Orthopaedic oncology Structured oral examination question 2: Enchondroma
Orthopaedic oncology Structured oral examination question 2: Enchondroma
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Figure 7.2 Enchondroma.
EXAMINER: Tell me about these radiographs of this chap’s right foot. (Figure 7.2.)
CANDIDATE: Well they’re AP and oblique views and they
show an expansile, lytic lesion in the proximal phalanx of his second toe.
EXAMINER: What do you think it is?
CANDIDATE: The radiographs show features consistent with an enchondroma. It has a short zone of transition and appears quite well defined. There’s also some stippled calcification within the substance of the lesion, which suggests a chondroid matrix.
EXAMINER: How would you treat this lesion?
CANDIDATE: Well, I would want to get more information so
I would take a full history and examination. I would also want to get more imaging of the lesion with an MRI and discuss the pictures with a bone tumour MDT. If there’s any doubt about the diagnosis they may want to do a biopsy, but in general the surgical treatment of an enchondroma is with curettage, with or without grafting.
General advice: Even if the diagnosis appears obvious and is of a benign lesion, don’t be rushed into offering surgical treatment. Always work through history, examination and imaging. You will never be criticized for discussing the diagnosis with a bone tumour MDT, but you will end up in a very tricky discussion with the examiners and fail if you have made the wrong diagnosis, it turns out to be malignant, and you’ve not discussed it with an MDT first.
Other points:
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50% of solitary enchondromas arise in the hands. Malignant transformation is very rare, but when it does occur it is usually in large lesions of long bones.
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Enchondromatosis = Ollier’s disease (risk of bone malignancy is 10%, but if visceral and
brain malignancies are included then the overall risk is 25%).
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