case presentation enchondroma

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5/16/12

Case presentation

Dr.AnupkumarAgrawal



5/16/12

Case

• A 16 yr old male presentated with swellingover little finger of right hand

• No h/o pain



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There is e/olytic /expansilegeographic area

of radiolucency atdiaphysio-metaphysialregion of 5thmetacarpal of right hand andsimilar lesion at

middle phalanx of same digit

There is corticalthinning&endosteal



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Differential diagnosis

most likely diagnosis—Enchondroma Other possibilities are

1. Simple bone cyst

2. Aneurysmal bone cyst

3. Fibrous dysplasia

4. Non ossifying fibroma (FCD)

5. Eosinophilic granuloma

6. Giant cell tumor



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ENCHONDROMA• Age group—10-30yr

• M.C.site –phalanges and metacarpals

• Usually asymptomatic

• Radiological features are

1. Geographic ,expansile lytic lesion

2. Diaphysial –metaphyseal region

3. Centrally placed

4. Stippled or punctate calcification (ring or

arc pattern



Click icon to add picture

5/16/12 enchondroma involving the

proximal end of the proximal





5/16/12 Axial computed tomography

image demonstrates a fluffy


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Simple bone cyst• Age group < 20yr (80% cases between 4-

10yr)• M.C.site –long bone –humerus (proximal

metaphysis) rare in small bones

•

Clinically silent until pathological fractureoccurs

•

Radiological features1. Expansile ,lytic geographic metaphyseal

2. Truncated cone appearance

3. Calcification is rare



Aneurysmal bone cyst• Age 5-20 yr

• M.c.site-long bones-metaphysis

• Radiological features

1. Eccentric expansile,metaphyseal,saccular protrusion of bone

2. thin peripheral cortex

3. Blow out appearance or finger in ballonsign

4. Periosteal new bone formation

5. MRI demonstrate a classic fluid –fluid

ib d l i



Fibrous dysplasia• Age 3-15yr

• Monostotic and polyostotic

• m.c.bone-ribs,craniofacial &proximalfemur

• Rare in small bone of hand


1. Diametaphyseal,geographic expansilelucent lesion

2. Ground glass appearance

3. Thick sclerotic margin (rind)




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Im



Non ossifying fibroma• age group

• Fibrous cortical defect-4-8yr• Non ossifying fibroma-8-20 yr

• M.c. bone –long bones-around knee joint

• Diametaphyseal region

• Rare in small bone of hand&feet


1. Eccentric,expansile ,flame shaped

2. Thinning of cortex,endosteal scalloping



Eosinophilic granuloma• Age group <20yr

• M.c. bone –skull (axial skeleton)• Rarely small bone of hand


1. Solitary Geographic expansile lytic ,roundto oval

2. Endosteal scalloping ,cortical thinning

3. Sharply demarcated borders

4. Hole within hole appearance(beveling of edges)




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ic

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Lateral skull radiograph in a30-year-old woman with



Giant cell tumor• Age group -20-40yr

•

M.c.site –long bones-distal femur• Rare in small bones of hand

• Metaphyseal-epiphyseal

• Begins in metaphysis and then extends tosubarticular location


1. Eccentric,expansile ,geographic lytic

2. Cortical thinning and wide zone of transition

3 Soap bubble appearance(heavy

case presentation enchondroma

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