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Nakamura H, Kudo T, Kobayashi H, Taguchi Y, Takagi M. Extraskeltal Outgrowth of Solitary Synovial Osteochondroma of the Cervical Spine: A Case Report. NMC Case Rep J 2020; 7:89-92. [PMID: 32695554 PMCID: PMC7363636 DOI: 10.2176/nmccrj.cr.2019-0126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 11/12/2019] [Indexed: 11/20/2022] Open
Abstract
We report a rare case of a solitary synovial osteochondroma (SSO) in the cervical canal. A 37-year-old man presented with neck pain and the forearm dysesthesia developed immediately after a trivial motor accident. Because of aggravation he visited our hospital though he was treated conservatively for 3 months. A computed tomography (CT) scan showed an oval shaped small mass with high density rim in the cervical canal at the level of the C6/7 facet joint. This mass compressing the dural sac was visualized with a high intensity signal in T2-weighted magnetic resonance imaging (MRI) and, interestingly, with high intensity in T1-weighted images. A surgical removal was carried out. Macroscopically, it consists of a solitary, firm, juxta-articular mass associated with synobia but lacking connection with the adjacent bone. Microscopically, it is similar to conventional osteochondromas. It differs from this entity by not arising from a bone surface and by a whole coverage of synobial tissue. The final diagnosis was a SSO. There have been anecdotal case reports of a SSO in various site including knee, fingers, buttocks, wrist, and so on. To the best of our knowledge, this is the first case report of SSO arising in the spinal canal.
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Affiliation(s)
- Homare Nakamura
- Department of Neurosurgery, St. Marianna University School of Medicine Yokohama City Seibu Hospital, Yokohama, Kanagawa, Japan.,Department of Neurosurgery, Ishioka Cardiology and Neurosurgery Hospital, Omitama, Ibaraki, Japan
| | - Tadashi Kudo
- Department of Neurosurgery, Ishioka Cardiology and Neurosurgery Hospital, Omitama, Ibaraki, Japan
| | - Hiroo Kobayashi
- Department of Neurosurgery, Ishioka Cardiology and Neurosurgery Hospital, Omitama, Ibaraki, Japan
| | - Yoshio Taguchi
- Department of Neurosurgery, St. Marianna University School of Medicine Yokohama City Seibu Hospital, Yokohama, Kanagawa, Japan
| | - Masayuki Takagi
- Department of Pathology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
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Hunter AM, Farnell C, Doyle JS. Extraskeletal Osteochondroma of the Great Toe in a Teenager. J Foot Ankle Surg 2019; 58:807-810. [PMID: 31079982 DOI: 10.1053/j.jfas.2018.11.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Indexed: 02/03/2023]
Abstract
Osteochondromas are common, benign surface tumors of bone, composed of the cartilage-capped bone confluent with the medullary canal of the metaphyseal bone. Extraskeletal osteochondromas have the same gross appearance and histologic characteristics as a typical osteochondroma but do not have any boney attachment to the surrounding osseous structures. They are rare and most frequently reported in the middle-age and older adults. We present the first case of an extraskeletal osteochondroma of the foot reported in a teenager. Our patient was a 17-year-old male complaining of a slow-growing mass along the medial border of the great toe that he first noted at the age of 14 years. The increasing size of the mass and frequency of complaints with shoe wear prompted medical attention. Imaging studies showed an ossified 1-cm boney mass with trabecular detail, located on the medial aspect of the great toe at the level of the interphalangeal joint, without any connection to the surrounding structures. An excisional biopsy revealed a well-circumscribed, easily removable mass, which proved to be an extraskeletal osteochondroma both clinically and histologically.
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Affiliation(s)
- Allison M Hunter
- Resident Physician, Department of Orthopedic Surgery, University of Alabama, Birmingham, AL.
| | - Chason Farnell
- Medical Student, School of Medicine, University of Alabama, Birmingham, AL
| | - J Scott Doyle
- Associate Professor, Department of Pediatric Orthopedic Surgery, Children's of Alabama, Birmingham, AL
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Schwaiger K, Ensat F, Neureiter D, Wechselberger G, Hladik M. Trigger Finger Caused by Extraskeletal Chondroma. J Hand Surg Am 2017; 42:e51-e55. [PMID: 27817941 DOI: 10.1016/j.jhsa.2016.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 09/08/2016] [Accepted: 10/03/2016] [Indexed: 02/02/2023]
Abstract
Chondroma is a relatively rare, but well-reported benign neoplasm. This lesion normally occurs attached to bone; however, they may be rarely found without association to bone and embedded in soft tissue. The authors describe the case of a 76-year-old man in whom flexor tendon triggering was associated with an extraskeletal chondroma between the annular ligament and the flexor tendon.
