Metachondromatosis: Clinical and radiological diagnosis and differential diagnosis / Metacondromatosis: diagnóstico clínico, radiológico y diagnóstico diferencial

The clinical case of a 9-year-old patient derived from Orthopedics to the Institute of Genetics at Universidad Nacional de Colombia due to a longstanding medical history of multiple bony outgrowths that required surgical management without etiologic diagnosis is presented in this paper. A possible diagnosis of metachondromatosis is suggested based on the clinical course, the family history, and the findings of the biopsy and regular growth parameters. On the other hand, differential diagnoses were compared taking into account the most common enchondromatosis type, based on data obtained during physical examination, radiological signs and other variables. This comparison was grounded on the review of existing literature on this type of entities.

En el presente artículo se presenta el caso clínico de una paciente de 9 años de edad remitida al Instituto de Genética de la Universidad Nacional de Colombia desde el servicio de Ortopedia por cuadro clínico de larga data, consistente en múltiples excrecencias óseas que han requerido manejo quirúrgico sin diagnóstico etiológico. Se Plantea la posibilidad de metacondromatosis como diagnóstico, basándose en el curso clínico, la historia familiar, los hallazgos en biopsia y los parámetros normales de crecimiento; también se compararon los diagnósticos diferenciales dentro de las encondromatosis más frecuentes teniendo en cuenta datos tomados del examen físico, signos radiológicos y otras variables, esta comparación se basó en la revisión bibliográfica de la literatura existente actualmente sobre este tipo de entidades.

Condrodisplasia metafisaria tipo Schmid: presentación de un caso / Schimd methaphyseal chondrodysplasia: a case presentation

Fundamento: condrodisplasia metafisaria tipo Schmid, forma parte de las displasias óseas poco frecuentes. Se caracteriza por talla baja, genu varum, pélvis pequeña, cifoescoliosis progresiva, deformidad de la muñeca, miopía, huesos largos cortos y displasia metafisaria grave, con cambios moderados en la columna y cambios mínimos en las manos y los pies. Objetivo: presentar un caso con diagnóstico de displasia ósea tratado por un equipo multidisciplinario para su posterior corrección quirúrgica. Caso clínico: paciente femenina de tres años de edad, con deformidad en miembros inferiores que le provocan baja talla por genu varum. Los antecedentes familiares no refieren datos de interés. En los antecedentes personales prenatales, perinatales y posnatales se encontró que el desarrollo fue normal hasta los 16 meses que comienza a caminar y se observa ligera deformidad que fue aumentando. Conclusiones: la condrodisplasia metafisaria tipo Schmid es una enfermedad hereditaria poco frecuente que se presenta con un patrón de herencia autonómico dominante. Al no existir otro miembro de la familia afectado, se planteó que en este caso ocurrió una nueva mutación o mutación de novo. Es necesario indagar acerca de su presencia en un paciente con deformidad severa de miembros inferiores, con estudio renal y bioquímicos normales. Es importante realizar un diagnóstico precoz, tratamiento y seguimiento multidisciplinario para corregir la deformidad con tratamiento quirúrgico.

Background: methaphyseal chondrodysplasia is a type of non-frequent bone dysplasia. It is characterized by short stature, genu varum, small pelvis, progressive kyphoscoliosis, wrist deformities, myopia, short long bones and serious methaphyseal dysplasia with moderate changes in the back and minimal changes in hands and feet. Objective: to present the case of a patient with the diagnosis of bone dysplasia treated by a multidisciplinary medical team for a subsequent surgical correction. Clinical case: a three-year-old female patient with a deformity in the lower limbs that causes short stature by genu varum. There was no information of interest in the family medical history. The medical history of the patient showed a normal prenatal, perinatal and postnatal development until she turned 16 months old and started to walk presenting a slight deformity that increased. Conclusions: Schmid methaphyseal chondrodysplasia is an uncommon hereditary disease with a dominant autosomal heredity pattern. Since no other member in the family was affected, there was a De novo mutation in this case. It is necessary to search for its presence in a patient with a serious deformity in the lower limbs with normal biochemical and renal studies. It is important to make an early diagnosis as well as to carry out a treatment and a multidisciplinary follow-up to correct the deformity by means of surgical treatment.

Presentación de una familia con diagnóstico de encondromatosis múltiple familiar / Presentation of a Family with Multiple Family Enchondromatosis

La encondromatosis múltiple familiar fue descrita por Virchow en 1910, se presenta con un patrón de herencia autosómico dominante. Las encondromatosis comprenden un grupo heterogéneo de síndromes congénitos caracterizados por la presencia de encondromas múltiples, asociados a malformaciones músculos esqueléticos secundarios al acortamiento de las extremidades. Se presentó una familia con cuatro afectados, a los que se les realizó diagnóstico donde se aplicó el método clínico a través del examen físico e imagenológico. Es importante la realización de un diagnóstico precoz de esta entidad por la posibilidad de realizar una prevención secundaria en los pacientes, así como para brindar un adecuado asesoramiento genético a la familia.

