Nora's lemsion of the anterior Maxilla: a rare case report and literature review

Bizarre parosteal osteochondromatous proliferation (BPOP), or eponymically Nora's lesion, is a rare growing, to a certain extent, exophytic lesion usually emanating from the periosteum or its adjacent layers. BPOP is idiopathically painful. Given its cartilage-producing nature and pain, BPOP is viewed with great suspicion. Regular post-surgical radiographs and clinical follow-up are mandatory. In the gnathic bones, the lesion is extremely rare. To the author's best knowledge, this paper reports the sophomoric appearance of BPOP in the anterior maxilla, in an adult female (AU)

La proliferación paraosteal osteocondromatosa bizarra (PPOB), o lesión de Nora según su epónimo, es un crecimiento inusual, exofítico, que procede del periostio o sus capas adyacentes. La PPOB es idiopáticamente dolorosa. Dada su naturaleza cartilaginosa y el dolor que la acompaña, la PPOB resulta una lesión sospechosa. Son obligatorios el estudio radiológico y seguimiento clínico postquirúrgicos. En los huesos maxilares, esta lesión es extremadamente infrecuente. En lo que conoce el autor, este artículo es la primera descripción de la PPOB de maxilar, en una mujer adulta (AU)

Arthroscopic resection of benign tumors of the knee posterior compartment: a report of 15 cases.

INTRODUCTION: The management of tumors located in the posterior compartment of the knee, whatever the nature of the tumor, remains surgical excision and can be done by open surgery or under arthroscopic control. The objective of this study was to evaluate the arthroscopic management of intra-articular tumors of the posterior compartment of the knee. The hypothesis is that tumors or tumor-like lesions confined to the posterior compartment are accessible by arthroscopy with low iatrogenic risk. MATERIALS AND METHODS: All patients with an intra-articular tumor of the posterior compartment of the knee were enrolled between 2009 and 2013. The surgical management consisted of arthroscopic resection. Patients underwent postoperative MRI, repeated at last follow-up. The outcomes were the occurrence of complications, functional evaluation using the Lysholm Knee Scoring Scale, and the recurrence rate. RESULTS: Fifteen patients were included. All patients had a complete resection. One case of delayed healing of the arthroscopic entry point was observed. At a mean 22months, the mean Lysholm Knee Score increased from 74 (±8.5) preoperatively to 92 (±7.7) postoperatively, a significant increase of 18 points (P=0.001). One patient had a recurrence of osteochondromatosis, requiring removal of a foreign body. DISCUSSION: Resection of posterior intra-articular tumors of the knee using arthroscopy is possible, subject to a learning curve.

[Nora's Lesion: A Rare Differential Diagnosis for Benign Peripheral Bone Tumours]. / Die Nora-Läsion: Eine seltene Differenzialdiagnose bei benignen peripheren Knochentumoren.

We report on a bizarre parosteal osteochondromatous proliferation (BPOP), also known as Nora's lesion, in a 43-year-old female patient.

Feline osteochondromatosis in a FELV-negative European shorthair cat.

OBJECTIVE: To report palliative treatment in a case of multifocal feline osteochondromatosis in a feline leukaemia virus (FeLV) negative European shorthair cat. CASE: A 6-year-old spayed female European shorthair cat was presented because of a right forelimb lameness caused by an osteochondromatous lesion which had trapped tendons, vessels and nerves of the antebrachium. Several other lesions were present which did not cause the animal discomfort. The cat was tested negative for FeLV. Palliative surgical removal of the mass was performed, resulting in a marked improvement of mobility with no local recurrence. The cat developed a non-regenerative anaemia after surgery, however the underlying cause was not identified upon request of the owner. Overall survival after surgery was only 2 months. The cat was then euthanised due to severe progression of the anaemia. CONCLUSION: Palliative surgical removal of osteochondromas may result in local improvement. However, owners need to be aware that it does not increase overall survival and that the prognosis is poor. Infection with FeLV is not necessarily associated with such lesions.

Recurrent bizarre parosteal osteochondromatous proliferation of the ulna with erosion of the adjacent radius: case report.

Bizarre parosteal osteochondromatous proliferation is an unusual entity that should be considered when evaluating a patient with a surface-based bone lesion. The aggressive features of bizarre parosteal osteochondromatous proliferation have occasionally led to misdiagnoses as malignant neoplasms and subsequent aggressive treatment. We present a case of a recurrent forearm bizarre parosteal osteochondromatous proliferation with unique radiographic features. This report serves to illustrate the importance of both radiographic and histopathologic review for correct diagnosis and discusses the successful management of a recurrent forearm lesion.

Neglected synovial osteochondromatosis of the elbow: a rare case.

