The incidence and outcome of chondral tumours as incidental findings on investigation of shoulder pathology

Abstract

Purpose
The aim of this study is to describe outcomes of incidental chondral tumours in the shoulder referred to our Bone Tumour Unit (BTU).

Methods
Our hospital radiology database was searched using the filtered terms “enchondroma”, “low-grade chondral tumour”, “chondrosarcoma” with “humerus”, “arm”, “shoulder”, “scapula” and “clavicle”. Case note review of results assessed primary reasons for referral, radiological diagnosis, recommended management with subsequent reviews and outcomes, either in clinic or surveillance scan reports.

Results
Ninety-nine patients had full case note review, mean age 54.5 years (range 18–84 years). Mean follow-up was 41.7 months (range 1–265 months). Over 50% of patients were referred for shoulder pain. Three patients had high-grade chondrosarcoma. Forty-three patients had interval scans, none showing any changes. Thirty-five patients had surgery for their lesions with one recurrence. Forty-four patients had alternative diagnoses made on clinical and radiological examination. At most recent follow-up, 70% of these patients were asymptomatic after physiotherapy/surgical attention to their alternative diagnoses.

Conclusions
Chondral lesions in the shoulder have low risk of malignant transformation and are rarely responsible for shoulder symptoms. We recommend patients be referred to a dedicated BTU for surveillance if there are any concerning features, but to proceed with management for any alternative diagnosis.

Full text

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European Journal of Orthopaedic Surgery & Traumatology (2020) 30:97–102
https://doi.org/10.1007/s00590-019-02532-1
ORIGINAL ARTICLE • SHOULDER - TUMORS
The incidence andoutcome ofchondral tumours asincidental ndings
oninvestigation ofshoulder pathology
S.S.Jassim1 · T.Hilton1· A.Saifuddin1· R.Pollock1
Received: 15 July 2019 / Accepted: 13 August 2019 / Published online: 17 August 2019
© Springer-Verlag France SAS, part of Springer Nature 2019
Abstract
Purpose The aim of this study is to describe outcomes of incidental chondral tumours in the shoulder referred to our Bone
Tumour Unit (BTU).
Methods Our hospital radiology database was searched using the filtered terms “enchondroma”, “low-grade chondral
tumour”, “chondrosarcoma” with “humerus”, “arm”, “shoulder”, “scapula” and “clavicle”. Case note review of results
assessed primary reasons for referral, radiological diagnosis, recommended management with subsequent reviews and out-
comes, either in clinic or surveillance scan reports.
Results Ninety-nine patients had full case note review, mean age 54.5years (range 18–84years). Mean follow-up was
41.7months (range 1–265months). Over 50% of patients were referred for shoulder pain. Three patients had high-grade
chondrosarcoma. Forty-three patients had interval scans, none showing any changes. Thirty-five patients had surgery for
their lesions with one recurrence. Forty-four patients had alternative diagnoses made on clinical and radiological exami-
nation. At most recent follow-up, 70% of these patients were asymptomatic after physiotherapy/surgical attention to their
alternative diagnoses.
Conclusions Chondral lesions in the shoulder have low risk of malignant transformation and are rarely responsible for
shoulder symptoms. We recommend patients be referred to a dedicated BTU for surveillance if there are any concerning
features, but to proceed with management for any alternative diagnosis.
Keywords Shoulder· Oncology· Chondrosarcoma
Introduction
The prevalence of shoulder pain in the UK population is
common. It is thought that 1–2% of adults consult their gen-
eral practitioner with new-onset shoulder pain every year [1].
The more frequent diagnoses include rotator cuff pathology,
subacromial impingement and degenerative joint disease.
Following investigation of shoulder pain with plain radio-
graphs, computed tomography (CT) and magnetic resonance
imaging (MRI), findings of incidental chondral tumours are
estimated at between 2 and 4% [2, 3]. Chondral tumours
such as enchondromas and chondrosarcomas are the more
common subtypes of bone tumours originating in the med-
ullary cavity of long bones. The most common sites are
the proximal tibia, proximal and distal femur and proximal
humerus. On their discovery, patients are typically referred
to their local bone tumour unit for further investigation and
management.
There can be uncertainty regarding their optimal manage-
ment. Enchondromas are benign lesions that do not need
surgical treatment if inactive and asymptomatic [4]. Grade
1 chondrosarcoma has been reclassified as an atypical carti-
laginous tumour as it rarely metastasizes. Surgical treatment
for both types of lesion involves curettage and local adjuvant
therapy with cement or bone graft. These procedures can
have potential complications including fracture and infec-
tion [5]. However, despite these potential morbidities, it is
estimated that 4% of solitary chondral tumours change into
secondary chondrosarcoma [6]. Therefore, some form of
surveillance is warranted.
In our Bone tumour unit (BTU), referrals of incidental
findings of such lesions are common to the multidisciplinary
team. The options for such tumours in the proximal humerus
* S. S. Jassim
shivan.jassim@doctors.org.uk
1 Bone Tumour Unit, Royal National Orthopaedic Hospital,
Brockley Hill, Stanmore, MiddlesexHA74LP, UK
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