What is the treatment for an enchondroma (a type of benign bone tumor)?

Treatment of Enchondroma

For solitary, asymptomatic enchondromas in the long bones, observation with annual radiologic follow-up is the preferred initial approach, as malignant transformation is exceedingly rare and surgical intervention carries considerable complication rates. 1, 2

Initial Management Strategy

Asymptomatic Lesions

• Active surveillance is now recommended by some reference centers for non-progressive asymptomatic lesions, particularly in the long bones of the extremities 3
• Annual radiologic follow-up should be performed for asymptomatic enchondromas or atypical cartilaginous tumors in long bones, irrespective of tumor size 2
• Only 6% of conservatively treated enchondromas required surgery for medical indications during follow-up 2
• The complication rate of enchondroma curettage is considerable (23% in one series), making observation a safer option for asymptomatic lesions 1

Symptomatic Lesions Requiring Surgery

• Curettage with or without local adjuvant therapy (phenol, cement, cryotherapy) is the standard treatment for symptomatic enchondromas 3
• Surgical indications include: persistent pain, radiologic growth, pathologic fracture, or patient preference after thorough discussion 2
• Most patients (81%) achieve full range of motion after curettage and bone grafting 4

Location-Specific Treatment Approaches

Hand Enchondromas

• Curettage is the standard of care for symptomatic lesions 5
• Cancellous bone grafting (autologous or allograft) is typically performed after curettage 6, 4
• Patients presenting with pathologic fracture have higher rates of postoperative extension deficit (28% vs 15%) 4
• In the phalanges of hands and feet, malignancy is extremely rare 3

Long Bone Lesions

• Atypical cartilaginous tumors in long bones of the limbs can be managed by curettage with or without local adjuvant therapy 3
• Alternative approach: active surveillance with close radiological monitoring for non-progressive asymptomatic lesions 3

Important Clinical Caveats

Signs of Malignant Transformation

• Pain at the site of a cartilaginous lesion may indicate malignancy 3
• Serial radiographs showing slow increase in size should raise concern 3
• Cartilage "cap" measuring >2 cm or documented growth after skeletal maturity suggests sarcomatous transformation 3
• Contrast-enhanced MRI can reveal high-grade areas and guide biopsy location 3

High-Risk Populations

• Patients with Ollier disease (enchondromatosis) have approximately 30% risk of malignant transformation to chondrosarcoma 3
• Patients with Maffucci syndrome also carry increased malignancy risk 3
• These syndromic patients require closer surveillance and should be counseled appropriately 3
• Recurrence rates are higher in patients with Ollier disease (23%) and giant form lesions (43%) 4

Surgical Technique Considerations

• Curettage followed by cancellous bone grafting is the most common approach 1, 6
• Internal fixation may not be necessary in all cases 4
• Adjuvant therapy options include phenol, cement, and cryotherapy 3
• Wide excision with negative margins is reserved for larger lesions or those with intraarticular/pelvic localization 3

Recurrence and Complications

• Recurrence of solitary enchondromas is rare (approximately 10% with minimum 2-year follow-up) 4
• Malignant transformation of solitary enchondroma to chondrosarcoma is exceedingly rare 1
• Postoperative complications include joint stiffness and soft-tissue deformities 5
• Most patients return to full function after surgery 5

Role of Chemotherapy and Radiation

• Chemotherapy has no role in the treatment of benign enchondromas 3
• Radiation therapy is not indicated for benign enchondromas 3
• These modalities are reserved only for malignant transformation to chondrosarcoma 3