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CT scan of the pelvis depicting a pedunculated solitary osteochondroma, arising from the right ala of the sacrum.
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Primary benign sacral tumors are rare representing only 1-4% of solitary exostoses and constituting 4% of all solitary spinal tumor. The tumor usually comes to attention in childhood or adolescence. The treatment of symptomatic lesions is resection. We present here a case of a sacral osteochondroma with characteristic histological and radiological...
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... We also realized that some SIJ joint anatomical variations (namely, the accessory SIJ and iliosacral complex), which can mimic sacroiliitis and are being increasingly recognized (4), might be challenging in the setting of-and might even be mistaken for-osteochondromatosis. Although flat bones, in particular the ilium and scapula, are commonly affected in patients with osteochondromatosis (2), there is no data in the literature, apart from a few case reports (5,6), regarding the prevalence of SIJ involvement in osteochondromatosis. In this study, we aimed to investigate the prevalence of SIJ involvement in patients with osteochondromatosis and how such involvement compares with SIJ anatomical variations. ...
Purpose:
Apart from a few case reports, sacroiliac joint (SIJ) involvement in osteochondromatosis has not been studied. We aimed to determine the prevalence and characteristics of such involvement using cross-sectional imaging.
Methods:
In this retrospective study, three observers (one junior radiologist and two musculoskeletal radiologists) independently reviewed computed tomography (CT) or magnetic resonance imaging (MRI) of patients in our database who had osteochondromatosis (≥2 osteochondromas across the skeleton) for SIJ involvement. The final decision was reached by the consensus of the two musculoskeletal radiologists in a later joint session.
Results:
Of the 36 patients with osteochondromatosis in our database, 22 (61%) had cross-sectional imaging covering SIJs (14 females, 8 males; age range 7-66 years; mean age 23 years; 13 MRI, 9 CT). Of these, 16 (73%) had intra-articular osteochondromas. For identifying SIJ osteochondromas on cross-sectional imaging, interobserver agreement was substantial [κ = 0.67; 95% confidence interval (CI): 0.34, 1.00] between the musculoskeletal radiologists and moderate (κ = 0.59; 95% CI: 0.23, 0.94) between the junior radiologist and the final consensus decision of the two musculoskeletal radiologists. In the cohort with cross-sectional imaging, the anatomical variations of the accessory SIJ (n = 6, 27%) and iliosacral complex (n = 2, 9%) were identified in six different patients with (n = 2) and without (n = 4) sacroiliac osteochondromas.
Conclusion:
Cross-sectional imaging shows frequent (73%) SIJ involvement in osteochondromatosis, which, although a rare disorder, nevertheless needs to be considered in the differential diagnosis of such SIJ anatomical variants as the accessory SIJ and iliosacral complex. Differentiating these variants from osteochondromas is challenging in patients with osteochondromatosis.
... MRI may show different signal characteristics because the size of the lesion and the degree of cartilage calcification are related to signal intensity. 49,86 The cartilage cap exhibits different signals depending on the degree of calcification. If the cartilage cap is highly calcified, it will show a low signal on T1-and T2weighted imaging. ...
Objective
Spinal osteochondromas are rare, and approximately less than 5% occur as spinal lesions. We report the case of a solitary osteochondroma of the spine and review and update the literature on spinal osteochondroma, including surgical treatment and subsequent results.
Case Description
A 73-year-old female patient complained of a 10-year history of back pain and a 4-year history of right-side lower extremity radiating pain with paresthesia. Computed tomography and magnetic resonance imaging (MRI) revealed a bony mass arising from the inferior articular process (IAP) of L3, presenting with features of compressive spinal stenosis at the L3–L4 level. The treatment strategy included the complete marginal excision of the lesion through the posterior approach, as well as complete decompression of the spinal canal and nerve roots. The patient’s symptoms resolved after surgery, and histopathological examination identified the lesion as an osteochondroma.
