Multiple Chondromas: Symptoms, Risks, and Care Tips for Your Child

Q: Multiple Chondromas: Symptoms, Risks, and Care Tips for Your Child

Hello： In response to your question, the likelihood of multiple osteochondromas transforming into malignant tumors is less than 1%. <br>The symptoms are generally not obvious; they typically grow faster than the original osteochondroma and are prone to associated soft tissue swel

Multiple Chondromas

Hello Dr.
Lee, my daughter is 11 years old and has been diagnosed with multiple chondromas after consultations at Chang Gung, Taipei Medical University, and Cathay hospitals.
She has noticeable protrusions of chondromas on her hands, feet, and fingers, with some curvature in her hands and feet, but she has no mobility issues and can play the piano.
However, due to the bone protrusions, she cannot bring her fingers together.
Over the past 4 to 5 years, she has undergone annual X-ray follow-ups, but in the last two years, doctors have advised against further X-rays due to radiation concerns.
Recently, my daughter has been experiencing knee pain, and the doctor prescribed paracetamol and an anti-inflammatory pain relief cream, which has provided slight improvement.
I would like to ask: (1) What is the likelihood of complications from these chondromas? What symptoms should we watch for? (2) What precautions should we take in daily life? Should we avoid vigorous physical activities? (3) Does annual X-ray exposure have adverse effects on the tumors? My husband has passed away, and my daughter is my only comfort and hope.
Please help us, Dr.
Lee.
Thank you!

Madam Zhu, 40~49 year old female. Ask Date: 2006/09/29

Dr. Li Wenlin reply Orthopedics

Hello: In response to your question, the likelihood of multiple osteochondromas transforming into malignant tumors is less than 1%.
The symptoms are generally not obvious; they typically grow faster than the original osteochondroma and are prone to associated soft tissue swelling.
In severe cases, they can lead to pathological fractures (which are not common with regular osteochondromas).

Theoretically, osteochondromas can be surgically removed after skeletal maturity (around age 13-14 for females and 16-17 for males), but it is not recommended to operate on every lesion.
Surgery is usually advised only for lesions that significantly affect function or aesthetics.
In fact, patients with this condition can lead normal lives and engage in activities without excessive restrictions, and exercise does not worsen the condition.
The only precaution is to avoid direct impact on the lesions, so non-contact sports are preferable.
X-rays are not contraindicated; however, multiple osteochondromas may present too many lesions.
If a single X-ray session captures all lesions, the accumulated radiation dose can be considerable, especially since the patient is still growing.
If changes in appearance and palpation can indicate whether lesions have enlarged, then fewer X-rays may be necessary.
If an annual X-ray is required, it is advisable to focus on a few key areas, such as both knees and shoulders, rather than taking too many images at once.
Wishing you all the best!

Reply Date: 2006/09/29

More Info

Multiple chondromas, also known as multiple cartilaginous tumors, are benign tumors that primarily affect the cartilage in various parts of the body, including the hands, feet, and other skeletal areas. They are often associated with a genetic condition known as multiple hereditary exostoses (MHE), which can lead to the development of multiple osteochondromas. Here’s a detailed overview addressing your concerns regarding your daughter’s condition.

1. Incidence and Symptoms of Multiple Chondromas
The incidence of multiple chondromas can vary, but they are generally considered rare. The symptoms can include visible lumps or bumps on the bones, which may cause deformities, as you have observed in your daughter's hands and feet. While these tumors are benign and typically do not metastasize, they can lead to complications such as pain, limited mobility, or nerve compression if they grow large enough or are located near critical structures.

In your daughter’s case, the knee pain she is experiencing could be related to the chondromas, especially if they are affecting the surrounding tissues or joints. It’s essential to monitor any changes in pain levels or mobility, as these could indicate the need for further evaluation.

2. Daily Life Considerations and Activity Restrictions
In terms of daily life, it is crucial to maintain a balance between activity and rest. While your daughter is currently able to play the piano and has no significant mobility issues, it is advisable to avoid high-impact sports or activities that could put excessive strain on her joints and bones. Activities such as running, jumping, or contact sports may increase the risk of injury or exacerbate her symptoms.

Encouraging low-impact exercises, such as swimming or cycling, can help maintain her physical fitness without putting undue stress on her joints. Additionally, regular follow-ups with her healthcare provider are essential to monitor her condition and adjust activity recommendations as necessary.

3. Radiation Exposure from X-rays
Regarding the concern about X-ray exposure, it is valid to be cautious about the cumulative radiation dose, especially in children. While X-rays are a valuable tool for monitoring the growth of chondromas, your doctor’s recommendation to limit them due to radiation exposure is prudent.
Alternatives to X-rays, such as MRI or ultrasound, can be considered for monitoring her condition. These imaging modalities do not involve ionizing radiation and can provide detailed information about soft tissues and cartilage. Discussing these options with her healthcare provider may help in making informed decisions about her ongoing care.

Conclusion
In summary, while multiple chondromas are generally benign, they can lead to complications that require careful management. Monitoring symptoms, adjusting activity levels, and considering alternative imaging methods are all important steps in ensuring your daughter’s health and well-being. It’s also crucial to maintain open communication with her healthcare team to address any new symptoms or concerns as they arise.

Your daughter is fortunate to have a caring parent like you, and with proper management, she can lead a fulfilling life despite the challenges posed by her condition. If you have further questions or concerns, do not hesitate to reach out to her medical team for guidance and support.

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