Enchondroma - Treatment, Symptoms, Causes, Surgery, Pictures
What is Enchondroma?
An Enchondroma is a noncancerous bone tumor that started off in the cartilage. The onset is in childhood and ceases to grow by adulthood although it remains to stay throughout adulthood. The benign tumor is very common and frequently found on the small bones of the hand and the feet. The tumor on the other hand can also occur in other bones of the body such as in the femur, tibia and humerus.
A cartilage is a flexible but rather stiff connective tissue that can be located in various areas of the body. It is mostly found in the nose, ears and the joints of the body such as the fingers, shoulders, hips and knees. The cartilage is composed of chondrocytes which is a specialized cell that makes extracellular matrix that consists of collagen fibers, elastin fibers and a substance that is rich in proteoglycan. The cartilage generally does not contain blood vessels compared to other connective tissues. The absence of blood vessels in the cartilage makes it grow and repair rather more slowly than other connective tissues. The primary function of the cartilage is to hold the bones together and provides a smooth surface to resist friction at the joints.
Enchondroma can affect people from all age groups although the peak onset is by the third decade of life and equally affects both men and women without racial predilection. It is generally a benign osseous tumor that is usually identified during routine imaging test of the knee particularly in Magnetic Resonance imaging test.
Enchondroma has been often asymptomatic that an affected individual is generally clueless about its existence until a routine imaging test is being done. Some patient on the other experiences symptoms which differ from one patient to another.
The common symptoms of Enchondroma include the following:
- Pain in the hand may be experienced if the tumor has grown large
- Swelling may also be noted
- Small pathological fracture
- Weakening of the hands and the feet due to the lesion
- The affected finger or other small bones may be seen with enlargement
- The affected small bone is also seen with slow growth.
The signs and symptoms of Enchondroma may have a similarity with other medical conditions that it is necessary to have a doctor consulted not only to isolate Enchondroma from another medical condition but also to get the proper medical attention. Generally, Enchondroma is asymptomatic and can only be identified when other medical condition requires a routine imaging test or in the event of a fracture. The symptom of pain in Enchondroma is sometimes suspected of chondrosarcoma or in which the tumor in Enchondroma has become malignant which is generally rare to occur. The pain on the other hand maybe associated with the small fracture and swelling. The pain may also be due to the lesion that is acting in an aggressive manner such as in the drawing of the cortex.
Enchondroma is usually elongated and oval shaped and the margin of the tumor is clearly defined. The large lesion on the other hand appears as lucent defect that has a scalloping endosteal with the cortex that is rather thin and expanded. An endosteal scalloping that is bigger than two thirds of the thickness of the cortex is suspected of chondrosarcoma.
Enchondroma under the plain film reveals a lucent tumor with internal mineralization which may be powder like or solid aggregate. Endochondral ossification that goes with the tumor resulted to the mineralization. Under the CT scan Endochondroma is revealed with matrix production while a high water content and a lobular organization is revealed in Magnetic Resonance Imaging.
Under the gross examination, Endochondroma appears as bluish-gray lobule with fine translucent tissue. The positive indication of a benign tumor is revealed under gross examination is the appearance of lamellar bone that surrounds the cartilage nodule. The diagnosis of Enchondroma on the other hand is rather not easy to achieve due to the similarity in some other medical condition that involves multiple growth of tumor.
The exact cause of Enchondroma just like any other tumor remains vague. Environmental and chemical exposures have not been clearly suggested including exposure to radiation and association with other personal activities.
The incidence of Enchondroma has been linked with the overgrowth of the cartilage that lies at the end of the bones. The unrelenting growth of the embryonic cartilage is also being linked with Enchondroma although both overgrowth and persistent growth of cartilage is still not established.
Enchondroma on the other hand is being linked with other conditions that involve multiple growth of tumor in the cartilage.
Ollier’s disease or Enchondromatosis is a rare disease characterized by the growth of tumor in multiple parts of the body.
Maffuci’s syndrome is characterized by the growth of multiple tumors associated with angiomas or tumor that is composed of blood vessels.
The appropriate treatment for Enchondroma depends on the age and overall health condition of the patient, tolerance for specific procedures, therapies and medications. The treatment preference of the patient is also being considered prior to treatment.
Observation is generally suggested to Enchondroma that does not cause weakness of the bone and in the absence of tumor progression. Enchondroma that is solitary and remains painless and asymptomatic is also suggested for observation
Most Enchondromas generally need not be treated especially if the condition remains asymptomatic and does not cause any discomfort to the patient. Regular monitoring of the tumor however is needed to make certain that the tumor is not increasing in size.
Surgical removal of the Enchondroma is regarded as curative. Enchondroma is a noncancerous tumor that usually does not progress and normally does not present a potential risk to the patient.
Surgery is indicated for Enchondroma that poses a risk of fracture in patient or if the pathological fracture has occurred. The fracture is generally allowed to heal before the removal of the tumor while careful considerations are necessitated prior to the procedure.
Enchondroma that has become painful due to swelling and pathological fracture may be recommended for biopsy. Other doctors on the other hand do not immediately recommend surgical removal especially those doctors who deemed that the symptom of pain is not most likely caused by Enchondroma.
Scraping off the tumor followed by bone grafting is the surgical procedure that is usually done when surgery is necessary. The Enchondroma is scraped off its site and the cavity is filled with filling substances or may be done with a bone grafting. Bone grafting procedure is done by transplanting a healthy bone from another part of the body to the area with Enchondroma that has been scraped off. Most Enchondromas do not recur after it has been removed although there is still a possibility that it may recur. Recurrence on the other hand may be an indication of a low-grade chondrosarcoma which is another health issue.