BACKGROUND: Synovial osteochondromatosis is a benign metaplastic proliferative disorder of the synovium characterised by the formation of multiple cartilaginous nodules in the synovium, many of which detach and become loose bodies. The disease is characteristically monoarticular, most commonly involving the knee. A site in the elbow was first reported in 1918 by Henderson, but any joint may be involved. Very few cases of synovial osteochondromatosis of the elbow have been reported in the literature. The presenting symptoms are usually diffuse discomfort in the affected joint and decreased range of motion with an accompanying gritty or locking sensation. The treatment of choice is excision of the synovium and removal of the loose bodies. CASE PRESENTATION: We report a rare neglected case covering a 32-year period of a locally aggressive synovial osteochondromatosis of the elbow in a 47-year-old man. Clinical examination revealed a significant increase in size of the left elbow compared to the contralateral one. The simple radiographs and the computed tomography showed multiple rounded, calcified bodies widespread throughout the elbow joint. At surgery we removed and counted a total of 312 loose bodies, varying in size from a few millimeters to 3 cm. The evaluation at 6 months postoperatively showed marked reduction in the volume of the elbow, improvement of extension and flexion and an increase of the Mayo elbow performance score from 50 points before surgery to 80 points at 6 months postoperative. CONCLUSION: Synovial osteochondromatosis is an uncommon condition characterized by the formation of multiple nodules of hyaline cartilage within the sub-synovial connective tissue. The differential diagnosis includes chronic articular infection, osteoarthritis, pigmented villonodular synovitis, mono-articular inflammatory arthritis and periarticular neoplasms like synovial sarcoma. The treatment of choice is excision of the synovium and removal of the loose bodies. The prognosis is good, but recurrences may occur if the removal is incomplete.

[Relapse of a parosteal osteochondromateous proliferation (Nora's lesion) of the distal thumb]. / Rezidiv einer bizarren paraossären osteochondromatösen Proliferation (Nora-Läsion) des Daumenendgliedes.

We report the case of a 29-year-old female patient with a relapse of a Nora lesion in an atypic location. The literature for this rare benign lesion is reviewed and etiology, diagnostics and therapy are discussed.

Osteocondromatosis múltiple familiar: a propósito de un caso / Multiple familial osteochondromatosis: presentation of a case

Los encondromas son tumores benignos de cartílago que crecen de forma lenta en las metáfisis de los huesos. Pueden ser lesiones solitarias o múltiples. Las encondromatosis comprenden un grupo heterogéneo de síndromes, difíciles de diferenciar, caracterizados por la presencia de múltiples encondromas que pueden llegar a producir malformaciones musculoesqueléticas (secundarias al acortamiento de extremidades), escoliosis, fracturas patológicas o seudoartrosis. La complicación más temida, el osteocondrosarcoma, puede acontecer hasta en el 25% de los pacientes. Exponemos el caso de un varón de 67 años, sin diagnósticos previos conocidos, que consulta por la aparición en cadera izquierda de una tumoración dolorosa y rápidamente deformante en el último año. Los antecedentes familiares y los datos clínico-radiológicos confirmaron el diagnóstico de osteocondromatosis múltiple familiar. Aun cuando la evolución clínica y los estudios de imagen hicieron sospechar una degeneración maligna (osteocondrosarcoma), esta no se confirmó en el estudio histopatológico de la pieza quirúrgica (AU)

Enchondromas are benign cartilage tumours that grow slowly in the bone metaphysis. They may involve solitary or multiple lesions. Enchondromatoses include a heterogeneous group of hardly distinguishable syndromes characterised by the presence of multiple enchondromas that may cause musculoskeletal malformations (secondary to limb shortening), scoliosis, pathological fractures, or pseudoarthrosis. The most dreaded complication, osteochondrosarcoma, occurs in up to 25% of patients. We present the case of a 67-year-old male with no previous diagnosis, requiring attention due to the appearance of a painful tumour in his left hip which degenerated rapidly over the past year. Family history and clinical-radiological data confirmed the diagnosis of Multiple Familial Osteochondromatosis. Although clinical evolution and imaging led to suspect a malignant degeneration (osteochondrosarcoma), this was not confirmed by the histopathological study of the surgical sample (AU)

[A man with a swelling of the knee]. / Een man met een zwelling in zijn knieholte.

A 72-year-old male presented with a dorsomedial swelling of the knee. X-rays showed isolated ossificated cartilage particles. The particles, which were found to be in a popliteal cyst, were surgically removed and analyzed by the pathologist. The diagnosis was synovial osteochondromatosis . Isolated synovial osteochondromatosis inside a popliteal cyst is uncommon.

