An unusual finding on a pelvic radiograph

• Published in: BMJ (Online) 2012-09, Vol.345 (sep24 1), p.e6261-e6261
• Main Authors: Manikam, L, Richards, P J, Jordan, T
• Format: Article
• Language: English
• Subjects: Aged; Bone Diseases - diagnosis; Bone Diseases - diagnostic imaging; Bone Diseases - etiology; Bones; Calcification; Chondrosarcoma - complications; Chondrosarcoma - pathology; Chondrosarcoma - surgery; Cysts; Diagnosis, Differential; Humans; Incidental Findings; Laryngeal Neoplasms - complications; Laryngeal Neoplasms - pathology; Laryngeal Neoplasms - surgery; Larynx; Male; Medical imaging; Neck Dissection - methods; NMR; Nuclear magnetic resonance; Pain; Patients; Pelvic Bones - diagnostic imaging; Pelvis; Preoperative Care - methods; Tomography, X-Ray Computed - methods; Treatment Outcome; Tumors
• ISSN: 0959-8138; 1756-1833; 1756-1833
• DOI: 10.1136/bmj.e6261

If these features are not visible on plain radiography, computed tomography or magnetic resonance imaging may be needed to aid diagnosis and to exclude malignant diseases, such as myeloma and chondrosarcoma. Enchondromas are usually managed conservatively, although rarely they can undergo malignant transformation. [...]lesions with at least one active feature-such as tumour pain, endosteal scalloping, cortical thickening, or medullary cavity enlargement-should undergo follow-up magnetic resonance imaging or bone scintigraphy to ensure that the appearance of the lesion has not changed. The result is often inconclusive, however, and typically leads to an excision biopsy of the lesion and the biopsy track to prevent malignant seeding should it prove to be cancer. [...]diagnosis may depend on clinical suspicion in the presence of radiological changes suggestive of malignant transformation. 3 Could the pelvic lesion and the chondrosarcoma of the larynx be connected? Short answer The laryngeal chondrosarcoma may have arisen as a result of malignant transformation of a laryngeal chondroma. 7 When multiple enchondromas and chondromas coexist, the diagnosis of an enchondromatosis syndrome, such as Ollier disease or Maffucci syndrome, should be considered. 12 13 14 Long answer Chondrosarcomas of the larynx are rare, constituting less than 2% of all laryngeal cancers. 15 Chondrosarcomas of the head and neck region form only 10% of all chondrosarcomas. 16 About 80% of chondrosarcomas are primary lesions with no known predisposing factors, although secondary chondrosarcomas can develop from pre-existing enchondromas. 17 Multiple enchondromas may occur in disorders such as Ollier disease, Maffucci syndrome, and metachondromatosis, all of which are rare.