Chondrosarcoma of the thumb arising from a solitary enchondroma

Malignant Transformation of an Enchondroma of the Hand: A Case Report

We present the case of the transformation of an enchondroma in the middle phalanx of the fourth finger of the left hand into a chondrosarcoma. The patient presented a lesion with clinical history, examination, and radiology findings consistent with an enchondroma, which was conservatively treated. Two years later, the patient came for a medical visit with a clinical and radiological variation of the lesion. Computed tomography scans and biopsy revealed a lesion with sarcomatous degeneration which was confirmed after the controlled amputation of the fourth finger. The malignant transformation potential of an enchondroma must be considered.

FREE FIBULAR GRAFT RECONSTRUCTION FOLLOWING RESECTION OF CHONDROSARCOMA IN THE FIRST METACARPAL

Chondrosarcoma is most frequently present in the pelvis and long bones and rarely seen in the bones of the hand. Traditionally the treatment of choice for involvment of the hand is ray amputation, however this causes significant functional deficit if there is thumb involvement. There are limited cases in literature of resection of thumb chondrosarcoma with restoration of function. We present a case of high grade chondrosarcoma of the first metacarpal treated with resection and free fibular graft reconstruction. We report excellent functional outcome with this procedure.

Secondary chondrosarcoma

Secondary chondrosarcoma is a distinctive type of tumor that originates from a preexisting cartilaginous lesion. Most commonly, it is associated with solitary or multiple osteochondromas. A fraction of cases arises from other conditions, such as Maffucci syndrome and Ollier disease. A sudden increase in the size of the cartilaginous cap of an osteochondroma is a sign of malignant transformation to secondary chondrosarcoma. However, there is no strict cutoff in terms of thickness of the cartilaginous cap that can be regarded as being pathognomonic of malignancy. Most cases of secondary chondrosarcoma are low to intermediate grade. Distant metastasis is uncommon, and the prognosis is good for most patients. Overall survival at 5 years is approximately 90%. Surgical resection with wide margins is the best treatment option, but local recurrence remains a significant problem in approximately 10% to 20% of patients. Patients with secondary chondrosarcoma of the pelvis are especially at risk for local recurrence.

Retrospective review of outcome after surgical treatment of enchondromas in the hand

BACKGROUND

Tumours of the skeleton of the hand are rare. While the majority of bone tumours are benign (89.4%), a small number show signs of malignancy (4.4%). Among the benign bone tumours of the skeleton of the hand, enchondromas are the most common, at 35-65%.

METHODS

In the period from 1998 to 2005, a total of 35 enchondromas on the hand were diagnosed at the Trauma Center Lorenz Boehler. These were 16 women and 19 men with an average age of 36 years (age range 16-66). The most common site of an enchondroma was the proximal phalanx in 17 cases, followed by the metacarpal bone in 8 cases and the middle phalanx in 5 cases. In five patients, an enchondroma was found in the carpal bones. Twenty-nine patients underwent surgery.

RESULTS

The follow-up findings (average follow-up time, 47 months) were assessed in accordance with the formula outlined by Wilhelm and Feldmaier. Twenty-five of 27 patients who underwent follow-up examination showed an excellent result. In two patients, the result was assessed as good on account of restricted mobility caused by increased scar formation. No recurrence was detected in X-ray controls.

CONCLUSION

Enchondromas of the hand are usually detected after a bagatelle trauma. For accurate diagnosis, conventional X-ray examination and if necessary, a contrast medium MRI should be performed. Histological investigation is compulsory due to the risk of malignancy. Depending on its spread, the defect in the extirpation cavity should be filled with autogenous spongy bone.

Dedifferentiated chondrosarcoma of the thumb: a case report

Dedifferentiated chondrosarcoma (DDCS) comprises approximately 10% of all chondrosarcomas and has the worst outcome with 5-year survival of 10%. The preferred localizations are femur, humerus and pelvis. We report a case of DDCS that arose in proximal phalanx of left-hand thumb of a 66-year-old man. He was admitted with a 2-month history of pain and swelling in his thumb. He had experienced a fracture 15 years ago in the same localization with a history of suspected preexisting enchondroma. Plain radiographs showed an expansive osteolytic lesion with milimetric calcifications while magnetic resonance imaging revealed intraosseous focal globular hyperintense spots consistent with chondroid areas as well as a surrounding soft tissue mass with intermediate signal intensity. In biopsy specimen we observed a low-grade chondrosarcoma next to a spindle cell sarcoma with an abrupt transition. He was treated with amputation and died of the disease within 9 months following the surgery. The presence of dedifferented chondrosarcoma in bones of hands was not previously reported. The presented case was provided with the macroscopic and microscopic features observed in amputation specimen in comparison with radiological findings.

