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Woltsche JN, Smolle M, Szolar D, Bergovec M, Leithner A. Prevalence and characteristics of benign cartilaginous tumours of the shoulder joint. An MRI-based study. Skeletal Radiol 2024; 53:59-66. [PMID: 37269383 PMCID: PMC10661778 DOI: 10.1007/s00256-023-04375-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 05/28/2023] [Accepted: 05/28/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Enchondromas (EC) of the shoulder joint are benign intraosseous cartilage neoplasms, with atypical cartilaginous tumours (ACT) representing their intermediate counterpart. They are usually found incidentally on clinical imaging performed for other reasons. Thus far the prevalence of ECs of the shoulder has been analysed in only one study reaching a figure of 2.1%. MATERIALS AND METHODS The aim of the current study was to validate this number via retrospective analysis of a 45 times larger, uniform cohort consisting of 21.550 patients who had received an MRI of the shoulder at a single radiologic centre over a time span of 13.2 years. RESULTS Ninety-three of 21.550 patients presented with at least one cartilaginous tumour. Four patients showed two lesions at the same time resulting in a total number of 97 cartilage tumours (89 ECs [91.8%], 8 ACTs [8.2%]). Based on the 93 patients, the overall prevalence was 0.39% for ECs and 0.04% for ACTs. Mean size of the 97 ECs/ACTs was 2.3 ± 1.5 cm; most neoplasms were located in the proximal humerus (96.9%), in the metaphysis (60.8%) and peripherally (56.7%). Of all lesions, 94 tumours (96.9%) were located in the humerus and 3 (3.1%) in the scapula. CONCLUSION Frequency of EC/ACT of the shoulder joint appears to have been overestimated, with the current study revealing a prevalence of 0.43%.
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Affiliation(s)
- Johannes Nikolaus Woltsche
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Maria Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
| | | | - Marko Bergovec
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
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Deckers C, de Rooy JWJ, Flucke U, Schreuder HWB, Dierselhuis EF, van der Geest ICM. Midterm MRI Follow-Up of Untreated Enchondroma and Atypical Cartilaginous Tumors in the Long Bones. Cancers (Basel) 2021; 13:cancers13164093. [PMID: 34439246 PMCID: PMC8393576 DOI: 10.3390/cancers13164093] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/29/2021] [Accepted: 08/11/2021] [Indexed: 12/11/2022] Open
Abstract
Simple Summary Over the last decade the incidence of enchondroma and atypical cartilaginous bone tumors (ACTs) increased enormously. Management of these tumors in the long bones is shifting towards active surveillance, as negative side effects of surgical treatment seem to outweigh the potential benefits. To support development of evidence-based guidelines for active surveillance, we studied the natural course of enchondroma and ACTs in the long bones. In this study, MRI analysis of 128 cases was performed with a minimum interval of 24 months between baseline and last MRI. Our data showed that the majority of the cartilaginous tumors (87%) remained stable or showed regression on MRI. Only 13% showed some progression on MRI, although none of the tumors developed characteristics of high-grade chondrosarcoma. Based on our results, active surveillance is considered safe for enchondroma and ACTs of the long bones, and follow-up schemes should be tailored on natural course. Abstract Management of atypical cartilaginous tumors (ACTs) in the long bones is shifting towards active surveillance to avoid unnecessary surgeries. The frequency and duration of active surveillance for these tumors is unclear as there is little knowledge of its biological behavior. In this retrospective study, we examined the natural course of enchondroma and ACTs through active surveillance. A total of 128 central cartilaginous tumors, located in the long bones, with a minimum interval of 24 months between baseline and last MRI were included. MRI characteristics (e.g., size, scalloping, fat entrapment) were scored and tumors were classified according to the changes between MRIs. Mean follow-up of this study was 50 months, range = 25–138 months. The majority of the cartilaginous tumors (87%) remained stable (n = 65) or showed regression (n = 46) on MRI. A total of 87% of the cases that developed tumor regression presented with entrapped fat at diagnosis. Only 13% (n = 17) showed some progression on MRI, although none of the tumors developed characteristics of high-grade chondrosarcoma. Based on our results, active surveillance is considered safe for enchondroma and ACTs of the long bones. We propose active surveillance for all asymptomatic enchondroma or ACTs in the long bones irrespective of tumor size, and follow-up schemes should be tailored on natural course.
