From the Guidelines
A chondroma is a benign tumor that originates from cartilage cells, most commonly found in the small bones of the hands and feet, but can also occur in other areas with cartilage, such as long bones, ribs, or pelvis.
Definition and Characteristics
- Chondromas are typically slow-growing and may not cause symptoms unless they press on surrounding tissues or weaken bone structure.
- Diagnosis often involves imaging studies like X-rays, CT scans, or MRI, which show a characteristic appearance of these cartilage-based growths.
- 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.
Treatment and Management
- Small, asymptomatic chondromas often require no treatment and are simply monitored over time.
- If a chondroma causes pain, increases in size, or threatens bone integrity, surgical removal may be recommended, typically involving scraping out the tumor and filling the cavity with bone graft if necessary.
- 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 should be surgically excised, aiming to excise the tumour with a covering of normal tissue over it 1.
Prognosis and Complications
- Chondromas rarely transform into malignant tumors (chondrosarcomas), but this risk increases in certain locations like the pelvis or when the tumors are multiple or large.
- Regular follow-up is important to monitor for any changes that might indicate complications or recurrence.
- Metastatic disease at presentation, histological grade, axial primary site, and size have been reported as prognostic factors in conventional chondrosarcomas 1.
From the Research
Definition of Chondroma
- Chondromas are benign tumors characterized by the formation of mature cartilage 2
- They typically involve the short bones of the hands and feet 2
Characteristics of Chondroma
- Chondromas may be either solitary or multiple as part of enchondromatosis affecting several bones 2
- Cases of multiple enchondromatosis with predominantly unilateral distribution are generally referred to as "Ollier's disease" or when accompanied by multiple hemangiomas as "Maffucci's syndrome" 2
- In cases with multiple chondromas, there is a considerable risk of malignant transformation (approximately 50%) 2
Diagnosis and Treatment
- Diagnosis of chondromas can be challenging, particularly in small biopsies 3
- Imaging characteristics, such as lobulated patterns with a high signal on T2-weighted magnetic resonance imaging (MRI) and ring- and arc-like calcifications on conventional radiography and computed tomography (CT), can be helpful for identification and characterization 4
- Treatment of single lesions (curettage and bone grafting) is usually uneventful, but any therapeutic approach to Ollier's disease or Maffucci's syndrome should be tailored to the individual distribution of lesions in the most severely deformed extremities 2
Malignant Transformation
- Cartilage-forming benign bone tumors are rather prone to undergo malignant transformation 5
- The rate of malignant transformation for cartilage-originating tumors was 5.1% (solitary osteochondromas 4.2%, multiple osteochondromas 9.2%, solitary enchondromas 4.2%) 5
- Early recognition and appropriate surgical treatment are required to achieve successful outcomes 5