Resolução espontânea de osteocondroma de fêmur distal: relato de caso / Spontaneous resolution of osteochondroma of the distal femur: case report

Introdução: o osteocondroma é o tumor ósseo benigno mais comum. Normalmente são assintomáticos e diagnosticados incidentalmente. Sua localização mais comum é no fêmur distal e raramente sofrem resolução espontânea. Objetivo: relatar um caso de osteocondroma do ambulatório de especialidades do Hospital do Servidor Público Municipal que foi acompanhado por três anos e evoluiu com resolução espontânea. Ainda, buscar na literatura casos que sejam semelhantes a procura de justificativas para esta evolução que não é comum. Método: relato de caso de paciente do Ambulatório de Especialidade do Hospital do Servidor Público Municipal, de 12 anos de idade, que foi acompanhado por três anos apresentando um tumor ósseo no fêmur distal compatível com diagnóstico de osteocondroma, que ao longo dos três anos evoluiu com resolução espontânea. Conclusão: osteocondromas raramente evoluem com resolução espontânea, quando isso ocorre geralmente são pacientes que ainda não atingiram a maturidade esquelética, apesar de algumas teorias sobre os mecanismos dessa evolução ainda são necessários mais estudos para conclusões mais definitivas. Palavras-chave: Resolução espontânea de tumor ósseo. Osteocondroma. Tumor Ósseo.

The Impact of Isolated Versus Multiple Osteochondromas: Analysis of the CoULD Registry.

PURPOSE: The burden of upper extremity (UE) osteochondromas on function and self-perception among pediatric patients is unclear. The purpose of our study was to study the impact of osteochondromas in comparison to population norms and to evaluate solitary versus multiple osteochondromas on subjective UE function as measured by patient rated outcomes. METHODS: We utilized the CoULD (Congenital Upper Limb Differences) Registry to review all pediatric patients presenting with osteochondromas between January 2014 and February 2021. Demographic information was collected and patients were classified as having either single or multiple osteochondromas. Patient-Reported Outcome Measurement Information System (PROMIS) and Pediatric Outcomes Data Collection Instrument (PODCI) tools were utilized for assessment. Scores for PODCI subscales of UE function, Pain/comfort, and Happiness and PROMIS domains of UE Function, Pain, Depression, Anxiety, and Peer Relations were reviewed. Differences between groups were analyzed using the Student t test. RESULTS: Ninety-nine patients met inclusion criteria for the study with an average age of presentation of 9.3 years and 61 patients (62%) were male. Overall, patients demonstrated worse UE Function as well as greater Anxiety and Depression in comparison to the population normals on PROMIS assessment. Patients also demonstrated worse patient and parent reported PODCI UE, Sports and Physical Functioning, Pain/Comfort and Global Functioning scores compared with population norms but demonstrated better than average happiness scores. Patients with multiple osteochondromas demonstrated greater PROMIS pain interference and more disability in PODCI Sports and Physical Functioning, Pain/Comfort and Global Functioning compared with those with solitary osteochondromas. CONCLUSION: Patients with UE osteochondromas have worse overall function in comparison to population norms, exceeding established minimally clinically important difference values. In addition, patients with multiple osteochondromas reported more pain and poorer physical function than those with solitary osteochondromas. Physicians should be alert to the physical and psychosocial burden of this disease. LEVEL OF EVIDENCE: Level II-prognostic.

Spontaneous regression of solitary osteochondromas in children: An option to consider in clinical practice.

Osteochondromas are neoplasm that belong to the family of cartilaginous histogenesis tumors and represent 90% of all forms of exostoses. As most osteochondromas are asymptomatic, underdiagnosis is frequent. Symptomatic forms usually manifest before the age of 20 years, and the most common symptoms are pain and the detection of a bony mass. Herein, we report four cases of spontaneous regression of solitary osteochondromas in the light of literature. We consider that orthopedic surgeons should take into account the possibility of spontaneous regression of these tumors, before recommending surgery. Symptoms are usually mild and we recommend following these patients with X-ray and physical examination annually.

Trevor's disease of the distal radioulnar joint in two children with achondroplasia.

