Solitary enchondromas of long bones: pattern of referral and outcome

Enchondromas are benign cartilaginous tumors, often found incidentally and diagnosed by the radiographic appearance. Active growing enchondromas/low grade chondrosarcomas are diagnosed by clinical symptoms and possibly an aggressive appearance on the radiographs. This study aimed to answer the following questions: Who requests a referral? The radiologist reporting a possibility of sarcoma or the referring physician? What is the outcome of these patients?

We retrospectively reviewed the medical records of 115 patients with final diagnosis of enchondroma over three consecutive years and recorded the radiological diagnosis on report, patients' symptoms, our initial diagnosis, follow-up, and any decision for a biopsy/surgical management, as well as the histological final diagnosis.

Nearly 80% of patients were referred from an orthopedic surgeon. About half of the imaging reports mentioned a malignancy in the differential diagnosis of enchondroma. Very few had the classic signs of an aggressive/growing cartilage tumor. In radiological evaluation, we found scalloping/cortical erosion, lytic areas, cortical breaks, soft tissue extension in only 12 cases of which 8 underwent a biopsy. Of the study patients, 65% were diagnosed with adjacent joint problems.

Enchondromas are mostly diagnosed incidentally. They are frequently associated with adjacent joint or soft tissue pathologies, which are main source of the symptoms. Even small, well-defined lesions are often confused with a sarcoma or other malignancies, which may be due to the lack of education on bone tumors for both the radiologists and general orthopedists.