. Typically located at the lower part of the patella Some authors view this entity as a late form of Hoffa disease. This would explain the similar localization of these two pathologies.
We describe clinical, paraclinical and perioperative images of an intracapsular chondroma of the right knee evolving for 2 years in a young patient of 35 years.
Case Report
A femal patient, 35years, had a painful palpable mass in the right knee for two years gradually enlarging. On physical examination There was a firm, movable, tender mass in the infrapatellar area, Ligamentous knee exam was negative (Figure 1).
Radiographs of the right knee revealed an ovoid calcified mass in the Hoffa's fat pad (Figure 2).
On Magnetic resonance imaging (MRI) this soft-tissue mass is clearly seen, oval shaped and intracapsular (Figure 3). The tumour was surgically excised, It was Intracapsular, extrasynovial oval shaped, 6 x 3 cm (Figures 4-8)
The diagnosis of intracapsular chondroma was confirmed by histopathology (Figure 9).
Discussion
Intracapsular and para-articular chondromas have been named capsular osteomas, osteochondromas, or chondromas, depending on the relative proportions of bone and cartilage [2].
The Pathogenesis of these tumours is also controversial. 
Intra-capsular chondroma of the knee is a rare benign cartilaginous tumor resulting from extra synovial metaplasia.
Typically located at the lower part of the patella.
Some authors view this entity as a late form of Hoffa disease. This would explain the similar localization of these two pathologies, Our case showed the characteristic features of soft tissue chondroma. Lateral plain radiograph of the knee demonstrated a large soft tissue mass with a wide radiodensity due to calcification.
T2-weighted MR imaging demonstrates a heterogenous mass within the infrapatellar fat pad, with the high signal intensity representing chondroid matrix or edema and areas of low signal intensity representing calcification [3].
The diagnosis of these benign tumours is made clinically and radiologically in correlation with the pathological features. The main differential diagnoses are : calcifying bursitis, tumoral calcinosis, periosteal chondromas, calcified synovial sarcomas, localized nodular synovitis, primary synovial chondromatosis and soft tissue chondrosarcoma [4]. The treatment of choice for these tumours is surgical excision, while being careful not to injure the joint integrity. Malignant transformation has never been reported. With correct diagnosis unnecessary aggressive surgical treatment will be avoided [1]. In conclusion, intracapsular and paraarticular chondromas of the knee is a rare benign lesion and must be differentiated from other benign or malignant tumors which occur in the same region [5].
References
1. Samardziski M, Foteva M, Adamov A, Zafiroski G. Intracapsular and para-articular chondroma of knee: a report of four cases and review of the literature. Radiol Oncol. 2006;40(4):205-209.
2. Sakai H, Tamai K, Iwamoto A, Saotome K. Para-articular chondroma and osteochondroma of the infrapatellar fat pad: a report of three cases. Int Orthop. 1999;23(2):114-117.
3. Jacobson JA, Lenchik L, Ruhoy MK, Schweitzer ME, Resnick D. MR imaging of the infrapatellar fat pad of Hoffa. Radiographics. 1997;17:675-691.
4. Gonzales-Lois C, Garcia-de-la-Torre JP, SantosBriz-Terron A, Vila J, Manrique-Chico J, Martinez-Tello FJ. Intracapsular and para-articular chondroma adjacent to large joints: report of three cases and review of the literature. Skeletal Radiology. 2001;30:672-676.
5. Suk Ki Jang, Hyeok Jin Hong, Eun Mee Han, Su Min Kang, Jin Young Yoo, In Oak Ahn. Intracapsular and Paraarticular Chondroma of the Infrapatellar Hoffa's Fat Pad: A Case Report. JKSMRM. 2008;12:197-200.
Tables & Figures
Figure 1: right knee swelling

Figure 2: Standard knee radiograph (face / lateral)

Figure 3: MRI aspect of the right knee: 
a. Coronal T1 weighted image shows intermediate to low signal intensity similar to surrounding muscle (black arrows).
b. Sagittal T2 weighted image shows high signal intensity corresponding to areas of hyaline cartilage and low signal intensity corresponding to areas of calcified foci (arrowheads).

Figures 4 and 5: Intraoperative aspects.

Figures 6 and 7: Chondroma after excision

Figure 8: Radiograph of right knee (face / lateral) after excision


Figure 9: Histopathology of the chondroma showing  mature lobules of hyaline cartilage with focal calcification beneath synovial membrane (black arrow)
Download PDF