Osteocondroma: ignorar ou investigar?

Successful complete thoracoscopic resection of costal osteochondroma: A case report

Osteochondroma rarely occurs in the ribs; therefore, the treatment is not standardized. There are few studies of resection via complete thoracoscopic surgery (CTS), although video-assisted thoracoscopic surgery with mini-thoracotomy has been reported. Herein, we report a case of costal osteochondroma managed with CTS. A 23-year-old woman presented to our hospital due to left chest pain. Chest computed tomography revealed a bone-like structure protruding into the thoracic cavity from the left fourth rib. Thus, surgery was performed to obtain a definitive diagnosis and provide appropriate treatment. The tumor was resected from the base at the border of the normal bone via CTS using three 5.5-mm ports. A pathological diagnosis of costal osteochondroma was made. The patient had an uneventful clinical course and did not present with a recurrence 1 year after surgery. Therefore, CTS can be a good approach for cases with slim and stalked costal osteochondroma.

Tibial osteochondroma with thick cartilage which mimicked a chondrosarcoma: A case report

We report a case of tibial osteochondroma in a 25-year-old female who presented with a palpable calf mass. This mass was associated with a thick cartilaginous cap on cross-sectional imaging, suggesting chondrosarcoma. A CT-guided biopsy was performed, and histology, however, was consistent with osteochondroma. Orthopedic oncology recommended surgical excision due to the potential high sampling error with chondroid lesions. The patient underwent surgical resection, resulting in a final diagnosis of osteochondroma. No post-surgical complications occurred, and a 12-month follow-up showed no evidence of local recurrence. This case highlights the atypical imaging feature of a thick cartilaginous cap in a benign etiology without malignant transformation.

Rare retro-patellar multiple osteochondromas in patellar tendon: A case report

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 presented with swelling and a mass in his left knee, which raised suspicion of bone tumors. After evaluating x-ray images and conducting histopathological examinations, the diagnosis was confirmed as retro-patellar OC.

Misdiagnosis of Extraskeletal Osteochondroma in the Foot: A Report of 3 Cases

CASES

Two women presented with newly growing callosities beneath the first and second metatarsal heads, initially believed to reflect gastrocnemius tightness and plantar plate pathology. In another man, swelling at the posterolateral aspect of the heel was mistaken for a Haglund deformity. Subsequent imaging of each patient led to delayed diagnosis of extraskeletal osteochondroma (ESO). Surgical excision resolved symptoms in all 3 with no recurrence over 12 months later.

CONCLUSIONS

Whenever bony prominences newly develop in soft tissues of the foot, ESO should be suspected and appropriate imaging obtained. We describe physical features to help differentiate ESO from other common causes of foot overload.

Sino-orbital osteochondroma with malignant transformation to osteosarcoma

Purpose

Osteosarcoma is an aggressive malignant osteogenic tumor that commonly arises in long bones of pediatric populations. Primary osteosarcomas of the head and neck are rare, comprising less than 0.5% of malignancies in this region, usually affecting the mandible or maxilla. Here we present an extraordinary case of a rare benign osteochondroma of the ethmoid sinus and bilateral orbits evolving to an intermediate grade osteosarcoma.

Observations

An 80-year-old woman with a history of right orbital tumor resection 20 years ago presented to our clinic with right eye proptosis and palpable bony prominence of the right orbit and nasal bridge. Partial resection demonstrated sino-orbital osteochondroma. Relapse a year later prompted repeat partial resection with unchanged histology. The patient was followed clinically until an abrupt relapse four years after initial presentation. Imaging demonstrated a large bony mass involving the right orbit, ethmoid and frontal sinuses, and anterior cranial fossa. Repeat debulking confirmed transformation to intermediate grade osteosarcoma.

Conclusions

Osteochondroma is an extremely rare tumor in the orbit with only three cases previously reported. This patient is the first known case of benign osteochondroma of the orbit undergoing malignant transformation to osteosarcoma. Rapid progression of orbital osteochondroma should raise the suspicion of malignant transformation to osteosarcoma and prompt biopsy. Our patient subsequently underwent palliative radiation treatment and is stable with no gross progression.

