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A typical femoral osteochondroma X-ray. Note the protuberance on the external surface of the right femoral bone. Linear calcifications inside the tumor are also apparent. Reprinted with permission from (4).
Source publication
Osteochondroma, the most common benign bone tumor, is a projection on the external surface of the bone, which can be sessile or pedunculated. 85% of osteochondromas present as solitary lesions, while 15% occur in the context of hereditary multiple exostoses (HME), a genetic disorder that is inherited in an autosomal dominant manner. Although often...
Contexts in source publication
Context 1
... radiography should be the first imaging modality to assess an osseous lesion. Typically, osteochondroma presents as a well-defined protuberance on the external surface of a bone (Figures 1 and 2). The lesion varies from 1 to 10 cm and consists of a cortex and a medulla, which are in continuity with the underlying bone (1, 3). ...
Context 2
... radiography should be the first imaging modality to assess an osseous lesion. Typically, osteochondroma presents as a well-defined protuberance on the external surface of a bone (Figures 1 and 2). The lesion varies from 1 to 10 cm and consists of a cortex and a medulla, which are in continuity with the underlying bone (1, 3). ...
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Key Clinical Message
Osteochondromas (OCs) are developmental anomalies that originate from the periosteum and typically form during enchondral ossification near the joints. Retro‐patellar OC caused by exostosis forms in various intracapsular, intra‐tendon, and joint‐adjacent positions within the knee joint. In this case, a 19‐year‐old male presente...
We present a case of hereditary multiple exostoses with malignant transformation to chondrosarcoma in a woman complaining of enlargement and pain in the right thigh. Hereditary multiple exostoses is a rare genetic disorder characterized by multiple osteochondromas. Malignant transformation to chondrosarcoma of a pre-existing osteochondroma is a pos...
Hereditary multiple exostosis (HME) is a rare genetic disorder characterized by multiple bony spurs or lumps, commonly affecting the long bones. This case report exposes the clinical presentation, diagnosis, and management of HME in a 28-year-old female nurse, who initially presented with persistent bilateral knee pain. After extensive evaluation i...
Introduction and importance
Rib osteochondromas are rare genetic disorders, which can present as bony exostosis causing compression, impingement and damage to surrounding vessels, organs and structures within the thoracic cavity. The objective of this study was to clearly describe a rare presentation of rib osteochondromas in a pediatric patient al...
Background
Hereditary Multiple Exostoses (HME), also known as Multiple Osteochondromas (MO) is a rare genetic disorder characterized by multiple benign cartilaginous bone tumors, which are caused by mutations in the genes for exostosin glycosyltransferase 1 ( EXT1 ) and exostosin glycosyltransferase 2 ( EXT2 ). The genetic defects have not been stu...
Citations
... Primarily, it is managed conservatively, especially if it is asymptomatic. Malignant transformation into osteosarcoma happens in 1% of solitary OC, and it's generally of low grade, and surgery is curative in 80% of cases [11] . Local recurrence can occur in benign and malignant lesions. ...
SUMMARY. One of the most prevalent benign bony tumors seen in young adults and children is osteo�chondroma (OC), which is usually present on the exterior surface of long bones. Isolated scapular osteo�chondromas are quite uncommon. OC is frequently asymptomatic, however, it can be symptomatic if
they are largely causing tissue compression and restriction of the movement range. Herein, we discuss a
case of a 13-year-old girl whose mother accidentally discovered a right shoulder painless lump. The diag�nosis was established using a computed tomography scan and Magnetic Resonance Imaging. The tumor
was surgically excised and histopathology confirmed the diagnosis. Prompt identification and interven�tion are vital for efficient management. The surgical approach is the preferred therapy, especially for
symptomatic cases, thus providing a positive prognosis. An extended duration of observation is essential
to oversee the recurrence of potential complications or even malignant transformation.
RESUMEN. Uno de los tumores óseos benignos más prevalentes observados en adultos jóvenes y niños es el
osteocondroma (OC), que suele estar presente en la superficie exterior de los huesos largos. Los osteocondro�mas escapulares aislados son bastante infrecuentes. La OC suele ser asintomática; sin embargo, puede ser sinto�mática si causa en gran medida compresión del tejido y restricción del rango de movimiento. Aquí, discutimos
el caso de una niña de 13 años cuya madre descubrió accidentalmente un bulto indoloro en el hombro derecho.