Two children with achondroplasia who developed an abnormal bony outgrowth at the distal radioulnar joint (DRUJ), indistinguishable from an osteochondroma on histology, but the radiographic appearance, location, and asymmetry suggested the rare diagnosis of dysplasia epiphysealis hemimelica (DEH or "Trevor's disease"). One child experienced symptomatic relief with surgical excision and one was observed clinically due to lack of significant symptoms. These are the first presented cases of DEH in achondroplasia, both affecting the DRUJ. Due to the infrequency of DEH, more research is needed to better understand the potential connection to achondroplasia. For management, we suggest shared surgical decision making based on symptoms.

Osteochondroma of the talus in a 19-year-old female: A case report and review of the literature.

CASE: Osteochondroma is a benign bone tumor usually affecting areas around the knee, pelvis, neck and tibia. This disease rarely affects the talus. A case of a 19-years-old female with anteromedial ankle impingement with 8 years follow-up is reported. Surgery removal was the treatment of choice and histopathology examination revealed a benign solitary osteochondroma. CONCLUSION: Osteochondromas in the anterior and anteromedial side of talus are rarer and can cause multiple clinical manifestations including important ones such as limitation of ankle movement and pain. Different locations of solitary osteochondromas can influence both patients' symptoms and clinical examination findings.

[A young man with a painless swelling of the ankle]. / Een jongeman met een pijnloze zwelling van de enkel.

A 15-year-old boy presented with a swelling on the dorsolateral side of his right ankle. The swelling was moveable and painless. Radiography showed an exostosis with irregular calcification behind the talus. Resection was performed. Histological investigation showed a synovial ossified chondroma.

Enlarging nodule under the toenail · no history of trauma · unremarkable medical history · Dx?

A 28-year-old woman with an unremarkable medical history presented with an enlarging nodule that had been growing under her left great toenail for 6 months. The patient monitored the nodule, hoping that it would resolve on its own, but found that it steadily increased in size and began to displace the nail, causing pain. At the time of presentation, the nodule measured approximately 10 mm in diameter, and there was significant (~80°) superior displacement of the nail.

The unusual osteochondroma: A case of snapping scapula syndrome and review of the literature.

Snapping scapula syndrome is a rare condition characterized by crepitus of the scapula on motion of the ipsilateral upper extremity. It may be quite painful and disabling. The majority of cases are due to bursal and muscular disorders. Snapping scapula syndrome secondary to an underlying osteochondroma is an even more infrequent phenomenon. The case presented highlights the unusual post pubertal growth of an osteochondroma of the scapula that progressed to develop a snapping scapular syndrome. Review of the literature revealed less than fifty reported cases of this phenomenon secondary to an underlying osteochondroma.

Restorative Tissue Transplantation Options for Osteochondral Lesions of the Talus: A Review.

Symptomatic osteochondral lesions of the talus remain a challenging problem due to inability for cartilage lesions to heal. Numerous treatment options exist, including nonoperative management, marrow stimulating techniques, and autograft-allograft. Arthroscopic marrow stimulation forms fibrocartilage that has been shown to be biomechanically weaker than hyaline cartilage. Restorative tissue transplantation options are being used more for larger and cystic lesions. Newer biologics and particulated juvenile cartilage are currently under investigation for possible clinical efficacy. This article provides an evidenced-based summary of available literature on the use of biologics for treatment of osteochondral lesions of the talus.

Spontaneous Hemothorax, A Rare Face of Vertebral Osteochondroma.

BACKGROUND: Osteochondroma is the most common benign tumor of the bone. It is usually asymptomatic, but complications may result from mechanical injury to adjacent anatomic structures, such as the diaphragm and lung, when located intrathoracically. CASE REPORT: We report the unusual occurrence of a large hemothorax and lacerated right diaphragm in a 41-year-old woman caused by vertebral osteochondroma affecting the eleventh thoracic vertebra. Thoracoscopic exploration with resection of the osteochondroma and repair of the diaphragm was performed. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Spontaneous hemothorax is a potential life-threatening condition when the initial diagnosis is postponed and hemodynamic instability and hypovolemic shock occurs. Osteochondroma as a cause of spontaneous hemothorax is uncommon but may require urgent surgical intervention with video-assisted thoracoscopic surgery of thoracotomy to control the hemorrhage and prevent recurrence.

Osteochondroma: ignore or investigate? / Osteocondroma: ignorar ou investigar?