Review Results
This review study included 168 solitary osteochondroma cases. The most commonly involved spinal level was cervical (51.8%), and the most frequent spinal anatomic column involved was the posterior column (70.8%). Radiculopathy accounted for 30.3% of all cases, myelopathy accounted for 31.0%, and 7.7% exhibited both symptoms simultaneously. The recurrence rate was 6.0%.
Conclusion
Computed tomography and MRI can effectively diagnose spinal osteochondroma, and surgical treatment can effectively improve clinical outcomes. In almost all symptomatic cases, the best treatment is marginal excision of the tumor. Complete resection of the cartilaginous cap of the tumor is especially important to prevent recurrence.
... Few cases have been reported in the literature, with variable manifestations [5][6]. It may compress the spinal nerve roots and produce neurological symptoms or may remain as an asymptomatic painless mass [2,[7][8][9]. However excessive growth of the mass on the posterior aspect may cause difficulty in sleeping and sitting [10]. We report a case of solitary sacral osteochondroma in a young female who could not lie down on her back due to the pressure of the mass and sought treatment to get relief from the mechanical pressure symptom. ...
... The symptoms may vary from a painless mass to a substantial neurological deficit. All cases except that of Baruah et al. presented with a neurological deficit or radiculopathy due to spinal nerve compression [2,4,[7][8][9][10]. The patient in our study did not have any neurological involvement and produced only pressure symptoms on the skin that caused difficulty in lying down. ...
... The patient in our study did not have any neurological involvement and produced only pressure symptoms on the skin that caused difficulty in lying down. After review of the literature, it seems that neurological involvement in sacral osteochondroma is common in the upper sacral region, with a predominant anterior growth that protrudes into the spinal canal or impinges on the nerve root [2,4,[7][8][9]. Lower sacral osteochondroma with posterior outgrowth usually has a mass effect, causing discomfort upon lying down and sitting [10]. Patients with sacral tumors from posterior elements without neurological compromise may present late as no serious consequence such as neurological deficit is seen. ...
Sacral osteochondromas are rare tumors, and a handful of cases have been reported in the literature. The clinical manifestations of sacral osteochondral may vary from a painless mass to a complete neurological deficit. We report a case of sacral osteochondroma arising from S2-3 lamina causing difficulty in lying down in the supine position and sitting. Computed tomographic (CT) scan and magnetic resonance imaging (MRI) delineated the extent of the lesion and confirmed it to be a benign tumor. It was excised en bloc through a posterior midline approach. At two years follow-up, the patient was asymptomatic and the radiograph did not show any evidence of recurrence. To the best of our knowledge, this is the second case report on sacral osteochondroma, which caused postural difficulty in a young female.
... 16) adding our new case (Patient 2), there are only 4 reported cases of symptomatic oCs originating from the sacrum (table 2). [16][17][18] Complete excision of the cartilaginous component is recommended to decrease the likelihood of local recurrence. 18) Malignant transformation to chondrosarcoma is also reported to be 10% to 30% in hMe as compared to 1% to 5% in solitary oC, so complete excision of such lesion is very important. ...
... 6) as the neuroradiological examination tools, plain X-rays are insufficient in some cases, because of overlapping of osseous structures of the spine. 16,17,19) the computed tomography (Ct) scan is necessary, allowing radiologic diagnosis by showing cortical and medullary continuity between the tumor and the vertebra. 17) at Ct, all of our 5 cases contained honeycomb appearance or low density area in the central portion of the tumor. ...
... 16,17,19) the computed tomography (Ct) scan is necessary, allowing radiologic diagnosis by showing cortical and medullary continuity between the tumor and the vertebra. 17) at Ct, all of our 5 cases contained honeycomb appearance or low density area in the central portion of the tumor. at Mr imaging, the lesion manifests with a high intensity in the central area corresponding to the central cancellous bone in t 2 -weighted image. ...