El diagnóstico se estableció mediante tomografía computarizada y resonancia magnética. El tumor fue extirpa�do quirúrgicamente y la histopatología confirmó el diagnóstico. La pronta identificación e intervención son vi�tales para una gestión eficiente. El abordaje quirúrgico es la terapia preferida, especialmente en los casos sinto�máticos, proporcionando así un pronóstico positivo. Una duración prolongada de la observación es esencial pa�ra supervisar la recurrencia de posibles complicaciones o incluso una transformación maligna.
... Complete resection of the cartilaginous part of the tumor is the most important step to prevent recurrence [5]. In cases of incomplete resection, there is a 2-5% chance of recurrence of the lesion and after complete resection, recurrence is <2% [6,11]. ...
Introduction
Vertebral body osteochondroma presenting with myelopathic symptoms is exceptionally rare entity of spinal osteochondroma which arises from the posterior surface of vertebral body and leading to spinal canal stenosis and cord compression. Early definitive diagnosis and subsequent successful treatment is necessary in such cases to prevent life threatening complications.
Case Report
In this context, we report a case of a 20-years old female presented with mechanical neck pain, unsteady gait, giddiness with neurological deficit for the past 3 months. An MRI of the cervical spine revealed a mass growing from the posterior aspect of the C6 vertebral body and extending toward the vertebral canal, causing marked spinal cord compression.
Conclusion
The following case report not only describes the rare presentations of vertebral body osteochondroma but also emphasizes on surgical management by en bloc resection of tumor and anterior cervical fusion, resulting in a favorable outcome without any recurrence.
... . It has been reported that malignant transformation occurs in approximately 1% of solitary osteochondromas and 10% of HME cases [1]. Most patients with HME have germ line mutations in the tumor suppressor genes exostosin 1 (EXT1) or exostosin 2 (EXT2) [6][7][8]. ...
... The EXT genes encode glycosyltransferases, catalyzing heparan sulfate polymerization [6]. Traditionally, most osteochondromas are diagnosed incidentally as they are asymptomatic [1,9]. Osteochondromas that present with symptoms are usually painful due to compression of adjacent structures, including the nerve, artery, and bursa; bony deformity with or without limb malignment; fracture of the stalk of the osteochondroma; and malignant transformation [1,9,10]. ...
... Traditionally, most osteochondromas are diagnosed incidentally as they are asymptomatic [1,9]. Osteochondromas that present with symptoms are usually painful due to compression of adjacent structures, including the nerve, artery, and bursa; bony deformity with or without limb malignment; fracture of the stalk of the osteochondroma; and malignant transformation [1,9,10]. Plain radiographs are usually sufficient to diagnose osteochondromas; however, cross-sectional imaging such as computerized tomography and magnetic resonance imaging (MRI) are used to evaluate the cartilage cap, where increased thickness has been associated with cancerous degeneration, evaluate tumors in areas of complex anatomy, and evaluate marrow continuity to confirm diagnosis [9]. ...
Introduction
Osteochondromas are the most common benign tumors of the bone and can be sessile or pedunculated. Although osteochondromas are typically seen in the long bones, they are rarely seen in the small bones of the hand or foot. Verruca vulgaris, also known as the common wart, is one of the most common skin conditions presenting to physicians and must be distinguished either clinically or histologically from other hyperkeratotic conditions, including bone conditions such as bone tumors that can place pressure on the skin and cause callus formation that can mimic a wart or create skin deformity. A high index of suspicion for underlying bone mass or tumor should be entertained when evaluating patients for skin conditions, particularly of the hand or foot, with failure to improve with treatment.
Case Report
This case report presents a 20-year-old male with a pedunculated osteochondroma of the left fourth distal phalanx with hyperkeratotic skin overlying the mass at the end of the toe. He was initially treated by a family doctor and podiatrist for verruca vulgaris for over 5 years with two treatments of liquid nitrogen cryotherapy and surgical excision of the mass when the treating podiatrist encountered bone and recommended radiographs. The family requested follow-up with our practice several days later after they were told the patient had a bone tumor. The patient requested surgical excision of the osteochondroma secondary to pain with activities and difficulties with his vocation as a pilot.
Conclusion
All physicians must be mindful of an underlying bone tumor or mass in patients presenting with skin changes, particularly about the foot or hand. Knowledge that an underlying bone tumor can present as a verruca vulgaris may prevent a delay in diagnosis or unnecessary treatment when evaluating and treating a patient with a skin lesion. Fortunately, our case was a benign osteochondroma; a malignant tumor with a delay in diagnosis could lead to loss of limb or life.
