TITLE:
Enchondromas of Long Bones and Other Skeletal Lesions Found Incidentally Need Critical Evaluation, But Rarely Systematic Follow-Up
AUTHORS:
G. Ulrich Exner, Pascal A. Schai, Nadja Mamisch-Saupe, Michael O. Kurrer
KEYWORDS:
Incidental Bone Lesions, Enchondroma, Fibrous Dysplasia, Non-Ossifying Fibroma
JOURNAL NAME:
Open Journal of Orthopedics,
Vol.12 No.2,
February
28,
2022
ABSTRACT: Purpose: Incidental bone lesions are a
challenge for the specialist, who has to give recommendations for further
management. This review of our cases will assist in the decision whether the
lesion can be “neglected”, needs further active follow-up or
direct initiation of treatment. Patients and Methods: 153 cases of incidental
bone findings were presented to our musculoskeletal tumor service for
evaluation from July 2008 through June 2021. 73 of them were cartilaginous
tumors and 63 of these were diagnosed as enchondroma of a long bone based on
X-Ray and MRI. Results: Follow-up imaging of the enchondroma patients
was available for 35 patients at 1 to 13 years (mean 4.3 y), with no change in size except for one femoral diaphyseal enchondroma
with increasing diameter from age 18 to 20 years. 14 additional patients
answered written contact stating that they remained asymptomatic at 2 to 12
years (mean 5.6 y). None of the patients has been reported to
the Swiss Confoederation Cancer
Registry to have developed malignancy. Among the 10 other cartilaginous tumors were one chondrosarcoma grade II
exhibiting different imaging, 3 non-long-bone localizations (pelvis, scapula and
rib), 2 Ollier-type enchondromas, and 2 osteochondromas. Incidental
findings other than cartilaginous tumors were fibrous dysplasia (n = 31), non-ossifying fibroma (n = 31) and 18 other “sporadic” entities. Conclusions: Incidentally found enchondromas not exhibiting
aggressive features need no systematic
follow-up and patients can be “discharged” with the advice to present, if
symptoms would develop. This also applies to fibrous dysplasia and the other
sporadic lesions. 6 cases with other diagnoses needed specific treatment.