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”...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.展开更多
BACKGROUND Dedifferentiated chondrosarcoma(DDCS)accounts for 10%of all chondrosarcomas and has the poorest outcome,with a 5-year survival rate of 7%-25%.DDCS commonly occurs in the femur and pelvis,whereas DDCS of the...BACKGROUND Dedifferentiated chondrosarcoma(DDCS)accounts for 10%of all chondrosarcomas and has the poorest outcome,with a 5-year survival rate of 7%-25%.DDCS commonly occurs in the femur and pelvis,whereas DDCS of the finger is extremely rare.Furthermore,the histological findings of preexisting solitary enchondroma samples are important and valuable for diagnosing malignant transformations.CASE SUMMARY We report our experience with DDCS in the proximal phalanx of the left middle finger of an 87-year-old woman.She had undergone surgery for enchondroma,with curettage and artificial bone grafting,11 years ago,in the same location.Several years after the primary surgery,the left middle finger gradually started to enlarge,and the growth speed increased in the past year.Plain radiographs showed an expansive osteolytic lesion with calcifications and residual grafting material.Owing to the suspicion of malignancy,we performed ray amputation.Histological findings revealed an abrupt transition between the low-grade chondrosarcoma and dedifferentiated sarcoma components.The dedifferentiated components showed the features of a high-grade undifferentiated pleomorphic sarcoma.The patient was diagnosed with DDCS arising from a preexisting enchondroma.She had no local recurrence or distant metastasis and died of pneumonia 6 years and 10 months after the second surgery.CONCLUSION The histological findings of a precursor lesion showed a typical enchondroma,suggesting that DDCS can arise from enchondroma.展开更多
文摘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.
文摘BACKGROUND Dedifferentiated chondrosarcoma(DDCS)accounts for 10%of all chondrosarcomas and has the poorest outcome,with a 5-year survival rate of 7%-25%.DDCS commonly occurs in the femur and pelvis,whereas DDCS of the finger is extremely rare.Furthermore,the histological findings of preexisting solitary enchondroma samples are important and valuable for diagnosing malignant transformations.CASE SUMMARY We report our experience with DDCS in the proximal phalanx of the left middle finger of an 87-year-old woman.She had undergone surgery for enchondroma,with curettage and artificial bone grafting,11 years ago,in the same location.Several years after the primary surgery,the left middle finger gradually started to enlarge,and the growth speed increased in the past year.Plain radiographs showed an expansive osteolytic lesion with calcifications and residual grafting material.Owing to the suspicion of malignancy,we performed ray amputation.Histological findings revealed an abrupt transition between the low-grade chondrosarcoma and dedifferentiated sarcoma components.The dedifferentiated components showed the features of a high-grade undifferentiated pleomorphic sarcoma.The patient was diagnosed with DDCS arising from a preexisting enchondroma.She had no local recurrence or distant metastasis and died of pneumonia 6 years and 10 months after the second surgery.CONCLUSION The histological findings of a precursor lesion showed a typical enchondroma,suggesting that DDCS can arise from enchondroma.
