Hatori Masahito, Watanabe Mika, Kotake Hideyoshi, Kokubun Shoichi
Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
Tohoku J Exp Med. 2006 Mar;208(3):275-81. doi: 10.1620/tjem.208.275.
Enchondromas are the most common benign cartilaginous bone tumors arising in the medullary cavity of the small bones of the hand. In contrast, chondrosarcomas, commonly occurring in the pelvis and proximal femur and humerus, are very uncommon at this site. We report an unusual case of chondrosarcoma arising in the ring finger proximal phalanx with its radiological and histological features and reviewed the literature. The patient was an 80-year-old man whose chief complaint was swelling and pain for seven years. The findings of cortical irregular thickening by plain radiography and computed tomography and soft tissue extension by magnetic resonance imaging suggested the tumor was chondrosarcoma rather than a common enchondroma. Thorough curettage and artificial bone grafting was performed because of the age of the patient, his senile dementia and the strong desire of the patient and his family. Histological examination revealed that the tumor was composed of polygonal cells with eosinophilic cytoplasm proliferating in the chondromatous matrix with partially myxoid changes. Nuclear irregularity, binucleated cells, bone permeation and encasement were observed and the tumor was diagnosed as grade 2 chondrosarcoma. The tumor recurred five months after surgery. Amputation of the ring finger including the distal part of the 4th metacarpal was performed. At two years after surgery, the patient was free from recurrence or lung metastasis. In conclusion, details of radiological as well as pathological findings are essential for differential diagnosis between benign enchondroma and chondrosarcoma in the hand. Chondrosarcoma of the hand requires a prompt and more radical treatment than enchondroma. Wide excision is recommended to avoid local recurrence or metastasis.
内生软骨瘤是手部小骨骨髓腔内最常见的良性软骨性骨肿瘤。相比之下，软骨肉瘤常见于骨盆、股骨近端和肱骨，在该部位非常罕见。我们报告了一例发生于环指近节指骨的罕见软骨肉瘤病例，介绍了其影像学和组织学特征，并复习了相关文献。患者为一名80岁男性，主要症状为肿胀和疼痛7年。X线平片和计算机断层扫描显示皮质不规则增厚，磁共振成像显示软组织受累，提示该肿瘤为软骨肉瘤而非常见的内生软骨瘤。由于患者年龄、患有老年痴呆症以及患者及其家属的强烈意愿，进行了彻底刮除和人工骨移植。组织学检查显示，肿瘤由多边形细胞组成，嗜酸性细胞质在软骨样基质中增生，部分有黏液样改变。观察到核不规则、双核细胞、骨质浸润和包绕，肿瘤被诊断为2级软骨肉瘤。肿瘤在术后5个月复发。对环指包括第4掌骨远端进行了截肢。术后两年，患者无复发或肺转移。总之，影像学和病理学检查结果的细节对于手部良性内生软骨瘤和软骨肉瘤的鉴别诊断至关重要。手部软骨肉瘤比内生软骨瘤需要更迅速、更彻底的治疗。建议广泛切除以避免局部复发或转移。
