Maffucci syndrome is an extremely rare disorder characterized by benign overgrowths of cartilage (enchondromas), skeletal deformities and skin lesions composed of abnormal blood vessels. Enchondromas arise in bones, most frequently in the hands and feet and less often in the legs and long bones of the arm.
Maffucci syndrome is not seen at birth. Lesions usually develop early in childhood, most often between 1-5 years of age. The severity of the disorder is variable. Some patients have a very mild course, whereas others can develop serious complications.
The first sign of Maffucci syndrome is usually the growth of an enchondroma in a long bone. Enchondromas distort and weaken the affected bones, thus presentation with a pathologic fracture is common. These cartilaginous tumors cause bulging of the bones, bowing of the arms and legs, and often disproportionate (asymmetric) growth (different lengths of the arms or legs). The patient may exhibit short stature in adulthood. Enchondromas only affect one side of the body in approximately 40 per cent of patients.
Vascular lesions on the skin also usually appear in early childhood (around 4-5 years of age) and are often progressive. These lesions do not necessarily occur near the bones that have enchondromas. These vascular lesions begin as compressible, round, bluish spots. In time, they become firm, knotty, warty, and often contain calcium stones (phleboliths). The hand is the most common location; however vascular lesions can also occur in internal structures, such as the membranes that cover the brain and spinal cord (meninges), the tongue and the oral mucosa.
These vascular lesions used to be called “cavernous hemangiomas”. Microscopic studies have shown that they are comprised of abnormally-formed veins so that the more modern term is “venous malformation.” A benign vascular tumor, designated as “spindle cell hemangioma,” often arises in these malformed veins.
Patients with Maffucci syndrome are at risk to developing a malignant tumor, particularly a tumor of cartilage known as “chondrosarcoma.” The more enchondromas, the higher the risk of malignancy. The frequency has been estimated to be between 15-40 per cent; however, some investigators believe that chondrosarcoma in Maffucci is over-reported. Less frequently, other malignant, non-skeletal connective tissue neoplasms can occur in patients with Maffucci syndrome.
In 2011, the cause of Maffucci syndrome was discovered to be a mutation in a gene known as IDH1 (rarely IDH2). The same mutations were found in the related disorder Ollier disease. Since the defect occurs after fertilization (called a somatic mutation), Maffucci syndrome is not considered to be hereditary, that is, it cannot be passed along in a family. The cases occur randomly and there are no known pedigrees of affected family members.
The diagnosis of Maffucci syndrome is made by a detailed history, thorough physical examination and radiologic assessment. Surgical removal and microscopic study of the bony lesions confirm the presence of enchondroma and distinguish the tumor from chondrosarcoma.
Management of Maffucci syndrome is focused on the specific signs/symptoms in the particular affected individual. No intervention is needed for asymptomatic patients.
Treatment requires coordinated efforts of a team of specialists (multidisciplinary care).
The warty (verrucous) vascular lesions can be injected with a drug that shrinks and hardens the area (sclerosing agent); however, often surgical removal is also needed. Enchondromas can be surgically removed (resected) if necessary. A specialist in hand surgery is needed to correct the skeletal abnormalities of the hand that cause loss of function or recurrent fracture. An orthopedic surgeon addresses leg length discrepancy, abnormal curvature of the spine (scoliosis) or other skeletal abnormalities.
A patient with Maffucci syndrome should be regularly monitored because of the risk of malignant transformation of an enchondroma or development of a tumor elsewhere.
If a malignancy does not occur, patients with Maffucci syndrome have an otherwise normal life expectancy.
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Contact for additional information about Maffucci syndrome:
John B. Mulliken, MD,
Co-Director, Vascular Anomalies Center
Director, Craniofacial Centre
Boston Children’s Hospital
300 Longwood Avenue
Boston, MA 02115
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