Clinical, radiological and ultrasonographic features, treatment and outcome in 22 horses with caudal distal radial osteochondromata.

REASONS FOR PERFORMING STUDY: Although a well recognised clinical entity, only small numbers of osteochondromata on the caudal distal radius have previously been published and its occurrence in young racing Thoroughbreds has not previously been reported. Identification and management of associated lesions in the deep digital flexor tendon have received scant attention in the literature. HYPOTHESIS: Osteochondromata of the caudal distal radius occur commonly in young racing Thoroughbreds. They vary in size and location, sagittally and proximodistally, but the majority cause impingement damage to the deep digital flexor tendon. METHODS: Case records and diagnostic images of horses with osteochondromata of the caudal distal radius were reviewed retrospectively and follow-up information obtained. RESULTS: Twenty-five osteochondromata were identified in 22 horses, 19 of which were Thoroughbreds. All osteochondromata were metaphyseal. Twenty-two were in the middle one-third of the bone and laceration of the adjacent deep digital flexor tendon was identified in 21 limbs. Treatment in all cases consisted of removal of the osteochondroma with debridement of the deep digital flexor tendon when this was affected. All horses returned to work and none exhibited any evidence of recurrence. CONCLUSION: Osteochondromata of the caudal distal radius occur in young racing Thoroughbreds but are also identified in other horses. They have a consistent metaphyseal location and most are found in the middle one-third of the radius. Size varies, but most cause laceration of the adjacent deep digital flexor tendon. Treatment by removal of the mass and debridement of the tendon is associated with a good prognosis. POTENTIAL RELEVANCE: Osteochondromata of the caudal distal radius are an important cause of tenosynovitis of the carpal sheath of the digital flexor tendons in young racing Thoroughbreds. When present in the most common location of the middle one-third of the bone, they are likely to cause impingement damage to the deep digital flexor tendon. Tenoscopic surgery offers a good prognosis.

Bizarre parosteal osteochondromatous proliferation of the metatarsal: a pediatric case report and archival review.

UNLABELLED: Bizarre parosteal osteochondromatous proliferations (BPOP), also known as Nora's lesions, are rare tumors occurring most commonly in the hands and feet. They are benign and rarely exhibit radiological evidence of cortical invasion. We report a case of BPOP showing atypical magnetic resonance imaging features that are inconsistent with BPOP and having a novel chromosomal aberration. We also review the BPOP cases in our regional benign bone tumor database. LEVEL OF CLINICAL EVIDENCE: 4.

Use of latissimus dorsi and abdominal external oblique muscle for reconstruction of a thoracic wall defect in a cat with feline osteochondromatosis.

A 4-year-old, male castrated European shorthair cat was presented with a firm mass palpable on the right caudal rib cage. Lateral and ventrodorsal radiographs of the thorax revealed a 4x3x2cm large, expansile and radiodense mass originating from the distal part of the 13th rib. After removal of the tumour, which was histopathologically confirmed as feline osteochondromatosis, the diaphragm, omentum, external abdominal oblique and latissimus dorsi muscles were used to reconstruct the defect. Feline osteochondromatosis is induced by retroviruses, eg, feline leukaemia virus, for which the cat tested positive. The tumour was removed for palliative reasons, because such tumours have the tendency to transform into osteosarcomas. Six months after the surgical excision the cat showed no clinical signs of reoccurrence.

Forearm rebalancing in osteochondromatosis by radioulnar fusion.

Options for treatment of a skeletally immature child with forearm involvement from osteochondromatosis vary widely from natural history observation through ulnar distraction lengthening in combination radial and ulnar osteotomies. An important factor in surgical indications is the status of the radial head. In the presence of a radial head dislocation, particularly in a very young child, radioulnar diaphyseal fusion (single-bone forearm) is a viable surgical option. It restores axial alignment, corrects proximal and distal radioulnar joint dislocations by resection, maintains forearm growth through the distal radius, and provides a stable elbow with a restoration of motion in a single-stage procedure.

Bizarre parosteal osteochondromatous proliferation and periosteal chondroma: a comparative report and review of the literature.

Bizarre parosteal osteochondromatous proliferation and periosteal chondroma are rare, benign, bony lesions that may present in the hand. Bizarre parosteal osteochondromatous proliferation was first reported in the literature by Nora in 1983, and periosteal chondroma was first reported by Lichtenstein in 1952. This report provides a unique side-by-side comparison of these lesions, illustrating each with a clinical vignette. This report, coupled with a thorough review of the literature, serves to demonstrate that the history and physical exam characteristics, as well as the radiographic and gross appearances, are insufficient to differentiate between the two lesions. Histopathologic examination is required to confirm the diagnosis.