[Oradlist] TMJ: synovial chondromatosis.?

Allan G Farman agfarm01 at louisville.edu
Mon Sep 29 06:22:18 PDT 2008


Allan: I am sure your interpretation is correct. You should not take
single case reports too seriously - especially when they refer to
malignant transformation that is not backed by a larger meta analysis.
Chondrosarcoma in the mandibular condyle is a very rare condition in any
age group so the odds favor chondromatosis even on that basis alone. As
Jie Yang noted, the bone destruction typical of chondrosarcoma was
missing in the present case. Please do post the histopathology if
possible when available. AGF

Allan G. Farman, BDS, PhD, MBA, DSc, Diplomate ABOMR

Prof. Radiology & Imaging Science
Univ. Louisville School of Dentistry: SUHD
501 South Preston Street,
Louisville, Kentucky 40292, USA 

Tel: +1(502) 852.1241
Fax: +1(502)852.1626


>>> "Allan Abuabara" <allan.abuabara at gmail.com> 9/29/2008 5:50 AM >>>
Dear Dr. Yang,

the only strange fact that I see is the young age of the patient
(17y-o). I
really think it be synovial chondromatosis.

However, most of the articles say to make differential diagnosis with
Chondrosarcoma. There is even a story of chondrosarcoma transformation
(Perry BE, McQueen DA, Lin JJ. Synovial chondromatosis with malignant
degeneration to chondrosarcoma. Report of a case. J Bone Joint Surg Am.
1988
Sep;70(8):1259-61.).

I need CBTC and MRI images. Anyway, the treatment is surgical. So we
carry
out biopsy for final diagnosis.

Thanks for your reply.
Allan Abuabara.


On Sun, Sep 28, 2008 at 10:16 PM, Yang, Jie <JYANG at dental.temple.edu>
wrote:

