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Chondroma

This document discusses chondroma, a benign cartilage tumor. It begins by covering the incidence, pathology, clinical features, radiology, differential diagnosis and treatment of solitary enchondromas. It then discusses multiple enchondromatosis/Ollier's disease, its association with malignant changes, pathology, clinical features, radiology and treatment considerations. Throughout, it provides details on features that suggest malignant transformation and compares characteristics of benign versus malignant lesions.

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242 views20 pages

Chondroma

This document discusses chondroma, a benign cartilage tumor. It begins by covering the incidence, pathology, clinical features, radiology, differential diagnosis and treatment of solitary enchondromas. It then discusses multiple enchondromatosis/Ollier's disease, its association with malignant changes, pathology, clinical features, radiology and treatment considerations. Throughout, it provides details on features that suggest malignant transformation and compares characteristics of benign versus malignant lesions.

Uploaded by

pkalikinkarojha
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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CHONDROMA

Dr Deepak K Singh
PMRD, NIRTAR

INCIDENCE

Benign lesions of hyaline cartilage

Age
- multiple enchondromatosis - childhood
- solitary enchondromas - after the second
decade of life
- peak age of presentation - 35 years

Most common bone - small bones of the hands and feet

Arise in medullary canal - enchondromas.

Rarely on the surface of the bone - periosteal chondromas


or juxtacortical chondromas.

PATHOLOGY - MACRO
Color - glistening white, grayish-white, or pearly
tissues
Feel - gritty feel on palpation owing to the
intrinsic calcification
- easily cut with a knife, as if it were soft
chalk.

PATHOLOGY - MICRO
Proliferating nests of cartilage cells ,lack obvious
atypia
Foci of calcification
Plates of lamellar bone surround the lobules of
cartilage in a partial to complete circumferential
manner

PATHOLOGY SARCOMATOUS
CHANGE
Growing children
- with dysplastic cartilaginous lesions
likelihood of malignancy low
Adults
- difficult to differentiate an enchondroma
from a low-grade sarcoma
Site
- small peripheral cartilage tumors - benign
- large axial tumors likely to be malignant

CLINICAL FEATURE
Site
- 50% occur in the hand ( phalanges and carpal
bones )
- long tubular bones ( femur and humerus )
- occasionally the ribs, sternum, innominate
bones, and vertebral columns
Presentation
- usually diagnosed after local trauma
- some with a firm, local swelling in
affected phalanx or metacarpal without a
fracture or local pain.
- femur / humerus usually quiescent, with no
clinical signs evident until adulthood

RADIOLOGY SOLITARY
ENCHONDROMA
well-delineated, lucent defects

metaphyseal region of long bones


size - 1 to 8 cm
phalanges of the hand or foot - entire shaft
cortical rim - usually intact unless a fracture has occurred
through the weakened bone
calcification within the lesion appears as fine punctate
stippling

Larger long bones


- calcification more pronounced
- difficult to differentiate between
enchondroma and bone infarct
Usually no evidence of focal cortical erosion/
scalloping /thickening of cortex and bone
expansion
Older symptomatic adolescent
- cortical thinning and expansion in the larger
long bones represents features of low-grade
chondrosarcoma.

JUXTACORTICAL CHONDROMA

Small (<3 cm), well-defined lesions


Saucer-shaped defect on the surface of the bone
Underlying cortex sclerotic
Edges - buttressed by a thick rind of cortical bone

DIFFERENTIAL DIAGNOSIS
Bone infarct peripheral located calcification
Epithelial inclusion cysts in phalanges of hand
and feet
Solitary bone cyst / nonossifying fibroma/ fibrous
dysplasia in the metacarpal

TREATMENT

Solitary enchondromas in the hand


- complete curettage followed by autogenous
bone grafting
- recurrences may occur many years after
excision ,present with widening or cortical
erosion of the phalanx or metacarpal
- recurrence rate low in long bones and en bloc
wide excision

MULTIPLE ENCHONDROMATOSIS /
OLLIERS DISEASE

Rare condition
Many cartilaginous tumors in large and small
tubular bones and flat bones.
Cause - failure of normal endochondral
ossification - dyschondroplasia
Individual lesions similar to solitary chondroma
Most commonly - phalanges, femur, and tibia

PATHOLOGY
Numerous islands of glistening cartilage
Diaphyseal and metaphyseal regions.
Infrequently, in the epiphyseal region
Close proximity to the physis - severe limb length
discrepancies or angular deformities.
abnormal enchondroma cartilage near the
epiphyseal plate - pathognomonic fanlike
metaphyseal septation radiographs

PATHOLOGY SARCOMATOUS
CHANGE
highly cellular lesion with ominous nuclei mimick
a low-grade chondrosarcoma
Eventual malignant transformation 20% to 33%
Biopsy site in hand benign lesion
Biopsy site in pelvis or larger bones - suspicion
of low-grade sarcomas is higher.
high incidence of chondrosarcomatous
transformation in older individuals

CLINICAL FEATURE

Tendency toward unilateral involvement


- severe LLD - 10 to 25 cm by maturity
- angular deformities - increased incidence of varus angulation
in the lower femur
- deformity and enlargement of fingers
- forearm abnormalities - bowing, limited rotation, and ulnar
deviation of the hand

ASSOCIATION
When associated with hemangiomas of the
overlying soft tissues Maffucci syndrome.
Sarcoma - 25% of patients with Ollier disease
by 40 years of age.

MALIGNANT CHANGE
25% to 30% by 40 years of age with Olliers disease
Maffucci's syndrome
- higher likelihood of development of malignant
degeneration, nearly 100% expectation
- periodic surveillance of the brain and abdomen
for occult malignant lesions
Hallmark of possible malignancy
- Increased localized growth of a lesion in an
extremity + pain
Hematopoietic malignancies (ALL and CML)
sometimes associates with both Ollier's disease and
Maffucci's syndrome

RADIOLOGY
More extensive bone abnormality
Long bones
- radiolucent longitudinal streaks involve the
metaphysis and extend down into the
diaphysis
- epiphyses usually not affected
Cortex overlying thin
Calcification within the lesion
Shortening and angular deformity

ASSOCIATION WITH
CHONDROSARCOMA
More proximal locations - pelvis, proximal
humerus, proximal femur
Deep endosteal erosion - 2/3rd thickness of the
cortex
- CT best evaluate
endosteal erosion

Soft tissue mass

TREATMENT

Multiple enchondromatosis
- more difficult to treat
- no treatment for individual lesions
- obvious deformities - corrective
osteotomy, limb lengthening ,
epiphysiodesis
- monitor indefinitely for malignant change

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