Condroma

Chondroma

Chondroma is a benign tumor that develops from cartilage cells, with the short bones of the hands and feet as its main sites of occurrence. Generally, it can present as a solitary lesion or, in some cases, affect multiple bones, characterizing what is known as enchondromatosis.

Unilateral enchondromatosis, in turn, is a form of dyschondroplasia that is called Ollier’s disease. Maffucci Syndrome is characterized by the presence of multiple enchondromas associated with hemangiomas.

Although chondroma has a predilection for short bones, it can occasionally be found in long bones, such as the distal femur, proximal humerus and tibia. In these locations, it is important to make a differential diagnosis with other conditions, such as bone infarction, which is generally asymptomatic and can be identified by radiographic findings, and grade I central chondrosarcoma, which is symptomatic and evolves slowly over time and causes cortical erosion. inside the bone, getting bigger and bigger. 

Differentiating histologically between chondroma and grade I chondrosarcoma can be challenging, and a clinical and radiographic observation approach is preferable to determine the appropriate management, since grade I chondrosarcoma is slow to evolve, which allows observation in short periods of time, three to six months, performing imaging exams. If changes occur, with worsening of the images, the lesion should be considered as grade I chondrosarcoma and treated as such. The histological diagnosis of this neoplasm is controversial. 

Radiographically, chondroma is characterized by a rarefaction lesion, occasionally with foci of calcification, which may result in bone deformities.

The treatment of asymptomatic chondroma, discovered by chance, can only be observation, as it generally does not evolve and behaves like a scar, being just an examination finding. Curettage of a “chondroma”, which in reality was a grade I chondrosarcoma, can lead to the spread of the tumor, making it difficult to perform correct resection surgery with an oncological margin.

When the chondroma affects the outer surface of the bones, it is called juxtacortical chondroma and usually requires surgical treatment through partial parietal resection.

Chondroma is a benign cartilage tumor, generally harmless, but requires monitoring and, in a few cases, if it progresses, with an increase in the lesion, there is a need for surgical intervention, with resection of the tumor with an oncological margin, to guarantee the better outcome for the patient, avoiding recurrences.

Clinical monitoring of the patient without symptoms should be carried out with images at 3 months, 6 months and every year thereafter for early diagnosis and adequate treatment in time for a possible grade I chondrosarcoma, allowing this lesion to be treated appropriately. correctly and in good time. 

Author: Prof. Dr. Pedro Péricles Ribeiro Baptista

 Orthopedic Oncosurgery at the Dr. Arnaldo Vieira de Carvalho Cancer Institute

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