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Affiliation(s)
- Claudia Deckers
- Department of Orthopedics, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (H.W.B.S.); (E.F.D.); (I.C.M.v.d.G.)
- Correspondence:
| | - Jacky W. J. de Rooy
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
| | - Uta Flucke
- Department of Pathology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
| | - H. W. Bart Schreuder
- Department of Orthopedics, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (H.W.B.S.); (E.F.D.); (I.C.M.v.d.G.)
| | - Edwin F. Dierselhuis
- Department of Orthopedics, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (H.W.B.S.); (E.F.D.); (I.C.M.v.d.G.)
| | - Ingrid C. M. van der Geest
- Department of Orthopedics, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (H.W.B.S.); (E.F.D.); (I.C.M.v.d.G.)
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Jurik AG, Hansen BH, Weber K. Solitary enchondromas-diagnosis and surveillance : Danish guidelines. Radiologe 2021; 60:26-32. [PMID: 32322923 DOI: 10.1007/s00117-020-00681-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Enchondromas (EC) are frequent incidental findings on magnetic resonance imaging (MRI) performed for the diagnosis of joint pathology, especially observed on MRI examinations of the knee and shoulder. Enchondroma has potential for malignant transformation to chondrosarcoma (CS), and it may be difficult to distinguish EC from low-malignant CS on the basis of imaging or histopathology studies. Therefore, EC is mostly followed up to monitor any growth and/or changes indicating aggressive tumor.There is no consensual evidence on when and how to follow up patients with EC with regard to potential malignant transformation. Therefore, the Danish Multidisciplinary Cancer Groups initiated and supported the elaboration of Danish guidelines in 2020 based on a literature review. The guidelines are presented here, in addition to a summary of the background literature.
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Affiliation(s)
- Anne Grethe Jurik
- Department of Radiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 35, Entrance C, location C118/reference point C109, 8200, Aarhus N, Denmark.
| | - Bjarne Hauge Hansen
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Kolja Weber
- Department of Orthopaedic Surgery, Rigshospitalet, University of Copenhagen., Copenhagen, Denmark
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Engel H, Herget GW, Füllgraf H, Sutter R, Benndorf M, Bamberg F, Jungmann PM. Chondrogenic Bone Tumors: The Importance of Imaging Characteristics. ROFO-FORTSCHR RONTG 2020; 193:262-275. [PMID: 33152784 DOI: 10.1055/a-1288-1209] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Chondrogenic tumors are the most frequent primary bone tumors. Malignant chondrogenic tumors represent about one quarter of malignant bone tumors. Benign chondrogenic bone tumors are frequent incidental findings at imaging. Radiological parameters may be helpful for identification, characterization, and differential diagnosis. METHODS Systematic PubMed literature research. Identification and review of studies analyzing and describing imaging characteristics of chondrogenic bone tumors. RESULTS AND CONCLUSIONS The 2020 World Health Organization (WHO) classification system differentiates between benign, intermediate (locally aggressive or rarely metastasizing), and malignant chondrogenic tumors. On imaging, typical findings of differentiated chondrogenic tumors are 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). Depending on the entity, the prevalence of this chondrogenic pattern differs. While high grade tumors may be identified due to aggressive imaging patterns, the differentiation between benign and intermediate grade chondrogenic tumors is challenging, even in an interdisciplinary approach. KEY POINTS · The WHO defines benign, intermediate, and malignant chondrogenic bone tumors. · Frequent benign tumors: osteochondroma and enchondroma; Frequent malignant tumor: conventional chondrosarcoma. · Differentiation between enchondroma versus low-grade chondrosarcoma is challenging for radiologists and pathologists. · Pain, deep scalloping, cortical destruction, bone expansion, soft tissue component: favor chondrosarcoma. · Potential malignant transformation of osteochondroma: progression after skeletal maturity, cartilage cap thickness (> 2 cm adult; > 3 cm child). · Potentially helpful advanced imaging methods: Dynamic MRI, texture analysis, FDG-PET/CT. CITATION FORMAT · Engel H, Herget GW, Füllgraf H et al. Chondrogenic Bone Tumors: The Importance of Imaging Characteristics. Fortschr Röntgenstr 2021; 193: 262 - 274.
