Enchondroma

Lee A Fox, MD
Daniel S Williamson, MD, PhD

March 5, 1997

Presentation

Imaging Findings

Plain radiographs demonstrate a 2.0 x 1.0 cm expansile osteolytic lesion (arrows) in the distal half of the fifth metacarpal bone. The lesion is well circumscribed with an internal ground glass appearance. An acute nondisplaced fracture through the proximal aspect of the lesion is likely.

Diagnosis

Discussion

Twenty percent of enchondromas occur in long bones (femur and humerus). They appear as osteolytic lesions with or without calcifications. Slow growth up and down the shaft is observed. Other sites of enchondroma formation are the rib (at the cartilaginous end), sternum, and skull base. Flat bones are rarely affected.

When enchondromas occur in multiple bones, the condition is called multiple enchondromatosis or dyschondroplasia. Ollier’s disease is a rare entity in which widespread enchondromas are present--predominantly on one side of the body. This disease generally affects the extremities, causing foreshortening and deformation of the bones.

Enchondromas are slow growing, clinically benign tumors composed of mature hyaline cartilage. Most are incidentally discovered at an early age (10-30 years) as a palpable bony nodule. Males and females are equally affected. Infrequently they are symptomatic, causing soft tissue swelling and, less likely, pain at the lesion site. Pain can be a sign of pathologic fracture or malignant transformation. No treatment is required for asymptomatic lesions. If fracture occurs, as in this patient, it is usually treated with curretage and bone grafting.

A small percentage of enchondromas will undergo malignant transformation. This is usually a slow process, occurring over decades. It is more common in long bones than short.

References

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