... 1 Osteochondromas, typically manifest as a clearly defined protrusion on the outer surface of a bone. 13 CT is a powerful tool for detecting malignancies in anatomical regions that are challenging to visualize using plain radiographs such as shoulder. CT can be used to assess the presence of a cartilage cap and determine if it has calcification. ...
A 53 years-old woman presented with pain and restriction of left shoulder range of motion to our clinic. Complaints increasing gradually over the past four years. She had been diagnosed with frozen shoulder at different clinics from the beginning and she had received ineffective treatments. A rare diagnosis of intraarticular osteochondroma of proximal humerus was found and a surgical excision was performed. The occurrence of intraarticular osteochondroma in the glenohumeral joint is quite uncommon. This report will contribute to the literature in terms of osteochondroma being in an unusual location and growth occurring after skeletal maturity without undergoing malignant transformation.
... This lack of medullary continuity into the cavity of the lesion is a distinguishing quality of BPOP, differentiating it from an osteochondroma. 12,13 However, it is noteworthy that a few isolated cases have been documented with atypical findings, including cortical destruction and medullary continuity. 10,14 In the patient presented, the imaging shows a small medullary continuity at the base of the tumor (see Figures 1A + 1C). ...
Bizarre parosteal osteochondromatous proliferations, also known as Nora’s lesions, are rare benign tumors with a high recurrence rate. They are often difficult to identify because of their similar appearance to other tumors. We describe a 25-year-old healthy female patient with bizarre parosteal osteochondromatous proliferations in an uncommon location on the pelvic ilium, presenting with unique clinical findings of abdominal pain and femoral paresthesia and showing atypical radiographic findings. To the best of our knowledge, this is one of the very few cases ever reported in the literature of Nora’s lesion in this particular location and possibly the first case ever with this specific presentation. The lesions’ radiographic images, combined orthopedic and general surgery procedures, and histological analysis are detailed. The patient’s continued 4-year follow-up has demonstrated no symptoms or evidence of recurrence.
... bursa formation, or malignant transformation [1] . Indicators of potential malignant transformation include a cartilage cap thickness exceeding 2 cm in adults or 3 cm in children, the onset of new pain or growth, or rapid lesion expansion, particularly after the closure of the growth plate [2] . The lower extremities, specifically the metaphyseal structures of the femur and tibia around the knee joint, are commonly affected [ 3 ,4 ]. ...
Tibial exostosis, also known as osteochondroma, is a common benign bone tumor found predominantly in adolescents and young adults. Vascular complications associated with this tumor, such as arterial occlusion and pseudoaneurysm formation, are rare but can lead to significant morbidity if not promptly diagnosed and managed. We present a case of a 25-year-old patient who presented with thrombosis of the left popliteal vein and a painless swelling in the popliteal fossa. Radiographic and CT angiography revealed an exostosis on the proximal tibia causing arterial occlusion and venous compression. Surgical resection of the exostosis via a posterior knee approach resulted in successful resolution of symptoms and a favorable outcome at a 12-month follow-up. Histopathological examination confirmed the benign nature of the tumor with no evidence of malignant transformation. This case highlights the importance of prompt recognition and surgical intervention in managing vas-cular complications associated with tibial exostosis. A multidisciplinary approach involving orthopedic and vascular specialists is crucial for achieving optimal outcomes in such cases.
... Most osteochondromas are asymptomatic, but pelvic sarcomas may cause symptoms because of compression, fracture, bursitis, or increased size [25]. They grow slowly during childhood, with growth proportional to the overall immature skeleton, but should not enlarge after puberty [10]. ...
... Notably, most chondrosarcoma research fails to distinguish between central and peripheral chondrosarcomas, despite differing clinical behaviors, particularly among higher-grade tumors. Our study demonstrates that none of the patients with low-grade (Grade 1) tumors developed metastases or died as a result of the disease, consistent with the current understanding, which is that of a generally low malignant potential for central and peripheral low-grade chondrosarcoma [13,25,27,28]. Furthermore, our results emphasize that achieving a clear surgical resection margin, exceeding 1 mm, results in a very low local recurrence rate and high LRFS. ...
Background
Peripheral osteochondral tumors are common, and the management of tumors presenting in the pelvis is challenging and a controversial topic. Some have suggested that cartilage cap thickness may indicate malignant potential, but this supposition is not well validated.
Questions/purposes
(1) How accurate is preoperative biopsy in determining whether a peripheral cartilage tumor of the pelvis is benign or malignant? (2) Is the thickness of the cartilage cap as determined by MRI associated with the likelihood that a given peripheral cartilage tumor is malignant? (3) What is local recurrence-free survival (LRFS), metastasis-free survival (MFS), and disease-specific survival (DSS) in peripheral chondrosarcoma of the pelvis and is it associated with surgical margin?