We describe 5 cases of osteochondroma (OC) originating from lumbosacral spine which caused radiculopathy. Four cases originated from the lumbar spine; all from L4 inferior articular process and presented L5 radiculopathy, the other one case originated from the sacrum; the case from S1 superior articular process presented L5 radiculopathy. In all cases, definitive diagnosis was made with histopathological findings; typical cartilaginous capping was confirmed. The functional recovery was completed in all 5 cases. As for imaging study, post myelography computed tomography revealed the most diagnostic tool for understanding the relationship between nerve tissue and the tumor. In all 5 patients, the tumors contained a high signal intensity on T2-weighted images in the cental medullary area. OCs are sometimes difficult to diagnose because they mimic other conditions like bony spur formation due to osteoarthritis, so we should never fail to confirm the histopathological diagnosis of such lesions when suspected.
... This defect is characterized by an osteocartilaginous growth that originates near the end of a long bone and grows away from the joint. 5 Histologically, these lesions have central lamellar bone and peripheral cartilage with evidence of enchondral ossification of the bone and cartilage. 6 The most common site of origin of spinal osteochondromas is the neural arch, and the transverse process is a rare site of origin. ...
The incidence of osteochondroma is rare and only 2% of such tumors are found in the spine area. When they are found in the vertebral column, less than 1% of all osteochondromas and few tumors occur in the thoracic vertebrae. An osteochondroma arising from the transverse process of the vertebra is even rarer, especially following from the thoracic transverse process. Here we report a giant solitary osteochondroma arising from the thoracic transverse process of T8 vertebra and involving the corresponding transverse process and rib.
A 28-year-old man presented with a progressive thoracic node, and neuroradiological evaluation of the spine showed a giant mass lesion involving the transverse process of T8 vertebra and concomitant corresponding facet joint and rib on the left side. At surgery, a firm and cartilaginous tumor originating from the transverse process was radically excised and surgical curettage of the lesion was performed.
It is concluded that accurate and prompt diagnosis requires a high index of suspicion followed by surgical treatment to prevent severe morbidity in cases of primary spinal column tumors. The histological examination of this patient revealed the lesion was osteochondroma.
The best choice of treatment for spinal osteochondromas is surgical excision or curettage and spinal stabilization, if necessary.
... This defect is characterized by an osteocartilaginous growth that originates near the end of a long bone and grows away from the joint. 5 Histologically, these lesions have central lamellar bone and peripheral cartilage with evidence of enchondral ossification of the bone and cartilage. 6 The most common site of origin of spinal osteochondromas is the neural arch, and the transverse process is a rare site of origin. ...
... Osteochondroma contains a dense osteoid formation in the cortex and medulla of the osteochondroma and is continuous with the bone from which it originates. 5 Osteochondromas are common in the adolescent skeleton, whereas periosteal chondromas occur in young adults. ...
... For symptomatic lesions, complete excision with free resection margins along with the intact rim of underlying bone is curative. 1,5 No malignant transformation, metastasis or multiple lesions have been reported. Recurrence is rare. ...
