|
Year |
2002 |
|---|---|
|
Question Number |
140. |
|
Category |
Orthopaedic Disease |
Question
Low-grade malignant cartilage tumors of bone and best distinguished from benign cartilage tumors by
1- Immunohistochemical studies
2- Evaluating pain pattern and staging studies
3- Uptake on a bone scan
4- The Histologic appearance
5- The location of the lesion
Figures
Answer (click for answer)
Preferred Response: 2
The article quoted is from the academy journal and is a guide on how to differentiate enchondromas from low grade chondrosaracomas. Enchondromas are benign intramedullary tumors often found in the short tubular bones in the hands, but can be found in long bones. They are often asymptomatic and radiographs often demonstrate small cartilaginous lesions with intramedullary calcifications. Histologically they exhibit discrete islands of hyaline cartilage surrounded by lamellar bone. Low grade chondrosarcomas resemble enchondromas radiologically and histologically. They are, however, usually painful, located in the metaphysis of the humerous, femur, or tibia and are usually greater then 5 cm. Open biopsy of the lesion provides superior results versus needle biopsy. Most authors prefer to wait until final pathologic diagnosis has been made before further treatment. These tumors are staged according to the Enneking staging system. Enchondromas: I->tumor is latent, II-> tumor is active, III-> tumor is aggressive and for chondosarcomas: I-> Non-metastatic low-grade, II-> Non-metastatic high grade, III->Metastatic. Also A & B are added to the chondrosarcoma staging if the lesion has stayed within the bone (A) or extends outside of the bone (B).
Enchondromas are usually treated non-operatively with serial x-rays unless a pathologic fracture exists in which case excision and reconstruction are performed.
Chondrosarcomas are treated with wide-excision and usually the use of an adjuvant therapy either with cauterization of the cavity or with phenol and glycerol dabbed on the bone after the excision.
Reference: *Marco RA, et al. Cartilage tumors: Eval and treatment. JAAOS 2000; 8:292-304.