RESUMEN
Bizarre parosteal osteochondromatous proliferation (BPOP), also termed Nora lesion, is a rare, benign tumor most often located in the hands and feet. We herein present the second reported case of BPOP affecting the spine, an uncommon location. One year after surgical excision, the patient was pain-free and showed no evidence of recurrence. We reviewed a total of 323 cases of BPOP among 101 articles, providing the first systematic update on the latest knowledge of BPOP. The age of patients with BPOP ranges from 3 months to 87 years, peaking in the second and third decades of life. The hands are the most common location of BPOP (58.39%), followed by the feet (20.81%). Imaging features play a key role in the diagnosis of BPOP, but histopathologic diagnosis remains the gold standard. Differential diagnosis of BPOP should be based on the epidemiologic and clinical features as well as clinical examination findings. Surgical resection is the most extensively used treatment for BPOP. Recurrence is common (37.44%) and can be treated with re-excision. This article can deepen our understanding of BPOP and will be helpful for the diagnosis and treatment of BPOP in clinical practice.
Asunto(s)
Osteocondroma , Humanos , Osteocondroma/cirugía , Osteocondroma/patología , Osteocondroma/diagnóstico , Osteocondroma/diagnóstico por imagen , Masculino , Femenino , Adulto , Neoplasias de la Columna Vertebral/cirugía , Neoplasias de la Columna Vertebral/patología , Neoplasias de la Columna Vertebral/diagnóstico , Neoplasias de la Columna Vertebral/diagnóstico por imagen , Imagen por Resonancia Magnética , Persona de Mediana Edad , Diagnóstico DiferencialRESUMEN
Bony outgrowths of the distal phalanx of the great toe have been described in the literature but rarely. These subungual bony outgrowths can be caused by subungual exostosis or subungual osteochondromas. Both of these abnormalities are bony outgrowths with differences in the cartilage cap wherein the exostoses have fibrocartilage, and osteochondromas have hyaline cartilage. The subungual exostosis and osteochondroma that are protruding present symptoms of pain, redness, and deformed nail bed, whereas the nonprotruding osteochondromas have only a lump as the presenting symptom. In both conditions, excision of the lesion and curettage of the base helps prevent a recurrence. Curettage at the end of the excision of the bony outgrowth is required to avoid recurrence. After excision, the specimen should be sent for histopathologic examination to differentiate between the exostosis and osteochondromas, which are underreported in subungual locations, and to rule out malignant transformation. We present a 13-year-old girl with an isolated subungual nonprotruding exostosis of the great toe that was treated by excisional biopsy. The histopathologic examination confirmed it as osteochondroma, which is underreported.
Asunto(s)
Neoplasias Óseas , Exostosis , Enfermedades de la Uña , Osteocondroma , Humanos , Neoplasias Óseas/cirugía , Neoplasias Óseas/patología , Neoplasias Óseas/diagnóstico , Neoplasias Óseas/diagnóstico por imagen , Femenino , Osteocondroma/cirugía , Osteocondroma/diagnóstico por imagen , Osteocondroma/patología , Osteocondroma/diagnóstico , Exostosis/cirugía , Exostosis/diagnóstico , Adolescente , Enfermedades de la Uña/cirugía , Enfermedades de la Uña/patología , Enfermedades de la Uña/diagnóstico , Hallux/cirugía , Dedos del Pie/cirugíaRESUMEN
Osteochondromas are usually osseous outgrowths arising from the metaphyseal region of cortical bone. Moreover, osteochondroma can also arise from flat bones and the spine. However, their origin in the ribs is extremely rare and always near the costochondral junction. We present a 26-year-old male who presented with chief complaints of difficulty in walking for 2 weeks subsequently diagnosed with osteochondroma based on the presence of a cartilage cap on Magnetic resonance imaging.