Osteochondroma Pathogenesis: Mouse Models and Mechanistic Insights into Interactions with Retinoid Signaling

Osteochondromas are cartilage-capped tumors that arise near growing physes and are the most common benign bone tumor in children. Osteochondromas can lead to skeletal deformity, pain, loss of motion, and neurovascular compression. Currently, surgery is the only available treatment for symptomatic osteochondromas. Osteochondroma mouse models have been developed to understand the pathology and the origin of osteochondromas and develop therapeutic drugs. Several cartilage regulatory pathways have been implicated in the development of osteochondromas, such as bone morphogenetic protein, hedgehog, and WNT/β-catenin signaling. Retinoic acid receptor-γ is an important regulator of endochondral bone formation. Selective agonists for retinoic acid receptor-γ, such as palovarotene, have been investigated as drugs for inhibition of ectopic endochondral ossification, including osteochondromas. This review discusses the signaling pathways involved in osteochondroma pathogenesis and their possible interactions with the retinoid pathway.

Rapidly acquired valgus deformity of the knee after osteochondroma resection in multiple hereditary exostoses pediatric patients: A report of two cases

Patients with multiple hereditary exostoses (MHE) often develop leg length discrepancies and limb alignment deformity around the knee as part of the natural course of the disease. Limb alignment deformity occurring post-resection of an osteochondroma has been described in one case report and only pertaining to the proximal medial tibia location. Here we describe the case of 2 patients with MHE, a 7-year-old female who underwent resection of distal femur and proximal tibia osteochondromas and a 9-year-old female who had a distal femur osteochondroma resected. Both patients developed rapidly progressive valgus knee deformity requiring surgical intervention. Excision of osteochondromas near the physis of a skeletally immature patient can cause overgrowth from the involved side of the growth plate resulting in a rapidly progressing unilateral coronal plane deformity. Surgeons should be aware of this potential complication and closely follow growing patients with serial alignment radiographs and counsel the family regarding the potential of acquired limb deformity and subsequent surgeries.

Bilateral Proximal Tibiofibular Synostosis Caused by Osteochondroma in a 21-Year-Old Highly Active Male-First in Literature

Background and Objectives: Up until now, only one case of unilateral proximal tibiofibular synostosis caused by osteochondroma has been reported. This report is the first well-documented bilateral case of proximal tibiofibular synostosis caused by an osteochondroma. Case Report: A 21-year-old, highly active male patient with bilateral proximal tibiofibular synostosis caused by an osteochondroma suffering from persistent knee pain is presented. As conservative methods had failed, the patient was treated by bilateral open resection of the connecting bone. Histopathological findings confirmed the preoperative diagnosis. The patient returned to sports three weeks after surgery and continued soccer training six weeks after surgery. Discussion: The case report presents the successful treatment of a bilateral proximal tibiofibular synostosis caused by an osteochondroma by bilateral open resection of the connecting bone.

The FBXW7-NOTCH interactome: A ubiquitin proteasomal system-induced crosstalk modulating oncogenic transformation in human tissues

BACKGROUND

Ubiquitin ligases or E3 ligases are well programmed to regulate molecular interactions that operate at a post-translational level. Skp, Cullin, F-box containing complex (or SCF complex) is a multidomain E3 ligase known to mediate the degradation of a wide range of proteins through the proteasomal pathway. The three-dimensional domain architecture of SCF family proteins suggests that it operates through a novel and adaptable "super-enzymatic" process that might respond to targeted therapeutic modalities in cancer.

