History and Physical Examination
Enchondroma
Enchondromas are usually asymptomatic. In most cases, they are diagnosed incidentally during plain radiography. Expansile lesions in the short tubular bones of the hands can appear as bulbous swellings of the fingers.
Pain is a rare accompanying finding. Hence, the sudden appearance of pain in a previously asymptomatic lesion could suggest a pathologic microfracture or the transformation of a benign lesion to a malignant lesion. The rate of malignant change in solitary enchondroma is still controversial. By comparison, the rate of malignant change in Ollier disease is 10-30%, and that in Maffucci syndrome is substantially higher—as high as 100%, according to some authors.
Periosteal (juxtacortical) chondroma
Because periosteal chondromas are surface lesions, they may appear as palpable swellings. These tumors commonly arise where tendinous and ligamentous attachments to bone are present. The chondroma may interfere with the function of these structures and produce pain or local discomfort during activity.
Unusual presentations
The following unusual presentations of chondroma have been reported:
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Anterior knee pain produced by a patellar chondroma
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Periosteal osteochondroma of the proximal tibia presenting with features of Osgood-Schlatter disease
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Chondroma of the nasal tip
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Extraskeletal chondroma of the scalp
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Soft-tissue chondroma of the hard palate associated with cleft palate
Complications
Complications of chondroma include the following:
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Malignant transformation to chondrosarcoma
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Pathologic fracture, especially in short tubular bones
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Growth disturbance (periosteal chondroma can cause shortening of bone, which affects growth of the bone)
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Recurrence, which should be treated as a suspected malignancy
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Enchondroma of proximal femur.
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Plain radiograph reveals chondroma in left proximal femur (A) and low-grade chondrosarcoma in right superior pubic ramus and symphysis (B).
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MRI showing chondroma (A) and low-grade chondrosarcoma (B).
