Enchondroma vs low grade chondrosarcoma

Last revised by Ryan Thibodeau on 8 Feb 2024

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 chondrosarcoma

  • 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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  • Case 4: enchondroma
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