Open Access Full Text Article

Journal of General Surgery

www.scientonline.org J Gen SurgVolume 1 • Issue 1 • 001

Case Report

Intra-Capsular Chondroma of the knee: A Case Report

Essekkal M*, Hammani Y, El hayane M, Marzouki A and Boutayeb FDepartment of Trauma and Orthopedic Surgery, Morocco, Africa

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 ReportA 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).

*Corresponding author: 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

AbstractIntra-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 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 hyper-signal 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

This article was published in the following Scient Open Access Journal:Journal of General SurgeryReceived July 29, 2017; Accepted September 14, 2017; Published September 21, 2017

Figure 1: right knee swelling.

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

Page 2 of 3

www.scientonline.org J Gen SurgVolume 1 • Issue 1 • 001

Figures 4 and 5: Intraoperative aspects.

4

5

Figures 6 and 7: Chondroma after excision.

6

7

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).

a b

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].

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

Page 3 of 3

www.scientonline.org J Gen SurgVolume 1 • Issue 1 • 001

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].

References1. 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.

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).

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.