Chondroma differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Rohan A. Bhimani, M.B.B.S., D.N.B., M.Ch.[2]

Overview

Enchondroma must be differentiated from low-grade chondrosarcoma, fibrocartilaginous dysplasia, bone islands and bone infarcts. Periosteal chondroma must be differentiated from juxtacortical chondrosarcoma, osteochondroma and periosteal osteosarcoma.

Differential Diagnosis

Enchondroma

Enchondroma must be differentiated from the following:

Low-grade Chondrosarcoma

• When differentiating an enchondroma from a chondrosarcoma, the radiographic image may be equivocal. However, periostitis is not usually seen with an uncomplicated enchondroma.

Chondroblastoma

• Presence of bone marrow edema frequently seen surrounding chondroblastomas is helpful, as it is not a usual feature of chondromyxoid fibromas, giant cell tumors, or enchondromas.

Fibrocartilaginous dysplasia

• Fibrous dysplasia is seen with an extensive cartilagenous differentiation that results in a picture that mimics enchondroma.
• Cellular atypia in the surrounding stroma helps in the differentiation.

Bone Islands

• Small focus of compact bone within the cancellous bone.
• No cortical destruction or involvement of the surrounding soft tissues.

Bone Infarcts

• Differentiating an enchondroma from a bone infarct on plain film may be difficult.
• An enchondroma usually causes endosteal scalloping while an infarct will not.
• An infarct usually has a well-defined, sclerotic serpentine border, whereas an endochondroma does not have a well defined border.

Periosteal Chondroma

Periosteal chondroma must be differentiated from the following:

Periosteal chondrosarcoma

• Chondrosarcomas are generally greater in size and occur in older patients more than 50 years of age.
• They may extend into the soft tissue.
• Periosteal chondrosarcoma shows popcorn calcifications on radiographs, which present as a collection of scalloped radiolucencies and with a sclerotic margin.

Periosteal osteosarcoma

• Periosteal osteosarcomas are slow-growing, and primarily arise beneath the periosteum, inducing new bone formation.
• It seen as a radiolucent lesion on the bone surface with perpendicular striae and a peripheral Codman’s triangle on radiography.

Osteochondroma

• Osteochondromas are more commonly seen in adolescents, in contrast with periosteal chondromas, which typically occur in young adults.
• Osteochondromas may also be distinguished by the presence of a dense osteoid formation in the cortex and medulla of the mass, and by the continuation with its originating bone.

References

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