From the Guidelines
Enchondromas should be managed with observation and periodic imaging, with surgical intervention considered if symptoms develop or if there's concern for malignant transformation, as the risk of chondrosarcoma is significant, occurring in about 30% of patients, particularly in those with Ollier disease or Maffucci syndrome 1.
Enchondroma Overview
Enchondromas are benign, cartilaginous neoplasms that arise from the medullary cavity of bones, causing bone expansion, and typically grow to sizes up to 3 cm without causing pain 1. They can occur in various bones but are most commonly found in the short and long tubular bones of the limbs.
Diagnosis and Management
Diagnosis is primarily based on clinical findings, and when assessing individuals, it's crucial to consider alternate diagnoses such as other bone disorders 1. For asymptomatic enchondromas, no immediate treatment is necessary; instead, observation with periodic imaging (usually X-rays every 6-12 months initially) is recommended. However, surgical intervention should be considered if the enchondroma causes pain, increases the risk of fracture, shows growth on follow-up imaging, or if there's any concern for malignant transformation into chondrosarcoma, which can occur in about 30% of patients 1.
Risk of Malignant Transformation
The risk of malignant transformation to chondrosarcoma is a significant concern, particularly in conditions like Ollier disease and Maffucci syndrome, where multiple enchondromas are present 1. Local pain is a typical symptom of transformation, but asymptomatic cases can also occur. Increasing tumor size may also suggest transformation. Despite this, the prognosis for patients with secondary chondrosarcomas is generally good, with a 5-year survival rate of more than 90%, due to the often low grade of the sarcoma and its rare metastasis 1.
Special Considerations
In conditions like Ollier disease and Maffucci syndrome, the presence of multiple enchondromas not only increases the risk of malignant transformation but also introduces other complexities, such as the potential for vascular lesions in Maffucci syndrome, which can undergo malignant transformation in about 8.5% of cases 1. Therefore, a comprehensive approach to management, including regular monitoring and a low threshold for investigating symptoms or changes in the enchondroma, is essential to ensure early detection of potential complications 1.
From the Research
Definition and Treatment of Enchondroma
- Enchondromas are benign bone tumours originating from cartilages, mainly discovered incidentally in radiographs or due to symptoms like pathological fracture or pain 2.
- The two major treatment methods for enchondromas are conservative treatment through regular check-up and surgical excision using curettage 2.
Surgical Treatment Options
- Simple curettage is recommended for most expanding or symptomatic lesions, while small localized asymptomatic lesions can be treated conservatively 2.
- A study found that the combination of meticulous curettage, phenolization, and coralline hydroxyapatite grafting is a safe technique that prevents recurrence and allows adequate new bone formation 3.
- Another study found that intralesional curettage strategies for symptomatic benign to low-grade malignant chondrogenic tumors are feasible, but surgery did not prove superior compared to conservative clinical and radiological observation 4.
Outcomes of Surgery for Enchondromas
- A study found that half of the patients who underwent surgery for enchondromas involving hand phalanges and metacarpals were asymptomatic and fully recovered functionally, while the other half complained of some symptoms 5.
- Another study found that additional bone grafting in the treatment of enchondromas is not necessary and should be reserved for particular indications 6.
- The approach to managing the tumour cavity after curettage has no significant effect on outcomes, which are essentially satisfactory 5, 6.
Comparison of Treatment Methods
- A study compared the outcomes of conservative and surgical treatment of enchondromas and found that both groups had excellent and almost equal MSTS scores, but significantly less functional limitations were found in the non-surgery group 4.
- Sub-analysis of histologically diagnosed enchondromas in the surgery group found more pain, less function, and worse MSTS score compared to the non-surgery group 4.
- Larger lesions displayed significantly worse results after surgery compared to conservative treatment 4.