Asunto(s)
Neoplasias Óseas , Osteocondroma , Masculino , Humanos , Adulto , Neoplasias Óseas/diagnóstico , Neoplasias Óseas/diagnóstico por imagen , Osteocondroma/diagnóstico , Osteocondroma/diagnóstico por imagen , Costillas/diagnóstico por imagen , Costillas/patología , Paraparesia , Imagen por Resonancia MagnéticaRESUMEN
BACKGROUND: Osteochondromas, also known as exostoses, are the most common benign tumors of bone and can be classified into isolated and multiple osteochondromas. A great majority of osteochondromas is asymptomatic, painless, slow-growing mass, and incidentally found. However, osteochondromas occurring in adolescence or in adult patients can grow in size and become symptomatic as a result of mechanical irritation of the surrounding soft tissues or peripheral nerves, spinal cord compression, or vascular injury. CASE PRESENTATION: We present a case of a 13-year-old girl with spontaneous hemothorax, the cause of which was identified by limited thoracotomy with the aid of video-assisted thoracic surgery to be bleeding from a diaphragmatic laceration incurred by a costal exostosis on the left sixth rib. Preoperative chest computed tomography (CT) depicted a bony projection arising from the rib and bloody effusion in the intrathoracic cavity, but was unable to discern the bleeding cause from the lung or the diaphragm. This case will highlight our awareness that costal exostosis possibly results in bloody pleural effusion. Meanwhile, English literatures about solitary costal exostosis associated with hemothorax were searched in PubMed and nineteen case reports were obtained. Combined our present case with available literature, a comprehensive understanding of this rare disease entity will further be strengthened. CONCLUSIONS: Injury to the diaphragm is the primary cause of hemothorax caused by costal osteochondroma, including the present case. Thoracic CT scan can help establish a diagnosis of preoperative diagnosis of costal osteochondroma. Surgical intervention should be considered for those patients with symptomatic osteochondroma of the rib. Combined with our case and literature, prophylactic surgical removal of intrathoracic exostosis should be advocated even in asymptomatic patients with the presentation of an inward bony spiculation.
Asunto(s)
Neoplasias Óseas , Exostosis , Osteocondroma , Adolescente , Adulto , Neoplasias Óseas/cirugía , Diafragma/patología , Diafragma/cirugía , Exostosis/complicaciones , Exostosis/patología , Femenino , Hemotórax/diagnóstico , Hemotórax/etiología , Hemotórax/cirugía , Humanos , Osteocondroma/complicaciones , Osteocondroma/diagnóstico , Osteocondroma/cirugía , Costillas/cirugíaRESUMEN
Benign and malignant cartilaginous bone tumors of the hand are rare findings, however representing a particular pathology due to the capacity to induce significant functional impairment. Even though a large proportion of tumors of the hand and wrist are benign, these may present destructive characteristics, deforming adjacent structures until compromising function. The most appropriate surgical approach for most benign tumors is intralesional lesion resection. Malignant tumors often require wide excision, up to segment amputation to obtain tumor control. A five-year retrospective study was performed on patients admitted in our Clinic with benign cartilaginous tumors of the hand, in which 15 patients were admitted within this period, 10 presenting with enchondroma, four presenting with osteochondroma, and lastly one with chondromatosis. After clinical and imaging evaluation, all the aforementioned tumors were surgically removed. Definitive diagnosis for all bone tumors, either benign or malignant, was established by tissue biopsy and histopathological examination, dictating therapeutic strategy.
Asunto(s)
Neoplasias Óseas , Condroma , Osteocondroma , Humanos , Estudios Retrospectivos , Neoplasias Óseas/patología , Mano/patología , Osteocondroma/diagnóstico , Osteocondroma/patología , Osteocondroma/cirugíaRESUMEN
An 11-year-old boy presented with pain in the right knee, intermittent reverse ischemia of the right foot and paraesthesia of the right toes. An angio-CT showed a false aneurysm of the right superior popliteal artery, and a solitary osteochondroma of the posterior aspect of the distal femur. Excision of the aneurysm and the osteochondroma was performed in two-stages. The patient was clinically well at 1-year follow up.
