Chondromas

Chondromas are benign (not cancerous) tumors made of cartilage that are found mostly in the small bones of the hand and feet.

• They can also occur in the humerus (upper arm), femur (thigh bone), and ribs.
• These tumors rarely produce symptoms but can cause the affected bone to easily fracture.
• They don't spread and usually stop growing when your child's bones reach full growth potential.

They are classified as one of two types depending on where on the bone they are located:

• Enchondromas: This kind of chondroma is found in the marrow cavity of the bone
• Periosteal chondromas: This kind of chondroma forms at the surface of the bone

Some may continue to grow and transform into a malignant condition called chondrosarcoma in adulthood. Your child's doctor will pay close attention to any tumor that grows after skeletal maturity.

Chondromas account for 25 percent of all benign bone tumors. The exact cause is unknown.

Enchondromas are the most common type of bone tumor found in the hand. Boys and girls are equally affected. They can occur at any age but usually enchondromas are not discovered until people are in their 30s or 40s.

Periosteal chondromas are extremely rare. They usually appear earlier, which may be because they produce symptoms, leading to earlier detection.

Enchondroma

• Usually no symptoms
• Pain
• Fracture
• Tendinitis (usually in the upper arm)
• Painless swelling of a digit

Periosteal chondromas

• Dull, achy pain
• Swelling
• A mass that can be felt
• Sometimes no symptoms

In addition to a taking a complete medical history and performing a full physical examination, your child's doctor may use some combination of the following tests to diagnose either type of chondroma:

• X-rays
• Magnetic resonance imaging (MRI)
• Computerized tomography scan (also called CT or CAT scan)
• Bone scan
• Complete blood count (CBC)

Treatment for children with chondromas without symptoms may involve observation alone. Your child's doctor will watch for any signs of bone destruction or malignant transformation. Doctors will probably want to remove your child's chondromas that are causing symptoms, such as pain or fracture.

Removing the chondroma

The operation of choice, performed by an orthopaedic surgeon, usually involves curettage.

Curettage describes a procedure in which a tumor is surgically scraped out of the bone, leaving a cavity that is then packed with either donor bone tissue (allograft), bone chips taken from another bone (autograft), or other materials depending on the preference of the surgeon.

While the operation is performed, the surgeon will take a biopsy, a tissue sample of the tumor, so it can be examined under a microscope.

If the tumor is causing destruction or if doctors believe it will degenerate to a malignant condition known as chondrosarcoma, the tumor and surrounding healthy tissue may be surgically removed.

The long-term outlook for a patient with enchondroma or periosteal chondroma varies from patient to patient depending on:

• The extent of the disease
• The size and location of the tumor
• The presence of absence of malignant degeneration
• The age and overall health of your child
• Your child's tolerance for specific medication, procedures, or therapies

Generally, enchondroma and periosteal chondroma that are not causing any symptoms will resolve on their own as they stop growing at skeletal maturity. Due to the possibility of a transformation into a malignant condition, however, continual follow-up care is essential if your child is diagnosed with a chondroma.

The Bone and Soft Tissue Tumors Program at the Dana-Farber/Boston Children’s Cancer and Blood Disorders Center combines the expertise of Boston Children’s Hospital and Dana-Farber Cancer Institute for the comprehensive medical and surgical care of malignant bone and soft tissue tumors in children and teens.