Chondroma

Introduction:
Chondromas are benign tumors of hyaline cartilage that usually
occur in bones of enchondral origin
 Enchodroma – solitary lesion arise within the medullary cavity
 Ecchondroma – solitary lesion on the surface of bone, called subperiosteal or
juxtacortical chondromas
 Ollier disease - A syndrome of multiple enchondromas or enchondromatosis
 Maffucci syndrome - .enchondromatosis is associated with soft-tissue

Pathogenesis:
Islands of cartilage may persist in the metaphyses of bones formed by
endochondral ossification; sometimes they grow and take on the
characteristics of a benign tumour.

Incidence:
Age; any age but mostly in young people
Site: any bone preformed in cartilage
But frequently occurs in the bones of the hands and foot
May appear in the femur, tibia, and humerus
Usually in the metaphysis

Clinical presentation:
Usually asymptomatic and are discovered incidentally on x-ray or
after a pathological fracture. Lesions may be solitary or multiple and
part of a generalized dysplasia.
X-ray shows
A well-defined, centrally placed radiolucent area at the junction of
metaphysis and diaphysis; sometimes the bone is slightly
expanded. There is no reactive bone formation.
In mature lesions - flecks or wisps of calcification within the lucent area
(pathognomonic)
 During the active phase in adolescence, the lesion may slowly enlarge.
 In the inactive or latent phase in adulthood, the cartilaginous tissue may calcify
in a diffuse punctate or stippled configuration. These calcifications sometimes appear
on the radiograph as subtle “smoke ring” or “ring and arc” images.
 As the lesion matures, it develops a more reactive margin.
 do not enlarge after skeletal maturity
 Enchondromas resemble bone infarcts

Pathology
Gross: pearly-white cartilaginous tissue, with a central area of
degeneration and calcification.
Histologically: appearances are those of simple hyaline cartilage.

It can be difficult to distinguish between an active benign enchondroma and a lowgrade

malignant chondrosarcoma on the basis of histologic examination alone.
Therefore, if there is radiographic evidence of full-thickness cortical destruction (not
just endosteal scalloping from within) or MRI appearance of a soft tissue mass, this
may provide evidence that the lesion is a chondrosarcoma.
Treatment:
Asymptomatic solitary lesion – no treatment. Follow up
Enlarging or pathological fracture – curettage and fill the defect with bone
graft or cement
Recurrence rate – high
Prognosis:
There is a small but significant risk of malignant change –
 Solitary lesions - probably -<2% (hardly ever in a
child)
 Multiple lesions (Ollier’s disease) - 30 %
 Maffucci’s syndrome - 100 % (associated
haemangiomas)

Signs of malignant transformation

Patients over 30 years are:
(1) The onset of pain;
(2) Enlargement of the lesion; and
(3) Cortical erosion.
 biopsy is of little help in this regard as the cartilage usually looks
benign during the early stages of malignant transformation.
 If the other features are present, and especially in older patients
o treated as a stage IA malignancy;
o the biopsy then serves chiefly to confirm the fact that it is a
cartilage tumour.