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Affiliation(s)
- Hannes Engel
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Georg W Herget
- Department of Orthopaedics and Traumatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Hannah Füllgraf
- Institute for Surgical Pathology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Reto Sutter
- Department of Radiology, Balgrist University Hospital, Zurich, Switzerland; Faculty of Medicine, University of Zurich, Switzerland
| | - Matthias Benndorf
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Fabian Bamberg
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Pia M Jungmann
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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Bestic JM, Wessell DE, Beaman FD, Cassidy RC, Czuczman GJ, Demertzis JL, Lenchik L, Motamedi K, Pierce JL, Sharma A, Sloan AE, Than K, Walker EA, Ying-Kou Yung E, Kransdorf MJ. ACR Appropriateness Criteria® Primary Bone Tumors. J Am Coll Radiol 2020; 17:S226-S238. [PMID: 32370967 DOI: 10.1016/j.jacr.2020.01.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 01/25/2020] [Indexed: 12/28/2022]
Abstract
Although primary bone tumors are relatively uncommon, appropriate imaging evaluation is essential when they are suspected or incidentally detected. In almost all cases, radiographs are the most appropriate initial imaging study for screening and characterization of primary bone tumors. Radiographs often provide sufficient information for diagnosis and to guide the treating clinician. However, when conventional radiographs alone are inadequate, they still often guide the selection of the most appropriate next step for advanced imaging. MRI and CT are typically the most appropriate next step. MRI provides excellent soft-tissue contrast allowing for evaluation of the tissue composition (such as fat, hemorrhage, fluid levels) and anatomic extent of bone tumors. CT provides complementary information, with its ability to detect subtle matrix mineralization or periosteal reaction that may not be seen on radiographs or MRI. This publication focuses on six common variants to guide diagnosis and management of primary bone tumors. In addition to conventional radiographs, appropriate use of MRI, CT, PET/CT, bone scan, and ultrasound are discussed. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | | | - R Carter Cassidy
- UK Healthcare Spine and Total Joint Service, Lexington, Kentucky; American Academy of Orthopaedic Surgeons
| | | | | | - Leon Lenchik
- Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Kambiz Motamedi
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | | | - Andrew E Sloan
- University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio; Neurosurgery expert
| | - Khoi Than
- Oregon Health & Science University, Portland, Oregon; Neurosurgery expert
| | - Eric A Walker
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania and Uniformed Services University of the Health Sciences, Bethesda, Maryland
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van de Sande MAJ, van der Wal RJP, Navas Cañete A, van Rijswijk CSP, Kroon HM, Dijkstra PDS, Bloem JL(H. Radiologic differentiation of enchondromas, atypical cartilaginous tumors, and high‐grade chondrosarcomas—Improving tumor‐specific treatment: A paradigm in transit? Cancer 2019; 125:3288-3291. [DOI: 10.1002/cncr.32404] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
| | | | - Ana Navas Cañete
- Department of Radiology Leiden University Medical Center Leiden the Netherlands
| | | | - Herman M. Kroon
- Department of Radiology Leiden University Medical Center Leiden the Netherlands
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Patel A, Davies A, Botchu R, James S. A pragmatic approach to the imaging and follow-up of solitary central cartilage tumours of the proximal humerus and knee. Clin Radiol 2019; 74:517-526. [DOI: 10.1016/j.crad.2019.01.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 01/30/2019] [Indexed: 02/08/2023]
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8
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What are the differentiating clinical and MRI-features of enchondromas from low-grade chondrosarcomas? Eur Radiol 2017; 28:398-409. [DOI: 10.1007/s00330-017-4947-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 06/11/2017] [Accepted: 06/13/2017] [Indexed: 11/30/2022]
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9
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Ladd LM, Roth TD. Computed Tomography and Magnetic Resonance Imaging of Bone Tumors. Semin Roentgenol 2017; 52:209-226. [PMID: 28965542 DOI: 10.1053/j.ro.2017.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Lauren M Ladd
- Department of Radiology and Imaging Sciences, Indiana University Health, Indiana University School of Medicine, Indianapolis, IN.
