Here the replies to this case:
– fibrous dysplasia, ground glass, also ray involvement – the
distal phalanx is abnormal as well
– enchondromas in fingers usually don’t show a lot of chondroid
calcifications
– The lack of matrix mineralization in Enchondromas in fingers and
feet in general and in children is not uncommon (Skeletal Radiology 2012)
– Looks FD with cystic changes to me
– Just playing the odds, it’s most likely an enchondroma. In the
short tubular bones they often don’t mineralize, cause a lot of cortical
thinning, and easily path fracture. As long as there isn’t a big soft
tissue component, at our place this would likely be presumptive enchondroma
and they would go straight to surgical curettage and packing (and get
pathology samples to confirm while doing it)
– Background ground glass changes distal make me wonder Fibrous
dysplasia with proximal cartilaginous metaplasia. Differential though is
enchondromatosis with carpal and metacarpal involvement. Do not see
features for secondary abc. Think Mx is surgical -but wonder about anti
rankl Rx.
– FD
– Probably enchondroma, but would include fibrous dysplasia on the
differentials.
– If it was in the phalanx I would completely agree. But the
metacarpal bone should be seen as a long tubular bone. Therefore you should
be very carefull calling this a enchondroma. It is still possible also
because of the age of the patient but there is a bit thinned cortex and
some expansion. I would do MRI (bone tumor protocol) if fracture is
completely healed to assess it’s characteristics and FU if it is benign. In
added PowerPoint one case of the metacarpal bone 19 old, looks on xray
pretty harmless but MRI shows different. Differentiating low grade and high
grade CS can be difficault but if there is periostis, soft tissue mass,
periosteal reaction, reactive soft tissue edema, peri-tumoral intraosseous
edema, expansion of the medullary canal with thinner cortex, rapid
enhancement and cortical breakthrough it could be a grade 2 chondrosarcoma
(results still yet to be published 😊). Other research from Douis, same
results (different pathology).
Many thanks
Chris
Young, Peter C schrieb am Mittwoch, 4. Mai 2022 um 13:27:44 UTC+2:
>
> just playing the odds, it’s most likely an enchondroma.
>
>
>
> in the short tubular bones they often don’t mineralize, cause a lot of
> cortical thinning, and easily path fracture.
>
>
>
>
> as long as there isn’t a big soft tissue component, at our place this
> would likely be presumptive enchondroma and they would go straight to
> surgical curettage and packing (and get pathology samples to confirm while
> doing it)
>
>
>
> pete
>
>
>
> Peter C. Young, MD
> Section Head, Division of Musculoskeletal Radiology
> University Hospitals Cleveland Medical Center
> Case Western Reserve University
> 11100 Euclid Avenue Cleveland, OH 44102
> (216) 844-1542
>
>
> ——————————
> *From:* ocad…@googlegroups.com
> Christos Loupatatzis
> *Sent:* Wednesday, May 4, 2022 4:22 AM
> *To:* OCAD MSK
> *Subject:* Pathologic fractur_Finger_XRay_CT_Please help
>
> *External E-mail: Careful opening links or attachments.*
>
> Dear OCADers,
>
> Please share your opinion.
>
> Best wishes
>
> Chris
>
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OCAD_Pathologic-Fracture_Finger_XRay_CT_Please-help.pdf 