MIR Teaching file case bs009

Case Author(s): Vreeland, M.D. / Royal, M.D. , 08/24/94 . Rating: #D2, #Q3

Diagnosis: Enchondroma

Brief history:

35 year old woman with wrist and hand pain, being evaluated with bone scintigraphy to determine pattern of joint involvement.

Images:

Whole Body Bone Scintigraphy

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Full history/Diagnosis is available below

Diagnosis: Enchondroma

Full history:

This patient is a 35 year old woman with a 3 - 4 month history of bilateral wrist and hand pain. In addition, she has intermittent pain in the large joints of the knees and shoulders. This examination is being done to determine pattern of joint involvement and to rule out occult bony lesions of the hands or wrists.

Findings:

(1) Mildly increased activity involving the metacarpal- phalangeal joints of the second and third digits of both hands; great toe of right foot; knees bilaterally; shoulders bilaterally; and the tenth thoracic vertebral body in a pattern consistent with arthritic changes. CXR (not included in this case) demonstrated hypertrophic, degenerative changes of the tenth thoracic vertebrate. Radiographs of the hands (not included in this case) demonstrated minimal degenerative changes of the third metacarpophalangeal joints bilaterally, suggesting early degenerative changes or possible hemochromatosis.

(2) Incidentally noted is focally, mildly increased activity involving the distal third of the right femur. Correlative radiographs of the femur demonstrate a lesion most suggestive of enchondroma, with a bone infarct being a less likely possibility. Clinically, the patient is asymptomatic in this region.

(3) A region of extravasated radiopharmaceutical is incidentially noted in the right antecubetal fossa.

Discussion:

This case was presented to demonstrate the scintigraphic appearance of an enchondroma. Typically, enchondromas have only mildly increased activity. Markedly increased activity of enchondromas are most often associated with pathologic fractures. If enchondromas are painless, they are generally treated conservatively. Pain associated with an enchondroma may represent malignant degeneration.

Enchondroma:

- Benign cartilaginous growth in bones

- M:F - 1:1

- Frequently multiple (Enchondromatosis or Ollier Disease)

- Often, in the small bones of the wrists and hands

- Can be found in diaphyseal or central regions of the femur, tibia, humerus, radius, ulna, foot, or ribs.

- Generally, no cortical breakthrough or periosteal reaction

- Malignant degeneration in long bone enchondromas can occur in up to 15 -20% of cases, and are often associated with pain.