Methods
Between 2005 and 2022, 289 patients had diagnoses of peripheral cartilage tumors of the pelvis (either pedunculated or sessile) and were treated at one tertiary sarcoma center (the Royal Orthopaedic Hospital, Birmingham, UK). These patients were identified retrospectively from a longitudinally maintained institutional database. Those whose tumors were asymptomatic and discovered incidentally and had cartilage caps ≤ 1.5 cm were discharged (95 patients), leaving 194 patients with tumors that were either symptomatic or had cartilage caps > 1.5 cm. Tumors that were asymptomatic and had a cartilage cap > 1.5 cm were followed with MRIs for 2 years and discharged without biopsy if the tumors did not grow or change in appearance (15 patients). Patients with symptomatic tumors that had cartilage caps ≤ 1.5 cm underwent removal without biopsy (63 patients). A total of 82 patients (63 with caps ≤ 1.5 cm and 19 with caps > 1.5 cm, whose treatment deviated from the routine at the time) had their tumors removed without biopsy. This left 97 patients who underwent biopsy before removal of peripheral cartilage tumors of the pelvis, and this was the group we used to answer research question 1. The thickness of the cartilage cap was recorded from MRI and measuring to the nearest millimeter, with measurements taken perpendicular in the plane that best allowed the greatest measurement. Patient survival rates were assessed using the Kaplan-Meier method with 95% confidence intervals as median observation times to estimate MFS, LRFS, and DSS.
Results
Of malignant tumors biopsied, in 49% (40 of 82), the biopsy result was recorded as benign (or was considered uncertain regarding malignancy). A malignant diagnosis was correctly reported in biopsy reports in 51% (42 of 82) of patients, and if biopsy samples with uncertainty regarding malignancy were excluded, the biopsy identified a lesion as being malignant in 84% (42 of 50) of patients. The biopsy results correlated with the final histologic grade as recorded from the resected specimen in only 33% (27 of 82) of patients. Among these 82 patients, 15 biopsies underestimated the final histologic grade. The median cartilage cap thickness for all benign osteochondromas was 0.5 cm (range 0.1 to 4.0 cm), and the median cartilage cap thickness for malignant peripheral chondrosarcomas was 8.0 cm (range 3.0 to 19 cm, difference of medians 7.5 cm; p < 0.01). LRFS was 49% (95% CI 35% to 63%) at 3 years for patients with malignant peripheral tumors with < 1-mm margins, and LRFS was 97% (95% CI 92% to 100%) for patients with malignant peripheral tumors with ≥ 1-mm margins (p < 0.01). DSS was 100% at 3 years for Grade 1 chondrosarcomas, 94% (95% CI 86% to 100%) at 3 years for Grade 2 chondrosarcomas, 73% (95% CI 47% to 99%) at 3 and 5 years for Grade 3 chondrosarcomas, and 20% (95% CI 0% to 55%) at 3 and 5 years for dedifferentiated chondrosarcomas (p < 0.01). DSS was 87% (95% CI 78% to 96%) at 3 years for patients with malignant peripheral tumors with < 1-mm margin, and DSS was 100% at 3 years for patients with malignant peripheral tumors with ≥ 1-mm margins (p = 0.01).
Conclusion
A thin cartilage cap (< 3 cm) is characteristic of benign osteochondroma. The likelihood of a cartilage tumor being malignant increases after the cartilage cap thickness exceeds 3 cm. In our experience, preoperative biopsy results were not reliably associated with the final histologic grade or malignancy, being accurate in only 33% of patients. We therefore recommend observation for 2 years for patients with pelvic osteochondromas in which the cap thickness is < 1.5 cm and there is no associated pain. For patients with tumors in which the cap thickness is 1.5 to 3 cm, we recommend either close observation for 2 years or resection, depending on the treating physician’s decision. We recommend excision in patients whose pelvic osteochondromas show an increase in thickness or pain, preferably before the cartilage cap thickness is 3 cm. We propose that surgical resection of peripheral cartilage tumors in which the cartilage cap exceeds 3 cm (aiming for clear margins) is reasonable without preoperative biopsy; the role of preoperative biopsy is less helpful because radiologic measurement of the cartilage cap thickness appears to be accurately associated with malignancy. Biopsy might be helpful in patients in whom there is diagnostic uncertainty or when confirming the necessity of extensive surgical procedures. Future studies should evaluate other preoperative tumor qualities in differentiating malignant peripheral cartilage tumors from benign tumors.
