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Weekly Chest CasesArchive of Old Cases

Case No : 555 Date 2008-06-16

  • Courtesy of Eun Jin Chae, MD. / Asan Medical Center, University of Ulsan College of Medicine, Korea.
  • Age/Sex 36 / M
  • Chief ComplaintNo pulmonary symptom
  • Figure 1

Diagnosis With Brief Discussion

Diagnosis
Enchondromatosis (Ollier Disease)
Radiologic Findings
Figure 1. Multiple expansile osteolytic lesions with chondroid calcification in the ribs are shown on chest radiograph.
Figure 2. On chest CT, there is a bulging contoured osteolytic lesion with stippled calcification in the rib.
Figure 3. There are multiple masses in all phalanges and some of them developed to chondrosarcomas.
Figure 4. Chrondrosarcoma also developed in both pelvic bones.
Brief Review
The enchondroma is a tumor that develops in the medullary cavity and is composed of lobules of hyaline cartilage. Typical sites of involvement are the humerus, femur, and tibia. Rare areas of skeletal localization are the skull, facial bones, patella. clavicle, sternum, scapula, ulna and vertebrae. The enchondromas in the ribs may lead to osseous expansion, designated as enchondroma protuberans, that simulates the appearance of an osteochondroma, or to massive enlargement of the bone. The radiographic appearance of enchondromas is usually characteristic. A well-defined, medullary lesion with some degree of calcification, a lobulated contour, and endosteal erosion allow precise diagnosis in most cases. Cortical expansion or thickening and pathologic fracture are other potential radiographic characteristics.

Chondroid lesions of the ribs are always seen at or near the anterior end of the rib. Therefore, lesions at the costochondral junction, especially if calcified, are suggestive of a chondroid origin. Enchondroma, which cause focal expansion of the rib, may be seen and may be diagnosed if typical chondroid calcification-“rings and arcs” pattern-can be demonstrated.

Enchondromatosis (Ollier’s disease) is rare and nonhereditary, consisting of multiple, asymmetrically distributed intraosseous cartilaginous foci and subperiosteal deposition of cartilage, either exclusively or predominantly involving one side of the body; the affected bones are often shortened and deformed.

Chondrosarcoma is the dominant malignant tumor encountered, although other neoplasms of of the soft tissue, such as hemangiosarcoma, lymphangiosarcoma, and fibrosarcoma are reported.
References
1. Resnick D, Kyriakos M, Greenway GD. Tumors and tumor-like lesions of bone: imaging and pathology of specofoc lesions. In Resnick D, Manke D. Diagnosis of bone and joint disorders, 2nd ed. W.B. Saunders Company, Philadelphia; 1988, p3679-3688.
2. Guttentag AR, Salwen JK. Keep your eyes on the ribs: the spectrum of normal variants and diseases that involve the ribs. RadioGraphics 1999;19:1125-1142.
Please refer to
Keywords
Chest wall, Multiple organ, Benign tumor,

No. of Applicants : 85

▶ Correct Answer : 45/85,  52.9%
  • - The Armed Forces HamPyeong Hospital , Korea (South) Bae Geun Oh
  • - Shiga University of Medical Science , Japan Norihisa Nitta
  • - China Medical University,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Kasturba Medical College Manipal , India Paresh Desai
  • - Osaka University , Japan Osamu Honda
  • - Shinsegye Rad Clinic, Daegu , Korea (South) Gi Beom Kim
  • - Marien Hospital, Hamm , Germany Davis Chiramel
  • - , Korea (South) Kwon Kim
  • - BOLLINENI HOSPITAL NELLORE , India jignesh dubal
  • - brm hospital , India chemmandi sudhan
  • - Puget Sound VA Health Care System , United States Julie Takasugi
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Shinchon Severance Hospital , Korea (South) Ho-Joon Lee
  • - Gachon University Gil Medical Center , Korea (South) Soo Jin Choi
  • - Soon chun hyang university hospital bucheon , Korea (South) Hyelin Kim
  • - Trakya Univercity School of Medicine , Turkey Armagan Sarac
  • - MD PG Resident, PIMS,LONI, MAHARASHTRA, INDIA , India Sushant Bhadane
  • - Soonchunhyang university Bucheon hospital , Korea (South) Minhee Lee
  • - mediciti hospitals , India paramjyothi gongati
  • - ottawa , Canada nishard abdeen
  • - Central Queensland Medical Imaging , Australia Sandeep Joshi
  • - Gimpo Woori Hospital , Korea (South) Son Youl Lee
  • - Alnoor Specialist Hospital , Saudi Arabia Ahmed Mohamed
  • - Yonsei University college of medicine Severance hospital , Korea (South) Hua Sun Kim
  • - OSWAL CANCER HOSPITAL , India LOVKESH MITTAL
  • - Saga University, Japan , Japan Ryoko Egashira
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - Apollo Hospital, Ahmedabad. , India Sandip R Shah
  • - apollo hospitals , India harish bhambore
  • - McGill University , Canada Fawaz Alharbi
  • - MEDINOVA DIAGNOSTICS , India Harsha NS
  • - IRSA LA ROCHELLE FRANCE , France jean-luc BIGOT
  • - Cheongshim international medical center , Korea (South) Yang Hae Jum
  • - Dongguk University International Hospital , Korea (South) Hee Seok Choi
  • - Homs National Hospital , Syria Rami Abou zalaf
  • - CHRA , France stephanie besse
  • - radiology department ANNECY , France gilles GENIN
  • - Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
  • - Pe d , France Fabrice Bing
  • - All India Institute of Medical Sciences , India Ashish Gupta
  • - Aba Prefecture People Hospital竊ŒSichuan Maerkang竊Œchina , China pu peng
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - Chungnam National University hospital , Korea (South) Kyoung Jin Oh
  • - Depatment of Radiology, Yongsan Hospital, College of Medicine, Chung-Ang University , Korea (South) Jae Seung Seo
  • - Jackson Memorial Hospital , United States Naganathan Mani
▶ Correct Answer as Differential Diagnosis : 14/85,  16.5%
  • - McGill University Health Centre , Canada Amr Ajlan
  • - KMC,Manipal , India satish maddukuri
  • - IRSA La Rochelle France , France Denis Chabassie
  • - partner, aditya imaging centre , India vivek patel
  • - Regional Imaging Ltd. - Riverina, NSW, Australia , Australia Rashid Hashmi
  • - EKH-Berlin , Germany Michael Weber
  • - Government Medical college, Kozhikkode , India jineesh thottath
  • - Konkuk university hospital , Korea (South) Jeong Geun Yi
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - Ondokuz Mayis University , Turkey Cetin Celenk
  • - Vitalife Clinics , Pune , India. , India Rahul Deshmukh
  • - All India Institute of medical sciences , India Justin Moses
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Armed Forces Chun-Cheon Hospital , Korea (South) ChaeHun Lim
▶ Semi-Correct Answer : 1/85,  1.2%
  • - Mackay Memorial Hospital, Taipei , Taiwan Chia-Fu Tsai
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