Incidental long bone cartilage lesions: is any further imaging workup needed?
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SCIENTIFIC ARTICLE
Incidental long bone cartilage lesions: is any further imaging workup needed? Sagheer Ahmed 1 & Shams Jubouri 1 & Michael Mulligan 1 Received: 17 July 2020 / Revised: 22 October 2020 / Accepted: 1 November 2020 # ISS 2020
Abstract Objective To determine the rate of chondrosarcoma in incidentally discovered painless long bone cartilage lesions and to determine if any further imaging is needed. Materials and methods A cartilage lesion was said to be an enchondroma when it had characteristic matrix mineralization and no aggressive features. Search of all imaging reports and tumor board files for keywords enchondroma, cartilage lesion, chondroid, and chondrosarcoma. Retrospective review of medical records and imaging studies from 4.5-year period. Data points collected included patient age, sex, lesion site, size, symptoms, type of imaging, imaging appearance, and length of follow-up. Only patients with no pain were included as enchondroma. Patients with final diagnosis of chondrosarcoma were included for comparison of all features. Results Only 1/73 (1.4%) patients with an initial incidentally discovered painless lesion was later diagnosed, with new symptoms, as atypical cartilage tumor. Average age was 59.4 years. Bones involved were the femur (n = 33), humerus (n = 30), tibia (n = 7), fibula (n = 2), and ulna (n = 1). Average enchondroma size was 3.9 cm (range 1.4–11.5). Average follow-up was 47 months (range 2–196 months). Eleven long bone chondrosarcomas were identified. All chondrosarcoma patients had pain and aggressive imaging findings. Conclusion Our study reveals that the rate of chondrosarcoma in incidentally found painless chondroid lesions without aggressive features in long bones is low. Imaging follow-up may be needed only in the setting of new symptoms. Keywords Enchondroma . Atypical cartilage tumor . Chondrosarcoma . Rate . Follow-up
Introduction Enchondroma is one of the most common tumors of the skeleton, representing 12‑24% of all benign skeletal tumors and 3–10% of all primary skeletal tumors [1]. The true prevalence is not known, but incidental cartilage lesions with characteristic imaging findings are encountered frequently on radiographs of emergency department and trauma patients, those having MRI studies of the shoulder (up to 2.1%) and knee (up to 2.9%) and in other settings like whole-body screening of cancer patients [2–6]. Enchondroma and atypical cartilage tumor (ACT) can be difficult to differentiate based on imaging
* Michael Mulligan [email protected] 1
Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 South Greene St., Baltimore, MD 21201, USA
findings [7]. However, certain features including the lesion size, degree of endosteal scalloping, cortical thickening, rim of surrounding edema, lobulated contours with ill-defined margins, and pain at the site tend to favor a diagnosis of ACT [8–10]. Because of these diagnostic difficulties, algorithms have been developed to help radiologists and referring clinicians
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