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Risk factors for local recurrence from atypical cartilaginous tumour and enchondroma of the long bones

  • Costantino Errani
  • Shinji Tsukamoto
  • Giovanni Ciani
  • Manabu Akahane
  • Luca Cevolani
  • Piergiuseppe Tanzi
  • Akira Kido
  • Kanya Honoki
  • Yasuhito Tanaka
  • Davide Maria Donati
Original Article • TUMORS - LIMBS

Abstract

Introduction

The purpose of our study is to verify possible clinical and radiological findings with regard to distinguishing enchondroma from atypical cartilaginous tumour (ACT). In addition, this study determined risk factors that are associated with local recurrence of enchondroma or ACT treated with curettage.

Materials and methods

We retrospectively reviewed the records of 54 patients with enchondroma and 35 patients with ACT of the long bones treated by curettage between 1986 and 2015. The minimum follow-up was 18 months. The relationship between clinical and radiological factors and the tumour type or local recurrence was assessed using Chi-square test or Fischer exact test.

Results

Endosteal scalloping (p = 0.004) and soft tissue extension (p = 0.017) were shown to statistically favour ACT over enchondroma; by contrast, pain (p = 0.034) was more frequent in enchondroma compared to ACT. All patients with enchondroma had no local recurrence; in contrast, local recurrence occurred in four patients with ACT (11%). Soft tissue extension (p = 0.049) and the diagnosis of ACT (p = 0.021) were associated with an increased risk of local recurrence. We had a disease progression in three of four patients with local recurrence, and these had higher histological grade than the original tumour.

Discussion

Our data show that endosteal scalloping and soft tissue extension could be helpful in the differential diagnosis between enchondroma and ACT. We suggest following only those patients with ACT after surgery to identify any possible recurrence and, in case of recurrence, treat these patients with resection for the risk of disease progression.

Keywords

Atypical cartilaginous tumour Enchondroma Chondrosarcoma Surgery Curettage Recurrence Imaging 

Notes

Compliance with ethical standards

Conflict of interest

All authors declare to have no conflict of interest.

