Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 South Greene St., Baltimore, MD, 21201, USA.
Skeletal Radiol. 2021 Jun;50(6):1189-1196. doi: 10.1007/s00256-020-03664-w. Epub 2020 Nov 10.
To determine the rate of chondrosarcoma in incidentally discovered painless long bone cartilage lesions and to determine if any further imaging is needed.
A cartilage lesion was said to be an enchondroma when it had characteristic matrix mineralization and no aggressive features. Search of all imaging reports and tumor board files for keywords enchondroma, cartilage lesion, chondroid, and chondrosarcoma. Retrospective review of medical records and imaging studies from 4.5-year period. Data points collected included patient age, sex, lesion site, size, symptoms, type of imaging, imaging appearance, and length of follow-up. Only patients with no pain were included as enchondroma. Patients with final diagnosis of chondrosarcoma were included for comparison of all features.
Only 1/73 (1.4%) patients with an initial incidentally discovered painless lesion was later diagnosed, with new symptoms, as atypical cartilage tumor. Average age was 59.4 years. Bones involved were the femur (n = 33), humerus (n = 30), tibia (n = 7), fibula (n = 2), and ulna (n = 1). Average enchondroma size was 3.9 cm (range 1.4-11.5). Average follow-up was 47 months (range 2-196 months). Eleven long bone chondrosarcomas were identified. All chondrosarcoma patients had pain and aggressive imaging findings.
Our study reveals that the rate of chondrosarcoma in incidentally found painless chondroid lesions without aggressive features in long bones is low. Imaging follow-up may be needed only in the setting of new symptoms.
确定偶然发现的无痛长骨软骨病变中软骨肉瘤的发生率，并确定是否需要进一步进行影像学检查。
当软骨病变具有特征性基质矿化且无侵袭性特征时，将其定义为内生软骨瘤。通过关键词搜索所有影像学报告和肿瘤委员会文件，寻找内生软骨瘤、软骨病变、软骨样、软骨肉瘤。回顾性分析 4.5 年期间的病历和影像学研究。收集的数据点包括患者年龄、性别、病变部位、大小、症状、影像学类型、影像学表现和随访时间。仅将无疼痛的患者纳入内生软骨瘤组。将最终诊断为软骨肉瘤的患者纳入进行所有特征的比较。
仅有 1/73（1.4%）例最初偶然发现无痛病变的患者，随后出现新症状，被诊断为非典型软骨肿瘤。平均年龄为 59.4 岁。受累骨骼包括股骨（n=33）、肱骨（n=30）、胫骨（n=7）、腓骨（n=2）和尺骨（n=1）。平均内生软骨瘤大小为 3.9cm（范围 1.4-11.5cm）。平均随访时间为 47 个月（范围 2-196 个月）。共发现 11 例长骨软骨肉瘤。所有软骨肉瘤患者均有疼痛和侵袭性影像学表现。
我们的研究表明，偶然发现的无痛、无侵袭性特征的长骨软骨病变中软骨肉瘤的发生率较低。仅在出现新症状时，可能需要进行影像学随访。