| | - Trenton D Roth
- Department of Radiology and Imaging Sciences, Indiana University Health, Indiana University School of Medicine, Indianapolis, IN
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10
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Sampath Kumar V, Tyrrell PNM, Singh J, Gregory J, Cribb GL, Cool P. Surveillance of intramedullary cartilage tumours in long bones. Bone Joint J 2017; 98-B:1542-1547. [PMID: 27803232 DOI: 10.1302/0301-620x.98b11.37864] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 07/12/2016] [Indexed: 11/05/2022]
Abstract
AIMS The purpose of this study was to determine if clinical and radiological surveillance of cartilage tumours with low biological activity is appropriate. PATIENTS AND METHODS A total of 98 patients with an intramedullary cartilage neoplasm in a long bone met our inclusion criteria and were included in the study. These patients had undergone a total of 384 scans. Patients with radiological follow-up of more than three years (46 patients) were divided into two groups: an active group (11 patients) and a latent group (35 patients). RESULTS Active lesions had a total growth in all three planes that was > 6 mm, whilst latent lesions had < 6 mm of growth. Most latent lesions were heavily calcified: active lesions were calcified less than 50% (p = 0.025). CONCLUSION Clinico-radiological surveillance can identify growing cartilage lesions: MRI is the surveillance modality of choice. A CT scan is recommended, in addition, at presentation to assess the amount of calcification within the lesion. A first follow-up MRI is suggested one year from diagnosis. If the total growth in the cartilage lesion is > 6 mm, surgical treatment should be considered. Otherwise, a second surveillance scan can be performed at three years to determine further management. Cite this article: Bone Joint J 2016;98-B:1542-7.
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Affiliation(s)
- V Sampath Kumar
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, UK
| | - P N M Tyrrell
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, UK
| | - J Singh
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, UK
| | - J Gregory
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, UK
| | - G L Cribb
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, UK
| | - P Cool
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, UK
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12
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Vanel D, Rimondi E, Vanel M, Gambarotti M, Alberghini M. Solitary bone lesions: which ones to worry about? Cancer Imaging 2012; 12:409-13. [PMID: 23022684 PMCID: PMC3460560 DOI: 10.1102/1470-7330.2012.9049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The question is not classic: which signs suggest a possible malignancy when faced with a solitary bone lesion? Usually radiologists try to identify the leave me alone lesions, for which nothing is needed. Here we consider the suspicious lesions. Clinical and radiological indicators are proposed, leading to a probability. Nowadays, a biopsy is nevertheless always requested before treating a malignant lesion, even if suspicion is very high. But histology should integrate with the radiological signs.
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Affiliation(s)
- Daniel Vanel
- Department of Radiology, The Rizzoli Institute, Bologna, Italy.
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13
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The imaging of cartilaginous bone tumours. I. Benign lesions. Skeletal Radiol 2012; 41:1195-212. [PMID: 22707094 DOI: 10.1007/s00256-012-1427-0] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 03/18/2012] [Accepted: 04/23/2012] [Indexed: 02/02/2023]
Abstract
Benign cartilage tumours of bone are the most common benign primary bone tumours and include osteochondroma, (en)chondroma, periosteal chondroma, chondroblastoma and chondromyxoid fibroma. These neoplasms often demonstrate typical imaging features, which in conjunction with lesion location and clinical history, often allow an accurate diagnosis. The aim of this article is to review the clinical and imaging features of benign cartilage neoplasms of bone, as well as the complications of these lesions.
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14
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Bierry G, Kerr DA, Nielsen GP, Rosenberg AE, Huang AJ, Torriani M, Bredella MA. Enchondromas in children: imaging appearance with pathological correlation. Skeletal Radiol 2012; 41:1223-9. [PMID: 22366808 DOI: 10.1007/s00256-012-1377-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 02/02/2012] [Accepted: 02/05/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Enchondromas are benign lesions that may present with nonspecific features on imaging in children. Correlation of histology with imaging findings is often required to make the final diagnosis of a benign lesion. The aim of this study was to review imaging and pathological findings of enchondromas in children. MATERIALS AND METHODS Imaging examinations of 12 enchondromas in 11 patients (median age 14 years) were retrospectively reviewed. Imaging evaluation included an assessment of lesion size, relationship to the growth plate, mineralization, matrix and periosteal reaction, intrinsic MR signal characteristics, and intraosseous and soft-tissue edema. Pathological findings were reviewed. RESULTS Lesions were located in the phalanx in 33% (4 out of 12), metacarpal in 25% (3 out of 12), femur in 33% (4 out of 12) and tibia in 8% cases (1 out of 12). The mean size was 28 mm (range, 11-70 mm). Matrix mineralization in a typical "rings-and-arcs" pattern was observed in 20% of the lesions with available radiographs/CT (2 out of 10). Lesions were expansive with endosteal scalloping in 75% of cases (9 out 12) and contacted the growth plate in 50% of cases (6 out of 12). All enchondromas in which MR imaging was available (5 out of 5) demonstrated typical cartilaginous matrix of lobules of high T2 signal, low T1 signal, and peripheral enhancement. CONCLUSION Enchondromas in children are relatively large lesions, with frequent endosteal scalloping and rare matrix mineralization.