References

  1. 1.
    Eefting D, Schrage YM, Geirnaerdt MJA, Le Cessie S, Taminiau AH, Bovée JV, Hogendoorn PC, EuroBoNeT consortium (2009) Assessment of interobserver variability and histologic parameters to improve reliability in classification and grading of central cartilaginous tumors. Am J Surg Pathol 33(1):50–57. doi: 10.1097/PAS.0b013e31817eec2b CrossRefPubMedGoogle Scholar
  2. 2.
    Parlier-Cuau C, Bousson V, Ogilvie CM, Lackman RD, Laredo J-D (2011) When should we biopsy a solitary central cartilaginous tumor of long bones? Literature review and management proposal. Eur J Radiol 77(1):6–12. doi: 10.1016/j.ejrad.2010.06.051 CrossRefPubMedGoogle Scholar
  3. 3.
    Welkerling H, Kratz S, Ewerbeck V, Delling G (2003) A reproducible and simple grading system for classical chondrosarcomas. Analysis of 35 chondrosarcomas and 16 enchondromas with emphasis on recurrence rate and radiological and clinical data. Virchows Arch Int J Pathol 443(6):725–733. doi: 10.1007/s00428-003-0896-x CrossRefGoogle Scholar
  4. 4.
    van der Geest ICM, de Valk MH, de Rooy JWJ, Pruszczynski M, Veth RPH, Schreuder HWB (2008) Oncological and functional results of cryosurgical therapy of enchondromas and chondrosarcomas grade 1. J Surg Oncol 98(6):421–426. doi: 10.1002/jso.21122 CrossRefPubMedGoogle Scholar
  5. 5.
    Ferrer-Santacreu EM, Ortiz-Cruz EJ, González-López JM, Pérez Fernández E (2012) Enchondroma versus low-grade chondrosarcoma in appendicular skeleton: clinical and radiological criteria. J Oncol 2012:437958. doi: 10.1155/2012/437958 CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Schwab JH, Wenger D, Unni K, Sim FH (2007) Does local recurrence impact survival in low-grade chondrosarcoma of the long bones? Clin Orthop 462:175–180. doi: 10.1097/BLO.0b013e3180caac2c CrossRefPubMedGoogle Scholar
  7. 7.
    Murphey MD, Flemming DJ, Boyea SR, Bojescul JA, DE Sweet, Temple HT (1998) Enchondroma versus chondrosarcoma in the appendicular skeleton: differentiating features. Radiogr Rev Publ Radiol Soc N Am Inc 18(5):1213–1237. doi: 10.1148/radiographics.18.5.9747616 Google Scholar
  8. 8.
    Ferrer-Santacreu EM, Ortiz-Cruz EJ, Díaz-Almirón M, Pozo Kreilinger JJ (2016) Enchondroma versus chondrosarcoma in long bones of appendicular skeleton: clinical and radiological criteria-A follow-up. J Oncol 2016:8262079. doi: 10.1155/2016/8262079 CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Choi BB, Jee WH, Sunwoo HJ, Cho JH, Kim JY, Chun KA, Hong SJ, Chung HW, Sung MS, Lee YS, Chung YG (2013) MR differentiation of low-grade chondrosarcoma from enchondroma. Clin Imaging 37(3):542–547. doi: 10.1016/j.clinimag.2012.08.006 CrossRefPubMedGoogle Scholar
  10. 10.
    Hickey M, Farrokhyar F, Deheshi B, Turcotte R, Ghert M (2011) A systematic review and meta-analysis of intralesional versus wide resection for intramedullary grade I chondrosarcoma of the extremities. Ann Surg Oncol 18(6):1705–1709. doi: 10.1245/s10434-010-1532-z CrossRefPubMedGoogle Scholar
  11. 11.
    Dierselhuis EF, Gerbers JG, Ploegmakers JJW, Stevens M, Suurmeijer AJH, Jutte PC (2016) Local treatment with adjuvant therapy for central atypical cartilaginous tumors in the long bones: analysis of outcome and complications in one hundred and eight patients with a minimum follow-up of two years. J Bone Joint Surg Am 98(4):303–313. doi: 10.2106/JBJS.O.00472 CrossRefPubMedGoogle Scholar
  12. 12.
    Souna BS, Belot N, Duval H, Langlais F, Thomazeau H (2010) No recurrences in selected patients after curettage with cryotherapy for grade I chondrosarcomas. Clin Orthop 468(7):1956–1962. doi: 10.1007/s11999-009-1211-1 CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Hanna SA, Whittingham-Jones P, Sewell MD, Pollock RC, Skinner JA, Saifuddin A, Flanagan A, Cannon SR, Briggs TW (2009) Outcome of intralesional curettage for low-grade chondrosarcoma of long bones. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol 35(12):1343–1347. doi: 10.1016/j.ejso.2009.06.001 Google Scholar
