A Case Report of Chondromyxoid Fibroma of the Neck of Femur, Intracapsular Location

Neck Femur Case Report Introduction: Chondromyxoid fibroma (CMF) is an uncommon benign tumor accounts for <2% of all benign and <1% all bone tumors. It is a cartilage tumor with myxoid and fibrous elements. Because of rarity and resemblance with other benign and malignant tumor, diagnosis of this tumor always remains challenging. Often, this lesion affects metaphysis of long growing bones of children and young adults. Common locations of this tumor are around the growth plate of proximal tibia and fibula and distal femur.

Case Report: A 21-year-old male presented to orthopedic outpatient department with a history of the left hip pain for 1 year, following a trivial fall before 1 year. The patient was not able to do heavy strenuous activities such as running, jumping, and other sports activities. Terminal range of movements were painful. Magnetic resonance imaging suggested of cystic lesion involving synovial lining near head-and-neck junction of the left femur. Curettage of the lesion was done. The bone defect was not found to be large enough to be filled with bone graft. Histopathological examination showed lobular pattern with stellate to spindle-shaped cells on the myxoid background.

Conclusion: CMF of subcapital region of femoral neck is an extremely unusual presentation. When occurring in middle-aged persons and in uncommon locations, this can raise suspicion of chondrosarcoma. Although intralesional curettage has the risk of recurrence in post-operative period, sufficient and careful curettage and excision of lesion will be enough to treat these benign lesions with good prognosis. Keywords: Chondromyxoid fibroma, intracapsular, benign tumor.

Discussion :

CMF is one of the rare benign tumors of bone. Jaffe and Lichtenstein have described 1st time in 1948. Despite its name, CMF is by nature a tumor of predominantly chondroid cells and originate from physeal cartilage plate [5]. It occurs commonly in the second and third decades of life [3]. It has a slight male preponderance.
Some patients can be asymptomatic but Some patients can be asymptomatic but most of the patients presents with a mild pain with local tenderness, decrease range of movement of adjacent joint [9,10]. Approximately 5% of cases, it presents with pathological fracture. Radiologically, it normally appears as lobulated or oval eccentric lytic lesion with well-defined sclerotic margins. It is often expensile without any periosteal reaction. Pseudotrabeculation or septation may be present [4]. CT scan can help to identify any breach in cortical integrity and intralesional calcifications [11]. MRI features are often non-specific lesion appeared as decreased signal intensity on T1-weighted images and increased signal intensity on T2- weighted images [11]. more……