Recurrent Chondromyxoid Fibroma of the Second Toe Distal Phalanx Treated with Distal Phalangectomy: A Case Report.

Background/

Objectives

Chondromyxoid fibroma (CMF) is a rare benign cartilaginous bone tumor, accounting for less than 1% of all primary bone tumors. Although CMF most commonly arises in the metaphysis of long bones, involvement of the phalanges of the toes is uncommon. We report a pediatric case of CMF arising in the distal phalanx of the second toe that recurred four years after initial surgical treatment and discuss its management.

Methods

A 10-year-old girl presented with a painless mass in the distal phalanx of the second toe. Imaging studies demonstrated an expansile osteolytic lesion with cortical thinning, showing a somewhat aggressive radiologic appearance. Intralesional curettage and debridement were performed to preserve the digit, and the bone defect was reconstructed using allogenic cancellous bone graft and demineralized bone matrix. Histopathological examination confirmed the diagnosis of CMF.

Results

Four years later, the patient returned with progressive enlargement of the lesion, indicating tumor recurrence. Because of the recurrent nature of the tumor and progressive cosmetic deformity and recurrence-related anxiety, distal phalangectomy was performed. At the one-year follow-up, the patient showed no evidence of recurrence and maintained satisfactory functional and cosmetic outcomes.

Conclusions

CMF of the toe phalanx may show delayed recurrence after curettage, requiring prolonged radiologic surveillance. In recurrent cases, definitive resection should be considered based on a combination of oncologic, anatomic, and patient-centered factors, with distal phalangectomy providing reliable local control in anatomically expendable digits.