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Yiannakas M, Ioannides C, Pantzara M, Michaelides M. Radiofrequency ablation for the treatment of a presumed enchondroma in the flat bones of the pelvis. Skeletal Radiol 2023; 52:1057-1061. [PMID: 36773084 DOI: 10.1007/s00256-023-04291-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/12/2023]
Abstract
Herein, a 30-year-old Caucasian female who presented with a persistent pain in the right pelvic region due to an enchondroma and treated with RF ablation is described. An initial MRI of the pelvis revealed a well-circumscribed lesion in the right inferior ischiopubic ramus with a maximum diameter of 9.5 mm. The final diagnosis was established by a percutaneous CT-guided bone biopsy, which excluded malignancy and revealed an enchondroma. About a month after the biopsy, a percutaneous radiofrequency ablation (RFA) of the lesion was performed. The symptoms resolved completely gradually 2 months after the treatment and a follow-up imaging with MRI showed complete resolution of the pathological enhancement indicating necrosis of the lesion. RFA has not been previously reported as a treatment option of enchondromas found in flat bones of the pelvis and could be a safe alternative minimally invasive treatment option in such cases, avoiding major operations.
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Affiliation(s)
- Marios Yiannakas
- Department of Diagnostic and Interventional Radiology, German Oncology Center, 1 Nikis Ave, 4108, Limassol, Cyprus.
| | - Cleanthis Ioannides
- Department of Diagnostic and Interventional Radiology, German Oncology Center, 1 Nikis Ave, 4108, Limassol, Cyprus
| | - Maria Pantzara
- Department of Diagnostic and Interventional Radiology, German Oncology Center, 1 Nikis Ave, 4108, Limassol, Cyprus
| | - Michalis Michaelides
- Department of Diagnostic and Interventional Radiology, German Oncology Center, 1 Nikis Ave, 4108, Limassol, Cyprus
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Gassert FG, Breden S, Neumann J, Gassert FT, Bollwein C, Knebel C, Lenze U, von Eisenhart-Rothe R, Mogler C, Makowski MR, Peeken JC, Wörtler K, Gersing AS. Differentiating Enchondromas and Atypical Cartilaginous Tumors in Long Bones with Computed Tomography and Magnetic Resonance Imaging. Diagnostics (Basel) 2022; 12:diagnostics12092186. [PMID: 36140587 PMCID: PMC9497620 DOI: 10.3390/diagnostics12092186] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/27/2022] [Accepted: 09/06/2022] [Indexed: 11/16/2022] Open
Abstract
The differentiation between the atypical cartilaginous tumor (ACT) and the enchondromas is crucial as ACTs require a curettage and clinical as well as imaging follow-ups, whereas in the majority of cases enchondromas require neither a treatment nor follow-ups. Differentiating enchondromas from ACTs radiologically remains challenging. Therefore, this study evaluated imaging criteria in a combination of computed tomography (CT) and magnetic resonance (MR) imaging for the differentiation between enchondromas and ACTs in long bones. A total of 82 patients who presented consecutively at our institution with either an ACT (23, age 52.7 ±18.8 years; 14 women) or an enchondroma (59, age 46.0 ± 11.1 years; 37 women) over a period of 10 years, who had undergone preoperative MR and CT imaging and subsequent biopsy or/and surgical removal, were included in this study. A histopathological diagnosis was available in all cases. Two experienced radiologists evaluated several imaging criteria on CT and MR images. Likelihood of an ACT was significantly increased if either edema within the bone (p = 0.049), within the adjacent soft tissue (p = 0.006) or continuous growth pattern (p = 0.077) were present or if the fat entrapment (p = 0.027) was absent on MR images. Analyzing imaging features on CT, the likelihood of the diagnosis of an ACT was significantly increased if endosteal scalloping >2/3 (p < 0.001), cortical penetration (p < 0.001) and expansion of bone (p = 0.002) were present and if matrix calcifications were observed in less than 1/3 of the tumor (p = 0.013). All other imaging criteria evaluated showed no significant influence on likelihood of ACT or enchondroma (p > 0.05). In conclusion, both CT and MR imaging show suggestive signs which can help to adequately differentiate enchondromas from ACTs in long bones and therefore can improve diagnostics and consequently patient management. Nevertheless, these features are rare and a combination of CT and MR imaging features did not improve the diagnostic performance substantially.