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Affiliation(s)
- Guillaume Bierry
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E 55 Fruit Street, Boston, MA 02114, USA
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15
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Duckworth LV, Reith JD. Well-Differentiated Central Cartilage Tumors of Bone: An Overview. Surg Pathol Clin 2012; 5:147-61. [PMID: 26837919 DOI: 10.1016/j.path.2011.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Well-differentiated hyaline cartilage tumors are among the most common tumors encountered in the skeleton; their radiographic and pathologic classification and clinical management can be challenging. Pathologists find cartilage tumors difficult because their precise classification is as dependent on the clinical and radiographic findings as the histologic features; the distinction between benign and malignant cartilage neoplasms demands good communication and teamwork between pathologists, orthopedic surgeons, and radiologists. This review focuses on the necessary clinical, radiographic, and pathologic features that allow distinction between enchondroma and low-grade central chondrosarcoma and interpretation of lesions encountered in the enchondromatosis syndromes.
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Affiliation(s)
- Lizette Vila Duckworth
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - John D Reith
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA; Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, FL, USA
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16
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Vanel D, Kreshak J, Larousserie F, Alberghini M, Mirra J, De Paolis M, Picci P. Enchondroma vs. chondrosarcoma: a simple, easy-to-use, new magnetic resonance sign. Eur J Radiol 2012; 82:2154-60. [PMID: 22227263 DOI: 10.1016/j.ejrad.2011.11.043] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION There is no clear radiologic or pathologic agreement on the differences between enchondroma and conventional chondrosarcoma, which has huge therapeutic consequences. Microscopically, an enchondroma is composed of "islands of intramedullary hyaline cartilage surrounded by marrow fat", and a chondrosarcoma a "diffuse cartilaginous replacement (invasion) of the marrow which leads to complete 'trapping' of host lamellar bone trabeculae." The marrow around islands of cartilage should be detectable on magnetic resonance imaging (MR). Enchondroma may be the precursor of chondrosarcoma; benign cartilaginous islands are often seen microscopically at the periphery of chondrosarcoma. We attempted to detect these islands at the periphery of chondrosarcomas on MR and correlate them microscopically. MATERIALS AND METHODS We examined our database for all patients with a chondrosarcoma of the long and flat bones between 1990 and 2007. Only those with a preoperative MR who underwent an en bloc resection were included, yielding 32 patients. We looked for low-signal islands surrounded by high (fat) signal on T1-weighted images, and high-signal islands surrounded by low signal on T2-weighted fat saturated images at the periphery of the main tumour mass. Microscopic correlation was performed in all cases. RESULTS On microscopy, there were 23 conventional chondrosarcomas, nine dedifferentiated. Peripheral islands surrounded by fat were detected on MR in 19 cases, corresponding to benign cartilage in 18 cases and to the benign scar of a needle biopsy tract in one. There were no peripheral islands detected radiographically or microscopically in 13 cases. CONCLUSION Cartilaginous islands microscopically detected at the periphery of some chondrosarcomas are easily and reliably diagnosed on MR.
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Affiliation(s)
- Daniel Vanel
- Department of Research, Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Pathology, Istituto Ortopedico Rizzoli, Bologna, Italy.
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Rajiah P, Ilaslan H, Sundaram M. Imaging of primary malignant bone tumors (nonhematological). Radiol Clin North Am 2011; 49:1135-61, v. [PMID: 22024292 DOI: 10.1016/j.rcl.2011.07.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Primary malignant bone tumors are uncommon and are diagnosed typically based on radiographic and microscopic findings combined with clinical and demographic features. CT and MR imaging scans are useful in further staging the tumors by determining intraosseous and extraosseous spread.
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Affiliation(s)
- Prabhakar Rajiah
- Division of Musculoskeletal Radiology, Imaging Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A21, Cleveland, OH 44195, USA.
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