Asunto(s)
Aneurisma Falso , Neoplasias Óseas , Osteocondroma , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/etiología , Niño , Fémur , Humanos , Masculino , Osteocondroma/diagnóstico , Osteocondroma/diagnóstico por imagen , Arteria Poplítea/diagnóstico por imagen , Arteria Poplítea/cirugíaAsunto(s)
Neoplasias Óseas/diagnóstico , Exostosis/diagnóstico , Enfermedades de la Uña/diagnóstico , Piel/patología , Adulto , Neoplasias Óseas/patología , Neoplasias Óseas/cirugía , Células Epiteliales/patología , Exostosis/patología , Exostosis/cirugía , Traumatismos de los Dedos/complicaciones , Humanos , Masculino , Enfermedades de la Uña/patología , Enfermedades de la Uña/cirugía , Osteocondroma/diagnóstico , Piel/citologíaAsunto(s)
Neoplasias Óseas/diagnóstico , Osteocondroma/diagnóstico , Adolescente , Neoplasias Óseas/patología , Neoplasias Óseas/cirugía , Legrado , Diagnóstico Diferencial , Femenino , Humanos , Imagen por Resonancia Magnética , Osteocondroma/patología , Osteocondroma/cirugía , Dedos del Pie/diagnóstico por imagen , Dedos del Pie/patología , Dedos del Pie/cirugíaRESUMEN
Bone tumors of the foot are an uncommon finding. Most tumors are found incidentally on imaging and are benign. Care must be taken although due to the aggressive nature of malignant bone tumors that can occur in the calcaneus. Malignant lesions will more commonly present with symptoms of pain and swelling. Often misdiagnosed as soft tissue injuries, it is critical to be able to diagnose and treat these lesions early. Imaging plays an important role with plain films and advanced imaging. Surgical treatments can range from curettage with grafting to amputation for more aggressive lesions.
Asunto(s)
Quistes Óseos/diagnóstico , Quistes Óseos/terapia , Neoplasias Óseas/diagnóstico , Neoplasias Óseas/terapia , Calcáneo , Calcáneo/cirugía , Condroblastoma/diagnóstico , Condroblastoma/terapia , Condroma/diagnóstico , Condroma/terapia , Condrosarcoma/diagnóstico , Condrosarcoma/terapia , Ganglión/diagnóstico , Ganglión/terapia , Tumor Óseo de Células Gigantes/diagnóstico , Tumor Óseo de Células Gigantes/terapia , Humanos , Lipoma/diagnóstico , Lipoma/terapia , Osteoblastoma/diagnóstico , Osteoblastoma/terapia , Osteocondroma/diagnóstico , Osteocondroma/terapia , Osteoma/diagnóstico , Osteoma/terapia , Osteosarcoma/diagnóstico , Osteosarcoma/terapia , Sarcoma de Ewing/diagnóstico , Sarcoma de Ewing/terapiaRESUMEN
BACKGROUND: Benign bone tumors are common incidental findings in the pediatric population during radiographic evaluation. Counseling these patients requires reassurance and raises questions about the natural history of these tumors over time. The purpose of this study was to estimate the prevalence and observe the behavior of benign childhood bone tumors in an asymptomatic population. METHODS: A historical, longitudinal radiographic collection of healthy children was reviewed, which included comprehensive left-sided radiographs of the extremities at yearly intervals. In this study, 262 subjects with 25,555 radiographs were screened for benign bone tumors at a median age of 8 years (range, 0 to 18 years). All potential tumors were reviewed by a multidisciplinary panel, which confirmed the radiographic diagnosis of each lesion, the age at which the lesion first appeared, and the age at which it had resolved. Prevalence rates were calculated using the number of distinct subjects available for each radiographic location and age. RESULTS: Thirty-five tumors were identified in 33 subjects, including 19 nonossifying fibromas, 8 enostoses, 6 osteochondromas, and 2 enchondromas. The prevalence rate for all tumors combined increased with age and was 18.9% overall. The overall prevalence rates for specific tumor types were 7.5% for nonossifying fibromas, 5.2% for enostoses, 4.5% for osteochondromas, and 1.8% for enchondromas. Nonossifying fibromas demonstrated a bimodal distribution of prevalence, with a peak at 5 years (10.8%) and another after skeletal maturity (13.3%). The median age at the first appearance for all tumors combined was 9 years (range, 2 to 15 years), but varied by tumor