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Research Paper | Orthopaedic Surgery | India | Volume 12 Issue 2, February 2023
A Study on Clinical and Radiological Profile of Benign Cartilage Tumors of Long Bones
Thushar Ramesh
Abstract: Introduction: Cartilaginous tumors are second most primary bone tumors and are characterized by formation of hyaline or myxoid cartilage. Benign cartilage tumors are common than malignant ones33. Enchondroma of appendicular skeleton are usually symptom free and found incidentally on evaluation of trauma or adjacent joint pathologies4. Benign cartilaginous lesions behave in an inactive fashion and do not require intervention, unless they are symptomatic or cause functional impairment or complications from fractures. The clinical management and prognosis depend on the site and the histological diagnosis. With limited tissue, the differential diagnosis may be problematic, particularly with regard to distinguishing enchondroma from low - grade chondrosarcoma. In the current WHO classification system Grade 1 Chondrosarcoma has been renamed as ?Atypical Cartilage Tumors? (ACT). ACT never metastasizes and is not considered as malignancy5. Surgical treatment consists of curettage alone or curettage with bone grafting or bone cementing. Materials and Methods: Patients with benign cartilaginous lesions of long bone diagnosed clinically and radiologically from Orthopedic Oncology clinic at the Amala Institute of Medical Sciences from January 2012 to January 2018 were included in study. Sample size was found to be 48. Consecutive sampling was done. Patient details collected from tumor registry maintained in the Orthopedic oncology clinic. Patients was examined at 6 monthly intervals for a period of 5 years in the absence of symptoms or sooner in case of symptoms like recent onset of pain at site of lesion or visible swelling. Surgically treated patients will be subjected to clinical examination and radiological examination if symptomatic. Radiological modality used was plain radiographs. Results and Discussion: Forty - eight patients were included in the study. The mean age group of patients was found to be 43.15 ? 17.31 (19 - 83) years. Male were patients 21 (43.75%) and female patients were 27 (56.25%). Most common bone affected was Distal Femur 32 (66.67%). Pain was presenting complaint in 45 (93.75%) patients. In 3 (6.25%) patients the tumor was an incidental finding. Lytic lesion with specs of calcification was most common x - ray finding in 43 (89.58%) patients. Most common pre operative histological finding was Enchondroma in 32 (91.43%) patients, in 3 (8.57%) patients it was Grade 1 chondrosarcoma. Surgical intervention was done in 35 (72.92%) patients, while 13 (27.08%) patients were managed conservatively. In surgically treated patients 32 (91.43%) had post operative biopsy finding of enchondroma, in 3 (8.57%) patients report came as low - grade chondrosarcoma. In surgically treated patients 32 (91.43%) had final diagnosis of enchondroma, in 3 (8.57%) patients as Low - grade chondrosarcoma\ACT. In conservative management group 13 (100%) patients had enchondroma as final diagnosis. In conservative management group the cause of symptom was found to be unrelated to tumor. Two patients presented with pain during follow - up in surgical group, one patient was 65 years old female who underwent curettage and bone grafting for enchondroma of distal femur at third 6 monthly follow up, another patient was 65 year old male patient who underwent curettage and bone cementing for distal femur for grade 1 chondrosarcoma fifth 6 monthly follow. Both the patients underwent x - rays and it showed no signs of recurrence. No further complaints during subsequent follow up. None of the patients in surgically treated groups had recurrence. in patients managed conservatively the lesion was found to be stable and asymptomatic. Conclusion: In this study we have followed up 48 patients with benign cartilage tumours of long bones attended orthopaedic oncology clinic. Most commonly patients presented with pain. Tumor was an incidental finding in 3 patients. Most common radiological finding was lytic lesion with specs of calcification. Distal femur was involved in 32 patients. Surgical intervention was done in 35 patients, while 13 patients were managed conservatively. Patients managed conservatively had symptom unrelated to tumour and lesion was found to be stable in subsequent follow - us. Both groups had 6 monthly follow - ups. None of the patients had local recurrence or new onset of symptoms related to tumor. In the small group of conservatively managed patients, it appears to be a safe option if strict follow up is assured and symptoms are unrelated to tumour.
Keywords: Enchondroma, Atypical Cartilage Tumors, Grade1Chondrosarcoma, Curettage, Bone grafting, Bone cementing
Edition: Volume 12 Issue 2, February 2023,
Pages: 206 - 215