Abstract
Purpose: Incidental bone lesions are a challenge for the specialist, who has to give recommendations for further management. This review of our cases will assist in the decision whether the lesion can be “neglected”, needs further active follow-up or direct initiation of treatment. Patients and Methods: 153 cases of incidental bone findings were presented to our musculoskeletal tumor service for evaluation from July 2008 through June 2021. 73 of them were cartilaginous tumors and 63 of these were diagnosed as enchondroma of a long bone based on X-Ray and MRI. Results: Follow-up imaging of the enchondroma patients was available for 35 patients at 1 to 13 years (mean 4.3 y), with no change in size except for one femoral diaphyseal enchondroma with increasing diameter from age 18 to 20 years. 14 additional patients answered written contact stating that they remained asymptomatic at 2 to 12 years (mean 5.6 y). None of the patients has been reported to the Swiss Confoederation Cancer Registry to have developed malignancy. Among the 10 other cartilaginous tumors were one chondrosarcoma grade II exhibiting different imaging, 3 non-long-bone localizations (pelvis, scapula and rib), 2 Ollier-type enchondromas, and 2 osteochondromas. Incidental findings other than cartilaginous tumors were fibrous dysplasia (n = 31), non-ossifying fibroma (n = 31) and 18 other “sporadic” entities. Conclusions: Incidentally found enchondromas not exhibiting aggressive features need no systematic follow-up and patients can be “discharged” with the advice to present, if symptoms would develop. This also applies to fibrous dysplasia and the other sporadic lesions. 6 cases with other diagnoses needed specific treatment.
Highlights
Each case presenting with an incidental finding in musculoskeletal imaging raises concern regarding diagnosis and further management.Among the series of incidental bone findings referred to our tumor group for evaluation cartilaginous tumors were the most frequent, usually referred with the objective to “rule out sarcoma”.Several authors (Patel et al [1], Davies et al [2], and Ahmed et al [3]) recently questioned, whether follow-up imaging is needed in incidentally found painless chondroid lesions in long bones without aggressive features in imaging.Historically the risk of developing chondrosarcoma ex enchondroma has been overestimated, as enchondromas were detected in standard radiographs only in the presence of distinct calcifications
Patients and Methods: 153 cases of incidental bone findings were presented to our musculoskeletal tumor service for evaluation from July 2008 through June 2021. 73 of them were cartilaginous tumors and 63 of these were diagnosed as enchondroma of a long bone based on X-Ray and MRI
Based on X-Ray and MRI 73 of the patients had cartilaginous tumors and 63 of these were diagnosed as enchondroma of a long bone
Summary
Each case presenting with an incidental finding in musculoskeletal imaging raises concern regarding diagnosis and further management.Among the series of incidental bone findings referred to our tumor group for evaluation cartilaginous tumors were the most frequent, usually referred with the objective to “rule out sarcoma”.Several authors (Patel et al [1], Davies et al [2], and Ahmed et al [3]) recently questioned, whether follow-up imaging is needed in incidentally found painless chondroid lesions in long bones without aggressive features in imaging.Historically the risk of developing chondrosarcoma ex enchondroma has been overestimated, as enchondromas were detected in standard radiographs only in the presence of distinct calcifications. Each case presenting with an incidental finding in musculoskeletal imaging raises concern regarding diagnosis and further management. Among the series of incidental bone findings referred to our tumor group for evaluation cartilaginous tumors were the most frequent, usually referred with the objective to “rule out sarcoma”. Several authors (Patel et al [1], Davies et al [2], and Ahmed et al [3]) recently questioned, whether follow-up imaging is needed in incidentally found painless chondroid lesions in long bones without aggressive features in imaging. We wish to contribute to the discussion of how to proceed with enchondromas found incidentally regarding follow-up. We include the other incidental bone lesions to expand on differential diagnostic aspects
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