Chondroma in a sesamoid bone of the thumb: case report

Sesamoid tumors of the hand are uncommon. We report a 50-year-old man presenting with a right thumb sesamoid chondroma. Surgical excision was successfully performed. At 12-month follow-up, the thumb function is normal, and there is no evidence of other lesions or recurrence.

A case of metacarpal chondrosarcoma of the thumb

Enchondroma is the most common primary benign bone tumor of the hand. Chondrosarcomas in this location, however, are extremely rare. It often is difficult to make a histological distinction between benign cartilaginous tumors and low-grade chondrosarcomas, because enchondromas at this site often show histological features suggestive of malignancy. However, distinguishing the two conditions is clinically relevant because chondrosarcomas of the hand require prompt and more radical treatments such as ray amputations. On the other hand, Mankin has recently given attention to a less aggressive behavior of chondrosarcomas of the phalanges compared with those of other locations. And also, ray amputation does not cause much functional deficit in the finger but does for the thumb. This is a case report of chondrosarcoma affecting the metacarcal bone of the thumb, treated by en block resection and preserving the function of the thumb by bone graft reconstruction, with reference to the literature.

[Chondrosarcoma of the hand]

The authors report 5 cases of chondrosarcoma of the hand brought together over a period of 20 years. The series comprises 3 men and 2 woman of average age 42 years. In two cases the tumour arose from degeneration in a preexisting lesion of Ollier's disease. Diagnosis was made on clinical and radiological criteria. Confirmation of the diagnosis by histological examination proved to be difficult in 2 cases. The treatment was surgical, with ray amputation in 3 cases and curettage with bone graft in the other 2. None of the patients had a recurrence at 4.5 years mean follow-up.

Chondrosarcoma of the Ring Finger: A Case Report and Review of the Literature

Enchondromas are the most common benign cartilaginous bone tumors arising in the medullary cavity of the small bones of the hand. In contrast, chondrosarcomas, commonly occurring in the pelvis and proximal femur and humerus, are very uncommon at this site. We report an unusual case of chondrosarcoma arising in the ring finger proximal phalanx with its radiological and histological features and reviewed the literature. The patient was an 80-year-old man whose chief complaint was swelling and pain for seven years. The findings of cortical irregular thickening by plain radiography and computed tomography and soft tissue extension by magnetic resonance imaging suggested the tumor was chondrosarcoma rather than a common enchondroma. Thorough curettage and artificial bone grafting was performed because of the age of the patient, his senile dementia and the strong desire of the patient and his family. Histological examination revealed that the tumor was composed of polygonal cells with eosinophilic cytoplasm proliferating in the chondromatous matrix with partially myxoid changes. Nuclear irregularity, binucleated cells, bone permeation and encasement were observed and the tumor was diagnosed as grade 2 chondrosarcoma. The tumor recurred five months after surgery. Amputation of the ring finger including the distal part of the 4th metacarpal was performed. At two years after surgery, the patient was free from recurrence or lung metastasis. In conclusion, details of radiological as well as pathological findings are essential for differential diagnosis between benign enchondroma and chondrosarcoma in the hand. Chondrosarcoma of the hand requires a prompt and more radical treatment than enchondroma. Wide excision is recommended to avoid local recurrence or metastasis.

Deforming chondrosarcoma of the fingers secondary to a long-term enchondromatosis of 28 years

Enchondromatosis of the hand in the context of the Oilier disease is an infrequent pathologie associated with a high rate of malignancy. In this work, we present a case with multiple enchondromas affecting mainly the fourth and fifth rays of the hand, and with multiple ipsilateral lesions in the foot, sacroiliac joint and iliac bone. This patient is, in addition, an unusual case for a long-term progression (28 years), serious deforming appearance and for the double malignant degeneration to chondrosarcoma of the affected fingers. Clinical features, tumor factors, criterion of diagnosis and prognosis, surgical strategy and follow-up evaluation are analysed, as well as a review of the literature.