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J.P Crestanello Nese y cols. Rev Esp Cir Oral y Maxilofac 2006;28,5 (septiembre-octubre):295-300 © 2006 ergon
erosión cortical y extensión a los tejidos
blandos alertan sobre la posible maligni-
dad.1,5,6
Histológicamente también, puede ser
difícil diferenciar al C del condrosarcoma
por presentar características superpues-
tas.2 Diferenciarlo de un condrosarcoma
de alto grado no presenta dificultades his-
tológicas. Sin embargo, la distinción de
un condrosarcoma de bajo grado esta
dentro de los problemas más difíciles en
patología ósea. De forma que se ha pro-
puesto que todas las lesiones óseas car-
tilaginosas sintomáticas sean considera-
das y tratadas como condrosarcomas. Y Figura 6. La microfotografía muestra cartílago hialino maduro. Se True chondromas could like-
muchos patólogos consideran el diag- observa una masa homogénea uniforme de condrocitos con núcle- ly be no more than chance
nóstico de C como un potencial condro- os pequeños.
Figure 6. Photo-micrograph showing mature hyaline cartilage, con-
sarcoma.1,6 sisting of a homogeneous mass of uniform chondrocytes with small surfaced nodules. The over-
La diferenciación entre la lesión benig- nuclei.
na y la maligna se basa en evidencia de
invasión y en los hallazgos de más de una figura mitótica. La presencia
de alguno de estos signos indica una alta probabilidad de maligni-
dad.8,16 Por lo contrario las figuras mitóticas son extremadamente
raras sino inexistentes en el C.1 Y finalmente algunos autores sugie-
ren el examen de varios bloques en todos los tumors cartilaginosos
debido a que las áreas diagnósticas condrosarcoma pueden ser solo
focales.7
El tratamiento aconsejado para el C es la excisión amplia, no radi-
cal, con un margen de hueso y tejido blando normal. Esto se debe
a la posible superposición clínica e histológical y a que casi el veinte
por ciento (20%) de los condrosarcomas de cabeza y cuello han sido
diagnosticados inicialmente como C. El curetaje ha resultado en recu-
rrencia local en un número significativo de casos.1,2,6,7,11 La radiote-
rapia esta contraindicada porque el tumor no es radiosensible y ade-
más por la potencial transformación maligna.1,11
Es esencial que se realiza un seguimiento prolongado de los pacien-
tes. Si ocurre una recurrencia, el diagnóstico inicial debe ser recon-
siderado por la posibilidad de una malignidad de bajo grado.2,7
Conclusiones
Un nuevo caso de un C maxilar se presentó. En este caso la lesión
se localizó en una región donde previamente se enucleó una quiste
odontogénico inflamatorio y sus características clínicas hiceron pen-
sar en un quiste residual. La biopsia incisional confirmó el diagnósti-
co de C. Una vez con el diagnóstico de C la posibilidad de un con-
drosarcoma de bajo grado debe ser considerado.
El diagnóstico diferencial en esta ubicación en particular puede
incluir cualquier lesión benigna osteolítica. Por lo que se debe con-
siderar los tumores óseos comunes a los otros huesos de la econo-
mía, conjuntamente con las lesiones de origen odontogénico. La his-
toria, el examen físico y el estudio de las imágenes debe ser realiza-
do y luego se debe realizar una biopsia para definir el diagnóstico y
tratamiento más apropiado.
299
in the tongue, the cheek, on
the nasal surface of the soft
palate and arising in hyper-
plastic tissue in denture-bear-
ing areas.3,6,12,14-16 Chondro-
ma could be a manifestation
of Maffucci's syndrome.18
The chondroma usually is
slow growing painless
swelling of the jaw. The
patient could know the pres-
ence of a mass or have mod-
erate symptoms for several
years previous to diagnosis.
