Back to ISAWE Scenarios
oncology

Enchondroma

intermediate
6 min
28 marks
6 questions
Clinical Scenario
A 35-year-old woman is referred after an X-ray for a hand injury incidentally revealed a bony lesion in her proximal phalanx. She has no pain or swelling in the affected finger. On examination, there is no mass, tenderness, or limitation of movement. The X-ray shows a well-defined lytic lesion in the proximal phalanx with stippled calcification and no cortical breach.
AP radiograph of the hand demonstrating an enchondroma in the proximal phalanx of the ring finger. The lesion shows classic features: central location in the medullary cavity, well-defined margins, stippled 'popcorn' calcification, and mild endosteal scalloping. No cortical destruction, periosteal reaction, or soft tissue mass is seen. This is the most common location for enchondroma.
Open Full Size

AP radiograph of the hand demonstrating an enchondroma in the proximal phalanx of the ring finger. The lesion shows classic features: central location in the medullary cavity, well-defined margins, stippled 'popcorn' calcification, and mild endosteal scalloping. No cortical destruction, periosteal reaction, or soft tissue mass is seen. This is the most common location for enchondroma.

Source: Educational illustration of an enchondroma in the proximal phalanx • OrthoVellum Educational Use

Questions

Question 1 (4 marks)

Describe the clinical and radiographic features of enchondroma.

Question 2 (5 marks)

How do you differentiate enchondroma from low-grade chondrosarcoma?

Question 3 (6 marks)

What are the multiple enchondroma syndromes?

Question 4 (5 marks)

Describe the management of enchondroma.

Question 5 (4 marks)

Discuss enchondroma of the hand specifically.

Question 6 (4 marks)

What are the outcomes and surveillance recommendations?

Exam Day Cheat Sheet

Must Mention

  • •Most common in hands (40-50%)
  • •Hands = low malignant potential (<1%)
  • •Red flags: >5cm, scalloping >2/3, pain, growth
  • •Ollier = 25-30% malignant transformation
  • •Maffucci = enchondromas + hemangiomas = 100%
  • •Observe asymptomatic hand lesions

Common Pitfalls

  • •Unnecessary surgery on hand lesions
  • •Missing transformation risk
  • •Wrong Ollier/Maffucci risk
  • •Not knowing red flags
  • •Wrong surveillance protocol
  • •Confusing with chondrosarcoma