Osteochondromas are bone protuberances surrounded by a cartilage layer. They generally affect the extremities of the longbones in an immature skeleton and deform them. They usually occur singly, but a multiple form of presentation may be found. They have a very characteristic appearance and are easily diagnosed. However, an atypical site (in the axial skeleton) and/or malignant transformation of the lesion may sometimes make it difficult to identify osteochondromas immediately by means of radiographic examination. In these cases, imaging examinations that are more refined are necessary. Although osteochondromas do not directly affect these patients' life expectancy, certain complications may occur, with varying degrees of severity...

Osteocondromas são protuberâncias ósseas envolvidas por uma camada de cartilagem. Atingem, habitualmente, as extremidades dos ossos longos no esqueleto imaturo e os deformam. Em geral são únicos, mas a forma de apresentação múltipla pode ser encontrada. De aspecto bastante característico, são de fácil diagnóstico. Contudo, por vezes, a localização atípica (esqueleto axial) e/ou a malignização da lesão podem dificultar a sua pronta identificacão por exames radiográficos. Nesses casos, exames de imagem mais apurados são necessários. Apesar de não afetarem diretamente a expectativa de vida do portador, algumas complições, com variados graus de gravidade, podem ocorrer...

Cell biology of osteochondromas: bone morphogenic protein signalling and heparan sulphates.

Frequent benign outgrowths from bone known as osteochondromas, exhibiting typical endochondral ossification, are reported from single to multiple lesions. Characterised by a high incidence of osteochondromas and skeletal deformities, multiple hereditary exostoses (MHE) is the most common inherited musculoskeletal condition. While factors for severity remain unknown, mutations in exostosin 1 and exostosin 2 genes, encoding glycosyltransferases involved in the biosynthesis of ubiquitously expressed heparan sulphate (HS) chains, are associated with MHE. HS-binding bone morphogenetic proteins (BMPs) are multifunctional proteins involved in the morphogenesis of bone and cartilage. HS and HS proteoglycans are involved in BMP-mediated morphogenesis by regulating their gradient formation and activity. Mutations in exostosin genes disturb HS biosynthesis, subsequently affecting its functional role in the regulation of signalling pathways. As BMPs are the primordial morphogens for bone development, we propose the hypothesis that BMP signalling may be critical in osteochondromas. For this reason, the outcomes of exostosin mutations on HS biosynthesis and interactions within osteochondromas and MHE are reviewed. Since BMPs are HS binding proteins, the interactions of HS with the BMP signalling pathway are discussed. The impact of mouse models in the quest to better understand the cell biology of osteochondromas is discussed. Several challenges and questions still remain and further investigations are needed to explore new approaches for better understanding of the pathogenesis of osteochondromas.

An epiphyseal osteochondroma causing mechanical symptoms in the knee.

A case of an epiphyseal osteochondroma in the anteromedial aspect of left tibia in a 4 year old girl, who was presented with knocking between knees and limping. Surgical excision of this bony growth was curative and resolved the mechanical symptoms completely. Interesting clinical and imaging features are presented. The possibility of solitary epiphyseal osteochondroma should be kept in mind for any bony lesion close to the joint, especially in a young child. Early excision of the lesion is recommended to avoid intra-articular development and mechanical block to joint motion.

Large para-articular osteochondroma of the knee joint: a case report.

A unique case of large intra-articular osteochondroma of the knee of a 15-year duration is presented along with a review of the literature. The tumor may have remained asymptomatic for such a long period because of its slow growth and stretch elongation of the quadriceps mechanism.

A rare presentation of cervical osteochondroma arising in a spinous process.

STUDY DESIGN: The case of a 21-year-old woman with a palpable neck mass is reported. OBJECTIVE: To describe the rare presentation of an osteochondroma arising in the right bifid tip of the C5 spinous process presenting as a palpable neck mass. Emphasis will be placed on the pathophysiology, symptomatology, complications, imaging, and surgical management. SUMMARY OF BACKGROUND DATA: Osteochondromas rarely occur in the cervical spine and lesions arising from the neural arch may present as a palpable neck mass. METHODS: The patient's medical and imaging history and medical literature were reviewed. RESULTS: A 21-year-old woman presented with a hard palpable mass in her lower cervical spine. Review of radiography, CT, MRI, and skeletal scintigraphy demonstrated an expansile bone lesion arising in the right bifid tip of the C5 spinous process with dense chondroosseous matrix in the distal tip of the lesion. Wide C5 laminectomy with en bloc resection of the tumor alleviated her symptoms. Biopsy revealed osteochondroma without malignant degeneration. CONCLUSIONS: Patients with cervical spine osteochondromas may present with a multitude of symptoms and complications depending on the size and location of the lesion. These may include pathologic fracture, spinal stenosis, nerve root compression, cranial nerve deficits, myelomalacia, and malignant degeneration to chondrosarcoma. Advanced imaging modalities are required for characterization, diagnosis, surgical planning, and management of these rare spinal lesions.

