Endogenous chondromas are benign tumors that occur within the medullary cavity and are composed of hyaline cartilage tissue, accounting for approximately 15% of benign bone tumors. Endogenous chondromas can be solitary or multiple, and multiple cases are also called endogenous chondromatosis, or Ollier’s disease.
I. Clinical characteristics
1.Age
It can occur at any age, but it is more common between 10 and 40 years old.
2.Gender
The ratio of male to female is about 3:2.
3.Site
It is most common in tubular bones of hands and feet, especially in palms and finger bones, followed by long bones and ribs. About half of the solitary endogenous chondrosarcomas occur in the hands, and about 25% occur in the long tubular bones, with more upper limbs than lower limbs.
4.Symptoms and signs
Patients often have no obvious clinical symptoms. Some patients visit the clinic because of painless swelling, and a few patients visit the clinic because of pain caused by pathological fracture. Local pressure pain and percussion pain may be present.
X-ray features
The typical X-ray shows a central cystic osteolytic destruction with swelling and thinning of the bone cortex, often with reactive sclerotic bone at the edges. Pathological fractures are sometimes seen. In endogenous chondrosarcoma occurring in long tubular bone, calcification shadow can be seen in the osteolytic lesion.
Pathological changes
1.Major body
The tumor tissue is grayish-white translucent with slightly pearly luster, brittle, with calcification, ossification, mucinous and cystic changes.
2.Microscopic
The tumor is composed of mature hyaline cartilage with round, oval or polygonal cells, located in the trap in the cartilage matrix, with chondrogenic bone and calcification visible.
Differential diagnosis
1.Chondrosarcoma
The most common symptoms are gradually increasing pain and progressive enlargement of the mass, irregular osteolytic destruction with blurred borders can be seen on X-ray, which can break through the bone cortex to form a soft tissue mass, and cotton wool-like calcification shadow can be seen in the tumor.
2.Giant cell tumor of bone
Giant cell tumor of bone is mostly seen in 20-40 years old, the lesion is located in the end of long bone, eccentric, without calcification and ossification shadow inside, and there is no reactive sclerotic bone around it in general.
V. Treatment and prognosis
Endogenous chondrosarcoma must be treated surgically, usually by scraping the bone graft within the lesion, which must be done thoroughly and inactivate the tumor cavity in order to reduce recurrence. Internal fixation can be performed at the same time in cases of concomitant pathological fractures.
The prognosis of solitary endogenous chondrosarcoma is good, and local recurrence is rare after surgery. Multiple endogenous chondrosarcomas occurring in the pelvis and scapula (Ollier’s disease), 1/3 of which may malign into chondrosarcoma.