type. Nonossifying fibromas often resolved (7 [37%] of 19), with further resolution possible beyond the last available radiograph. Enostoses, osteochondromas, and enchondromas persisted until the last available radiographs in all subjects. CONCLUSIONS: The prevalence of benign childhood bone tumors of the extremities was 18.9% in a historical asymptomatic population. Longitudinal radiographs allowed observation of the timing of the first appearance and the potential for resolution for each tumor type. These findings provide unique evidence to answer many commonly encountered questions when counseling patients and their families on benign bone tumors. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Asunto(s)
Enfermedades Asintomáticas/epidemiología , Neoplasias Óseas/epidemiología , Condroma/epidemiología , Fibroma/epidemiología , Osteocondroma/epidemiología , Adolescente , Neoplasias Óseas/diagnóstico , Huesos/diagnóstico por imagen , Niño , Preescolar , Condroma/diagnóstico , Extremidades/diagnóstico por imagen , Fibroma/diagnóstico , Humanos , Hallazgos Incidentales , Lactante , Recién Nacido , Estudios Longitudinales , Masculino , Osteocondroma/diagnóstico , Prevalencia , Radiografía/estadística & datos numéricos , Remisión EspontáneaRESUMEN
Osteochondroma is described as a capped benign bony neoplasm that forms on the outer surface of bone. These tumors affect nearly 6 million people per year. Although osteochondromas most often involve the appendicular skeleton, many involve the spine, with many cases located in the cervical spine. When osteochondromas involve the spine, they can present with a variety of symptoms, including pain, radiculopathy, and myelopathy, which may necessitate surgical treatment. Spinal osteochondromas can be classified into 2 types: multiple osteochondromas in the context of patients with multiple hereditary exostosis (MHE) and solitary osteochondroma or solitary exostosis (SE). Previous reviews have captured only some of the available literature on cervical osteochondromas and have generally focused on either SE or those associated with MHE. The purpose of our review was to provide an extensive review of all previously reported cervical osteochondromas and to compare osteochondroma characteristics, clinical presentation, and outcomes in the context of MHE and SE.
Asunto(s)
Vértebras Cervicales/cirugía , Manejo de la Enfermedad , Osteocondroma/diagnóstico , Osteocondroma/cirugía , Neoplasias de la Columna Vertebral/diagnóstico , Neoplasias de la Columna Vertebral/cirugía , Vértebras Cervicales/patología , Humanos , Resultado del TratamientoRESUMEN
Exostosis is a type of benign bone tumor in which trabecular (spongy) bone overgrows its normal border in a nodular pattern. When the growth occurs under the nail bed, it is termed subungual exostosis or Dupuytren exostosis. This condition may mimic other bony abnormalities such as an osteochondroma and may present with nail deformities with or without pain. For this reason, a biopsy of the lesion is necessary to rule out a precancerous growth. In rare cases, pediatric patients may have subungual exostosis, as demonstrated in our case.
Asunto(s)
Neoplasias Óseas , Exostosis , Enfermedades de la Uña , Osteocondroma , Neoplasias Óseas/diagnóstico , Niño , Exostosis/diagnóstico , Exostosis/cirugía , Humanos , Enfermedades de la Uña/diagnóstico , Uñas , Osteocondroma/diagnóstico , Osteocondroma/cirugíaRESUMEN
Osteochondroma of the talus is a rare entity that can cause pain, swelling, restriction of movements, synovitis and tarsal tunnel syndrome (TTS). We present three such cases with varying presentation. Case 1 presented with synovitis of the ankle along with a bifocal origin of the talar osteochondroma. Case 2 presented with TTS as a result of compression of the posterior tibial nerve. Case 3 presented with deformity of the foot. In all the three cases, the mass was excised en bloc and histologically proven to be osteochondroma. In case 3, the ankle joint was reconstructed with plate, bone graft and arthrodesis of the inferior tibiofibular joint. All the three cases had good clinical outcomes.
