Chondromas are a common benign lesions of hyaline cartilage that affect all age groups. They have limited growth ability, and have no aggressive behavior.
- 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)
- 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
- 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 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.
- 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.
- 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.
- 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
- Low-grade chondrosarcoma.
- Fibrous dysplasia.
- Bone islands.
- Bone infarcts.
- Patients with solitary enchondromas usually consists of observation with serial radiographs:
- If the lesion remains radiographically stable and asymptomatic, no further intervention is indicated.
- 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.
Patients with benign lesions generally have a good prognosis if they treated appropriately, and most of them remain asymptomatic.