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Affiliation(s)
- Karl Schwaiger
- Department of Plastic, Aesthetic and Reconstructive Surgery, Hospital of St. John of God (Barmherzige Brüder) Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria.
| | - Florian Ensat
- Department of Plastic, Aesthetic and Reconstructive Surgery, Hospital of St. John of God (Barmherzige Brüder) Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Daniel Neureiter
- Department of Pathology, Paracelsus Medical University, Salzburger Landeskliniken, Salzburg, Austria
| | - Gottfried Wechselberger
- Department of Plastic, Aesthetic and Reconstructive Surgery, Hospital of St. John of God (Barmherzige Brüder) Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Michaela Hladik
- Department of Plastic, Aesthetic and Reconstructive Surgery, Hospital of St. John of God (Barmherzige Brüder) Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
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Sumida K, Kobayashi N, Nambu A, Tago M, Shibuya I, Kawamoto M. Solitary synovial chondromatosis arising in the gluteus maximus bursa: computed tomography and magnetic resonance imaging findings. Acta Radiol Open 2016; 5:2058460115617352. [PMID: 26998347 PMCID: PMC4780096 DOI: 10.1177/2058460115617352] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 10/22/2015] [Indexed: 11/20/2022] Open
Abstract
Chondral tumors in soft tissue are referred to as soft-tissue chondromas or extraskeletal chondromas, or as synovial chondromatosis if they arise in synovial tissue. We report the case of a 29-year-old man with synovial chondromatosis, also called synovial osteochondromatosis, which appeared in a solitary and extra-articular form. On magnetic resonance imaging (MRI) and computed tomography, the central portion of the tumor showed similar characteristics to bone marrow, despite the absence of any connection to adjacent bone. T2-weighted imaging displayed marked peripheral hyperintensity consistent with a cartilaginous area. These findings suggested the presence of enchondral ossification and were similar to those of skeletal osteochondroma, with the exception of the absence of attachment to bone. MRI is useful for distinguishing solitary synovial chondromatosis from other lesions, such as myositis ossificans, extraskeletal chondrosarcoma, and parosteal osteosarcoma.
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Affiliation(s)
- Kaoru Sumida
- Department of Radiology, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan; Department of Radiology, National Center Hospital of Neurology and Psychiatry, Tokyo, Japan
| | - Noriko Kobayashi
- Department of Radiology, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan
| | - Atsushi Nambu
- Department of Radiology, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan
| | - Masao Tago
- Department of Radiology, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan
| | - Isao Shibuya
- Department of Orthopedics, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan
| | - Masashi Kawamoto
- Department of Diagnostic Pathology, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan
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Ikeda K, Osamura N, Kasashima S. A large extraskeletal chondroma in the hand of an elderly patient--a case report. HAND SURGERY : AN INTERNATIONAL JOURNAL DEVOTED TO HAND AND UPPER LIMB SURGERY AND RELATED RESEARCH : JOURNAL OF THE ASIA-PACIFIC FEDERATION OF SOCIETIES FOR SURGERY OF THE HAND 2013; 18:111-4. [PMID: 23413864 DOI: 10.1142/s0218810413720088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This paper examines a case of extraskeletal chondroma in the hand of an 82-year-old female, first noticed about two years ago. Magnetic resonance imaging showed a mass in the carpal tunnel which extended from the wrist to the palm. The tumor was located between the thenar area and the hypothenar area at the palm level. There was no continuity to the carpal bone or radius bone. The entire size of the tumor was 120 mm × 45 mm × 42 mm. Although extraskeletal chondroma is sometimes seen, a large one in the hand is extremely rare. Since the tumor was too large to excise totally because median nerve entrapped it, it was divided into two parts and excised. After the operation, there was no neurological deficit or pain in the median nerve lesion.
