Shoulder EnchondromaHip enchondroma




Benign intramedullary cartilage lesion




Enchondroma are presumed to be remnants of hyaline cartilage

Derived from the epiphyseal growth mechanism that failed to undergo enchondral ossification




10% of benign bone tumours

Most frequent cartilaginous tumour


Young adults


Stop growing in adults and calcify


Malignant transformation 



- grade 1 / 2 / 3

- low / intermediate / high


Grade 1

- atypical cartilaginous tumour / low grade chondrosarcoma

- locally aggressive

- low metastatic potential


Can be difficult to diagnose on imaging including MRI





- long bones

- tubular bones of hand and feet




Usually incidental finding




Intralesional calcification - punctate, stippled calcification and broken rings


Differential diagnosis long bone with intralesional calcification

1.  Enchondroma

2.  Bone infarct 

3.  Chondrosarcoma


Enchondroma Distal Femur0001Enchondroma Distal Femur0002


Humerus enchondromaHumerus enchondroma 2


Hand / Foot


Enchondroma foot Thumb enchondroma


CT Scan


Shoulder EnchondromaShoulder Enchondroma CT


Enchon Sh 1Ench SH 2Ench Sh 3




MRI Enchondroma0001MRI Enchondroma0002


Enchondroma shoulder 1Enchondroma shoulder 2Enchondroma 3


Imaging differential diagnosis


Can be very difficult to distinguish between low grade chondrosarcoma / atypical cartilaginous tumour and enchondroma


Enchondroma versus chondrosarcoma


Murphey et al Radiographics 1998

- 92 enchondromas versus 95 chondrosarcomas

- factors associated with chondrosarcoma on presentation and imaging

- pain

- deep endosteal scalloping (>2/3 cortical thickness)

- cortical destruction

- soft tissue mass

- high uptake on bone scan


Crim et al Eur J Radiol 2015

- enchondroma versus grade 1 chondrosarcoma

- correct diagnosis enchondroma xray 67% and MRI 58%

- correct diagnosis chondrosarcoma xray 21% and MRI 58%


Low grade versus high grade chondrosarcoma


Douis et al Eur Radiol 2014

- 179 cartilaginous tumours

- MRI features associated with high grade versus low grade chondrosarcoma

- bone expansion / periostitis / soft tissue mass / tumour length



Endosteal scalloping



Large, central enchondroma




Composed of masses of hyaline cartilage without characteristic architecture

- typically bland cartilage

- no pleomorphism / anaplasia / hyperchromasia


Enchondroma Nephron GNU Free Documentation License Version 1.3


Histology differential diagnosis


Can be very difficult to distinguish between low grade chondrosarcoma / atypical cartilaginous tumour and enchondroma

- sampling issues

- difficult histological differentiation


Eefting et al Am J Surg Pathol 2009

- enchondroma versus grade 1 chondrosarcoma / atypical cartilage tumour

- low reliabilty (0.5 kappa)

- reliable signs mucoid matrix degeneration and host bone entrapment




Typically surveillance of benign looking enchondroma


Surgical indications



- pain

- concerning radiological features


Risk pathological fracture


Curettage of low grade chondrosarcoma


Errani et al Eur J Orthop Surg Traumatol 2017

- 54 enchondroma and 35 patients atypical cartilaginous tumour (ACT) long bone

- treated with curettage

- no local recurrence with enchondroma

- 4/35 (11%) local recurrence with ACT

- 3/4 of those with local recurrence had disease progression with higher grade than previous


Dierselhuis et al Cochrane Database Sys Review 2019

- intralesional treatment versus wide resection for low grade / Grade 1 chondrosarcoma long bones

- 14 studies and 511 participants

- 419 treated with intralesional treatment, 91 with wide resection

- no difference in recurrence free survival

- lower complication rates and better functional outcomes with intralesional treatment




See boneschool page




Enchondroma foot 1Enchondroma foot 2