UNMASKING AN ATYPICAL L2 VERTEBRAL ENCHONDROMA: FROM IMAGING DILEMMA TO HISTOLOGICAL DIAGNOSIS – A CASE STUDY

Abstract

Enchondroma is a benign tumor that originates from hyaline cartilage tissue and occurs as a result of abnormal proliferation of chondrocytes in the medullary cavity of the bone. Characteristic for this lesion is the formation of a chondroid matrix, which can cause expansion of the bone space and local structural changes. Enchondromas are most often detected in young and adult individuals, and in many cases they are asymptomatic and are diagnosed incidentally during imaging studies performed for other reasons. The most common localization is the small bones of the hand and foot, especially the phalanges, but they can also occur in long bones, such as the humerus, femur and tibia. The clinical picture of enchondroma is most often nonspecific. Patients usually do not have pronounced symptoms, but in larger lesions, local pain, swelling or weakening of the bone structure with an increased risk of pathological fracture may occur.
Radiologically, enchondroma is most often characterized by a well-circumscribed osteolytic change with the presence of calcifications in the chondroid matrix, which is an important diagnostic sign.
In contrast to enchondroma, osteoblastoma is a rare benign tumor of the bone that originates from osteoblasts – cells responsible for the creation of new bone tissue. Its main characteristic is the production of osteoid and immature bone matrix, which distinguishes it from tumors of cartilage origin. Although benign, osteoblastoma can show locally aggressive behavior, especially when it is larger in size or is located in anatomically sensitive regions.
The most common localization of osteoblastoma is the axial skeleton, especially the posterior elements of the spine, such as the lamina, pedicles and facet joints. It occurs less frequently in long bones, where it can be localized in the metaphyseal and diaphyseal regions of the femur, tibia and humerus. Unlike enchondroma, which often has a silent clinical course, osteoblastoma most often presents with persistent localized pain, which may be accompanied by limitation of movement and impaired function of the affected body part. It is of particular importance to correctly distinguish these two benign bone lesions because their approach to treatment and follow-up may be different.
Identification of the specific characteristics of these two conditions is essential for proper clinical assessment, avoidance of diagnostic dilemmas, and application of appropriate treatment methods and further monitoring.