findings as firm, smooth –
lying skin or mucosa is sel-
dom involved due to the
gradual expansion of the lesion. If arising in dentate regions,
tooth mobility and root resorption are possible.1,2,7,8,17
The radiographic findings of the chondroma is not char-
acteristic. An irregular, radiopaque and radiolucent mottled
mass may be seen.1 However the lesion most often presents
as an irregular radiolucent area2 that it could mimicked a
mesiodens or other lesions.4 The absence of cortical destruc-
tion and soft tissue extension favor a benign diagnosis.8
The chondroma should be clinically, radiologically and
histologically differentiated from the chondrosarcoma. Clin-
ical and radiographic features often provide little useful infor-
mation to distinguish the chondroma from the well differ-
entiated chondrosarcoma. The size of the lesion is a help-
ful feature. Most chondromas have been reported in the
range of 1 to 3 cm. Most chondrosarcomas have measured
more than 5.5 cm.2,18 Additional signs of persistent, unre-
lenting pain along with radiographic evidence of cortical ero-
sion and soft tissues extension are foreboding signs of malig-
nancy.1,5,6
Distinction between chondroma and chondrosarcoma
may be difficult because of overlapping histologic features.2
Distinguishing chondroma from high grade chondrosarco-
ma presents no difficulty. However the distinction from low
grade chondrosarcoma is among the most difficult problems
in bone pathology. So an argument has been proposed that
all symptomatic cartilaginous lesions be considered and treat-
ed as chondrosarcomas. Many pathologists regard the diag-
nosis of chondroma as representing a potential chon-
drosarcoma.1,6
The differentiation of the benign versus the malignant
lesion is based on evidence of invasion and the finding of
more than a rare mitotic figure. The presence of one of those
signs indicates a high probability of malignacy.8,16 Conversely,
mitotic figures are extremely rare to nonexistent in the ben-
ing chondroma.1 Finally, some authors suggest the exami-
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Varios signos clínicos y radiográficos pueden ser de ayuda para
distinguir este caso de un condrosarcoma. Primero, el tamaño del
tumor era de 2,0 cm y en la biopsia se encontró una cápsula. El
examen histológico de la pieza quirúrgica final mostró cartílago
hialino maduro con alguna arquitectura cellular sin hueso y con la
ausencia de invasión de los tejidos blandos en los márgenes amplios
pero no radicales. Además, no se observaron figuras mitóticas.
No ha habido recurrencia del tumor en 2 años y 7 meses desde
la remoción. De todas formas se plantea el control a largo plazo.
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Chir Maxillofac 1990;91:480-2.
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Condroma maxilar
nation of multiple blocks for all cartilaginous tumors due
to areas diagnostic of a chondrosarcoma may be only focal.7
Because of the possible clinical and histological overlap
and consideration that twenty percent (20%) of H&N chon-
drosarcomas may be initially diagnosed as benign the treat-
ment of the chondroma is a wide, although not radical, exci-
sion. The resection with a margin of normal soft tissue and
bone is preferred. Curettage has resulted in local recurrence
in a significant number of cases.1,2,6,7,11 Radiotherapy is con-
traindicated because the tumor is not radiosensitive. In adit-
tion, potential malignant transformation is possible.1,11
Prolonged follow – up is essential. If recurrence occurs,
the original diagnosis should be reconsider for the possibil-
ity of low grade malignancy.2, 7
Conclusions
A new case of maxillary chondroma was presented. The
lesion presented similar in appearance to, and in an area of
previous enucleation of an inflammatory odontogenic cyst.
An initial incisional biopsy confirmed the diagnosis of chon-
droma. Once the histologic diagnosis of chondroma is given,
the possibility of a low grade chondrosarcoma should be con-
sidered.
Differential diagnosis in this particular location may
include any osteolitic benign lesion. In the maxillary region,
one should consider that the same tumors of the other bones
could be found together with lesions of odontogenic origin.
The history, physical examination and the appropriate analy-
sis by imaging must be done and the final diagnosis should
be obtained under biopsy to define the more appropriate
diagnosis and treatment.
Several clinical and radiographic signs may be helpful in
distinguishing this case from chondrosarcoma. First, the
tumor size was 2.0 cm and at biopsy a capsule was found.
Histologic examination of the final surgical specimen showed
hyaline mature cartilage with some amount of cellular archi-
tecture without bone and absence of invasion of the sur-
rounding tissue in the wide but not radical margins. Mitot-
ic figures were absent.
Long term follow up is planned. There has been no recur-
rence of the tumor in 2 years and 7 months since its removal.