RECENT FINDINGS

Several F-box containing proteins have been characterized either as tumor suppressors (FBXW8, FBXL3, FBXW8, FBXL3, FBXO1, FBXO4, and FBXO18) or as oncogenes (FBXO5, FBXO9, and SKP2). Besides, F-box members like βTrcP1 and βTrcP2, the ones with context-dependent functionality, have also been studied and reported. FBXW7 is a well-studied F-box protein and is a tumor suppressor. FBXW7 regulates the activity of a range of substrates, such as c-Myc, cyclin E, mTOR, c-Jun, NOTCH, myeloid cell leukemia sequence-1 (MCL1), AURKA, NOTCH through the well-known ubiquitin-proteasome system (UPS)-mediated degradation pathway. NOTCH signaling is a primitive pathway that plays a crucial role in maintaining normal tissue homeostasis. FBXW7 regulates NOTCH protein activity by controlling its half-life, thereby maintaining optimum protein levels in tissue. However, aberrations in the FBXW7 or NOTCH expression levels can lead to poor prognosis and detrimental outcomes in patients. Therefore, the FBXW7-NOTCH axis has been a subject of intense study and research over the years, especially around the interactome's role in driving cancer development and progression. Several studies have reported the effect of FBXW7 and NOTCH mutations on normal tissue behavior. The current review attempts to critically analyze these mutations prognostic value in a wide range of tumors. Furthermore, the review summarizes the recent findings pertaining to the FBXW7 and NOTCH interactome and its involvement in phosphorylation-related events, cell cycle, proliferation, apoptosis, and metastasis.

CONCLUSION

The review concludes by positioning FBXW7 as an effective diagnostic marker in tumors and by listing out recent advancements made in cancer therapeutics in identifying protocols targeting the FBXW7-NOTCH aberrations in tumors.

Peroneal Nerve Palsy due to Bulky Osteochondroma from the Fibular Head: A Rare Case and Literature Review

Common peroneal neuropathy is the most common compressive neuropathy in the lower extremities. The anatomical relationship of the fibular head with the peroneal nerve explains entrapment in this location. We report the case of a 14-year-old boy admitted with a left foot drop. The diagnosis was an osteochondroma of the proximal fibula compressing the common peroneal nerve. The patient underwent surgical decompression of the nerve and resection of the exostosis. Three months postoperatively, there was a complete recovery of the deficits. The association of osteochondroma and peroneal nerve palsy is rare. Early diagnosis is required in order to adjust the management and improve the results. It is worth to underscore that surgical resection is proven to be the appropriate treatment method ensuring high success rates.

Osteochondroma of the temporal styloid process: a common disease in a rare but vulnerable location

Osteochondromas, the most common benign bone tumor, are typically asymptomatic and discovered incidentally by imaging. Most frequently, osteochondromas occur at the metaphyses of long bones, and rarely involve the head and neck. We report the first case of a symptomatic osteochondroma of the temporal styloid process causing facial nerve paralysis.

Surgical Treatment on Subungual Osteochondromas in Paediatric Feet: A Case Series Study

Subungual osteochondroma (SO) is an infrequent and non-malignant bone tumour of the distal phalanx, especially prominent in paediatric populations. The aim of this research was to describe a case series of paediatric feet with SO which received surgical treatments. The secondary purpose was to compare these descriptive data by sex distribution. Methods: Twenty-three paediatric feet with SO confirmed by clinical or radiological features received surgical treatment. Socio-demographic (age, sex, height, weight and BMI) and clinical features (side, location, tumour or pain presence, and nail lift before surgery, as well as recurrence and adverse effects at one month after intervention) were reported. Results: Regarding clinical features before intervention, the most frequent locations of SO were the first toe (86.8%) and the right lower limb (56.5%). In addition, the presence of the tumour, pain and nail lift showed a prevalence of 91.3%, 69.5% and 47% of the study sample, respectively. Considering clinical features at one month after intervention, the most frequent adverse effect was the pain presence (69.5%). In addition, one case (4.4%) presented ulceration. Only one patient (4.4%) suffered from recurrence with a new tumour. There were not statistically significant differences by sex distribution (p > 0.05). Conclusions: This novel study showed that surgery treatment for SO in paediatric populations presented a very low recurrence degree with minor adverse effects and without differences by sex distribution. Thus, further randomized clinical trials should be carried out in order to determine the effectiveness of this intervention in this special population.

