Prevalence of Enchondromas of the Proximal Femur in Adults as an Incidental Finding on MRI of the Pelvis

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Abstract

Objective To determine the prevalence of enchondroma in adults as an incidental finding in the proximal femur on magnetic resonance imaging (MRI).

Materials and Methods A retrospective review of the MRI scans of the pelvis in a series of adult patients was conducted. All presented with nononcological musculoskeletal complaints. The site, size, and appearances of the enchondromas were identified according to criteria from previous studies.

Results A total of 1,209 proximal femora in 610 patients were reviewed and a total of 9 enchondromas were identified. These ranged from 0.6 to 2.5 cm in length (mean 1.3 cm). None showed aggressive features suggestive of malignancy. Three cases (33%) underwent follow-up MRI scans which showed no change in size or morphology.

Conclusion The prevalence on MRI of incidental enchondromas arising in the proximal femur is 0.7%. This is three to four times less common than seen in the proximal humerus and around the knee.

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Most cited references 22

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Incidence, outcomes and prognostic factors during 25 years of treatment of chondrosarcomas

HW Bart Schreuder, Gerard Schaap, Jos A M Bramer … (2018)

There are few studies detailing the incidence, patient outcomes and prognostic factors for chondrosarcomas (CS). Those that do exist have small sample sizes and/or use older datasets. The purpose of this study was to determine the incidence, overall survival (OS) and prognostic factors for OS of CS patients, as well as investigate the efficacy of curettage.

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Enchondroma versus chondrosarcoma in the appendicular skeleton: differentiating features.

M D Murphey, D J Flemming, S R Boyea … (1998)

Distinction of enchondroma versus intramedullary chondrosarcoma affecting the appendicular skeleton (proximal to the metacarpals and metatarsals) is a frequent diagnostic dilemma. The authors studied a large series of patients with these lesions (92 with enchondromas, 95 with chondrosarcomas) using statistical assessment of both clinical parameters and numerous radiologic manifestations on images from multiple modalities to identify differentiating features. Multiple clinical and imaging parameters demonstrated statistically significant differences between enchondroma and chondrosarcoma, particularly pain related to the lesion, deep endosteal scalloping (greater than two-thirds of cortical thickness), cortical destruction and soft-tissue mass (at computed tomography or magnetic resonance imaging), periosteal reaction (at radiography), and marked uptake of radionuclide (greater than the anterior iliac crest) at bone scintigraphy. All of these features strongly suggested the diagnosis of chondrosarcoma. These criteria allow distinction of appendicular enchondroma and chondrosarcoma in at least 90% of cases.

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Reliability of histopathologic and radiologic grading of cartilaginous neoplasms in long bones.

(2007)

Providing the best treatment options and appropriate prognostic information to patients with cartilaginous neoplasms of long bones depends on distinguishing benign from malignant lesions. Correlative interpretation of imaging, histopathology, and clinical information is the current method for making this distinction, yet the reliability of this approach has not been critically evaluated. This study quantifies the interobserver reliability of the determination of grade for cartilaginous neoplasms among a group of experienced musculoskeletal pathologists and radiologists. Nine recognized musculoskeletal pathologists and eight recognized musculoskeletal radiologists reviewed forty-six consecutive cases of cartilaginous lesions in long bones that underwent open biopsy or intralesional curettage. All diagnosticians had a bulleted history and preoperative conventional radiographs for review. Pathologists reviewed the original hematoxylin and eosin-stained glass slides from each case. Radiologists reviewed any additional imaging that was available, variably including serial radiographs, magnetic resonance imaging, and computed tomography scans. Each diagnostician classified a lesion as benign, low-grade malignant, or high-grade malignant. Kappa coefficients were calculated as a measure of reliability. Kappa coefficients for interrater reliability were 0.443 for the pathologists and 0.345 for the radiologists (p < 0.0001 for both). Kappa coefficients for a subgroup of cases determined to be high risk by subsequent clinical course were poorer at 0.236 and 0.206, respectively (p < 0.0001 for both). Slightly improved agreement among radiologists was noted for the twenty lesions that had magnetic resonance imaging available (Kappa = 0.437, p < 0.0001), but not for the lesions analyzed with serial plain radiographs or computed tomography scans. This study demonstrates low reliability for the grading of cartilaginous lesions in long bones, even among specialized and experienced pathologists and radiologists. This included low reliability both in differentiating benign from malignant lesions and in differentiating high-grade from low-grade malignant lesions, both of which are critical to the safe treatment of these neoplasms. This may explain in part the wide variation in outcomes reported for chondrosarcomas treated in different medical centers. New diagnostic and grading strategies linked to protocol-driven treatments are needed, but they must be measured against the long-term gold standard of patient outcomes.

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Author and article information

Journal

Journal ID (nlm-ta): Indian J Radiol Imaging

Journal ID (iso-abbrev): Indian J Radiol Imaging

Journal ID (doi): 10.1055/s-00050590

Title: The Indian Journal of Radiology & Imaging

Publisher: Thieme Medical and Scientific Publishers Pvt. Ltd. (A-12, 2nd Floor, Sector 2, Noida-201301 UP, India )

ISSN (Print): 0971-3026

ISSN (Electronic): 1998-3808

Publication date Collection: July 2021

Publication date (Electronic): 06 October 2021

Publication date PMC-release: 1 October 2021

Volume: 31

Issue: 3

Pages: 582-585

Affiliations

[1 ]Department of Musculoskeletal Radiology, The Royal Orthopaedic Hospital, Birmingham, United Kingdom

Author notes

Address for correspondence Rajesh Botchu, FRCR Department of Musculoskeletal Radiology, The Royal Orthopedic Hospital Bristol Road South, Northfield, Birmingham B31 2APUnited Kingdom drbrajesh@ 123456yahoo.com

Article

Publisher ID: 2120027

DOI: 10.1055/s-0041-1735915

PMC ID: 8590542

PubMed ID: 34790301

SO-VID: 8a29e93b-ee56-4470-bd3c-dfc9da984d0d

Copyright © Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ )

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This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.

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Prevalence of Enchondromas of the Proximal Femur in Adults as an Incidental Finding on MRI of the Pelvis

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Most cited references 22

Incidence, outcomes and prognostic factors during 25 years of treatment of chondrosarcomas

Enchondroma versus chondrosarcoma in the appendicular skeleton: differentiating features.

Reliability of histopathologic and radiologic grading of cartilaginous neoplasms in long bones.

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