Multiple family enchondromatosis was described by Virchow in 1910, is presented with a pattern of autosomal dominant inheritance. The enchondromatosis comprise a heterogeneous group of congenital syndromes characterized by the presence of multiple enchondromas associated with musculoskeletal deformities secondary to shortening of the limbs. A family with four members affected, whose diagnosis was made by the clinical method through physical examination and imaging was presented. It is important to made an early diagnosis of this disease because of the possibility of a secondary prevention in patients as well as to provide appropriate genetic counseling to the family.

Encondromatosis múltiple [Sindrome de Ollier] / Multiple enchondromatosis

Enchondromatosis or Ollier syndrome is defined by the presence of multiple enchondromas with an asymmetrical distribution of low prevalence. Enchondromas are common intra osseous benign cartilage tumors cartilaginous which develop to close proximity growth plate cartilage. Cartilage injuries can be very variable in terms of size, number, location, evolution of enchondroma, age of onset and of diagnosis, requirement for surgery. Clinical problems caused by enchondromas include skeletal malformations, an asymetrics hortening of extremity with limping, and potential risk of malignant change to chondrosarcoma. The condition in which multiple enchondromatosis is associated to soft tissue hemangiomas is known as Maffucci syndrome. So far, both Ollier disease and Maffucci syndrome have occurred only in isolated cases. It has not been established if the disease depends on a single gene or combination of several mutations. The diagnosis is based on clinical and radiological conventional analysis. Histological analysis has a limited role and is used if malignancy is suspected. There is no medical treatment for enchondromatosis. Surgical treatment is recommended only in case of complications. Though, it is difficult to establish a prognosis for Ollier disease, it is found that the early onset forms are usually more severe.

Early-onset Childhood Sarcoidosis with Incidental Multiple Enchondromatosis

The triad of rash, arthritis, and uveitis seems to be characteristic for early-onset childhood sarcoidosis. We describe an interesting case of early-onset childhood sarcoidosis coexisting enchondromatosis, which clinically masquerade as Langerhans cell histiocytosis. A 33 months old girl presented with skin rash, subcutaneous nodules with polyarthritis, and revealed the involvement of lymph nodes as well as spleen during work-up. She also presented with multiple osteolytic lesions which pathologically proven enchondromatosis. Oral prednisone was prescribed at 2 mg/kg/day for 2 months until when subcutaneous nodules and joint swellings almost disappeared, and then slowly tapered over a period of 5 months. We report an unusual case of early-onset childhood sarcoidosis presented with osteolytic bone lesions which were irrelevant to sarcoidosis.

Multiple Enchondromatosis: Ollier's Disease.

Multiple enchondromatosis (Ollier's disease) is a rare disease characterized by widespread enchondromas with a unilateral predominance, especially in fingers in early childhood. In general, the short tubular bones of the hand are involved, with progressive lesions resulting in cosmetic problems and functional deformities. Herein, we, describe two cases of Ollier's disease diagnosed on X-ray of hands followed by MRI. There was no evidence of cortical disruption or periosteal reaction associated in either case. The bone lesions revealed cartilaginous matrix. MRI using conventional T1W and T2W sequences and STIR showed expansile lesions within the metacarpals and phalanges of both hands with cartilaginous matrix.

Maffucci' s syndrome complicated by intracranial chondrosarcoma: two new illustrative cases

Maffucci's syndrome is a rare congenital condition, sometimes misdiagnosed as Ollier's disease, characterized by multiple enchondromas combined with hemangiomas and phlebectasia. Coexisting primary malignancies have been described sporadically. We report two cases of Maffucci's syndrome associated with cranial base chondrosarcoma, emphasizing pathophysiological features and the challenging management of intracranial chondrosarcomas. To the best of our knowledge, only twelve similar cases have been reported in the literature.

Síndrome de Maffucci é uma condição congênita rara, às vezes confundida com a doença de Ollier, caracterizada por encondromas múltiplos associados com hemangiomas e flebectasia. A concomitância com neoplasias primárias tem sido relatada esporadicamente. Nós relatamos dois casos de síndrome de Maffucci associada a condrossarcoma da base do crânio, enfatizando aspectos fisiopatológicos e o manejo desafiador dos condrossarcomas intracranianos. Em revisão da literatura, podemos encontrar o relato de apenas doze casos similares.