Understanding the Action of RARγ Agonists on Human Osteochondroma Explants

Osteochondromas are cartilage-capped growths located proximate to the physis that can cause skeletal deformities, pain, limited motion, and neurovascular impingement. Previous studies have demonstrated retinoic acid receptor gamma (RARγ) agonists to inhibit ectopic endochondral ossification, therefore we hypothesize that RARγ agonists can target on established osteochondromas. The purpose of this study was to examine the action of RARγ agonist in human osteochondromas. Osteochondroma specimens were obtained during surgery, subjected to explant culture and were treated with RARγ agonists or vehicles. Gene expression analysis confirmed the up-regulation of RARγ target genes in the explants treated with NRX 204647 and Palovarotene and revealed strong inhibition of cartilage matrix and increased extracellular matrix proteases gene expression. In addition, immunohistochemical staining for the neoepitope of protease-cleaved aggrecan indicated that RARγ agonist treatment stimulated cartilage matrix degradation. Interestingly, cell survival studies demonstrated that RARγ agonist treatment stimulated cell death. Moreover, RNA sequencing analysis indicates changes in multiple molecular pathways due to RARγ agonists treatment, showing similarly to human growth plate chondrocytes. Together, these findings suggest that RARγ agonist may exert anti-tumor function on osteochondromas by inhibiting matrix synthesis, promoting cartilage matrix degradation and stimulating cell death.

Multiple osteochondromas of the cervical spine, a potential cause of radiculopathy in the elderly: A case report and review of literature

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Osteochondroma is the most common type of bone tumor.

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It rarely arises on the cervical spine.

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It rarely occurs in the elderly.

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Although rare, it may be considered as a differential diagnosis of radiculopathy among the elderly.

Introduction

Osteochondroma is the most prevalent type of bone tumour, often arising in the long bones. Most are found in the third decade of life, and rarely in the axial skeleton of elderly patients. This case report aims to highlight the possibility of this differential diagnosis in an elderly patient with symptoms of radiculopathy, aside from degenerative cause.

Presentation of case

A 76-years-old woman presented to the authors’ hospital with complaints of pain and numbness of the left suboccipital and preauricular region. There was hypoesthesia of left C2 and C3 dermatome without any signs of myelopathy. CT-scan and MRI showed an expansile bone lesion from the posterior arch of C1 and lamina of C2. The patient underwent laminectomy of C1 and hemilaminectomy of C2. Postoperative histopathologic examination showed the features of osteochondroma. Radiologic follow-up after nine months showed no sign of recurrence. After eighteen months, the patient was ambulatory with complaints of fingers numbness and moderate neck pain.

Discussion

Osteochondroma usually arises in long bone metaphysis. This lesion normally ceases to grow with growth plate closure, but other findings suggest it may continue to grow beyond skeletal maturity. About 29.5% of all osteochondroma of the spine would cause radiculopathy, and 27% would cause myelopathy. The cervical spine osteochondroma is usually treated by en bloc resection through posterior approach.

Conclusion

Osteochondroma of the cervical spine in the elderly is rare. However, this diagnosis could be considered as a possible cause of radiculopathy in this age group aside from other degenerative causes.

Rib Exostoses Presenting as Mediastinal Masses: A Rare Presentation and Minireview of the Literature

Costal osteocartilaginous exostoses, also known as osteochondromas, are the most common neoplasms of the long bones but are rare tumors of the ribs. Osteochondroma is often asymptomatic and incidentally observed. Tumors typically begin to grow before puberty and continue until bone maturation is reached. Our paper presents the case of a 16-year-old young male who was admitted to the hospital with nonspecific symptoms and having a family history of exostosis. Chest X-ray and computed tomography imaging revealed multiple costosternal exostoses, manifested as mediastinal masses, with protrusion into the thoracic cavity, exerting compressive effects on the ascending aorta and pulmonary parenchyma. Surgery is required in childhood if lesions are painful. But if tumor formation occurs in adulthood, such pathological bony outgrowths should always be resected for avoiding further complications. In this patient, surgical intervention removed the tumoral masses and improved the symptoms. Subsequently, histological exam confirmed the diagnosis of osteocartilaginous exostoses and showed the lack of dysplastic changes.