Level of Evidence
Level III, diagnostic study.
... The number and size of OCs increase during childhood and remain stable after the closure of the growth plate [11]. The disruption of osseous growth, long bone bowing, angulation of the joints, and a reduction in range of motion are the most prevalent clinical concerns related to MO [12][13][14][15][16]. Malignant transformation of an existing OC into secondary peripheral chondrosarcoma during adulthood is the most feared complication, reported in about 5% of patients [9]. ...
Purpose
To evaluate the health-related quality of life and associated risk factors for Multiple Osteochondromas patients.
Methods
A cross-sectional, observational study was conducted from May to December 2022 during the routine visit to the referral center for rare skeletal disorders. All patients with Multiple Osteochondromas aged ≥ 3 years were included. EuroQol 5-dimension questionnaires, and demographic, clinical, and surgical history data were collected. Descriptive statistics, Fisher’s exact test, One-sample t-test, Spearman’s correlation, and multiple linear and logistic regression were performed to analyze the data. Results are reported following STROBE guidelines.
Results
A total of 128 patients were included in the study, with a mean age of 14 [SD, 10] years. The mean EQ-5D Index Value was 0.863 [SD, 0.200] and the EQ-VAS was 84 [SD, 19] with a positive correlation between two scores [r = 0.541, p < 0.001]. Patients frequently referred problems in pain/discomfort [78.8%], anxiety/depression [50%], and usual activities [38.8%] dimensions. Increasing age was the common risk factor for health-related quality of life [p < 0.000], as well as Index Value and VAS scores were significantly lower in surgical patients [p = 0.001 and p < 0.001, respectively].
Conclusion
Increasing age and surgical procedures were found highly associated with reduced health-related quality of life in Multiple Osteochondromas patients. Our findings provide relevant information to support the establishment of patient-centered healthcare pathways and pave the way for further research into medical and non-medical therapeutic strategies for these patients.
... Osteochondromas are typically located in the metaphysis, away from joints. Flat bones like sternum, scapula, ribs, and hips are rarely affected (less than 5%) [4,5]. were found in the foot and ankle. ...
This case report describes a rare occurrence of talar osteochondroma extending into syndesmosis, causing disruption of the interosseous membrane and the posterior inferior tibiofibular ligament (PITFL). This type of presentation for a talar osteochondroma is the first of its kind reported in the literature based on current knowledge. A detailed preoperative radiological assessment was crucial in planning the surgical approach and preparing for syndesmotic stabilization during the excision. The patient underwent successful and complete excision of the osteochondroma, and the syndesmosis was stabilized using a cortical screw along with anatomical repair of the PITFL. Apart from delayed wound healing, the patient exhibited good functional outcomes in terms of gait and ankle range of motion at the six-month follow-up. This case serves as a valuable reference for similar presentations in the future, emphasizing the importance of thorough preoperative assessment and appropriate treatment planning.
... The exact incidence of osteochondromas is unknown as many of these tumors are asymptomatic and therefore remain undiagnosed. 8 Osteochondromas are usually discovered incidentally or while investigating for complaint related to osteochondroma itself. 10 Majority of them seek consultation for complications like osseous deformity, fracture, mechanical or neurovascular impingement, bursa formation and malignant transformation. ...
... If complete resection is achieved, the recurrence rate is less than 2%. 8 As the lesion is symptomatic in our case, we performed complete excision of lesion by removing osteochondroma at the normal bone base, along with cartilage cap and perichondrium. ...
Low-back pain is the most common symptom encountered in orthopaedic spine out-patient practice. In young adults, the usual causes are soft tissue injuries, myofascial pain, annular tear of the intervertebral disc, sacroiliitis and spondyloarthropathies. We report a case of 20-year-old skeletally mature male presenting with chronic low back pain who was treated symptomatically elsewhere. He presented to us for second opinion and upon clinical assessment, he was diagnosed to have osteochondroma arising from the right postero-superior iliac spine. Osteochondromas are osteo-cartilaginous benign tumour with 1% malignant potential seen in adolescents and young adults. They usually arise from the metaphysis of long bones around the knee and occasionally reported in humerus, spine and pelvis. These lesions are mostly asymptomatic and found incidentally. En-bloc excision of the tumor is recommended for symptomatic osteochondromas. Clinicians should be aware of atypical pelvic osteochondromas which can present as extra-spinal cause of chronic low back pain.
