Chondroblastoma of the cervical-thoracic junction: global data and own experience

Abstract

Chondroblastoma (CB) ‒ a rare benign tumor of the skeleton that is presented by proliferation of chondroblasts with islands of eosinophilic chondroid matrix. CB accounts for less than 1% of all bone neoplasms, while the spine is affected in only 1.4% of all CB cases. Publications devoted to CB of the spine are sporadic and therefore have a considerable scientific interest due to the rarity of the pathology.

A clinical case of CB of the cervical-thoracic junction of a 38-year-old patient hospitalized to State Institution "Romodanov Neurosurgery Institute of the National Academy of Sciences of Ukraine" in November 2022 is presented. The anamnesis shows that in 2016 a pathological fracture of the Th2 vertebral body was diagnosed. In 2017, a surgical intervention - an open biopsy of the Th2 vertebral arch was performed in a private clinic, but the histopathological analysis, due to the insufficient amount of material and the absence of clinical data, was descriptive, with a certain diagnostic number of possible nosologies. Additional treatment was not performed. When applying in 2022 to the State Institution "Romodanov Neurosurgery Institute of the National Academy of Sciences of Ukraine", significant negative dynamics were noted: a fracture of the body of the Th1 vertebra, total destruction of the body of the Th2 vertebra, a change in the signal from the body of the Th3 vertebra, which indicated its focal lesion. The surgery was performed in two stages. The first stage included a ventral corpectomy of the Th1‒Th3 vertebrae with fusion using telescopic body replacement implant and a ventral rigid plate. During the second stage laminectomy of the Th1‒Th3 vertebrae with complete resection of the Th2 costotransverse joints and partial of Th1‒Th3 ones was performed. Stabilization system screws were installed transarticularly in the facet joints C6 and C7, transpedicularly in the bodies of the Th4‒Th6 vertebrae. To increase the fusion rigidity, additional fixation of the Th1 vertebra on the right and the Th3 vertebra on the left was performed through the remaining costotransverse joints. The patient was discharged with positive neurological dynamics.

The uniqueness of this case, in addition to the rarity of the histological variant of the pathology, lies in the possibility of tracking the dynamics of the disease on the basis of both neuroimaging methods and pathohistological and immunohistochemical diagnostics.

Features of the prevalence of spine CB in the population, the specifiс signs when performing a spiral computer and magnetic resonance imaging, macroscopic, histological and immunohistochemical characteristics of the tumor are considered in detail. The literature data on differential diagnosis, treatment methods and prognosis of disease are organized.

The material is of interest to specialists, since the timely selection of an adequate treatment method and its volume determines both the probability of tumor recurrence as well as prognosis concerning the patient’s life expectancy.