Asunto(s)
Neoplasias Óseas/diagnóstico , Deformidades Adquiridas del Pie/etiología , Osteocondroma/diagnóstico , Sinovitis/etiología , Astrágalo/patología , Síndrome del Túnel Tarsiano/etiología , Adolescente , Adulto , Articulación del Tobillo/diagnóstico por imagen , Articulación del Tobillo/patología , Articulación del Tobillo/cirugía , Artrodesis/instrumentación , Neoplasias Óseas/complicaciones , Neoplasias Óseas/patología , Neoplasias Óseas/cirugía , Placas Óseas , Trasplante Óseo , Niño , Femenino , Deformidades Adquiridas del Pie/cirugía , Humanos , Masculino , Osteocondroma/complicaciones , Osteocondroma/patología , Osteocondroma/cirugía , Osteotomía , Sinovitis/patología , Sinovitis/cirugía , Astrágalo/diagnóstico por imagen , Astrágalo/cirugía , Síndrome del Túnel Tarsiano/cirugía , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Trigger finger is stenosing tenosynovitis that occurs in A1 pulley. It usually occurs idiopathically in patients' 40s and 50s. On the other hand, pediatric trigger finger usually occurs before 8 years old in pediatric patients. Even though being rare, a tumor occurred in the soft tissue or bone near flexor tendons can cause a trigger finger. Trigger finger due to osteochondroma is very rare. Furthermore, most cases of trigger finger due to osteochondroma occur in pediatric patients with hereditary multiple osteochondromatosis (HMO). The authors report this case of a trigger finger caused by a solitary osteochondroma that occurred in the proximal portion of the proximal phalanx of the left middle finger, of a 21-year-old patient. The symptoms were relieved after excision of the osteochondroma. If a patient with unusual demographics visits, the cause of trigger finger may not be idiopathic. Evaluation methods such as x-rays and ultrasonography can be helpful to rule out other causes, such as tumors.
Asunto(s)
Neoplasias Óseas/complicaciones , Falanges de los Dedos de la Mano/diagnóstico por imagen , Osteocondroma/complicaciones , Trastorno del Dedo en Gatillo/etiología , Neoplasias Óseas/diagnóstico , Neoplasias Óseas/cirugía , Humanos , Imagen por Resonancia Magnética , Masculino , Procedimientos Ortopédicos/métodos , Osteocondroma/diagnóstico , Radiografía , Trastorno del Dedo en Gatillo/diagnóstico , Trastorno del Dedo en Gatillo/cirugía , Ultrasonografía , Adulto JovenRESUMEN
Osteochondromas are the most common benign bone tumors, which usually affect the metaphyseal region of long bones. Foot is an unusual location for these tumors with phalanges being a much rare site. Only a few case reports have been made of phalangeal osteochondromas. A patient with proximal phalangeal osteochondroma of third toe, presenting clinically as widening of the third web space, is described. A simple extraperiosteal excision of the tumor was done which resolved his forefoot deformity. At five years followup the patient had no recurrence or symptoms.
Asunto(s)
Neoplasias Óseas/diagnóstico , Neoplasias Óseas/cirugía , Osteocondroma/diagnóstico , Osteocondroma/cirugía , Falanges de los Dedos del Pie , Humanos , Masculino , Adulto JovenRESUMEN
Nail pathologies have a broad range of origin and may sometimes be complicated in presentation or clinical course, specifically when the pathology remains recalcitrant after treatment. In this case report we discuss a pathologic disorder that was initially misdiagnosed as a pyogenic granuloma surrounding an ingrown nail but was later found to be a benign neoplastic bone growth, Dupuytren exostosis, also known as a subungual exostosis. Operative treatment was deemed appropriate for the patient, and the exostosis was resected, leaving a soft-tissue void at the distal toe. The remaining void was filled with a perinatal graft, the use of which has been deemed effective anecdotally in both chronic and acute lower-extremity wounds but has not been widely discussed in the lower-extremity literature. This graft was placed to aid in wound healing over a potentially difficult wound bed. As amniotic, chorionic, and umbilical grafts become more prevalent in lower-extremity surgery, its antitumor effects should be further explored and published. This is the first case report, to our knowledge, of the successful use of a perinatal graft in the setting of a bone tumor, and it demonstrates that certain benign neoplasms can be treated with resection and placement of a perinatal graft while helping to prevent chronic wounds at surgical sites.
