33 year old male c/o pain in hand.
Case contributed by Dr. Mohamed Borg. Mansoura University.
Findings:
-Well defined slightly lobulated, homogeneous lesion is noted in head-body
junction of fifth metacarpal.
-It appears isointense on T1WI and hyperintense on T2WI and STIR images.
-It appears mildly expanding the cortex. No other similar lesion is
noted.
Diagnosis:
Enchondroma.
Discussion:
-Benign cartilaginous tumor.
-Develops in the medullary cavity
-Occurs in 2nd to 3rd decade
-Most common site is small bones of the hand
- Most common tumor of the hand
-Also foot, humerus, femur, tibia and ribs
-Hand lesions are usually asymptomatic or associated with pain and
swelling
-May fracture or, rarely, undergo malignant transformation
- Growth of lesion or pain should suggest malignant transformation
-Multiple enchondromas is called Ollier's disease
- Nonhereditary
- May have limb shortening of affected limb
- Madelung’s deformity of the wrist
- Enchondromas point toward the joint.
- Exostoses point away from joint
- Greater incidence of malignant transformation because there are
more lesions present (25%)
-With cavernous hemangiomas of soft tissues called Maffucci's
Syndrome.
- Nonhereditary
- Multiple hemangiomas usually on extremities (digits)
- Look for phleboliths in hemangioma
- Large enchondroma
- Growth disturbance of affected bones
- Malignant transformation
- Greater than solitary enchondroma, less than Ollier’s
- Hemangioma may become sarcoma in 5% of cases.
MRI
§ MRI is useful in evaluating for soft tissue extension and for confirming
the diagnosis. Enchondromas appear as well circumscribed somewhat
lobulated masses replacing marrow.
§ T1-intermediate to low signal
§ T2-typically of background intense high
signal
-they can be focal regions
of signal drop out where calcification
present.
-No bone marrow or soft tissue oedema.
§ T1 C+
-Enhancement is variable, and may be seen
both peripherally or of translesional
septae.
1 comment:
DD could be SBC
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