Enchondroma vs low grade chondrosarcoma

Last revised by Dai Roberts on 07 Feb 2021

Distinguishing between enchondromas and low-grade conventional chondrosarcomas is a frequent difficulty as the lesions are both histologically and radiographically very similar.

It is important to remember, though, that differentiating between them may be a moot point since both can either be closely followed up clinically and radiologically or treated if symptomatic.

Radiographic features

Useful features include:

  • size
    • lesion size over 5-6 cm favors chondrosarcomas
  • cortical breach
    • seen in 88% of long bone chondrosarcomas
    • seen in only 8% of enchondromas
  • deep endosteal scalloping involving > 2/3 of cortical thickness
    • seen in 90% of chondrosarcomas
    • seen in only 10% of enchondromas
  • permeative or moth-eaten bone appearance
    • seen in high-grade chondrosarcomas, not in low-grade tumors
  • soft tissue mass beyond bone
    • not seen in enchondroma
  • increased uptake on bone scan
    • seen in 82% of chondrosarcomas
    • seen in only 21% of enchondromas
  • location
    • hands and feet are uncommon locations for chondrosarcoma
    • outside hand and feet, chondrosarcomas outnumber enchondromas 5:1
    • spine, pelvis, sacrum, and ribs are rare locations for enchondromas
  • patient age
    • enchondromas commonly appear in young adults
    • chondrosarcomas tend to appear in middle-aged patients
  • pain
    • chondrosarcomas almost always present with pain
    • enchondromas are painless unless they cause a pathological fracture

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Cases and figures

  • Case 1: chrondrosarcoma - cortical scalloping
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  • Case 2: chondrosarcoma - increased uptake
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  • Case 3: enchondroma
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