Enchondroma in the Fibular Diaphysis: A Case Report

TL;DR

A 46-year-old woman with a suspected enchondroma in her fibula underwent imaging and surgical treatment due to diagnostic uncertainty and bone cortex disruption.

Contribution

This case report highlights the diagnostic challenges and treatment decisions in differentiating enchondroma from low-grade chondrosarcoma.

Findings

A solitary bony lesion with calcifications and sclerotic margin was identified in the fibular diaphysis.

Surgical treatment was chosen over non-surgical management due to advanced age and bone cortex disruption.

Computed tomography, MRI, and bone scintigraphy were used to guide the treatment decision.

Abstract

Chondroma is a benign tumor formation that occurs through the proliferation of cartilaginous tissue. It can be located centrally (enchondroma) or peripherally, often appears between 10-30 years of age, and is commonly discovered incidentally. This case report describes a 46-year-old woman presenting with pain in the left calf and partial functional impotence. The onset of her symptoms was affirmatively marked by a mild skiing-related trauma. Following protocol, X-ray imaging (antero-posterior and lateral views) of the calf was performed, with the only finding being a solitary bony lesion, with internal calcifications, sclerotic margin and radiolucent internal matrix. Facing the uncertainty of diagnosis from a clinical and radiographic standpoint, it was decided to admit the patient for further evaluation and start the standard protocol of imaging investigations - computed tomography, magnetic resonance imaging, and bone scintigraphy - and determine the subsequent therapeutic behavior. Differential diagnosis between enchondroma and low-grade chondrosarcoma can be difficult due to their histopathological similarity. The therapy of choice in enchondroma comprises non-surgical treatment (observation) if the lesion remains unaltered in imaging, or curettage/filling with bone substitutes/allografts, but considering the advanced age and interruption of the bone cortex in our case, we opted for curative surgical treatment.

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