Solitary enchondromas of long bones: pattern of referral and outcome

Abstract

Objectives: Enchondromas are benign cartilaginous tumors, often found incidentally and diagnosed by the radiographic appearance. Active growing enchondromas/low grade chondrosarcomas are diagnosed by clinical symptoms and possibly an aggressive appearance on the radiographs. This study aimed to answer the following questions: Who requests a referral? The radiologist reporting a possibility of sarcoma or the referring physician? What is the outcome of these patients?

Methods: We retrospectively reviewed the medical records of 115 patients with final diagnosis of enchondroma over three consecutive years and recorded the radiological diagnosis on report, patients' symptoms, our initial diagnosis, follow-up, and any decision for a biopsy/surgical management, as well as the histological final diagnosis.

Results: Nearly 80% of patients were referred from an orthopedic surgeon. About half of the imaging reports mentioned a malignancy in the differential diagnosis of enchondroma. Very few had the classic signs of an aggressive/growing cartilage tumor. In radiological evaluation, we found scalloping/cortical erosion, lytic areas, cortical breaks, soft tissue extension in only 12 cases of which 8 underwent a biopsy. Of the study patients, 65% were diagnosed with adjacent joint problems.

Conclusion: Enchondromas are mostly diagnosed incidentally. They are frequently associated with adjacent joint or soft tissue pathologies, which are main source of the symptoms. Even small, well-defined lesions are often confused with a sarcoma or other malignancies, which may be due to the lack of education on bone tumors for both the radiologists and general orthopedists.