BENIGN CARTILAGE FORMING TUMORS

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BENIGN CARTILAGE FORMING TUMORS

• PRESENTED BY
• G. MICHAEL WHITEHEAD, B.S., D.C., D.A.C.B.R.

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OSTEOCHONDROMA

• PRESENTED BY
• G. MICHAEL WHITEHEAD, B.S., D.C., D.A.C.B.R.

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OSTEOCHONDROMA

• General Considerations
• Aka Osteocartilaginous exostosis
• Cartilaginous-capped bony growth off the surface
  of the bone
• M/C benign skeletal growth
• Growth of osteochondromas continues to maturity

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OSTEOCHONDROMA

• General Considerations
• Growth of the osteochondroma continues to
  maturity.
• Presentations
• Solitary osteochondroma
• Multiple osteochondromas
• HME (Hereditary multiple exostosis)
• Pedunculated or sessile

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OSTEOCHONDROMA

• Signs and Symptoms
• M/C age at discovery ? 10-20 yoa
• Male to female 21
• Majority are asymptomatic
• M/C complaint ? hard painless mass near a joint
• Fracture of the stalk ? pain and swelling
• Pressure on nerves and vessels
• Malignant degeneration to chondrosarcoma

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OSTEOCHONDROMA

• Skeletal Locations
• M/C locations distal femur and proximal tibia
• Humerus, scapula, pelvis, ribs, vertebrae and
  sacrum are less common sites
• Long bones metaphyseal
• Spine secondary centers of ossification

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OSTEOCHONDROMA

• Radiographic
• Pedunculated
• Osteocartilaginous cap on a long narrow stalk
• M/C locations knee, hip and ankle
• Sessile
• Broad base with localized widening of shaft

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OSTEOCHONDROMA

• Radiographic
• Uninterrupted merging of the cortex and medullary
  bone of the host bone with the osteochondroma
• Cartilaginous cap may calcify extensively
• Osteochondroma points away from the joint (coat
  hanger exostosis)

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OSTEOCHONDROMA

• Advanced Imaging
• Bone scintigraphy demonstrates uptake
• CT and MRI are helpful in assessing the thickness
  of the cartilaginous cap
• CT and MRI are beneficial in suspected cases of
  malignant degeneration

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OSTEOCHONDROMA

• Differential Diagnosis
• Supracondylar process
• Enchondroma
• Trevors Disease
• Blounts disease

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HEREDITARY MULTIPLE EXOSTOSIS

• General Considerations
• Aka HME, diaphyseal aclasia
• Characterized by multiple osteochondromas mainly
  in the metaphysis
• Relatively common condition
• Malignant degeneration to chondrosarcoma

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HEREDITARY MULTIPLE EXOSTOSIS

• Signs and Symptoms
• M/C discovered between ages 2 and 10
• Males 21 over females
• Hard, painless masses near joints
• Bone deformity
• Usually bilateral and symmetrical

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HEREDITARY MULTIPLE EXOSTOSIS

• Signs and Symptoms
• Symptoms related to nerve and blood compromise
  and joint movement.
• Bayonet hand deformity
• Shortening of the ulna.
• Outward bowing of radius.
• Subluxation of radio-ulnar joint.

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HEREDITARY MULTIPLE EXOSTOSIS

• Skeletal Locations
• Long bones especially of the lower extremity are
  m/c sites
• Pelvis, ribs, scapula
• Shortening of the metacarpals and phalanges
  occurs

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ENCHONDROMA

• PRESENTED BY
• G. MICHAEL WHITEHEAD, B.S., D.C., D.A.C.B.R.

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ENCHONDROMA

• General Considerations
• Aka Chondroma
• Benign tumor of cartilage
• Originates from a cartilage rest displaced from
  the epiphyseal plate
• Lesions located near the axial skeleton have
  greater potential for malignant degeneration
• M/C benign tumor of the hand

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ENCHONDROMA

• Signs and Symptoms
• Incidence greatest between 2nd and 5th decade
• MF
• Usually asymptomatic in short tubular bones and
  discovered incidentally or after pathologic
  fracture
• Pain or pathologic fracture in long bones

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ENCHONDROMA

• Skeletal Locations
• M/C site short tubular bones of hands
• Humerus, femur
• Toes, metatarsals, tibia, fibula, ulna
• Rare sites include ribs, sternum, pelvis

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ENCHONDROMA

• Radiographic
• Metaphyseal origin with apparent migration down
  the shaft
• May extend into epiphysis after the plate closes
• Usually involves the middle and distal aspects of
  metacarpals and proximal aspect of the phalanges
• Central or slightly of axis location within the
  medullary cavity

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ENCHONDROMA

• Radiographic
• Well marginated geographic lesion
• Thin cortex or thickened cortex, endosteal
  scalloping
• Often are expansile
• No cortical breakthrough
• Matrix calcification ? sparse or very heavy
• Bone scintigraphy demonstrates uptake

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ENCHONDROMA

• Treatment and Prognosis
• Most lesion require no treatment
• Symptomatic lesions require careful curettage,
  cryosurgery and bone chips
• Irradiation is contraindicated
• Potential for malignant degeneration

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ENCHONDROMA

• Differential Diagnosis
• Medullary bone infarct
• Chondrosarcoma
• Epidermoid inclusion cyst

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MULTIPLEENCHONDROMATOSIS

• General Considerations
• Aka Olliers disease
• Osseous dysplasia characterized by hypertrophic
  cartilage that has not been resorbed or ossified
  normally.
• Usually discovered before 10 years of age

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MULTIPLEENCHONDROMATOSIS

• Signs and Symptoms
• Marked shortening of the extremities
• Severe deformity, deforming masses, and facial
  asymmetry
• Maffucci syndrome
• Enchondromas
• Cavernous hemangiomatosis

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MULTIPLEENCHONDROMATOSIS

• Radiographic
• Rounded or linear radiolucencies in metaphyses
  and shafts of tubular bones
• Lesions are expansile with or without matrix
  calcification
• Bone shortening and deformity due to eccentric
  growth

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CHONDROBLASTOMA

• General Considerations
• Aka Codmans tumor
• Uncommon bone tumor originating from
  chondroblasts in the epiphyseal cartilage plate
• Usually seen before epiphyseal plate closure

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CHONDROBLASTOMA

• Signs and Symptoms
• Peak age range is 10-25 Range 8-59
• Joint pain, tenderness, heat, swelling
• Limitation of motion
• Weakness, numbness and muscle atrophy

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CHONDROBLASTOMA

• Skeletal Locations
• Arises in epiphyseal cartilage plate, extends
  into the epiphysis
• M/C sites distal femur, proximal tibia, upper
  humerus, femoral head and greater trochanter,
  distal tibia

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CHONDROBLASTOMA

• Radiographic
• Well demarcated, oval or round radiolucency
• Most are eccentric and may expand the cortex
• Matrix calcification on occasion
• Thin, sharply demarcated sclerotic margin is
  characteristic

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CHONDROBLASTOMA

• Differential Diagnosis
• Giant-cell tumor
• Complications
• Formation of secondary ABC
• Malignant degeneration after radiation treatment