Osteochondroma of acromioclavicular joint

Osteochondroma is the most common type of benign bone tumour. It is a benign chondrogenic lesion derived from aberrant cartilage from the perichondral ring, and it commonly presents in the proximal humerus, proximal femur and knee. Osteochondroma is usually solitary but can be multiple with patients with hereditary multiple exostoses. Malignant changes happen in approximately 1% of cases. Osteochondroma usually causes local pain or swelling. We discuss a unique case of an osteochondroma that highlights the fact that osteochondroma can occur in the most unlikely places, and they should be properly visualised via radiography to evaluate any extensions and compromised surrounding structures before surgical intervention.

Surgical treatment of rare case of scapula osteochondroma in a resource limited setting: A case report

INTRODUCTION

Osteochondroma also known as exostosis is one of the most common benign bone tumours, and are characterized by bone protuberances surrounded by a cartilage layer. They generally affect the extremities of the long bones in an immature skeleton and deform them. They are easily diagnosed at the level of the appendicular skeleton. However, atypical localization and malignancy are sometimes challenging to diagnose on clinical evaluation and plain radiography. Therefore, more refine diagnostic tools may be required. Scapula localization of solitary exostosis is relatively rare.

CASE PRESENTATION

We report the case of a 17 years old male patient reporting worsening shoulder pain since 3 years with right scapula winging. Computer tomography (CT) scan revealed an osteochondroma on the ventro-medial surface of the right scapula extending into the scapulo-thoracic space. Surgical excision was done and histopathological study confirmed osteochondroma of the scapula. We noted excellent post-operative pain alleviation after two weeks, full range of motion and a better self-esteem.

DISCUSSION

The scapula is involved in 3.0-6.4% of all cases. Osteochondroma usually arises on the anterior surface of the scapula. Surgical excision is an excellent treatment option for symptomatic patients with scapula osteochondroma. In our case presentation we used a muscle sparing technique. No muscle detachment will ensure rapid and better postoperative recovery. Surgical removal is useful in eliminating painful symptoms and avoids possible malignant transformation.

CONCLUSION

Good clinical outcome is expected with surgical excision of symptomatic scapula osteochondromas especially using muscle-sparing technique which offers a quick functional rehabilitation of patients.

Distal Fibular Osteochondroma Resulting in Tarsal Tunnel Syndrome: Case Report and Literature Review

BACKGROUND

Osteochondromas are benign osseous tumors encountered most routinely by physicians responsible for diagnosing musculoskeletal disorders. Often, these osseous lesions are identified following symptoms related to their impingement on adjacent soft tissue or bone.

METHODS

This article presents a unique case of an asymptomatic osteochondroma of the distal fibula in a 29-year-old Caucasian woman that manifested clinically as an impingement on the tibial nerve.

RESULTS

After resection of the osteochondroma, the patient's tarsal tunnel syndrome symptoms resolved.

CONCLUSIONS

This case report demonstrates a never-before-described osteochondroma of the distal fibula traversing posterior to the ankle joint and impinging on the tibial nerve. After resection, the patient's symptoms resolved.

Knee locked in flexion: incarcerated semitendinosus tendon around a proximal tibial osteochondroma

This case reports on a knee locked in flexion due to incarceration of the semitendinosus tendon around an osteochondroma in a patient with a history of multiple hereditary exostoses (MHE). An 18-year-old female with history of MHE presented with acute right medial knee pain and inability to extend her knee. Radiographs confirmed multiple lower extremity osteochondromas, notably a large, 3-cm pedunculated osteochondroma about her right medial proximal tibia. This was assessed as a locked knee secondary to incarcerated hamstring tendons around an osteochondroma. Excision of the osteochondroma restored normal flexion and extension of her knee. At the 3-month follow-up visit, she had returned to all activities with no recurrent medial knee pain or locking. The differential diagnosis for a locked knee joint can be broad, but tendon incarceration should be considered in appropriate patients with significant symptoms. In patients with a history of MHE, osteochondromas may be the cause of tendon entrapment.

Characteristics of Benign and Malignant Bone Tumors Registered in the Hiroshima Tumor Tissue Registry, 1973-2012

BACKGROUND

Reported information on the characteristics of benign bone tumors is disjointed, and the long-term trends in the occurrence of malignant bone tumors by histological type have not been reported in Japan. Our aim was to describe the characteristics of both benign and malignant bone tumors as described in cases registered in the Hiroshima Tumor Tissue Registry from 1973 to 2012.