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Affiliation(s)
- Felix G. Gassert
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California San Francisco, 185 Berry St., Suite 350, San Francisco, CA 94107, USA
- Correspondence: ; Tel.: +49-89-4140-8797
| | - Sebastian Breden
- Department of Orthopaedic Surgery, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Jan Neumann
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Florian T. Gassert
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Christine Bollwein
- Department of Pathology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Carolin Knebel
- Department of Orthopaedic Surgery, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Ulrich Lenze
- Department of Orthopaedic Surgery, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Rüdiger von Eisenhart-Rothe
- Department of Orthopaedic Surgery, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Carolin Mogler
- Department of Pathology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Marcus R. Makowski
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Jan C. Peeken
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
- Institute of Radiation Medicine (IRM), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, 85764 Munich, Germany
| | - Klaus Wörtler
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Alexandra S. Gersing
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
- Department of Neuroradiology, University Hospital of Munich (LMU), Marchioninistrasse 15, 81377 Munich, Germany
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[Knee pain in a female marathon runner]. Radiologe 2017; 58:68-71. [PMID: 29236137 DOI: 10.1007/s00117-017-0328-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
Primary cartilage-forming tumors of the bone are frequent entities in the daily work of skeletal radiologists. This article describes the correlation of pathology and radiology in cartilage-forming skeletal tumors, in particular, enchondroma, osteochondroma, periosteal chondromas, chondroblastoma and various forms of chondrosarcoma. After reading, the radiologist should be able to deduce the different patterns of cartilage tumors on radiographs, CT, and MRI from the pathological aspects. Differentiation of enchondroma and chondrosarcoma is a frequent diagnostic challenge. Some imaging parameters, e. g., deep cortical scalloping (more than two thirds of the cortical thickness), cortical destruction, or a soft-tissue mass, are features of a sarcoma. Osteochondromas are bony protrusions with a continuous extension of bone marrow from the parent bone, the host cortical bone runs continuously from the osseous surface of the tumor into the shaft of the osteochondroma and the osteochondroma has a cartilage cap. Chondromyxoid fibromas are well-defined lytic and eccentric lesions of the metaphysis of the long bones, with nonspecific MRI findings. Chondroblastomas have a strong predilection for the epiphysis of long tubular bones and develop an intense perifocal bone marrow edema. Dedifferentiated chondrosarcomas are bimorphic lesions with a low-grade chondrogenic component and a high-grade noncartilaginous component. Most chondrogenic tumors have a predilection with regard to site and age at manifestation.
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González Del Pino J, Lozano Calderón SA, Chebib I, Jupiter JB. Intralesional Versus Wide Resection of Low-Grade Chondrosarcomas of the Hand. J Hand Surg Am 2016; 41:541-549.e5. [PMID: 26803570 DOI: 10.1016/j.jhsa.2015.12.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 12/14/2015] [Accepted: 12/14/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To report our experience with intralesional curettage (resection with positive margins) and amputation (resection with negative margins) of low-grade chondrosarcomas (LCS) of the hand. MATERIALS AND METHODS Skeletally mature patients treated surgically for LCS of the hand at our institutions were reviewed. Demographics and oncological history were collected. Results of the entire cohort and by treatment modality were analyzed radiographically, functionally (strength, Disabilities of the Arm, Shoulder, and Hand measure), cosmetically, and oncologically (recurrence, Musculoskeletal Tumor Society score, metastasis, and mortality rates). RESULTS Seventeen cases in 16 patients were identified. Nine patients were women. Average age at surgery was 43 years (range, 20-80 years). Mean follow-up was 18 years (range, 9-23 years). Six of the 17 lesions treated at different institutions with intralesional procedures presented as recurrent disease. We treated 3 with a repeat intralesional procedure and the remaining with wide resection. Recurrence incidence was the same in both groups. The remaining 11 new-onset cases were treated with intralesional procedures (6) or wide resections (5). One of the 6 tumors treated with an intralesional procedure recurred. None treated with wide resection recurred. Recurrence incidence combining new- onset and recurrent disease after intralesional procedures was 22% versus 13% for wide resections. Average grip strength was 37 kg (range, 21-55 kg), and pinch strength was 7.6 kg (range, 4.5-12.5 kg). Mean Disabilities of the Arm, Shoulder, and Hand score was 2 (range, 0-10). There were no wound complications, and appearance was satisfactory in most cases (visual analog scale score, > 8). Average Musculoskeletal Tumor Society score was 29 points (range, 21-30 points). No patients presented with metastatic disease or died because of LCS. CONCLUSIONS Intralesional resections aiming to preserve function are safe, recognizing that more than 1 procedure may be required. Amputation also plays a role with excellent functional outcome in cases in which severe joint deformity or involvement of soft tissues and neurovascular structures interferes with function. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Juan González Del Pino
- Department of Orthopaedic Surgery, Division of Hand Surgery, Hospital Universitario Santa Cristina, Madrid, Spain
| | - Santiago A Lozano Calderón
- Department of Orthopaedic Surgery, Division of Musculoskeletal Oncology, Harvard Medical School, Massachusetts General Hospital, Beth Israel Deaconess Medical Center, Boston, MA.
