Enchondroma protuberans. Report of a case and its distinction from chondrosarcoma and osteochondroma adjacent to an enchondroma

Enchondroma protuberans of the hand: A case report

Enchondroma protuberans (EP) is a rare form of enchondroma which demonstrates exophytic growth outside the margins of the bony cortex. A previously healthy 18-year-old male presented with chronic painless palpable mass of the left third finger. Radiograph showed a well-circumscribed expansile lucent lesion in the middle phalanx of the left third finger. The magnetic resonance imaging confirmed an expansile cortical-based lesion extending through the cortex into the soft tissues, which demonstrated high T2 signal with internal foci with low to intermediate signal suggestive of internal chondroid matrix. The patient underwent surgical excision, curettage and bone grafting, and surgical pathology study confirmed the diagnosis of EP. A rare case of EP involving a phalanx of the hand was described in this study. Imaging, particularly magnetic resonance imaging, plays a key role for accurate preprocedural diagnosis.

Enchondroma Protuberans of the Transverse Process of D8 Vertebra Extending to the 7th and 8th Ribs: A Rare Case Report

Background

Enchondroma protuberans (EP) is rare, benign cartilaginous bone tumor arising from the intramedullary cavity of long bones and usually protrudes beyond the cortex with an exophytic growth pattern resembling osteochondroma. This study reports on a rare case of EP arising from the transverse process of the D8 vertebra and extending to the adjacent 7th and 8th ribs and the paraspinal tissues.

Methods

A 45-year-old female patient came in with complaints of upper back pain radiating up to the left costal margin for the past 6 months. There were no parasthesias, and there was no history of any sensory or motor symptoms. On physical examination there was midline and left paraspinal tenderness over the D6 to D8 region. Anteroposterior and lateral X-ray images revealed a well-defined oval ossific mass lesion over the lateral aspect of the D8 vertebra, extending to the 7th and 8th ribs on the left side, and multiple bridging osteophytes were noted. Computed tomography scan showed an ossific mass lesion arising from the D8 transverse process with extension to the adjacent 7th and 8th ribs; its margins were well defined, with no periosteal reaction. Magnetic resonance imaging showed a well-defined expansile mass lesion arising from the transverse process of the D8 vertebra matrix; it was was isointense with adjacent marrow and had no evidence of calcifications or vascular flow voids and no encroachment into the spinal canal.

Results

Complete resection of the mass lesion with the adjacent part of the 7th and 8th ribs and with intramedullary curettage was performed and sent for histopathologic examination. Histopathology showed bony trabeculae with normal mucosal elements, and a mild hypercellularity with binucleation. Chondrocytes in the myxoid matrix located in round lacunae were compatible with enchondroma, with no evidence of atypia. The postoperative period was uneventful, and after 12 months there were no signs of recurrence noted in computed tomography scan.

Conclusions

EP is a rare presentation in the dorsal spine; it should be considered in the differential diagnosis of osteochondroma, enchondroma, chondrosarcoma, and periosteal chondroid tumors.

Enchondroma protuberans of the phalanx

Enchondroma protuberans is a rare tumour that rises from an intramedullary enchondroma with an exophytic growth pattern. Although it causes an interesting clinical picture it is benign, and marginal resection of the tumour with bone grafting of the intramedullary defect is curative. We report a case of an enchondroma protuberans of the fifth middle phalanx of the right hand treated by resection, curettage, and autologous bone grafting, with recovery of the normal function of the hand and fingers.

Enchondroma protuberans of the hand

OBJECTIVE

Enchondroma protuberans is a rare tumor that arises from an intramedullary enchondroma with an exophytic growth pattern. The purpose of this study was to describe imaging findings of this disease that were obtained using both radiography and MRI.

CONCLUSION

It is necessary to understand the characteristic imaging findings of enchondroma protuberans to avoid misdiagnosis. When radiography does not allow a clear diagnosis of enchondroma protuberans, MRI may be helpful for diagnosis.

From the archives of the AFIP: imaging of primary chondrosarcoma: radiologic-pathologic correlation

Chondrosarcoma is a malignant tumor that produces cartilage matrix, and lesions that arise de novo are called primary. Primary chondrosarcoma is the third most common primary malignant tumor of bone, constituting 20%-27% of all primary malignant osseous neoplasms. There are numerous types of primary chondrosarcomas, including conventional intramedullary, clear cell, juxtacortical, myxoid, mesenchymal, extraskeletal, and dedifferentiated. The conventional intramedullary chondrosarcoma is the most frequent type, and it most commonly involves the long bones or pelvis in up to 65% of cases. Although the pathologic appearance varies with specific lesion type, chondrosarcomas grow with lobular type architecture, and these hyaline cartilage nodules demonstrate high water content and peripheral enchondral ossification. Imaging features directly reflect this pathologic appearance, and the various subtypes often show distinctive features. Radiographic findings often suggest the diagnosis of chondrosarcoma because of identification of typical "ring-and-arc" chondroid matrix mineralization (representing the enchondral ossification) and aggressive features of deep endosteal scalloping and soft-tissue extension. These latter features are usually best assessed, as is lesion staging, with computed tomography (CT) or magnetic resonance (MR) imaging. CT is optimal to detect the matrix mineralization, particularly when it is subtle or when the lesion is located in anatomically complex areas. Both CT and MR imaging depict the high water content of these lesions as low attenuation and very high signal intensity with T2-weighting, respectively. Understanding and recognizing the spectrum of appearances of the various types of primary chondrosarcoma allow improved patient assessment and are vital for optimal clinical management including diagnosis, biopsy, staging, treatment, and prognosis.

Enchondroma protuberans: a case report

Enchondroma protuberans is a rare benign cartilaginous tumor. There have been only 5 cases previously described in the world literature. It must be differentiated from other more common and aggressive tumors to avoid radical resection. A case report of a 7-year-old boy presenting with enchondroma protuberans in the third metacarpal is presented. The patient underwent an initial incisional biopsy followed by a marginal resection of the soft tissue component and intramedullary curettage. After a 36-month follow-up period, there is no evidence of recurrence.