METHODS

Cases were identified with the International Classification of Diseases for Oncology (ICD-O-3) topography code C40-C41 (bones, joints, and articular cartilage), and histological types were classified according to the World Health Organization 2013 system. We described the distribution of the cases by behavior, sex, skeletal site of tumor occurrence, histological type, period at diagnosis (in 10-year groups), and age at diagnosis (in 10-year groups).

RESULTS

We observed 2,542 benign bone tumors, 272 intermediate bone tumors, and 506 malignant bone tumors. We confirmed that 81.6% of benign bone tumors were chondrogenic, consisting primarily of osteochondromas and enchondromas. Giant cell tumor of bone was the most dominant type of intermediate tumor, whereas osteogenic tumors and chondrogenic tumors were the most dominant types of malignant tumors. Among malignant bone tumors, 41.7% of tumors occurred in the long bones of the lower limb, and there were different peaks of age at the time of diagnosis for osteogenic tumors and chondrogenic tumors. A similar distribution of histological types was seen throughout the 40-year observation period.

CONCLUSIONS

Osteochondroma and enchondroma differed in terms of the age of the patient at the time of diagnosis and the skeletal sites where the tumors most frequently occurred. Giant cell tumor had a large impact on occurrence as a common type of intermediate bone tumor.

CLINICAL RELEVANCE

The results of the present study, based on pathological tissue registry data, provide knowledge about the epidemiological and pathological features of bone tumors in Japan.

Differential diagnosis of a neoplastic condition in a prehistoric juvenile individual from La Falda site, Northwest Argentina

Bone neoplasms or tumors are of great interest for paleopathological studies due to their close relationship with health and survivorship as well as for their epidemiologic and demographic relevance. However, the identification of these lesions in archaeological specimens is very uncommon. The aim of this paper is to report the case of skeleton R5 E#1 from the prehistoric cemetery La Falda, in the Northwest region of Argentina. During the osteopathological analysis of the skeletal series, proliferative lesions in several bones of the skeleton of a 7-10-year-old juvenile were observed (i.e., both scapulae; left clavicle, humerus, and ulna, both os coxae, femora, and fibulae, and right foot bones). Age-at-death estimation, location and distribution pattern, and morphological appearances of the lesions indicated that this juvenile suffered from a neoplastic condition. A comprehensive differential diagnosis was carried out, suggesting that these lesions were compatible with hereditary multiple osteochondromas. However, Ewing's sarcoma was not definitively ruled out as a probable diagnosis. Thus, this work adds new evidence to the existence of neoplastic conditions in the prehistoric populations of the Americas, and it contributes original data to perform a differential diagnosis for multiple proliferative lesions.

Osteochondroma of the Hyoid: First Pediatric Case and Literature Review

Osteochondromas, the most common benign bone tumors, are cartilaginous neoplasms of unknown origin with rare malignant potential. Osteochondromas rarely occur in the head and neck, and diagnosis relies on a combination of clinical, radiological, and histological criteria. Excision is often curative. We describe the first reported case of hyoid osteochondroma in an adolescent male with multiple osteochondroma, discuss its surgical management, and perform a review of the salient literature. Osteochondroma represents a rare diagnosis to include in the differential of any midline neck mass.

Multifocal bone and bone marrow lesions in children - MRI findings

Polyostotic bone and bone marrow lesions in children may be due to various disorders. Radiographically, lytic lesions may become apparent after loss of more than 50% of the bone mineral content. Scintigraphy requires osteoblastic activity and is not specific. MRI may significantly contribute to the correct diagnosis and management. Accurate interpretation of MRI examinations requires understanding of the normal conversion pattern of bone marrow in childhood and of the appearances of red marrow rests and hyperplasia. Differential diagnosis is wide: Malignancies include metastases, multifocal primary sarcomas and hematological diseases. Benign entities include benign tumors and tumor-like lesions, histiocytosis, infectious and inflammatory diseases, multiple stress fractures/reactions and bone infarcts/ischemia.