J Korean Orthop Assoc.  2009 Jun;44(3):294-300. 10.4055/jkoa.2009.44.3.294.

Outcomes and Decision Making for the Management of Intramedullary Cartilage Tumors of the Long Bones

• Han I
• Kang JY
• Cho HS
• Lee SH
• Oh JH
• Kim HS

• KMID: 2186337
• DOI: http://doi.org/10.4055/jkoa.2009.44.3.294

Abstract

PURPOSE: Intramedullary cartilage forming tumors in the meta-diaphysis of the long bones can represent an enchondroma or a low-grade chondrosarcoma, with the latter requiring adequate surgical treatment. However, these two lesions have overlapping clinical and histological features and so they pose a diagnostic and therapeutic dilemma. The purpose of this study was to analyze the clinical outcome and to determine the relevant clinical and radiographic parameters for deciding on the treatment for these tumors.
MATERIALS AND METHODS
We conducted a retrospective review of 73 patients who were treated for enchondroma or low-grade chondrosarcoma that was located in the metaphysis or diaphysis of the bones. There were 20 men and 53 women with an average age of 49 years (range: 18-80). The locations were the proximal humerus (n=34), distal femur (24), proximal femur (6), proximal tibia (3), proximal fibula (2), humerus shaft (2) and femur shaft (2). 41 patients were treated surgically and 32 patients were simply observed based on the following parameters at presentation; the presence of pain, the tumor length and radiographic evidence of endosteal erosion.
RESULTS
All of the 32 patients who were initially observed had no evidence of disease progression at the last follow-up (average: 3.2 years, range: 1.0-14.9). Forty (98%) of the surgically treated patients showed no recurrence at the the last follow-up (average: 4.3 years, range: 1.0-14.0).
CONCLUSION
The presence of pain, tumor length and radiographic evidence of endosteal erosion should be considered to determine the best course of treatment for intramedullary cartilage forming tumors in the meta-diaphysis of the long bones. With the appropriate selection of the patients, these tumors can be successfully treated nonoperatively.

Keyword

Enchondroma; Grade 1 chondrosarcoma; Treatment; Long bone; Cartilage tumor

MeSH Terms

Cartilage
Chondroma
Chondrosarcoma
Decision Making
Diaphyses
Disease Progression
Female
Femur
Fibula
Follow-Up Studies
Humans
Humerus
Male
Recurrence
Retrospective Studies
Tibia

Figure

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  Fig. 1 Measurement of tumor length by MRI (A) and plain radiograph (B) of the same patient. The longest length of the tumor parallel to longitudinal axis of the bone was measured. The length measured by MRI was usually longer than the length measured by plain radiograph.

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  Fig. 2 Representative MRI scan (A) and plain radiograph (B) of an endosteal erosion.

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  Fig. 3 A representative case treated by observation. A 45-year-old female presented with an incidentally found intramedullary cartilage tumor of the proximal humerus. The length of the tumor was 5.5 cm and endosteal erosion was absent. The lesion did not progress during 7 years of follow-up.

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  Fig. 4 A representative case treated by surgery. A 35-year-old female presented with a painful intramedullary cartilage tumor of the proximal humerus measuring 6.5 cm. MRI shows endosteal erosion by the tumor. The patient was treated with curettage and cementation of the lesion.

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