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503 LOW-GRADE INTRAMEDULLARY CARTILAGE TUMORS: A REASSESSMENT OF DIAGNOSIS AND TREATMENT.
  1. D. Shearer,
  2. B. P. Rubin,
  3. J. F. Eary,
  4. E. U. Conrad
  1. Department of Orthopaedics and Sports Medicine, Department of Pathology, and Division of Nuclear Medicine, University of Washington School of Medicine, Seattle, WA

Abstract

Background Benign and malignant cartilage-based neoplasms are known as enchondroma and chondrosarcoma, respectively. Enchondromas are usually asymptomatic and do not require treatment other than periodic clinical follow-up. Clinical behavior of chondrosarcoma ranges significantly, from high-grade lesions with a high rate of metastasis and mortality to low-grade lesions that tend only to be aggressive locally. Preoperative differentiation of enchondroma and low-grade chondrosarcoma relies upon tumor imaging, but a reliable clinical algorithm does not exist. Histologic examination of these tumors similarly fails to differentiate these tumors without correlation to imaging. Further exacerbating this problem, many institutions treat low-grade chondrosarcoma with en bloc resection, a highly morbid procedure that may not be warranted.

Study Design and Methods Clinical, imaging, and treatment data from 250 patients with enchondroma and conventional chondrosarcoma were reviewed with the two-fold purpose of (1) defining a clinical algorithm and (2) determining whether intralesional curettage is adequate treatment for low-grade chondrosarcoma. To assess the potential of immunohistochemistry as a marker of malignancy, an equal number (n = 100) of enchondroma and chondrosarcoma core samples were assayed for a variety of suspected malignant markers.

Results Among enchondromas, 42% were treated surgically due to uncertainty of malignancy preoperatively. Pain was not a statistically significant indicator of malignancy (p = .14). There were no recurrent enchondromas (n = 74). The recurrence rate among low-grade chondrosarcomas treated with curretage and cryotherapy in the appendicular skeleton was 8% (1/18) and 43% (3/7) in the axial skeleton. The recurrence rate for resected tumors was 14% (1/7) in the appendicular skeleton and 25% (2/8) in the axial skeleton.

Conclusion A clinical algorithm consistently applied to intramedullary cartilage tumors has the potential to significantly decrease the number unnecessary surgical procedures. Furthermore, low-grade chondrosarcoma in the appendicular skeleton can be treated with curretage and cryotherapy to improve long-term functional outcome without increasing the risk of local recurrence relative to en bloc resection.

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