Painless progressively enlarging swelling in the little finger

Himanshu Sharma, M J Jane

A 64 year old gentleman presented with a recent enlargement of a long-standing painless swelling (measuring 8 x 6 cm) in the left little finger. He had a pre-existing small lump for 60 years and amputation of left ring finger for enchondroma 45 years ago. Routine referral was done and took 18 months before this gentleman could be seen in the clinic. The biopsy confirmed a chondrosarcomatous change.

Dedifferentiated chondrosarcoma of the phalanx arising 60 years after an initial diagnosis of enchondroma is very interesting. Long duration of symptoms should not preclude the clinical suspicion of a chondrosarcoma, even in the absence of pain. Although this has not compromised the patient survival due to the low metastatic potential of chondrosarcoma, it resulted in more extensive local surgery in the form of little finger ray resection rather than excision. Unnecessary delay could be avoided by timely urgent referral and a high index of clinical suspicion.