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      Encondroma osificado en fémur. Una localización atípica. A propósito de un caso Translated title: Ossified enchondroma in femur. An atypical location. Case study

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          Abstract

          RESUMEN Presentamos el caso de un hombre de 61 años en el que se halló de forma incidental un encondroma a nivel proximal de fémur. Tras seguimiento, se observó la estabilidad de la lesión. El encondroma es un tumor de origen cartilaginoso benigno. Se localiza principalmente en las falanges de las manos y los pies, aunque puede observarse en húmero o fémur. Por lo general, es una lesión asintomática y se halla de manera incidental. En las radiografías suelen verse lesiones redondeadas bien definidas con radiolucidez central. Se recomienda el seguimiento con radiografías seriadas para comprobar la progresión o estabilidad de la lesión y hacer su diagnóstico diferencial con el condrosarcoma.

          Translated abstract

          ABSTRACT We report the case of a 61-year-old man in whom an enchondroma was incidentally detected at the proximal level of the femur. After follow-up the lesion was stable. Enchondroma is a benign cartilaginous tumor. It is located mainly in the phalanges of the hands and feet, although it can be seen in the humerus or femur. It is usually an asymptomatic lesion, found incidentally. On x-rays, well-defined round lesions with central radiolucency are usually observed. Follow-up with serial x-rays is recommended to verify the lesion’s course or stability and make its differential diagnosis with chondrosarcoma.

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          Usefulness of radiography in differentiating enchondroma from central grade 1 chondrosarcoma.

          The purpose of this study was to evaluate clinical symptoms and radiographic features that allow radiologists to differentiate between enchondroma and central grade 1 chondrosarcoma. Such differentiation is important because of differences in management. Clinical symptoms and location and size of 35 enchondromas and 43 central grade 1 chondrosarcomas were analyzed. Radiographic features were assessed independently by three observers. The chi-square test and linear discriminant analysis were used to identify features with discriminating strength. Kappa values were calculated to validate the consistency of observations among observers. A consensus diagnosis made by histology and long-term follow-up was used as the standard. No statistically significant correlation was found between clinical symptoms and the benign or malignant nature of the neoplasms. Grade 1 chondrosarcomas were more likely to be found in the axial skeleton and in flat bones. Also, chondrosarcomas were significantly larger than enchondromas (p < .001). Ill-defined margins and lobulated contours were the only morphologic features seen on radiographs that allowed significant discrimination (p = .004 and .009, respectively). An optimal combination of four radiographic features still left 72 of the 78 lesions with a 10-90% probability of malignancy, indicative of poor discriminating power. Kappa values generally showed poor to fair agreement. Location in the axial skeleton and size greater than 5 cm are the most reliable predictors of central grade 1 chondrosarcoma. Morphologic features seen on radiographs and clinical symptoms do not improve the ability to differentiate between enchondromas and central grade 1 chondrosarcomas.
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            Arthroscopic treatment for femoral neck enchondroma: case report

            INTRODUCTION Enchondromas are benign hyaline cartilage tumours that radiographically present with irregular intra lesional calcification [1]. Plain radiographs are usually sufficient for the diagnosis, but CT and magnetic resonance imaging (MRI) scans are useful for better assessment of the lesion, in particular for the exclusion of chondrosarcoma [1, 2]. Treatment consists of observation with periodic examinations to assess the evolution of the lesion [1, 2]. Surgical treatment is indicated when there is evolution of the lesion or when it becomes symptomatic. Curettage with or without bone grafting is usually curative [2]. Hip arthroscopy [3] allows getting good visualization of the central and peripheral compartment of the hip, thereby decreasing the morbidity resulting from open surgery [4]. CASE REPORT A 47-year-old female patient was referred with left hip pain. On physical examination, she had a normal range of motion (Flexion: 140°, ER and IR: 40°, adduction: 30°, abduction: 60°) with a positive FADIR and a negative FABER test. X-ray and MRI revealed a chondroid lesion without cortex invasion, located in the medial aspect of the femoral neck, with 2.8 cm (Fig. 1a–c). No other intra-articular problem was found. After initial treatment with NSAID’s for 6 weeks the pain persisted. Meanwhile there was no radiological change of the lesion. Arthroscopic curettage of the lesion was proposed. Fig. 1. (a) Preoperative X-ray. (b, c) MRI image, demonstrating a medial femoral neck lesion. (d, e) Arthtroscopic exposure of femoral neck after T-shaped capsulotomy. (f, g) Curettage of the lesion. (h) Defect after curettage. (i) Arthroscopic view of a cannulated screw in position. (j, k) Post-operative X-ray. (l) X-ray after hardware removal. The patient underwent hip arthroscopy in supine position. An anterolateral portal was used as vision portal and an anteromedial portal and an anteromedial proximal portal were used as work portals. After establishing the portals we accessed the pre-capsular space and the femoral neck was visualized after a T-shaped capsulotomy (Fig. 1d–f). To access the medial side of the femoral neck, the hip was flexed and externally rotated. Curettage of the lesion was performed under fluoroscopic control (Fig. 1f–h). Prophylactic femoral neck fixation was performed using two cannulated screws under arthroscopic and fluoroscopic visualization (Fig. 1l). Histology confirmed the diagnosis of enchondroma without evidence of atypical cells or necrosis. Post-operative instruction for the patient was partial weight bear for 6 weeks and an immediate rehabilitation program consisting of range of movement exercises. Four months post-operatively, the patient reported considerable reduction of pain. At 8 months post-operative, X-ray showed that the defect was filled up and the patient underwent hardware removal. After 10 months, she reported a WOMAC score of 85 (63.3 pre-op), an MHHS of 87 (69 pre-op) and a VAS for pain score of 3 (8 pre-op). DISCUSSION/CONCLUSION This case report shows that arthroscopic curettage of a femoral neck enchondroma is a plausible option. It is not a difficult procedure for a surgeon accustomed to hip arthroscopy. Moreover, it is less invasive compared with hip arthrotomy and has a good clinical outcome. CONFLICT OF INTEREST STATEMENT None declared.
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              Are the tubular bones of the hand really the commonest site for an enchondroma?

              To investigate whether the long-held view that the hand is the commonest site for an enchondroma is actually correct in light of more sensitive imaging techniques that are able to demonstrate small enchondromas at other skeletal sites.
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                Author and article information

                Journal
                albacete
                Revista Clínica de Medicina de Familia
                Rev Clin Med Fam
                Sociedad Española de Medicina de Familia y Comunitaria (Barcelona, Cataluña, Spain )
                1699-695X
                2386-8201
                2023
                : 16
                : 3
                : 295-297
                Affiliations
                [2] Murcia orgnameCentro de Salud Abanilla España
                [1] Albacete orgnameCentro de Salud Zona VIII España
                Article
                S1699-695X2023000300010 S1699-695X(23)01600300010
                10.55783/rcmf.160310
                1ba33015-0cae-489b-a021-7b2ae36318d0

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 14 January 2022
                : 19 July 2022
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 10, Pages: 3
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                SciELO Spain

                Categories
                Un paciente con ... (caso clínico)

                benigno,tumor,encondroma,Tumor,Enchondroma,Benign
                benigno, tumor, encondroma, Tumor, Enchondroma, Benign

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