Asunto(s)
Neoplasias Óseas , Exostosis , Enfermedades de la Uña , Osteocondroma , Neoplasias Óseas/diagnóstico , Neoplasias Óseas/cirugía , Exostosis/diagnóstico , Exostosis/cirugía , Humanos , Uñas , Osteocondroma/diagnóstico , Osteocondroma/cirugíaRESUMEN
AIM: To provide a diagnostic approach to distinguish osteochondroma-induced pseudoaneurysm from sarcoma on imaging and prevent biopsy which may be fatal. MATERIALS AND METHODS: A retrospective study of the orthopaedic oncology database was performed to identify all patients referred to specialist orthopaedic oncology service with a final diagnosis of osteochondroma-induced pseudoaneurysm. The demographics of the cohort, the anatomical location of the osteochondromas and pseudoaneurysms, and the imaging appearances were assessed. RESULTS: Seven contemporary and one historical case of osteochondroma-induced-pseudoaneurysm were identified. There were five patients with solitary osteochondroma and three cases of hereditary multiple exostosis. Five cases underwent magnetic resonance imaging (MRI) of which pulsation artefact was present in 40%. On MRI, all the present cases demonstrated a small central pseudoaneurysm surrounded by multiple eccentric layers of thrombus and haemorrhage, which was termed the "eccentric-whorl sign". CONCLUSION: Osteochondroma-induced pseudoaneurysms are often misdiagnosed as malignant transformation of an osteochondroma or a soft-tissue sarcoma and referred for urgent biopsy. This study presents the largest case series, which includes the first documented case diagnosed in 1934. Differentiating and characterising pseudoaneurysms from sarcomas is imperative in order to prevent a biopsy, which could be fatal.
Asunto(s)
Aneurisma Falso/diagnóstico , Neoplasias Óseas/complicaciones , Imagen por Resonancia Magnética/métodos , Osteocondroma/complicaciones , Arteria Poplítea , Adolescente , Adulto , Aneurisma Falso/etiología , Neoplasias Óseas/diagnóstico , Niño , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Humanos , Extremidad Inferior , Masculino , Osteocondroma/diagnóstico , Estudios Retrospectivos , Sarcoma/diagnóstico , Neoplasias de los Tejidos Blandos/diagnóstico , Adulto JovenRESUMEN
Background: Management of musculoskeletal tumors remains challenging for orthopedic surgeons. The aim of this cross-sectional study was to present the prevalence and localization of musculoskeletal disorders diagnosed and treated at a tertiary referral military hospital. Method: A total of 552 patients' medical records who presented to our clinic between 2009 and 2014 with the diagnosis of musculoskeletal tumors were retrospectively analyzed according to age, gender, bone/soft tissue localization, histopathological diagnosis, incidence, and treatment. Results: Of the cases diagnosed with tumor, 225 were soft tissue localized, 317 bone localized, and 10 tumor-like lesions. The most common primary benign soft tissue tumors were lipoma, ganglion, and giant cell tumor of tendon sheath, while the most common malignant soft tissue tumors were liposarcoma and synovial sarcoma, respectively. The most common primary bone tumors were osteochondroma, enchondroma, and simple bone cyst, while the most common malignant bone tumors were osteosarcoma, Ewing sarcoma and chondrosarcoma, respectively. Myositis ossificans was found as the most common tumor-like lesion. Conclusion: Descriptive data in musculoskeletal tumors is crucial in terms of improving treatment and reducing mortality. In this study, no significant difference was found between the data of tertiary military hospital regarding epidemiology of musculoskeletal system tumors and those from the literatures around Turkey.