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Bone Tumors

Bone Tumors

 

EnchondromaScreen Shot 2016-03-04 at March 4,2016 04.03.44 PM

An enchondroma is a type of benign (non-cancerous) bone tumor that originates from cartilage. Cartilage is the specialized, gristly connective tissue that is present in adults and the tissue from which most bones develop. Cartilage plays an important role in the growth process. There are many different types of cartilage that are present throughout the body. An enchondroma most often affects the cartilage that lines the inside of the bones. The bones most often involved with this benign tumor are the miniature long bones of the hands and feet. It may, however, also involve other bones such as the femur (thighbone), humerus (upper arm bone), or tibia (one of the two lower leg bones).

Enchondromas are the most common type of hand tumor. While it may affect an individual at any age, it is most common between the ages of 10 and 20 years. The occurrence between males and females is equal.

While the exact cause of enchondroma is not known, it is believed to occur either as an overgrowth of the cartilage that lines the ends of the bones, or as a persistent growth of original, embryonic cartilage.

 

Ollier’s disease (enchondromatosis)

when multiple sites in the body develop the tumors. Ollier disease manifests as greater than normal growth of the cartilage in the long bones of the legs and arms so that growth is abnormal and the outer layer (cortical bone) of the bone becomes thin and more fragile. These masses of cartilage are benign (non-cancerous) tumors known as enchondromas. Enchondromas may occur at anytime. After puberty these growths stabilize as cartilage is replaced by bone. In rare cases, the enchondromas may undergo malignant changes (e.g., chondrosarcomas). The exact cause of Ollier disease is not known, although in some cases it may be inherited as an autosomal dominant genetic trait.

When the enchondromas of Ollier Disease are accompanied by substantial, most often benign, proliferation of blood vessels (hemangiomas), the array of symptoms is known as Maffucci Syndrome.

 

Maffucci’s syndrome

Maffucci syndrome is a rare genetic disorder that affects both males and females. It is characterized by benign enlargements of cartilage (enchondromas); bone deformities; and dark, irregularly shaped hemangiomas. No racial or sexual predilection is apparent. No familial pattern of inheritance has been shown, but the disease manifests early in life, usually around the age of 4 or 5 years, with 25% of cases being congenital. The disease appears to develop from mesodermal dysplasia early in life. Patients apparently are of average intelligence, and no associated mental or psychiatric abnormalities seem to be present. About 160 cases have been published in the English literature.

 

Osteochondromas

Osteochondroma is the most common benign bone tumor. The tumor is often diagnosed as an incidental finding. Osteochondromas account for approximately 35% of benign bone tumors and 9% of all bone tumors. Most are asymptomatic, but they can cause mechanical symptoms depending on their location and size.

 

Subungual Exostosis (Bone Spur Under Toenail)

Subungual exostosis is an outgrowth of bone from the tip of the toe. This happens below the nail hence the term “subungual”. It is a benign tumor derived from the bone and cartilage. The cause is unknown. Constant irritation to the bone has been proposed as a possible causative factor. Previous trauma and longstanding infection may contribute. The most common site for the lesion is on the first toe, usually on the inner or medial aspect. A firm nodule develops below the nail bed and, as it grows upwards, the nail plate separates from the bed. Pain is a common complaint when this happens. The lesion tends to grow slowly over weeks to months. Subungual exostosis may occur at any age but half of the reported cases tend to occur by 20 years of age. Women are reported to be more commonly affected.

 

Symptoms

Individuals with an enchondroma often have no symptoms at all. The following are the most common symptoms of an enchondroma. However, each individual may experience symptoms differently. Symptoms may include:

· hand pain that may occur if the tumor is very large, or if the affected bone has weakened causing a hand fracture

· enlargement of the affected finger

· slow bone growth in the affected area

The symptoms of enchondroma may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

 

Diagnosis

Because an individual with an enchondroma has few symptoms, diagnosis is sometimes made during a routine physical examination, or if the presence of the tumor leads to a fracture in the hand.

In addition to a complete medical history and physical examination, diagnostic procedures for enchondroma may include the following:

· x-rays – a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.

· radionuclide bone scans – 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. This test is to rule out any infection or fractures.

 

Treatment

Specific treatment for enchondroma will be determined by your physician based on:

· your age, overall health, and medical history

· extent of the disease

· your tolerance for specific medications, procedures, or therapies

· expectations for the course of the disease

· your opinion or preference

Treatment may include:

· surgery (in some cases, when bone weakening is present or fractures occur)

· bone grafting – a surgical procedure in which healthy bone is transplanted from another part of the patient’s body into the affected area.

If there is no sign of bone weakening or growth of the tumor, observation only may be suggested. However, follow-up with repeat x-rays may be necessary. Some types of enchondromas can develop into malignant, or cancerous, bone tumors later. Careful follow-up with a physician may be recommended.