Chondroma

March 12, 2021 | By : OrthoFixar | Orthopedic Pathology
| Last updated on March 19, 2021


Chondromas are a common benign lesions of hyaline cartilage that affect all age groups. They have limited growth ability, and have no aggressive behavior.

Location

  • Chondroma occurs on surfaces of distal femur, proximal humerus, and proximal femur, it’s called “periosteal juxtacortical chondromas.
  • When it’s found in the medullary cavity in the metaphysis of long bones, they are called enchondromas.
    • The most common site for enchondromas are the phalanges of the hand (the most common tumor of the small bones of the hands and feet).
  • Enchondromas are rare in flat bones ( pelvis, ribs, scapulae, and vertebrae) and extremely rare in the craniofacial bones.
  • Chondromas may arise from the synovial sheaths of tendons or from the soft tissues adjacent to the tendons in the hand and feet of adults (soft-tissue or synovial chondromas)

Epidemiology

  • The incidence of chondroma is unclear because most lesions are found incidentally.
  • All age groups are affected, but most commonly diagnosed at the age of 20-50 years old.
  • Female = male
See Also: Differential Diagnosis for Bone Lesions

Associated Diseases

Ollier’s disease

  • Ollier’s disease (also called “Multiple enchondromatosis”) is a rare condition in which many cartilaginous tumors appear in the large and small tubular bones and in the flat bones.
  • Inheritance pattern is sporadic.
  • It is caused by failure of normal endochondral ossification.
  • These tumors are located in the epiphysis and the metaphysis and shaft.
  • Deformities resulting from Ollier’s disease include shortening and bowing of the long bones.
    • Shortening is caused by lack of epiphyseal growth, broadening of the metaphyses.
  • Malignancy risk is 25-30 % of patients.

Maffucci Syndrome

  • Maffucci syndrome is a Multiple enchondromatosis (Ollier’s disease) associated with hemangiomas of the overlying soft tissues.
  • Inheritance pattern is sporadic.
  • Malignancy risk is 23-100 % of patients.
    • Patients with Maffucci syndrome also have a markedly increased risk of visceral malignancies, such as astrocytomas and gastrointestinal malignancies.

Clinical Evaluation

  • The patient is usually asymptomatic.
  • Frequently discovered incidentally during an unrelated radiographic examination or after a pathological fracture.
  • When lesions are not causing pain, serial radiographs are obtained to ensure that the lesions are inactive.
    • Radiographs are obtained every 3 to months for 1 to 2 years and then annually as necessary.

Chondroma Radiology

  • Radiology appearance is a benign well-defined tumor with intralesional calcification.
    • These calcification is irregular and has been described as “stippled,” “punctate,” or “popcorn.”
  • The lesion size is 1 to 10 cm.
  • Small endosteal erosion or cortical expansion may be present.
  • Small endosteal erosion (<50% width of the cortex) or cortical expansion may be present.
    • CT is best to evaluate endosteal erosion that could indicate a chondrosarcoma (malignant transformation).
  • Bone scan: increased uptake due to continual remodeling of the endochondral bone within the lesion.
  • MRI shows the lesion as lobular and bright on T2-weighted images, with no bone marrow edema or periosteal reaction.
    • It is not necessary for diagnosis.

Chondroma Histology

  • Gross appearance is of blue-gray, lobulated hyaline cartilage with a variable amount of calcifications throughout the tumor.
  • Endochondral ossification encases the cartilage lobules with lamellar bone.
  • The cells are bland, with uniform, dark-stained nuclei; they have no pleomorphism, necrosis, mitoses, or multinucleate cells.

Chondroma Differential Diagnoses

  1. Low-grade chondrosarcoma.
  2. Fibrous dysplasia.
  3. Bone islands.
  4. Bone infarcts.

Treatment

Non-operative treatment:

  • Patients with solitary enchondromas usually consists of observation with serial radiographs:
    • If the lesion remains radiographically stable and asymptomatic, no further intervention is indicated.

Operative Treatment

  • If a lesion grows, or if it becomes symptomatic:
    • Extended curettage and bone grafting.
  • Pathologic fracture:
    • Currettage and bone grafting with immobilization.
  • Periosteal chondromas are usually excised with a marginal margin.

Prognosis

Patients with benign lesions generally have a good prognosis if they treated appropriately, and most of them remain asymptomatic.


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