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Affiliation(s)
- Kazuo Ikeda
- Department of Orthopaedic Surgery, Kanazawa Medical Center, Kanazawa 920-8650, Japan.
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Abstract
Extraskeletal osteochondroma near the hip is rare and its pathological diagnosis is based on radiological and histopathological examination. It is vital that such a diagnosis be considered when a discrete, ossified mass is localized in soft tissues, even at atypical sites. Differential diagnoses include myositis ossificans, a lipomatous lesion, a pseudomalignant osseous tumour, an ossifying fibromyxoid tumour, an extraskeletal chondroma with endochondral ossification, synovial (osteo) chondromatosis, tumoural calcinosis, a synovial sarcoma and an extraskeletal osteosarcoma. Clinical awareness of this benign entity is important as no malignant transformation or metastasis has been reported. Marginal excision with histopathological identification is the treatment of choice.
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Singh R, Jain M, Siwach R, Sen R, Rohilla RK, Kaur K. Soft-tissue osteochondroma of the heel pad: a case report and review of literature. Foot Ankle Surg 2010; 16:e76-8. [PMID: 20655006 DOI: 10.1016/j.fas.2010.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2009] [Accepted: 05/04/2010] [Indexed: 02/04/2023]
Abstract
Extraskeletal osteochondroma of the foot are rare benign cartilaginous tumours. We present a case of soft-tissue osteochondroma in the heel pad superficial to the postero-inferior aspect of the calcaneus. We propose the pathogenesis of this lesion might be related to metaplasia in the plantar aponeurosis as described in literature, or it may be a fracture of the calcaneal osteochondroma, growing and presenting as soft-tissue lesion in the heel pad.
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Affiliation(s)
- Roop Singh
- Department of Orthopaedic Surgery, Paraplegia & Rehabilitation, PtBD Sharma PGIMS, Rohtak 124001, Haryana, India.
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Veras E, Abadeer R, Khurana H, Tan D, Ayala A. Solitary synovial osteochondroma. Ann Diagn Pathol 2010; 14:94-9. [PMID: 20227014 DOI: 10.1016/j.anndiagpath.2009.10.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2009] [Revised: 10/23/2009] [Accepted: 10/30/2009] [Indexed: 11/16/2022]
Affiliation(s)
- Emanuela Veras
- Department of Pathology, Memorial-Sloan Kettering Cancer Center, New York, NY 10065, USA.
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Spencer RJ, Blitz NM. Giant extraskeletal osteochondroma of the plantar midfoot arch. J Foot Ankle Surg 2008; 47:362-7. [PMID: 18590903 DOI: 10.1053/j.jfas.2008.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2007] [Indexed: 02/03/2023]
Abstract
Osteochondromas found within the soft tissue without osseous or intra-articular involvement are better described as extraskeletal osteochondromas. They are slow-growing, benign, osseous tumors, and are often misdiagnosed as conventional osteochondromas. Though extraskeletal osteochondromas are rare, they typically affect the digits of the hands or feet. We present a patient with a giant symptomatic extraskeletal osteochondroma that developed in the plantar medial longitudinal arch of the foot. To the authors' knowledge, this is the largest isolated extraskeletal osteochondroma in the arch of the foot identified in the literature. The diagnosis of an extraskeletal osteochondroma should be considered when a well-defined osseous mass occurs in the soft tissue.
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Affiliation(s)
- Robert J Spencer
- Department of Podiatry, Kaiser Permanente Medical Centers, Vallejo, California, USA
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Ratcliff JR, Naqvi A, de la Roza G, Strauss JA, Damron TA. Soft tissue osteochondroma: case report and immunohistochemistry for parathyroid hormone–related protein. Ann Diagn Pathol 2006; 10:222-9. [PMID: 16844564 DOI: 10.1016/j.anndiagpath.2005.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Surface lesions of bone usually present little diagnostic dilemma because the majority are conventional osteochondromas. Other surface bone lesions include periosteal chondroma, periosteal chondrosarcoma, and parosteal osteosarcoma. Mineralized soft tissue lesions such as myositis ossificans, synovial chondroma, and synovial sarcoma may present in a similar fashion when they occur in a juxtaarticular position. The soft tissue osteochondroma or paraarticular osteochondroma may simulate some of these more aggressive tumors, and its recognition is important to avoid overtreatment. A case of an 11-year-old male with a soft tissue osteochondroma is reported to illustrate the characteristic radiographic and histological features of this rare entity. No prior reports have examined soft tissue osteochondroma for expression of parathyroid hormone related protein, an established cartilage tumor proliferative mitogen.
