Manual of Surgery Volume First: General Surgery. Sixth Edition.Thomson, Alexis
Science
Manual of Surgery Volume First: General Surgery. Sixth Edition.
Thomson, Alexis
Surgery
#Chondroma.#--A chondroma is mainly composed of cartilage. Processes of
vascular connective tissue pass in between the nodules of cartilage
composing the tumour from the fibrous capsule which surrounds it. On
section it is of a greyish-blue colour and semi-translucent. The tumour
is firm and elastic in consistence, but certain portions may be densely
hard from calcification or ossification, while other portions may be
soft and fluctuating as a result of myxomatous degeneration and
liquefaction. These tumours grow slowly and painlessly, and may surround
nerves and arteries without injuring them. They may cause a deep hollow
in the bone from which they originate. All intermediate forms between
the innocent chondroma and the malignant chondro-sarcoma are met with.
Chondroma may occur in a multiple form, especially in relation to the
phalanges and metacarpal bones. When growing in the interior of a bone
it causes a spindle-shaped enlargement of the shaft, which in the case
of a phalanx or metacarpal bone may resemble the dactylitis resulting
from tubercle or syphilis. A chondroma appears as a clear area in a
skiagram.
A _skiagram_ of a bone in which there is a chondroma shows a clear
rounded area in the position of the tumour, which must be differentiated
from similar clear areas due to other kinds of tumour, especially the
myeloma; when it has undergone calcification or ossification, it gives a
shadow as dark as bone.
[Illustration: FIG. 50.--Chondroma growing from infraspinous fossa of
Scapula.]
[Illustration: FIG. 51.--Chondroma of Metacarpal Bone of Thumb.]
_Treatment._--In view of the unstable quality of the chondroma,
especially of its liability to become malignant, it should be removed as
soon as it is recognised. In those projecting from the surface of a
bone, both the tumour and its capsule should be removed. If in the
interior, a sufficient amount of the cortex should be removed to allow
of the tumour being scraped out, and care must be taken that no nodules
of cartilage are left behind. In multiple chondromas of the hand, when
the fingers are crippled and useless, exposure to the X-rays should be
given a trial, and in extreme cases the question of amputation may have
to be considered. When a cartilaginous tumour takes on active growth, it
must be treated as malignant.
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