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Enchondroma - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describes the condition of Enchondroma. Follow me on twitter: https://twitter.com/#!/DrEbraheim_UTMC View my profile on Linkedin:   / nabilebraheim   Enchondroma occurs in about 1%. It is a benign cartilage tumor seen as an incidental finding on the x-rays. The cartilage will look like calcified arcs, rings, or punctate calcification. It is located in the metaphysis of long bones such as the proximal femur, proximal tibia, proximal humerus and distal femur. 42% occurs in small tubular bones such as the hands and feet. In fact, it is the most common tumor of the hands and feet. If it occurs in the pelvis or in the scapula, it is chondrosarcoma. Enchondroma is a cartilage lesion with basophilic cytoplasm. It has benign histologic features. It appears acellular or hypocellular with a lot of matrix and some cells that does not have any atypical cells or any pleomorphism. It appears more cellular in the hands and the feet (appears malignant, but it is not malignant). Enchondroma has no symptoms. It is frequently discovered incidentally during unrelated x-ray exams. Enchondroma does not cause pain unless there is a pathologic fracture (check for another source of pain). Sometimes it becomes initially clinically evident after a pathologic fracture, especially in the hands and feet. There is a calcified, well defined lesion. You will see rings, arcs, stippled calcification, and punctate calcification. It is uniformly distributed, no cortical destruction (cortex is intact), endosteal scalloping or erosion can occur, but it is less than 50% of the cortical width and no soft tissue mass. Bone scan will have increased uptake. Bone scan will be “cold” if it is bone infarct (hot in enchondroma). Look at T2 MRI, you will see a lesion with high uptake. You find a lobular lesion and a bright signal on T2 due to the high water content of the cartilage. Biopsy is usually not done. There is difficulty in interpreting the low grade cartilage lesion from enchondroma. When pain or endosteal scalloping occurs in more than 2/3 of the cortex, think about chondrosarcoma (rule out low grade chondrosarcoma). The diagnostic distinction between a benign enchondroma and low grade chondrosarcoma is difficult. It should be based on clinical history and radiographic findings. Chondrosarcoma is usually large in size, it has a soft tissue mass, may have cortical destruction and periosteal reaction with significant endosteal scalloping. There may be lucency on the x-ray and chondrosarcoma occurs more in the pelvis and scapula, and does not occur in the hands or the feet. Enchondroma does not cause symptoms and no need for any treatment such as surgery. Do observation and follow-up x-rays (3 months, 6 months, or yearly) and no further work-up is necessary. If there is pain, check for another source of the pain (enchondroma in the proximal humerus: check for impingement, rotator cuff tear, or arthritis). Enchondroma in the hand and feet: pathological fracture could be treated surgically, especially if the lesion is big, because repeated fractures can occur. Immobilize the fracture with protective splint until union will allow the fracture to heal, then you will do curettage and bone graft. If the lesion is large and further pathologic fracture is expected, then you will do curettage and bone graft. Ollier’s disease is multiple enchondromatosis. The lesion is present from birth. It does not have a known inheritance pattern. It is an inborn error of endochondral ossification. Patient will have shortened, bowed affected limbs. It has a high incidence of malignancy (up to 25%). Maffucci syndrome has multiple enchondromatosis and hemangiomas. It has a high risk of malignant vascular tumor (angiosarcoma).