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Affiliation(s)
- J Robyn Ratcliff
- Department of Orthopedic Surgery, Upstate Medical University, State University of New York at Syracuse, Syracuse, NY 13210, USA
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11
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Singh R, Sharma AK, Magu NK, Kaur KP, Sen R, Magu S. Extraskeletal osteochondroma in the nape of the neck: a case report. J Orthop Surg (Hong Kong) 2006; 14:192-5. [PMID: 16914787 DOI: 10.1177/230949900601400217] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Extraskeletal osteochondroma in the nape of the neck is rare and its pathological diagnosis is based on radiological and histopathological examination. It is vital that such a diagnosis be considered when a discrete, ossified mass is localised in soft tissues, even at atypical sites. Differential diagnoses include myositis ossificans, a lipomatous lesion, a pseudomalignant osseous tumour, an ossifying fibromyxoid tumour, an extraskeletal chondroma with endochondral ossification, synovial (osteo) chondromatosis, tumoural calcinosis, a synovial sarcoma, and an extraskeletal osteosarcoma. Clinical awareness of this benign entity is important as no malignant transformation or metastasis has been reported. Marginal excision with histopathological identification is the treatment of choice.
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Affiliation(s)
- R Singh
- Department of Orthopaedic Surgery, Pt BD Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India.
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12
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Cumming D, Massraf A, Jones JWM. Extraskeletal chondroma as a cause of carpal tunnel syndrome: a case report. HAND SURGERY : AN INTERNATIONAL JOURNAL DEVOTED TO HAND AND UPPER LIMB SURGERY AND RELATED RESEARCH : JOURNAL OF THE ASIA-PACIFIC FEDERATION OF SOCIETIES FOR SURGERY OF THE HAND 2005; 10:327-30. [PMID: 16568538 DOI: 10.1142/s0218810405002954] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2005] [Accepted: 12/19/2005] [Indexed: 05/08/2023]
Abstract
We report a case of carpal tunnel syndrome as a result of an extraosseous chondroma in a 47-year-old gentleman. This case demonstrates the importance of clinical examination and occasional radiographs in this not uncommon condition. We also highlight that this well known entrapment syndrome is not only caused by the common causes that we all know, but also any space-occupying lesion in the carpal tunnel compressing the median nerve.
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Affiliation(s)
- D Cumming
- Department of Orthopaedic Surgery, Peterborough Hospitals NHS Trust, Thorpe Road, Peterborough, UK.
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Nakanishi H, Araki N, Mukai K, Ohno H, Matsui Y, Hosoya T. Soft-tissue osteochondroma in the calcaneal pad: a case report. J Foot Ankle Surg 2001; 40:396-400. [PMID: 11777235 DOI: 10.1016/s1067-2516(01)80007-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Soft-tissue osteochondromas of the foot are infrequently occurring lesions. A 65-year-old woman presented with soft-tissue osteochondroma in the soft tissues superficial to the plantar aspect of the calcaneus. The mass was densely ossified without cortical destruction or other alteration in the adjacent calcaneal bone on x-rays and computed tomography images. A 99m Tc bone scan showed a focal area of an increased uptake at the site of the mass below the calcaneus. Magnetic resonance imaging demonstrated high signal mass on T1-weighted images, isointense to fatty marrow, adjacent to the thickened plantar aponeurosis. The mass was completely excised. Histologically, mature lamellar bone was seen centrally, and the periphery was capped with hyaline cartilage. Since the tumor was located in the plantar aponeurosis and comprised of a single nodule of well-developed bone with well-organized endochondral ossification, the pathogenesis of this lesion might be related to metaplasia.
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Affiliation(s)
- H Nakanishi
- Department of Orthopedic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Japan
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