 Chondromas
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Chondromas are benign tumors made of cartilage that are found mostly in the small bones of the hand and feet, although they can also occur in long, tubular bones, primarily the humerus (upper arm), femur (thigh bone) and ribs. They are classified as one of two types depending on where on the bone they are located:
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Echondromas: These tumors are found in the marrow cavity of the bone known as the medullary canal.
- Periosteal Chondromas: This kind of chondroma forms at the surface of the bone.
These tumors rarely produce symptoms, but can cause the affected bone to easily fracture. They do not spread and usually stop growing at skeletal maturity, when bones reach full growth potential. However, some may continue to grow and transform into a malignant condition called chondrosarcoma in adulthood. Doctors will want to pay close attention to any tumor that grows past skeletal maturity, especially those that produce new pain. Bones most at risk for malignant transformation are those most central in location. For instance, tumors found in the pelvis or shoulder girdle have a higher tendency to transform than those found in the digital bones of the hands and feet (phalanges), which almost never undergo malignant change.
Echondromas can sometimes occur in multiple bones. This type of echondroma is associated with one of two conditions: Ollier's disease and Marfucci's syndrome.
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The exact cause of chondromas remains unknown. Chondromas account for 25 percent of all benign bone tumors. Echondromas, the most common of bone tumors found in the hand, are generally more common than periosteal chondromas, which are extremely rare. Males and females are equally affected. They can occur at any age but usually echondromas are not discovered until the third or sometimes fourth decade of life. Periosteal chondromas usually appear earlier, which may be because they produce symptoms, leading to earlier detection.
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Echondromas usually produce no symptoms, although patients may have pain or sustain a fracture because the tumor weakens the area. Malignant transformation, which is uncommon, can also produce pain. Periosteal chondromas, however, usually do produce symptoms. With that in mind, the following are the most common symptoms associated with chondromas.
Echondroma:
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Usually no symptoms
- Pain
- Fracture
- Tendinitis (usually in the upper arm)
- Painless swelling of a digit
Periosteal chondromas:
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Dull, achy pain
- Swelling
- A mass that can be felt
- Sometimes no symptoms
The signs and symptoms of chondromas may resemble other medical problems. Always consult a physician for a diagnosis.
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In addition to a taking a complete medical history and performing a full physical examination, your child's doctor may use some combination of the following tests to diagnose either type of chondroma:
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X-rays - a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
- Magnetic Resonance Imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body. This test is particularly useful in identifying tumors in areas that are difficult to image on a plain x-ray.
- Computerized Tomography scan (also called CT or CAT scan) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices) both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat and organs.
- Bone Scan - a nuclear imaging method to evaluate any degenerative and/or arthritic changes in the joints; to detect bone diseases and tumors; to determine the cause of bone pain or inflammation.
- Complete blood count (CBC) - a measurement of size, number and maturity of different blood cells in a specific volume of blo
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Specific treatment for echondroma or periosteal chondroma will be determined by your child's physician based on:
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your child's age, overall health, and medical history
- extent of the disease
- your child's tolerance for specific medications, procedures, or therapies
- how your child's physician expects the disease may progress
- your opinion or preference
Treatment for chondromas that are asymptomatic may involve observation alone. Doctors will want to watch for any signs of bone destruction or malignant transformation, particularly in adults with the condition.
Doctors will probably want to remove chondromas that are causing symptoms, such as pain or fracture. The operation of choice, performed by an orthopaedic surgeon, usually involves curettage. Curettage describes a procedure in which a tumor is surgically scraped out of the bone, leaving a cavity that is then packed with either donor bone tissue (allograft), bone chips taken from another bone (autograft), or other materials depending on the preference of the surgeon.
While the operation is performed, the surgeon will take a biopsy, a tissue sample of the tumor, so it can be examined under a microscope.
If the tumor is causing destruction or if doctors believe it will degenerate to a malignant condition known as chondrosarcoma, the tumor and surrounding healthy tissue may be surgically removed.
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The long-term outlook for a patient with echondroma or periosteal chondroma varies from patient to patient depending on:
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the extent of the disease
- the size and location of the tumor
- the presence of absence of malignant degeneration
- the age and overall health of your child
- your child's tolerance for specific medication, procedures or therapies.
Generally, echondroma and periosteal chondroma that are not causing any symptoms will resolve on their own as they stop growing at skeletal maturity. Some of these tumors, most often those that are found in the axial skeleton and not those in the extremities, may transform into a malignant condition in adulthood. Therefore, continous follow-up care is essential for a child diagnosed with a chondroma.
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