| | - Ivan Chebib
- James Homer Wright Pathology Laboratory, Massachusetts General Hospital, Boston, MA
| | - Jesse B Jupiter
- Department of Orthopaedic Surgery, Division of Hand Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA
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Beer-Furlan A, Balsalobre L, Vellutini EAS, Stamm AC. Endoscopic Endonasal Approach in Skull Base Chondrosarcoma Associated with Maffucci Syndrome: Case Series and Literature Review. World Neurosurg 2015; 85:365.e7-15. [PMID: 26348567 DOI: 10.1016/j.wneu.2015.08.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 08/21/2015] [Accepted: 08/22/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Maffucci syndrome is a nonhereditary disorder in which patients develop multiple enchondromas and cutaneous, visceral, or soft tissue hemangiomas. The potential malignant progression of enchondroma into a secondary chondrosarcoma is a well-known fact. Nevertheless, chondrosarcoma located at the skull base in patients with Maffuci syndrome is a very rare condition, with only 18 cases reported in the literature. CASE DESCRIPTION We report 2 other cases successfully treated through an expanded endoscopic endonasal approach and discuss the condition based on the literature review. CONCLUSIONS Skull base chondrosarcoma associated with Maffucci syndrome is a rare condition. The disease cannot be cured, therefore surgical treatment should be performed in symptomatic patients aiming for maximal tumor resection with function preservation. The endoscopic endonasal approach is a safe and reliable alternative for the management of these tumors.
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Affiliation(s)
- André Beer-Furlan
- São Paulo Skull Base Center, São Paulo, Brazil; DFVneuro Neurosurgical Group, São Paulo, Brazil.
| | - Leonardo Balsalobre
- São Paulo Skull Base Center, São Paulo, Brazil; São Paulo ENT Center, Professor Edmundo Vasconcelos Hospital, São Paulo, Brazil
| | - Eduardo A S Vellutini
- São Paulo Skull Base Center, São Paulo, Brazil; DFVneuro Neurosurgical Group, São Paulo, Brazil
| | - Aldo C Stamm
- São Paulo Skull Base Center, São Paulo, Brazil; São Paulo ENT Center, Professor Edmundo Vasconcelos Hospital, São Paulo, Brazil
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Mermerkaya MU, Bekmez S, Karaaslan F, Danisman M, Kosemehmetoglu K, Gedikoglu G, Ayvaz M, Tokgozoglu AM. Intralesional curettage and cementation for low-grade chondrosarcoma of long bones: retrospective study and literature review. World J Surg Oncol 2014; 12:336. [PMID: 25382793 PMCID: PMC4246483 DOI: 10.1186/1477-7819-12-336] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 10/20/2014] [Indexed: 12/16/2022] Open
Abstract
Background Various treatment strategies for low-grade chondrosarcomas with variable outcomes have been reported in the literature. The aim of this study was to assess the oncological and functional outcomes associated with intralesional curettage followed by adjuvant therapy comprising high-speed burring, thermal cauterization, and bone cementation with polymethylmethacrylate. Methods We performed a retrospective review of 21 consecutive patients with intramedullary low-grade chondrosarcoma of long bones treated by intralesional curettage and adjuvant therapy comprising high-speed burring, thermal cauterization, and cementation at our institution from 2007 to 2012. Results The average age of the patients was 48.7 (range, 18–71) years. There were 7 male and 14 female patients. The mean follow-up period was 58.4 (range, 26–85) months after surgery. The treated lesions were located in the proximal humerus (n =10), proximal tibia (n =6), and distal femur (n =5). At the average follow-up time point of 58.4 (range, 26–85) months, no patient had developed local recurrence and no distant metastases were observed. The average Musculoskeletal Tumor Society score among all 21 patients was 95% (84–100). Conclusions The combination of intralesional curettage, application of high-speed burring, thermal cauterization, and cementation is an effective treatment strategy for low-grade intramedullary chondrosarcoma of long bones. Excellent oncological and functional results can be obtained.
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Westhoff B, Stefanovska K, Krauspe R. [Hereditary multiple exostoses]. DER ORTHOPADE 2014; 43:725-32. [PMID: 25118677 DOI: 10.1007/s00132-013-2224-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Hereditary multiple exostosis (HME) is a hereditary autosomal dominant disease in which multiple exostoses occur. Typically, the exostoses are primarily located at the metaphysis and migrate with continued growth towards the diaphysis. Clinical problems are caused by local pain, impingement of muscle tendons and neurovascular structures, malformation - especially in the forearm - and malignant transformation - especially exostoses at the trunc and pelvic girdle. METHODS A causal therapy is currently not available. Mechanical irritation is an indication for resection of the exostosis. Axial deviation of the lower extremity is treated according to the same principles as primary malalignments (temporary hemiepiphysiodesis/corrective osteotomy). RESULTS The indication for correction of axial deviation at the upper extremity depends on age, extent as well as functional and cosmetic impairment. This should be discussed with the patient in detail. The patient has to be informed about the risk of malignant transformation after cessation of growth. Growing mass or new occurrence of symptoms after end of growth are suspicious and require further diagnostic examinations.
