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Chondromas
What are chondromas?
Chondromas are benign tumors
made of cartilage that are found
mostly in the
small
bones of the hand and feet, although they can also occur in long, tubular
bones,
primarily the humerus (upper arm), femur (thigh bone) and ribs.
They
are classified as one of two types depending on where on the bone they are
located:
·
Echondromas: These tumors are found in
the marrow cavity of the bone
·
known as the medullary canal.
·
Periosteal
Chondromas: This kind of chondroma forms at the surface of the bone.
These
tumors rarely produce symptoms, but can cause the affected bone to easily
fracture. They do not spread and usually stop growing at
skeletal maturity, when
bones reach full growth potential. However, some may
continue to grow and transform
into a malignant condition called chondrosarcoma in
adulthood. Doctors will want to pay
close
attention to any tumor that grows past skeletal maturity, especially those that
produce
new pain. Bones most at risk for malignant transformation are those most
central
in location. For instance, tumors found in the pelvis or shoulder girdle have
a
higher tendency to transform than those found in the digital bones of the hands
and feet (phalanges), which almost never undergo
malignant change.
Echondromas can sometimes occur in
multiple bones. This type of echondroma is
associated with one of two conditions: Ollier's disease and Marfucci's syndrome.
What causes chondromas and who is affected by them?
The exact cause of chondromas remains unknown.
Chondromas account for
25 percent of all benign bone tumors. Echondromas, the most common of bone tumors
found
in the hand, are generally more common than periosteal chondromas, which
are
extremely rare. Males and females are equally affected. They can occur at any
age
but usually echondromas are not discovered until the third or sometimes fourth
decade
of life. Periosteal chondromas usually appear earlier, which may be because t
hey
produce symptoms, leading to earlier detection.
What are the symptoms of chondromas?
Echondromas
usually produce no symptoms, although patients may have pain
or
sustain a fracture because the tumor weakens the area. Malignant
transformation,
which
is uncommon, can also produce pain. Periosteal chondromas, however, usually
do
produce symptoms. With that in mind, the following are the most common
symptoms associated with chondromas.
Echondroma: Periosteal
chondromas:
The
signs and symptoms of chondromas may resemble other medical problems.
Always
consult a physician for a diagnosis.
How are chondromas diagnosed?
In
addition to a taking a complete medical history and performing a full physical
examination, your child's doctor may use some combination of the following tests
to
diagnose either type of chondroma:
X-rays - a diagnostic test that uses invisible electromagnetic
energy
beams to produce
images of internal tissues, bones, and organs onto film.
Magnetic Resonance Imaging
(MRI) - a diagnostic procedure
that uses a
combination of large magnets, radiofrequencies and a computer to produce
detailed images of organs and structures within the body. This test is
particularly useful in identifying tumors in areas that are difficult to image
on
a plain x-ray.
Computerized Tomography
scan (also called CT or CAT scan)
- a diagnostic
imaging
procedure that uses a combination of x-rays and computer technology
to
produce cross-sectional images (often called slices) both horizontally and
vertically, of the body.
including the bones, muscles, fat and organs.
Bone Scan - 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.
Complete blood count (CBC) - a measurement of size, number and maturity
of different blood
cells in a specific volume of blood
Treatment
Specific
treatment for echondroma or periosteal chondroma will be determined
by your child's
physician based on:
·
your child's age,
overall health, and medical history
·
extent of the
disease
·
your child's
tolerance for specific medications, procedures, or therapies
·
how your
child's physician expects the disease may progress
·
your opinion
or preference
Treatment for chondromas that are
asymptomatic may involve observation alone.
Doctors will want to watch for any signs
of bone destruction or malignant
transformation, particularly in adults with the
condition.
Doctors will probably want to remove
chondromas that are causing symptoms,
such as pain or fracture. The operation of
choice, performed by an orthopedic
surgeon, usually involves curettage.
Curettage describes a procedure in which
a tumor is surgically scraped out of
the bone, leaving a cavity that is then
packed with either donor bone tissue
(allograft), bone chips taken from another bone
(autograft), or other materials
depending on the preference of the surgeon.
While the operation is performed, the
surgeon will take a biopsy, a tissue sample
of the tumor, so it can be examined under
a microscope.
If the tumor is causing destruction or
if doctors believe it will degenerate to a
malignant condition known as chondrosarcoma, the
tumor and surrounding healthy
tissue may be surgically removed.
What is the long-term outlook for a patient with a chondroma?
The long-term outlook for a patient with echondroma
or periosteal chondroma
varies from patient to patient depending on:
·
the extent of
the disease
·
the size and
location of the tumor
·
the presence
of absence of malignant degeneration
·
the age and
overall health of your child
·
your child's tolerance for specific medication,
procedures or therapies.
Generally, echondroma and periosteal chondroma that
are not causing any
symptoms will resolve on their own as they stop growing at
skeletal maturity.
Some of these tumors, most often those that are
found in the axial skeleton
and not those in the extremities, may transform into a
malignant condition in
adulthood.
Therefore, continuous follow-up care is essential
for a child diagnosed with
a chondroma.
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