  14. 14.
    Mohler DG, Chiu R, McCall DA, Avedian RS (2010) Curettage and cryosurgery for low-grade cartilage tumors is associated with low recurrence and high function. Clin Orthop 468(10):2765–2773. doi: 10.1007/s11999-010-1445-y CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Verdegaal SHM, Brouwers HFG, van Zwet EW, Hogendoorn PCW, Taminiau AHM (2012) Low-grade chondrosarcoma of long bones treated with intralesional curettage followed by application of phenol, ethanol, and bone-grafting. J Bone Joint Surg Am 94(13):1201–1207. doi: 10.2106/JBJS.J.01498 CrossRefPubMedGoogle Scholar
  16. 16.
    Aarons C, Potter BK, Adams SC, Pitcher JD, Temple HT (2009) Extended intralesional treatment versus resection of low-grade chondrosarcomas. Clin Orthop 467(8):2105–2111. doi: 10.1007/s11999-008-0691-8 CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Bauer HC, Brosjö O, Kreicbergs A, Lindholm J (1995) Low risk of recurrence of enchondroma and low-grade chondrosarcoma in extremities. 80 patients followed for 2–25 years. Acta Orthop Scand 66(3):283–288CrossRefPubMedGoogle Scholar
  18. 18.
    Donati D, Colangeli S, Colangeli M, Di Bella C, Bertoni F (2010) Surgical treatment of grade I central chondrosarcoma. Clin Orthop 468(2):581–589. doi: 10.1007/s11999-009-1056-7 CrossRefPubMedGoogle Scholar
  19. 19.
    Leerapun T, Hugate RR, Inwards CY, Scully SP, Sim FH (2007) Surgical management of conventional grade I chondrosarcoma of long bones. Clin Orthop 463:166–172. doi: 10.1097/BLO.0b013e318146830f PubMedGoogle Scholar
  20. 20.
    Geirnaerdt MJ, Hermans J, Bloem JL, Kroon HM, Pope TL, Taminiau AH, Hogendoorn PC (1997) Usefulness of radiography in differentiating enchondroma from central grade 1 chondrosarcoma. AJR Am J Roentgenol 169(4):1097–1104. doi: 10.2214/ajr.169.4.9308471 CrossRefPubMedGoogle Scholar
  21. 21.
    Crim J, Schmidt R, Layfield L, Hanrahan C, Manaster BJ (2015) Can imaging criteria distinguish enchondroma from grade 1 chondrosarcoma? Eur J Radiol 84(11):2222–2230. doi: 10.1016/j.ejrad.2015.06.033 CrossRefPubMedGoogle Scholar
  22. 22.
    Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ (1993) A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop 286:241–246Google Scholar
  23. 23.
    Skeletal Lesions Interobserver Correlation among Expert Diagnosticians (SLICED) Study Group (2007) Reliability of histopathologic and radiologic grading of cartilaginous neoplasms in long bones. J Bone Joint Surg Am 89(10):2113–2123. doi: 10.2106/JBJS.F.01530 CrossRefGoogle Scholar
  24. 24.
    Lai X, Chen S (2015) Identification of novel biomarker candidates for immunohistochemical diagnosis to distinguish low-grade chondrosarcoma from enchondroma. Proteomics 15(13):2358–2368. doi: 10.1002/pmic.201400528 CrossRefPubMedGoogle Scholar
  25. 25.
    Ahlmann ER, Menendez LR, Fedenko AN, Learch T (2006) Influence of cryosurgery on treatment outcome of low-grade chondrosarcoma. Clin Orthop 451:201–207. doi: 10.1097/01.blo.0000229293.98850.5d CrossRefPubMedGoogle Scholar
  26. 26.
    Rajeh MA, Diaz JJ, Facca S, Matheron AS, Gouzou S, Liverneaux P (2017) Treatment of hand enchondroma with injectable calcium phosphate cement: a series of eight cases. Eur J Orthop Surg Traumatol 2:251–254CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France 2017

Authors and Affiliations

  • Costantino Errani
    • 1
  • Shinji Tsukamoto
    • 2
  • Giovanni Ciani
    • 1
  • Manabu Akahane
    • 3
  • Luca Cevolani
    • 1
  • Piergiuseppe Tanzi
    • 1
  • Akira Kido
    • 2
  • Kanya Honoki
    • 2
  • Yasuhito Tanaka
    • 2
  • Davide Maria Donati
    • 1
  1. 1.Orthopaedic, Musculoskeletal Oncology DepartmentIstituto Ortopedico RizzoliBolognaItaly
  2. 2.Department of Orthopaedic SurgeryNara Medical UniversityNaraJapan
  3. 3.Department of Public Health, Health Management and PolicyNara Medical UniversityNaraJapan

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