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Affiliation(s)
- B Westhoff
- Klinik für Orthopädie und Orthopädische Chirurgie, Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland,
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Herget GW, Kontny U, Saueressig U, Baumhoer D, Hauschild O, Elger T, Südkamp NP, Uhl M. [Osteochondroma and multiple osteochondromas: recommendations on the diagnostics and follow-up with special consideration to the occurrence of secondary chondrosarcoma]. Radiologe 2014; 53:1125-36. [PMID: 24129968 DOI: 10.1007/s00117-013-2571-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE Osteochondroma represents the most common form of benign bone tumor. Clinical manifestations include deformity of bone, compression of surrounding tissue and vascular or neurological compromise. Osteochondromas may be solitary (solitary osteochondroma, SO) or multiple (multiple osteochondromas MO). Recurrence after surgery is a known problem especially in MO and malignant transformation is rare but more common in MO than in solitary cases. Reliable recommendations regarding diagnostics and clinical follow-up are currently lacking. PATIENTS AND METHODS A comprehensive literature review and a review of own patient files with SO/MO treated between 2000 and 2011 in this hospital were performed. The age of patients at diagnosis, tumor localization, clinical aspects, recurrence and the risk of malignant transformation in secondary (i.e. epiexostotic) chondrosarcoma were analyzed. The follow-up including patients who received surgery ranged between 2 and 127 months for patients with SO and between 2 and 84 months for MO. RESULTS A total of 39 patients with SO from this hospital were included in the study. Out of 36 patients who received surgery 3 recurrences were registered after an average time of 62 months. In addition, 11 patients with MO were identified and all received surgery. In 5 out of 11 cases recurrences occurred after an average time of 20.6 months. Secondary chondrosarcomas were not recorded in this series. According to the literature an increased risk of malignant transformation was found for osteochondromas of the axial skeleton, in the proximal aspect of the extremities, as well as for recurrent tumors and for MO. Pain and/or increase in size of lesions after skeletal maturation were the most common clinical signs of transformation. There was a wide time interval between the initial diagnosis and the development of secondary chondrosarcoma. In MO secondary chondrosarcoma has been described before skeletal maturity. CONCLUSIONS The risk of malignant transformation of SO is generally low. Axial lesions as well as recurrent osteochondromas and MO seem to have an increased risk of malignant transformation. The follow-up, requiring sufficient primary diagnostics, includes regular self-control and can usually be clinically carried out in more peripherally located lesions but in certain cases supplementary X-ray imaging is needed. In cases of anatomical regions which are more difficult to access manually, follow-up examination by magnetic resonance imaging (MRI) is the method of choice. Especially MO patients seem to benefit from long-term follow-up: when the tumor is located in the trunk and in (proximal) long bones MRI or whole-body MRI, respectively, should be performed once a year after skeletal maturity because of the higher risk of malignant transformation in these patients.
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Affiliation(s)
- G W Herget
- Department Orthopädie und Traumatologie, Universitätsklinikum Freiburg, Hugstetterstr. 55, 79106, Freiburg, Deutschland,
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Streitbuerger A, Hardes J, Gebert C, Ahrens H, Winkelmann W, Gosheger G. [Cartilage tumours of the bone. Diagnosis and therapy]. DER ORTHOPADE 2006; 35:871-81; quiz 882. [PMID: 16865383 DOI: 10.1007/s00132-006-0991-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Primary malignant bone tumours are rare. The annual incidence of these tumours is 10 per 1 million. Nearly 30% of the primary malignant bone tumours are malignant cartilage tumours. The frequency of benign cartilage tumours cannot be definitely estimated because these tumours are normally clinically inapparent and therefore often diagnosed as an incidental finding. The cartilage tumours appear as benign lesions (e.g. chondroma), as borderline tumours (proliferative chondroma vs grade I chondrosarcoma) or as highly malignant chondrosarcoma (e.g. dedifferentiated chondrosarcoma). Commensurate with the different clinical and oncological manifestations of the cartilage tumours, there are wide differences in the treatment and clinical course of the individual tumour. This article discusses the problems in the diagnosis and treatment of cartilage tumours from an orthopaedic point of view.
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Affiliation(s)
- A Streitbuerger
- Klinik und Poliklinik für allgemeine Orthopädie, Universitätsklinikum Münster, Albert-Schweitzer-Strasse 33, 48149 Münster.
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