Bone & joints
Other chondrogenic tumors
Enchondroma
Author: Nat Pernick, M.D.
Last author update: 1 August 2013
Last staff update: 6 January 2023
Copyright: 2003-2023, PathologyOutlines.com, Inc.
PubMed Search: Enchondroma of hands and feet
Table of Contents
Definition / general | Terminology | Epidemiology | Sites | Radiology description | Radiology images | Treatment | Case reports | Gross description | Gross images | Microscopic (histologic) description | Microscopic (histologic) images | Differential diagnosisCite this page: Pernick N. Enchondroma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/bonechondromaenchondroma.html. Accessed February 8th, 2023.
Definition / general
- Usually asymptomatic or pain due to pathologic fracture
- May be due to displaced growth plate
- 70% solitary; 30% multiple
- Multiple enchondromas: may produce severe deformities; associated with chondrosarcomatous transformation
Terminology
- Enchondroma protuberans: rare, exaggeratedly eccentric enchondroma resembling osteochondroma radiologically (Hum Pathol 1982;13:734)
- Maffuci syndrome: multiple enchondromas and soft tissue hemangiomas; also ovarian carcinoma, brain gliomas
- Ollier disease: nonhereditary disease of multiple enchondromas of long bones and flat bones (up to 50% of skeleton) with associated skeletal deformities, histologic features of low grade chondrosarcoma should be ignored if radiographically benign; most lesions regress when skeleton matures; often ovarian sex cord tumors
Epidemiology
- Age 20 - 49 years, M = F
Sites
- Small bones of hands and feet (rare in thumb or ribs)
Radiology description
- Thinning but preservation of cortex, O ring sign, no penetration into soft tissue, pathologic fractures common
- Long bones: well circumscribed tumor of metaphysis or diaphysis with flecks of calcification; doesn’t invade the cortex
Radiology images
Contributed by Mark R. Wick, M.D. and AFIP
Finger Xray
Enchondroma of finger
Tibia Xray
Multifocal in Ollier disease, CT scan
Distal femur Xray
Femur Xray
Enchondroma of distal femur
Enchondromatosis
(Ollier disease)
Treatment
- Excision, may recur if incompletely excised
- Often no treatment recommended
Case reports
- 34 year old man with Ollier disease (Hum Pathol 2000;31:1299)
- 53 year old man with multiple foci of chondrosarcomatous transformation (Hum Pathol 1984;15:91)
- Patient with tenosynovial chondroma of hand (Hum Pathol 1978;9:476)
Gross description
- Well circumscribed, pale blue, solid, resembles cartilage but without myxoid change
Gross images
Contributed by Mark R. Wick, M.D. and AFIP
Multifocal in Ollier disease
Enchondroma expands the rib
Microscopic (histologic) description
- Lobules of hyaline cartilage encased by bone and covered by perichondrium (fibrous tissue)
- Resembles low grade chondrosarcoma due to hypercellularity, binucleation, myxoid change but radiographically is benign
- Calcification, endochondral ossification
- Necrosis common in benign lesions due to avascular cartilage
- Tongues of bone extend into cartilage (versus sharp interface at growth plate)
- More atypia present with Ollier disease and Maffuci syndrome
- Long bones: hypocellular, few binucleated cells, may be multifocal but does not infiltrate marrow; no myxoid change
Microscopic (histologic) images
Contributed by Mark R. Wick, M.D. and AFIP
Various images
Islands of cartilage
Sparsely cellular cartilage
Cellular areas with moderate nuclear pleomorphism
Differential diagnosis
- Epiphyseal dysplasia:
- In babies, affects multiple joints
- Low grade chondrosarcoma:
- Breaks through or erodes cortex, marked myxoid change, large tumors occupy marrow space and entrap bony trabeculae
