Narrow Results

Secondary chondrosarcomas according to malignant transformations of the solitary enchondromas were extremely rare in the hand.

The aim of this study is to present a case of a 43-year-old male having rare malignant transformation of the solitary enchondroma treated with total excision and replacement with iliac bone graft.

Chondrosarcoma is most frequently present in the pelvis and long bones and rarely seen in the bones of the hand. Traditionally the treatment of choice for involvment of the hand is ray amputation, however this causes significant functional deficit if there is thumb involvement. There are limited cases in literature of resection of thumb chondrosarcoma with restoration of function. We present a case of high grade chondrosarcoma of the first metacarpal treated with resection and free fibular graft reconstruction. We report excellent functional outcome with this procedure.

Background: Primary malignant tumours of the hand are extremely rare, with chondrosarcoma being the most common. We describe six consecutive cases of chondrosarcoma (CS) of the hand, with a follow-up of 12 months to 10 years after surgical intervention.

Methods: Five cases were primary tumors and one was secondary to Ollier’s disease. Mean age at diagnosis was 67.5 years (range 46 to 85 years) and three patients were males. The bone most commonly affected was the proximal phalanx (in 4 patients), followed by the metacarpal bone (3 cases in the other 2 patients). The first symptom was an increase in volume in five cases and a pathological fracture in one. The x-ray study showed signs of malignancy in two cases only. In the other four cases, CT and MRI studies were necessary to complete the diagnosis.

Results: Primary amputation was performed in two cases and intralesional curettage and cancellous bone autograft in four. Primary amputation was performed in two cases and intralesional curettage and cancellous bone autograft in four. We found three grade I/III CS and three grade II/III CS in the histological study. Local recurrences occurred in three patients, two being grade II/III CS. One of the three had undergone an initial amputation and underwent re-amputation, another had had curettage of the lesion and was amputated, and the third patient decided not to undergo the procedure due to her age. A pulmonary nodule was suspected at the most recent follow up in a fourth patient, who had been diagnosed with a grade II/III CS.

Conclusions: Although CS of the hand bones behaves as a locally aggressive lesion, it rarely metastasizes. Intralesional curettage with a cancellous bone autograft appears to be a good option in low-grade CS to preserve the function, keeping in mind the high rate of recurrence. Wide excision or amputation is recommended when severe joint deformity or soft tissue involvement interferes with hand function.