Curettage and cryosurgery for enchondroma and atypical cartilaginous tumors of the long bones: Oncological results of a large series

Abstract

Background and Objectives: Intralesional surgical treatment is the preferred therapy for atypical cartilaginous tumors (ACTs) of the long bones in many institutions. However, the literature is still controversial regarding intralesional treatment versus wide resection. Due to the relative rarity of these tumors, studies reporting on the results of intralesional treatment are often small sample studies. Methods: We retrospectively analyzed the oncological results of 55 enchondromas, 119 ACTs, and 5 chondrosarcomas grade 2 (CS2) treated with curettage and cryosurgery between the years 2004 and 2017 at our institution. The median follow-up period was 53 months (range, 24-169 months). Results: In total, seven cases (three ACT, four CS2) recurred. Residual tumor was detected in 20 cases. Three cases underwent secondary curettage and cryosurgery due to local recurrence. Four cases underwent wide resection and reconstruction due to local recurrence with aggressive imaging characteristics. In total, 20 postoperative complications were seen. Conclusion:Curettage and cryosurgery for enchondroma and ACT show very good oncological results with a low recurrence rate and acceptable complication rate.Curettage and cryosurgery is reliable as a surgical treatment for enchondroma and ACT. Further research should define the criteria for determining which specific cartilaginous tumors necessitate surgical treatment.

Pathological fractures through enchondromas of the proximal humerus mimicking malignancy: a case report

“…In the authors' patients, the evolution in subsequent radiographic follow-up (including the luck of having a previous radiograph in the first case) and the absence of symptoms before the fracture were considered sufficient to warrant the diagnosis of benignity and endorse the decision of conservative management over surgery with further morbidity. 4,11,19,20 CONCLUSION These cases illustrate this paper's conclusion: a pathological fracture in a long bone revealing a chondroid tumor of uncertain aggressiveness should be managed cautiously. In the absence of endosteal scalloping and a healed fracture, after informed consent, it would be reasonable to consider long-term (5+ years) observation for changes concerning for an active lesion.…”

“…The clinical and imaging data before the fracture and subsequent behavior are crucial in the diagnosis and management. In the authors’ patients, the evolution in subsequent radiographic follow-up (including the luck of having a previous radiograph in the first case) and the absence of symptoms before the fracture were considered sufficient to warrant the diagnosis of benignity and endorse the decision of conservative management over surgery with further morbidity 4,11,19,20…”

Der atypische chondrogene Tumor

“…Eine kostengünstigere und weniger toxische Alternative stellt Wasserstoffperoxid dar, dessen Effektivität bei Riesenzelltumoren des Knochens bestätigt wurde [25]. Auch flüssiger Stickstoff, welcher mindestens 2-mal hintereinander in die Tumorhöhle instilliert werden muss, um gute zytotoxische Effekte zu erzielen, kann als Adjuvans zur Anwendung kommen [7,34].…”

Differentiating Enchondromas and Atypical Cartilaginous Tumors in Long Bones with Computed Tomography and Magnetic Resonance Imaging

“…The different diagnostic imaging features of ACTs, which mainly occur in the long bones more proximally (especially within the femur), and enchondromas, which most commonly appear in the proximal humerus or more distally in the long bones, have been discussed previously [ 9 , 16 ]. Murphey et al evaluated differentiating criteria for enchondromas and chondrosarcomas (including former grade 1) and showed that cortical destruction, soft tissue mass, periosteal reaction and endosteal scalloping (>2/3 of cortical thickness) strongly suggested the diagnosis of chondrosarcoma.…”