From the Guidelines
Chondromas are typically benign tumors that can be managed with watchful waiting or surgical removal, depending on their location and symptoms, with the goal of minimizing morbidity and mortality while maintaining quality of life. When considering the management of chondromas, it's essential to weigh the risks and benefits of different approaches. According to the most recent and highest quality study, surgical excision with wide margins is recommended for higher-grade chondrosarcomas (grade II-III) and all chondrosarcomas of the pelvis or axial skeleton 1. Some key points to consider in the management of chondromas include:
- The distinction between benign enchondroma or osteochondroma and atypical cartilaginous tumour/chondrosarcoma grade I can be difficult, but can be aided by the use of dynamic contrast-enhanced MRI 1
- Atypical cartilaginous tumours in the long bones of the limbs can be managed by curettage with or without local adjuvant therapy, with a high chance of success 1
- Low-grade peripheral chondrosarcomas (arising from osteochondromas) should be surgically excised, aiming to excise the tumour with a covering of normal tissue over it 1
- Radiation therapy (RT) can be considered for unresectable disease, after incomplete surgery, and for symptoms palliation, with modern RT techniques and high-dose RT recommended for patients with skull base chondrosarcomas 1
- Evidence suggests that certain subtypes of chondrosarcomas, such as mesenchymal chondrosarcoma (MCS) and dedifferentiated chondrosarcoma (DCS), are more sensitive to chemotherapy (ChT) 1
From the Research
Definition and Types of Chondroma
- Chondroma is a type of benign bone tumor, which can be further classified into different types such as osteochondroma, enchondroma, and extraskeletal chondroma 2, 3, 4.
- Osteochondroma is the most common benign bone tumor, and it can be sessile or pedunculated 2.
- Extraskeletal chondroma is a rare, benign cartilaginous tumor that can occur in various locations, including the neck 4.
Clinical Presentation and Diagnosis
- Chondromas can be asymptomatic, but symptoms may occur due to compression of adjacent vessels or nerves, fractures, osseous deformities, bursa formation, or malignant transformation 2, 3, 4.
- Imaging studies such as X-rays, CT scans, and MRI can help diagnose chondromas, but microscopic differentiation between benign and malignant tumors can be difficult 3, 4.
- Cartilage cap thickness >2 cm in adults or >3 cm in children, as well as new onset of pain or growth, or rapid growth of the lesion, may indicate malignant transformation 2.
Treatment and Prognosis
- Surgical resection is the treatment of choice for symptomatic chondromas, and complete excision with free margin is essential to prevent local recurrence 2, 3, 4.
- Wide excision with a margin of at least 4 cm is recommended for chondrosarcomas, which can arise from benign chondromas 3, 5.
- Chemotherapy and radiation therapy are not effective for conventional chondrosarcomas, but emerging radiation technologies may play a role in treating tumors in complex areas 5.
- Prognosis varies depending on the type and grade of the tumor, with low-grade lesions having a better prognosis than high-grade lesions 5.