Cartilaginous Tumours

• Benign Cartilaginous Tumours


  • Enchondroma

  • Ollier’s Disease

  • Maffucci Syndrome

  • Chondroblastoma
• Enchondroma Overview


  • Age 10-30yrs

  • M:F (1:1)

  • Mc affects the hand

  • Malignant degeneration in <2% (mc chondrosarcoma)

  Features

  • Asymptomatic

  • Can be painful following minor trauma due to pathologic fracture

  • Can cause hard, focal enlargement of a digit

  Differentials: Benign soap-bubbly lesions (FEGNOMASHIC), Bone infarct/chondrosarcoma

  Treatment: Leave me alone lesion (painful or fractured, can be excised)

  Advanced imaging: Not necessary, CT - calcification, Bone scan - hot (bone infart cold)
• Enchondroma Radiographic Features


  • Geographic, expansile lesion with well-defined margins

  • Cortex is intact

  • Can be concentric or eccentric

  • Usually in the metaphysis (but can involve entire bone)

  • 30-50% demonstrate stippled calcification
• Enchondroma


  Well defined mildly expansile lucent lesion with internal septations in the proximal metaphyseal region of the proximal phalange of the third digit.

  
• Enchondroma


  Stippled calcification (serpiginous calcification)

  Differentials: Low grade chondrosarcoma or Bone infarct

  
• Ollier's Disease (Enchondromatosis) Overview


  • Multiple enchondromas

  • Non-hereditary

  • Can get large and atypical looking

  • Can cause growth disturbances and deformities

  • Malignant degeneration in ~10% of cases
• Maffucci Syndrome Overview


  • Multiple enchondromas with soft tissue venous malformations. “Soft tissue hemangiomas”

  • Non-hereditary

  • Malignant degeneration in ~25% of cases
• Maffucci Syndrome


  Well-defined expansile soap bubbly lesions seen through out the hand. Stippled calcification. Soft tissue masses.

  (Multiple enchondromas with multiple soft tissue masses)

  
• Maffucci Syndrome


  Multiple expansile lucent lesions. Deformity. Lots of soft tissue masses.

  
• Chondroblastoma Overview


  • Age 10-25 years

  • M:F (2:1)

  • Mc affects the knee

  Features

  • Long-standing, mild joint pain at the site of the lesion

  Differentials: Giant cell tumor, Eosinophilic granuloma, Avascular necrosis, Degenerative cysts & Chondrosarcoma

  Treatment: Excision

  Advanced imaging: Not necessary
• Chondroblastoma Radiographic Features


  • Well-defined, eccentric, geographic lucency

  • Epiphyseal location, with occasional metaphyseal extension after the growth plate fuses

  • 30-50% demonstrate stippled calcification
• Difference between Chondroblastoma and Giant Cell Tumour

  • Chrondroblastoma starts in the epiphysis and expands into the metaphysis

  • Giant Cell Tumour starts in the metaphysis and expands into the epiphysis

  (Draw a circle around the tumour and put a dot in the centre)
• Ollier's Disease


  Multiple well-defined expansile soap bubbly lucent lesions (multiple enchondromas) through out the bones of the hand and distal radius

  
• Chondroblastoma


  Well-defined lucent lesion in the metaphyseal region of the proximal tibia

  
• Malignant Cartilaginous Tumours


  • Primary chondrosarcoma

  • Secondary chondrosarcoma
• Primary Chondrosarcoma Overview


  • Age 40-60 years

  • M:F (2:1)

  • Many subtypes, we will focus on conventional chondrosarcoma

  • Mc occurs in the pelvis & knee

  • Slow-growing and less aggressive than other bone sarcomas

  • Usually spreads by direct extension but can metastasise to the lungs

  Features

  • Pain & swelling in the region of the lesion

  • Solid soft tissue mass can be palpated if body part is thin enough

  Differentials: Enchondroma, Bone infarct & Low-grade chondrosarcoma

  Treatment: Excision

  Advanced Imaging: CT - calcifications, MRI - staging & Bone scan - hot (bone infarct cold)
• Primary Chondrosarcoma Radiographic Features


  • Variable, can look aggressive or benign

  • Usually large & lucent, ill-defined & expansile

  • 75% will demonstrate calcification

  • Large soft tissue mass, may contain calcification (rings and arcs)

  • Metaphyseal and diaphyseal location
• Primary Chondrosarcoma


  Aggressive lucency surrounding 'enchondroma'. Codman's Triangle. Spiculated periosteal reaction. Soft tissue mass.

  
• Secondary Chondrosarcoma Overview


  • Arise from pre-existing benign lesions (chondroblastoma) usually carilaginous tumour (but also Paget’s disease & fibrous dysplasia)
• Chondrosarcoma


  Large soft tissue mass & cortical destruction

  
• Secondary Chondrosarcoma


  Osteochondroma, malignant degeneration (arc & rings soft tissue calcification) & Large soft tissue mass