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Presented by Edward McCarthy, M.D. and prepared by Angelique W. Levi, M.D.
Case 2: A 35 year old man had the acute onset of pain in his finger.
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Question 1 of 1
1. Question
Week 29: Case 2
A 35 year old man had the acute onset of pain in his finger. A radiograph demonstrated a lytic lesion with a pathologic fracture in the 2nd metacarpal./images/EMCcase2xray.jpg
/images/EMCcase2a.jpg
/images/EMCcase2b.jpgCorrect
Answer: Enchondroma
Histology: An enchondroma is the most common primary bone tumor of the hands or feet. They consist of lobules of hyaline cartilage. Mild atypia may be present.
Discussion: By contrast, chondrosarcomas in the hands or feet are extremely rare. A threshold for diagnosing a chondrosarcoma in the hands and feet must be very high. Enchondromas show some atypia and may show cortical expansion in the hands. These radiographic features, in a long bone, would be indicative of chondrosarcoma. However, in the hand, they are within the definition of an enchondroma. The principle criteria for diagnosing a chondrosarcoma in the hand would be invasion of the soft tissues adjacent to the bone.
A giant cell reparative granuloma is a lytic lesion, that may occur in the hands. This entity must be considered radiologically if a destructive bony lesion is present in the hand. However, histologically giant cell reparative granuloma does not show cartilage. Rather it is consisted of multinucleated, osteoclast-like
giant cells in a fibrous matrix with reactive bone.Incorrect
Answer: Enchondroma
Histology: An enchondroma is the most common primary bone tumor of the hands or feet. They consist of lobules of hyaline cartilage. Mild atypia may be present.
Discussion: By contrast, chondrosarcomas in the hands or feet are extremely rare. A threshold for diagnosing a chondrosarcoma in the hands and feet must be very high. Enchondromas show some atypia and may show cortical expansion in the hands. These radiographic features, in a long bone, would be indicative of chondrosarcoma. However, in the hand, they are within the definition of an enchondroma. The principle criteria for diagnosing a chondrosarcoma in the hand would be invasion of the soft tissues adjacent to the bone.
A giant cell reparative granuloma is a lytic lesion, that may occur in the hands. This entity must be considered radiologically if a destructive bony lesion is present in the hand. However, histologically giant cell reparative granuloma does not show cartilage. Rather it is consisted of multinucleated, osteoclast-like
giant cells in a fibrous matrix with reactive bone.