Osteochondroma of the coronoid process (Jacob's disease): an unusual cause of restricted jaw motion.

Osteochondromas are the most common benign bone tumor, most commonly found in the ends of long bones; however, they rarely involve facial bones, particularly the mandible. Osteochondromas involving the coronoid process have rarely been reported in the literature but pose a diagnostic dilemma. When large enough, osteochondromas of the mandibular coronoid process can form a joint with the zygomatic arch (Jacob's disease). This pseudoarticulation results in restricted jaw motion, which can clinically be mistaken for temporomandibular joint dysfunction. We report a case of a 39-year-old man with chronic restricted jaw motion undiagnosed for several years.

Scapular osteochondromas treated with surgical excision.

A retrospective review was performed of all osteochondroma excisions at our institution from 1994 to 2007. Postoperative functional assessment was completed with use of the Disabilities of the Arm, Shoulder and Hand (DASH) survey and a self-report questionnaire. Eight osteochondromas were excised at a mean patient age of 21.63 years. Presenting reports included pain, mass, pseudowinging, and snapping of the scapula. Physical examination identified pseudowinging, palpable mass, and pain with shoulder motion. The lesions arose from the ventral surface of the scapula in 5 patients, the dorsal surface in 2, and the inferior acromion in 1. The resected specimen averaged 10.8cm(3). A reactive bursa was found and resected in 4 patients. At mean of 4.17 years postresection, no signs of recurrence were found in 7 patients (88%). The single patient with a recurrence had undergone 2 additional surgical procedures. Six patients (75%) reported no/mild pain with routine and strenuous activities. One patient reported moderate and 1 patient reported moderate/severe pain with routine and strenuous activities. Four patients reported post-resection function as excellent, 2 as good, 1 as average/good, and 1 as average/poor. Six patients (75%) reported feeling very satisfied with the results, 1 reported feeling satisfied, and 1 reported feeling unsatisfied. The average DASH score was 11.7 (range, 0.00-46.67). No winging or pseudowinging was identified in those available for examination, and no difference was identified in range of motion comparing the operative to the nonoperative upper extremity. Near normal functional outcomes can be expected following excision of scapular osteochondromas.

Exostosis tibial: osteocondroma / Tibial exostoses: osteochondroma

El osteocondroma o exostosis cartilaginosa es el tumor óseo más frecuente, representando el 10-15% de la totalidad. Alrededor del 3% de la población lo padece. Es un tumor propio de individuos jóvenes con ligero predominio en varones. Puede ser solitario o múltiple, formando parte del síndrome de exostosis múltiple hereditaria. Suele ser un hallazgo accidental, normalmente asintomático, cuya localización más frecuente es la rodilla, aunque puede aparecer en otras localizaciones. El diagnóstico se realiza por imagen radiográfica, que suele ser patognomónica, y el tratamiento definitivo consiste en la extirpación quirúrgica (AU)

Osteochondroma, also known as osteocartilaginous exostoses, is the most common bonetumor, representing 10-15% of them. According to research, around 3% of the population suffers from this disease. This tumor is common among young people and it has a small predominance in males. Its radiologic features are often pathognomonic. Osteochondromas can be either solitary or multiple. They are connected with hereditary multiple exostoses. And usually reveal themselves as incidental, mostly located in knees. Surgical excision is the definitive treatment for this pathology (AU)

Scapular osteochondroma treated with arthroscopic excision using prone positioning.

Osteochondromas, or exostoses, are common benign bone tumors. Most commonly, osteochondromas arise in the metaphyseal regions of long bones (femur, humerus, tibia). Seldom are osteochondromas found on the undersurface of the scapula; these osteochondromas invoke mechanical irritation that leads to bursa formation, snapping, and even winging of the scapula. Many authors have reported performing open surgical excision when these osteochondromas become symptomatic. In this report, we describe the case of a woman in her mid-20s with painful scapular snapping and winging from an osteochondroma treated with arthroscopic excision using prone positioning.