Periosteal chondroma is a slow-growing benign cartilaginous tumour of periosteal origin. It occurs mostly in the second and third decades of life and is found mostly in long, tubular bones.1–3 A few cases have been reported in the cervical spine.3 Clinical manifestation in the spine usually includes pain, swelling and sometimes a mass. The patient may also present with neurologic deficit due to the mass effect of the lesion on the cord or nerve roots. Radiologically, a mildly destructive tumour originating in the posterior neural arch of the spine and containing stippled calcification suggests the diagnosis of periosteal chondroma.3 Computed tomography shows a soft-tissue mass of iso or high density, containing stippled calcifications and local bone destruction.3 Magnetic resonance imaging shows a sharply delineated subperiosteal lobulated mass at the bone surface, consisting of a matrix with bright signal, with a hypointense lining on T2-weighted images and hypo-to isointense signal relative to muscle on T1-weighted images.4Grossly, the lesions are ovoid and dull white or blue-white in colour. A fibrous capsule always marks the boundary of the lesion. Histologically, immature cartilage cells predominate. There is increased cellularity, cellular pleomorphism and binucleate cells within the tumour, but no mitotic figures are found.1Chondrosarcoma is always a major differential diagnosis in cases of periosteal chondroma. However, differentiation between the 2 lesions can be quite difficult. Chondrosarcomas are larger in size, occur in older people and may have a soft-tissue extension. Isotopic bone scanning is usually more intense in the malignant tumour and can help in the preoperative differentiation between the 2 types of lesions.1 Periosteal chondrosarcoma tends to permeate the underlying bone without the formation of reactive bone. When it is difficult to reach a diagnosis, an excision biopsy should be performed.1In the present case, owing to the large size of the lesion, the possibility of chondrosarcoma could not be ruled out in spite of cytologic findings suggesting a benign tumour. Therefore, an excision biopsy was performed. Perioperative presence of a surrounding fibrous capsule and absence of soft-tissue extension favoured periosteal chondroma. Later, histopathologic findings confirmed that the lesion was periosteal chondroma.Periosteal chondroma also needs to be differentiated from osteochondroma. Osteochondroma contains a dense osteoid formation in the cortex and medulla of the osteochondroma and is continuous with the bone from which it originates.5 Osteochondromas are common in the adolescent skeleton, whereas periosteal chondromas occur in young adults.Other lesions that may be considered in the differential diagnosis are osteoblastomas and aneurysmal bone cysts. They are usually markedly expansile rather than destructive and possess characteristic outer sclerotic rims.The treatment for an asymptomatic and latent periosteal chondroma is observation. For symptomatic lesions, complete excision with free resection margins along with the intact rim of underlying bone is curative.1,5 No malignant transformation, metastasis or multiple lesions have been reported. Recurrence is rare. No recurrence was noted in our patient after a follow-up of 3 years.The present case posed quite a diagnostic challenge owing to its atypical location and large size. The aim of this report is to highlight that, in cases of suspected chondroid tumour, a differential diagnosis of periosteal chondroma should also be considered.
Osteochondroma is one of the most common benign bone tumors, mainly involving the bone ends of long bones, and involving the spine is rare. It often involves the competing, followed by the thoracic and lumbar spine, and rarely involves the sacrum. We report the imaging findings of a solitary osteochondroma of the sacrum. The patient was a 37-year-old woman who presented clinically with progressive low back pain associated with left buttock pain and discomfort. CT and MRI showed that the lesion originated from the left lamina of S1 and grew anteriorly and superiorly, resulting in compressive resorption of the L5 vertebral bone, left foraminal stenosis and adjacent nerve root swelling. The patient underwent surgery and the mass was completely excised and recovered well postoperatively. Osteochondroma arising from the sacrum is rare and can lead to compressive resorption of adjacent bone, and imaging techniques are conducive to the localization and characterization of the lesion and provide useful information for clinical treatment.
Periosteal chondromas are uncommon benign cartilaginous neoplasms which account for 5 cm in greatest diameter with an average size of 3 cm, with proximal humerus being a characteristic location. Large periosteal chondromas are very rare. Clinically, they present as palpable often painful masses. Radiographically, they appear as radiolucent bone surface tumours that form sharply marginated erosions (“saucerisation”) of the cortex and are well demarcated from the underlying medullary cavity by a thin rim of sclerosis. Histologically, these tumours are well circumscribed, and are characterised by lobules of cartilage with benign clusters of chondrocytes that do not have a permeative growth pattern. Occasionally, these tumours can be more cellular showing nuclear pleomorphism and binucleation, which can be misdiagnosed as chondrosarcoma. Periosteal chondromas are treated with en-bloc excisions. This case report describes a case of giant periosteal chondroma of proximal humerus.
Primary benign bone tumors of the sacrum are extremely rare, and cartilaginous lesions have been reported only as case reports or small series. The histotypes affecting the sacrum and reported in literature were osteochondroma, chondroblastoma, chondromyxoid fibroma, and periosteal chondroma. Since clinical, imaging, and histologic characteristics vary immensely, as well as type of treatment, each of these lesions will be discussed in separate paragraphs.
