Enchondroma & Chondroblastoma Flashcards
What are enchondromas comprised of?
hyaline cartilage
What population is primarily affected by enchondromas?
10-30 years (<20), keep for life
Enchondromas form in bones of ____ ossification.
endochondral
What is the preferential location of enchondromas?
- medullary long bone
- hands & feet
If an enchondroma undergoes malignant degeneration, what will it turn into?
chondrosarcoma
What is the chance of malignant transformation in a solitary enchondroma?
<1%
Multiple enchondromas are referred to as ____
Ollier Disease
(has possible hereditary component)
What is the chance of malignant transformation in Ollier Disease?
25%
Multiple enchondromas plus soft tissue hemangiomas are referred to as ____
Mafucci Syndrome
(rare)
Ollier Disease plus soft tissue hemangiomas are referred to as ____
Mafucci Syndrome
(rare)
What is the chance of malignant transformation in Mafucci Syndrome?
50%
What are the multiple forms of enchondroma called?
- Ollier disease
- Mafucci syndrome
What is the most common benign tumor of the hands and feet?
Enchondroma
How would a patient with an enchondroma present clinically?
- usually asymptomatic (incidental finding)
- Patho Fx (painful)
- No Fx + pain = possible malignancy
How would you differentiate between an enchondroma and a chondrosarcoma?
use MRI with contrast (inject with gadolinium) to highlight vascular structures
- enchondroma shows up normal
- chondrosarcoma shows high contrast (^angiogenesis)
What are the radiographic characteristics of an enchondroma?
- geographic lytic lesion w/ or w/out sclerotic border
- narrow/short ZoT
- 50% have stippled calcification
- intact & thinned cortex (expansile)
- endosteal scalloping
How does the matrix of an enchondroma in a long tubular bone compare to one in the hands and feet?
less geographic lytic, more stippled calcification (DDx: ICE)
What is endosteal scalloping?
curvilinear/ridged edges of inside surface of bone (endosteum) due to pressure erosion
How would a patient with Ollier Disease present clinically?
- manifests <10yrs old
- severe skeletal deformity
- shortened bones (dwarfing)
- patho Fx
What type of matrix calcification is seen in Ollier disease?
stippled calcification (hyaline cartilage)
What is the pattern of destruction in Ollier disease?
geographic lytic
Small, round lumps of calcium that form in a person’s veins, which may show up as white spots radiographically are called ____
phleboliths
What are the radiographic characteristics of Mafucci syndrome?
- multiple geographic lytic lesions
- phleboliths outside of pelvic basin
Multiple phleboliths outside of the pelvic basin indicates ____
hemangiomas
How would a patient with Mafucci syndrome present clinically?
- young manifestation
- shortened bones
- dense, purple-coloured skin
- bone deformities
- patho Fx
What is your list of differential diagnoses for stippled calcification in the medullary canal of a tubular bone in a patient under 40 years old?
- Enchondroma
- Chondrosarcoma
- Infarct
What is your list of differential diagnoses for stippled calcification in the medullary canal of a tubular bone in a patient over 40 years old?
- Chondrosarcoma
- Enchondroma
- Infarct
What follow-up would you order to determine a differential diagnosis for stippled calcification in the medullary canal of a tubular bone?
MRI w/ contrast
(NOT a biopsy, avoid mets)
What is another name for Ollier disease?
enchondromatosis
What is the preferential location of chondroblastomas?
- epiphyses (articular ends) & apophyses
- endochondral bones
- 90% medullary, 10% cortical
What age group is primarily affected by chondroblastomas?
10-25 years (prior to closure of epiphyses)
How would a patient with a chondroblastoma present clinically?
joint pain that is difficult to recreate with ortho tests
(bone pain, not mechanical)
What are the radiographic characteristics of chondroblastomas?
- geographic lytic lesion in epiphyseal region
(slow-growing, well-defined borders) - 3-6cm circular lesion
- internal calcification (50%)
What is your list of differential diagnoses for a bubbly lytic lesion involving the epiphysis or metaepiphysis of a young patient?
- ABC
- GCT
- Brodie abscess
What type of matrix calcification would be seen in a chondroblastoma?
stippled
What is the most common tumor to cross an open growth plate?
ABC
(starts in metaphysis)
What is the second most common tumor to cross an open growth plate?
chondroblastoma
(starts in epiphysis)
What imaging result gives an indirect indication that a chondroblastoma is painful?
STIR MRI for edema in marrow
(halo of edema)
What is the most likely diagnosis?
Enchondroma
50 year old patient. What is your list of differentials in order from most to least likely?
(Stippled - ICE)
1. Chondrosarcoma
2. Enchondroma
3. Infarct
What is the diagnosis?
Mafucci syndrome
What is the most likely diagnosis?
Enchondroma
What is the most likely diagnosis?
Enchondroma
What is the diagnosis?
Mafucci syndrome
Painful knee. There are 2 diagnoses present. Give both in order of clinical significance.
- Chondroblastoma (epiphyseal, kid)
- Bipartite patella