> I do not know why you would consider TMJ chondrosarcoma as your
> differential interpretation in this case. Unlike chondrosarcomas in
other
> parts of body, TMJ chondrosarcomas are almost always with bone
destruction
> and enlargement of joint spaces. None of these are seen in this case.
In
> addition, how many times have you seen a primary malignant tumor
> simultaneously involves both TMJs or any Joints in the body?
>
> Regards,
>
> Jie
>
>
*********************************************************************
> Jie Yang, DDS, MMedSc, MS, DMD
>
> Diplomate of American Board of Oral & Maxillofacial Radiology
> Associate Professor & Director of Oral and Maxillofacial Radiology
> Associate Professor of Radiology
> Temple University Schools of Dentistry and Medicine
>
> 3223 North Broad Street
> Philadelphia, PA 19140, USA
> Tel. 215-707-1579
> Fax. 215-707-5719
>
>  mailto:jyang at dental.temple.edu <mailto:jyang at dental.temple.edu> 
<mailto:
> jyang at dental.temple.edu> <mailto:jyang at dental.temple.edu>
>
*********************************************************************
>
>
> ________________________________
>
> From: oradlist-bounces at lists.ucla.edu on behalf of Allan Abuabara
> Sent: Sun 9/28/2008 7:06 PM
> To: Oral Radiology Discussion Group
> Subject: Re: [Oradlist] TMJ: synovial chondromatosis.?
>
>
> Dear Rejane, Kullman and Yang,
>
> The case of my suspicion is Synovial Chondromatosis is not my
patient. I am
> only the Radiologist who evaluated the images. The patient reported
> bilateral pain in TMJ, but normal open mouth (35-40mm). I suggested
cone
> beam CT and Magnetic ressonance imagin (MIR).
>
> My worry is exactly with TMJ chondrossarcoma. I am waiting the
feedback of
> the patient's doctor. Having news I will reply for you. But I ask:
Could it
> be bilateral chondrossarcoma? Would not it be very rare /  improbable
?
>
> Now I am sending the righ side images (panoramic TMJ radiograph - 
open
> mouth and maximum intercuspidation - MI). I regret the poor image
quality;
> they are scanned. All the same, we can view the radiopaque bodies.
>
> Best Regards.
> Allan Abuabara.
> DDS, Specialist in Oral & Maxillofacial Radiology.
> Joinville, SC - Brazil.
>
>
> On Sun, Sep 28, 2008 at 6:02 PM, Rejane Faria Ribeiro-Rotta <
> rejanefrr at gmail.com> wrote:
>
>
>         Dear Allan,
>
>        We are just finishing a case report to submit to publication
of a
> TMJ chondrossa
rcoma in a 11-years-old child. Until 2008 only 20 cases
have
> been reported in the english literature and the youngest patient is
17
> years-old.
>        One important part of the discussion is the differential
diagnosis
> which includes Synovial Chondromatosis. This benign proliferative
and
> metaplastic disorder of the synovium presents as two forms,
secondary
> synovial chondromatosis, typified by the presence of intra-articular
> osteocartilaginous loose bodies against a background of degenerate
joint
> disease, is common, whereas the primary form, in which synovial soft
tissue
> masses are the predominant feature, is relatively uncommon.  Primary
> synovial chondromatosis should be considered in the differential
diagnosis
> of the monarticular presentation of an intra-articular soft tissue
mass,
> particularly in the presence of bone erosions.  Permeation of
trabecular
> bone with "filling up" of marrow spaces should be considered a sign
of
> malignancy.
>        So, I would consider CT (including contrast injection) and/ou
MRI.
>        Regards
>        Rejane
>
>
>
>        2008/9/28, Leif Kullman <leikul at yahoo.com>:
>
> Dear Allan, it could be of course, as you suggest synovial
chondromatosis,
> but more differential diagnosis are possible like for example
> chondrocalcinosis or some sort of tumor. Can you give us some history
of the
> patient please? What about clinical findings?
> Do you have access to a CBCT, more and better imaging could be
useful.
>
> Best regards Leif
>
> Leif Kullman DDS, PhD
> Assoc. Professor
> Oral and Maxillofacial Radiology
> Faculty of Dentistry
> Kuwait University
>
> --- On Sat, 9/27/08, Allan Abuabara <allan.abuabara at gmail.com>
wrote:
>
>
>        From: Allan Abuabara <allan.abuabara at gmail.com>
>        Subject: [Oradlist] TMJ: synovial chondromatosis.?
>        To: "Oral Radiology Discussion Group"
<oradlist at lists.ucla.edu>
>        Date: Saturday, September 27, 2008, 7:56 PM
>
>
>
>        Dear Colleagues,
>
>        Attached (panoramic TMJ radiograph -  open mouth and maximum
> intercuspidation - MI) is a case of a woman, 17-y-o with pain in TMJ.
The
> images is from the left TMJ but the radiopaque images appear on both
sides.
>
>        My suspicion is synovial chondromatosis, although the
incidence is
> more common during the fourth and fifth decades of life.
>
>        What do you think about it?
>        Thanking you.
>
>        Allan Abuabara.
>        DDS, Specialist in Oral & Maxillofacial Radiology.
>        Joinville, SC - Brazil.
>
>
>
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>
>
>
>
>
>        --
>        ***************************************
>        Rejane Faria Ribeiro-Rotta
>        Professora associada, Departamento de Ciências
Estomatológicas
>        Faculdade de Odontologia, Universidade Federal de Goias
>        rejanefrr at gmail.com, rejanefrr at odonto.ufg.br 
>
>        Rejane Faria Ribeiro-Rotta, DDS, MS, PhD
>        Associate Professor, Department of Oral Medicine, School of
> Dentistry, Federal University of Goias, Brazil
>        rejanefrr at gmail.com, rejanefrr at odonto.ufg.br 
>        _______________________________________________
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>
>
>
>
>
>
> --
> Allan
>
>
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-- 
Allan



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