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Pathological fractures through enchondromas of the proximal humerus mimicking malignancy: a case report

INTRODUCTION Enchondromas (EC) are benign tumors of hyaline cartilage of intramedullary location that are most frequently found in young adults (20 to 40 yr old) with no sex predilection. EC is the most common benign bone tumor following osteochondroma, accounting for approximately 10% to 25% of all benign bone tumors. Location in the metaphysis of the proximal humerus (PH) is one of the most frequent in long bones, after the tubular bones of the hand. The main differential diagnosis to be considered is low-grade chondrosarcoma (LGC) or grade 1 chondrosarcoma. Numerous scientific articles analyze the clinical, imaging and histological differences between EC and LGC, both entities encompassed as cartilaginous tumor according to the 2013 World Health Organization Classification of Tumors Update. Distinguishing EC and LCG may be challenging, more so in association with a pathological fracture in long tubular bones. EC are usually asymptomatic and most are incidental findings; however, in the hand EC are a common cause of pathological fracture and may present with sudden pain in a previously asymptomatic patient. In other locations, a fracture through a chondroid tumor may be interpreted as an indirect sign of aggressiveness. Given the scant literature on this subject, this paper presents two cases referred to the authors’ unit for suspicion of chondrosarcoma of the PH and describes the process that led to a benign diagnosis. This case report was exempt from needing approval from an institutional review board. Informed consent was obtained from all patients described in the report.