What is the treatment approach for Enchondroma (cartilage tumor)?

Treatment Approach for Enchondroma

For asymptomatic enchondromas, observation with regular radiological follow-up is recommended, while symptomatic or aggressive lesions should be treated with curettage and bone grafting. 1

Diagnosis and Classification

Enchondromas are benign cartilaginous neoplasms that arise from the medullary cavity of bones and cause bone expansion. They typically:

• Grow to sizes up to 3 cm
• Are usually asymptomatic when small 2
• Can be solitary or multiple (in syndromes like Ollier Disease or Maffucci Syndrome)

Warning Signs of Potential Malignancy

• Pain at the site of a cartilaginous lesion (a key indicator of possible malignancy) 2
• Rapid growth of a mass
• Persistent unexplained symptoms 2
• Lesion size >3 cm

Treatment Algorithm

1. Asymptomatic Enchondromas

• Small, incidentally discovered lesions:
  • Regular radiological follow-up is recommended 3
  • Observation is preferred due to the considerable complication rate (23%) associated with curettage 3
  • Follow-up imaging every 6-12 months for 2 years, then yearly 1

2. Symptomatic Enchondromas

• For lesions <2 cm:

  • Curettage with or without local adjuvant therapy (phenol, cement, cryotherapy) 1
  • Autologous bone grafting (can be harvested using minimally invasive techniques) 4

• For lesions 2-6 cm:

  • Wide surgical excision with negative margins 1
  • Consider adjuvant treatments for larger lesions

3. Enchondromas with Pathologic Fractures

• Traditional approach:

  • Allow fracture to heal first, then perform tumor curettage and bone grafting

• Alternative approach:

  • Single-stage procedure through a modified lateral surgical approach
  • Curettage of the tumor and stabilization using injectable calcium sulfate cement 5
  • This approach avoids delayed diagnosis and prolonged disability

4. Location-Specific Considerations

• Phalanges of hands and feet:

  • Malignancy is extremely rare in these locations 2
  • Simple curettage with bone grafting is usually sufficient 6, 7

• Long bones and axial skeleton:

  • Central cartilaginous lesions should be considered atypical cartilaginous tumors/low-grade chondrosarcoma until proven otherwise 2
  • More aggressive surgical approach may be needed

Special Considerations

Malignant Transformation Risk

• Solitary enchondromas rarely transform into chondrosarcomas 3
• Higher risk of malignant transformation (up to 30%) in patients with multiple enchondromas (Ollier Disease or Maffucci Syndrome) 2
• Transformation typically occurs at a median age of 30-52 years 2

Syndromic Patients

• Patients with Ollier Disease or Maffucci Syndrome require lifelong surveillance due to increased risk of malignant transformation 2
• These patients should be educated about potential malignancy risk and advised to seek medical care for concerning symptoms 2

Post-Treatment Follow-up

• For low-grade lesions:

  • Physical examination and imaging of the lesion every 6-12 months for 2 years
  • Then yearly as appropriate 1

• For high-grade lesions or syndromic patients:

  • More intensive follow-up with physical examination and imaging every 3-6 months
  • Chest imaging every 3-6 months for 5 years, then yearly for at least 10 years 1

The treatment approach should be guided by the size, location, symptoms, and radiographic features of the enchondroma, with the primary goal of preventing complications while minimizing unnecessary interventions for benign lesions.