Low grade chondrosarcoma of the hand treated with curettage: Long term outcomes

Chondrosarcomas are primary bone malignancies, with most lesions of the hand representing low grade chondral tumours (LGCT). Low grade (grade one) chondrosarcomas are defined as Atypical Cartilaginous Tumours by the 2020 World Health Organisation Classification. Grades two and three are termed high-grade chondral tumours (HGCT).

To establish whether low-grade chondral tumours of the hand can be safely treated with simple curettage and assess recurrence rates.

Retrospective data was analysed from a tertiary referral hospital for bone tumours in the UK over a 13-year period. 158 patients with histological proven chondral tumours of the hand, requiring curettage, resection or amputation were included.

13 (8.2%) had HGCT and 145 (91.8%) had LGCT. 136 LGCTs underwent intralesional curettage (98.5%). 8 (5.1%) underwent wide local resection (6 LGCT and 2 HGCT). 14 (8.9%) underwent amputation (5 LGCT and 9 HGCT). All HGCT patients were free from recurrence at a median of 81.7 months. Patients expressing GD2/3 tumour marker antigens were more likely to be HGCT on histology compared with those not expressing GD2/3 and more likely to require extensive surgery.

In contrast to chondrosarcoma occurring in long bones, there is often discordance between histological and radiological appearance in lesions occurring in the small bones of the hand. These lesions may appear aggressive radiologically but prove to be low-grade on histology. We concluded that intralesional curettage was an effective method for managing LGCT of the hand, whilst more extensive surgery can be reserved for higher grade tumours. GD2/3 expression was associated with high-grade lesions.

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