In enchondroma, MRI will show that the lesion has signal characteristics identical to cartilage. Treatment is very different so the surgeon should be careful to separate these two tumors. Enchondroma may be highly expansile , especially in small bones such as the phalanges, so that the bone may be completely involved, deformed, and even destroyed. This is not considered a sign of malignancy in enchondromas of the foot or hand. This same behavior seen in a long bone such as the femur or humerus would be interpreted as a strong suggestion of malignancy.
Treatment depends on how expansile the lesion has become.
Lesions inside the medullary cavity may remain totally latent, are usually asymptomatic, and not treatment other than intermittent radiographic follow-up is indicated. Expansile lesions cause cosmetic and functional loss and pathological fracture. Enchondromas recur very rarely following treatment, so that total eradication of the lesion is not necessary, rather the goal should be is restoring appearance and function. Curettage and bone grafting is usually adequate. Highly expansile lesions in the phalanges are probably best treated with amputation of the involved portion of the toe, since the function and cosmetic results are not likely to be acceptable following attempted curettage.