臨床研究ジャーナル

A Solitary Enchondroma of Great Toe in an Adolescent Male: A Case Report

Abstract

Shivam Patel, Shail Shah*, Anurag Anand and Ashwin Deshmukh

Introduction: Solitary enchondromas are benign, usually asymptomatic. Enchondromas are cartilage tumors which are estimated to constitute 3%-17% of all bone tumors and approximately 20% of all cartilage tumors. Enchondroma has higher chances to convert in chondrosarcoma, which varies between 0% and 4.2%. It is difficult to obtain a valid risk estimate, as this requires histopathology MRI reports.

Case study: 17 year old male came to the OPD with swelling in his left great toe since 6 months. Swelling was associated with intermittent pain which was dull aching type, no aggravating or relieving factors. Swelling was insidious in onset and gradual in progression. On physical examination Mild restriction of motion of left great toe and a regular swelling over the dorsal aspect of left great toe, hard in consistency without any neurovascular impairment. No presence of scars, sinuses, pigmentation or any ulceration over the swelling. Palpation of the swelling confirmed the presence of a bony hard swelling, non pedunculated, smooth surface of size 3 × 3 × 2.5 cm with ill-defined margins. Swelling was expansile and fixed to skin. X-ray s/o Lytic lesions, scalloping of the cortex and whorls of calcification.

Discussion: The literature search was primarily performed in the PubMed database: “Chondroma”, “Chondrosarcoma”, “Diagnostic Imaging” and “Magnetic Resonance Imaging.” Dorsal incision was marked along the great toe along the tendon of extensor halluces longus, extending 2 cm proximal to MTP joint and distally to base of nail bed. Complete exposure of the tumour was done and along with excision of proximal phalanx after incising the dorsal aspect of the joint capsule. Swelling was expansile and multiloculated involving whole of the proximal phalanx and inseparable from the skin at some areas .Hence the decision was taken to remove whole of proximal phalanx along with tumour. Gap was filled up with fibular strut graft.

Conclusion: Solitary enchondromas aggressively increasing in size should be treated surgically bane gap caused after removing the tumor can be filled with bone graft or cement depending on the condition of cortex.