Surveillance for Enchondromas

Solitary Enchondromas

Patients with new or increasing pain attributable to the lesion, or radiographic evidence of growth, should obtain dedicated MRI imaging 1, 2

Patients with enchondromatosis require more intensive surveillance given the 30% risk of malignant transformation to chondrosarcoma 1, 2
Physical examination should be performed every 6-12 months starting from birth/diagnosis to assess for pain, increasing tumor size, and functional limitations 1, 2
Baseline Whole-Body MRI (WBMRI) should be performed at diagnosis, with periodic WBMRI after age 20 years 1, 2
Plain radiographs of known lesions should be performed every 2-3 years from the time of identification 1, 2
Annual dedicated MRI should be performed for lesions >5-6 cm or located in the pelvis/scapula 1, 2
Red flags requiring immediate evaluation include pain or increasing pain at lesion site, increasing tumor size on serial imaging, and cartilage cap thickness >2.0-3.0 cm on MRI or CT 1, 2, 3, 4

Differentiation between enchondroma and grade I chondrosarcoma is notoriously difficult even for expert pathologists, with significant interobserver variability 6
Orthopedic oncology providers should be involved in monitoring, particularly for enchondromatosis patients 3, 4