Giant extraskeletal osteochondroma of the plantar midfoot arch

Extraosseous osteochondroma of superficial fascia layer of the heel: A case report and review of literature

RATIONALE

Osteochondroma is a common benign bone tumor consisting of cartilage-covered bone confluent with the medullary canal of the epiphysis. Extraosseous osteochondroma shares the same appearance and histologic features as a typical osteochondroma but does not have any attachment to surrounding bone structures. Because of its low incidence, extraosseous osteochondroma is uncommon in clinical workups and thus prone to misdiagnosis. The diagnosis of extraosseous osteochondroma should be considered when there is a well-defined bony mass in the soft tissue with no direct continuity with the adjacent bone or joint. Here, we present a case of an imaging diagnosis of "calcified bursitis in the subcutaneous superficial fascial layer" and a postoperative pathological diagnosis of "extraosseous osteochondroma."

PATIENT CONCERNS

The patient was a 61-year-old man who had a right plantar heel mass for 2 years and recently visited the hospital because of discomfort in shoes.

DIAGNOSES

The patient was diagnosed with pathological examination.

INTERVENTIONS

After completing the relevant preoperative examination and preoperative preparation and excluding contraindications to surgery, surgery was performed under nerve block anesthesia.

OUTCOMES

We performed surgical resection, and the patient did not have obvious discomfort when discharged from the hospital. Auxiliary examination showed no abnormalities.

LESSONS

For foot tumors, we need to consider the possibility of extraosseous osteochondroma. After completing the auxiliary examination, we should determine the relationship between the tumor and its surrounding tissues and blood supply before surgery to avoid causing major trauma.

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.

Solitary submandibular soft tissue osteochondroma: A rare case report

Introduction

Soft tissue osteochondromas are rare benign tumors containing bone and cartilage that form in mesenchymal tissues with no connection to adjacent bone, cartilage, or periosteum. They mimic endochondral ossification and are usually encased in a fibrous tissue capsule. The occurrence of the tumor is extremely rare in the maxillofacial region.

Case presentation

A case of soft tissue osteochondroma in the submandibular region of a 47-year-old man with a medical history of muscular dystrophy and schizophrenia is presented here. The tumor had been gradually growing for 11 years before the patient's presentation to our clinics. Radiographic and clinical examination revealed a radiopaque mass in soft tissue that extended from the left anteroinferior border of the mandible and with no connection to the mandibular periosteum. Treatment involved surgical excision. A diagnosis of soft tissue osteochondroma was established by histopathological examination.

Clinical discussion

Previously, there have been only three reported cases of soft tissue osteochondroma in the maxillofacial region. The cause of this tumor is not clearly understood, with multiple hypotheses being proposed. Diagnosis usually involves radiology and histopathology, and the tumor is completely amenable to surgical excision.

Conclusion

Extraskeletal osteochondroma should be considered in the differential diagnosis of hard tissue lesions with no apparent connection to the underlying bone in the maxillofacial region. Although considered rare, clinical awareness about this tumor aids the practitioner in identifying, diagnosing and properly managing this tumor. There has been no report of recurrence or malignant transformation of the lesion.

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Soft tissue osteochondroma are tumors encased in a fibrous connective tissue capsule with no hard tissue connection.

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Extraskeletal osteochondromas are extremely rare in the maxillofacial region.

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Surgical excision is the standard of care.

Extraskeletal Osteochondroma of the Great Toe in a Teenager

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.

A Subdermal Osteochondroma in a Young Girl

Osteochondromas are common benign tumors of cartilage and bone. They are usually found as contiguous bone with a cartilage cap at the end of the growth plate of long bones. Similar to structure are extraskeletal osteochondromas. However, unlike typical osteochondromas, extraskeletal osteochondromas are noncontinuous with bone. To our knowledge, all reported extraskeletal osteochondromas have been contained within fascial compartments. Here we present the case of a 5-year-old female who had a slow growing mass of the anterior distal right thigh. Imaging studies revealed an ossified mass extending from dermal layer of the subcutaneous tissue with no connection to the underlying deep fascia. An excisional biopsy was performed and proved to be a subdermal extraskeletal osteochondroma.

A large extraskeletal osteochondroma of the foot

Osteochondromas are very common benign tumors composed of cartilage and bone. They are usually found at the end of the growth plate of long bones, most often at the area of the joints, and are contiguous with the medullary cavity. Extraskeletal osteochondromas, the same as their namesake, are composed of cartilage and bone. However, unlike typical osteochondromas, extraskeletal osteochondromas are not contiguous with bone, as their name implies. They usually arise from the synovial tissue and tendon sheaths. Although rare, extraskeletal osteochondromas have been reported to occur within the knee and around the hip; however, they are more commonly reported to occur in the hands and feet. When found in the hands or feet, these new growths are often very small and only occasionally symptomatic. We present the case of a 49-year-old female who had a slow-growing mass of 4 years' duration, located on the plantar aspect of her left foot. The mass was slowly becoming more palpable as it increased in size and was progressively causing pain and discomfort during ambulation. Imaging studies revealed an ossified mass bearing no connection to any other structure on the plantar aspect of her foot. An excision biopsy was performed, and the easily dissectible mass, although much larger than its usual presentation, proved to be an extraskeletal osteochondroma.

Extraskeletal osteochondroma of the medial arch of the foot

Extraskeletal osteochondromas are benign, slow growing, and often painless neoplasms. Although they are histologically similar to conventional osteochondromas, extraskeletal osteochondromas are not attached to a parent bone. When a well-defined osseous mass in the soft tissue without any direct continuity with the adjacent bone or joint is encountered, a diagnosis of extraskeletal osteochondroma should be strongly considered. It should be identified to avoid unnecessary aggressive surgical treatment. We present a patient with symptomatic extraskeletal osteochondroma of the medial arch of the foot. It was treated by local excision and no evidence of local recurrence clinically or radiographically after 51 months of follow-up.

LEVELS OF EVIDENCE

Therapeutic, Level IV, Case study.

Painful extraskeletal osteochondroma under the tarsal sesamoid: a case report and review of literature

Extraskeletal osteochondroma is a rare condition. To our knowledge, occurrence in the foot has been very rare. We present here a case wherein the patient developed a painful extraskeletal osteochondroma under the tarsal sesamoid. A fifty-one-year-old man presented at our department with a painful mass on the plantar part of the metatarsal joint of the right big toe. The mass had grown gradually in size for the past 7 months and was associated with pain while walking. Preoperative X-ray and a computed tomography showed that the tumor had no continuity with adjacent bone. Intraoperatively, a bony hard tumor was located in the subcutaneous tissue plantar to the tibial sesamoid. The mass was firmly attached to the sheath of the flexor hallucis brevis tendon. Macroscopically, the tumor was covered with glistering surface. The tumor was carefully dissected from the surrounding soft tissues and was removed. It was diagnosed as extraskeletal osteochondroma histologically. The patient had no recurrence at 1 year after operation.

Metatarsal stress fractures secondary to soft-tissue osteochondroma in the foot: case report and literature review

Soft-tissue osteochondromas are rare, benign tumours developing in the soft tissues. Diagnosis is challenging however, as the differential includes malignancy. As simple excision is curative, early recognition by clinical and radiological evaluation will help avoid unnecessary surgery. A 43-year-old gentleman presented to us with a painful lump on the plantar aspect of his foot. Initial imaging suggested bony involvement of the lesion, raising concerns of malignancy. Further investigation demonstrated the bony abnormalities to be stress fractures, caused by altered forces due to the lump. The lump was excised and histologically confirmed to be a soft-tissue osteochondroma. Soft-tissue osteochondromas have not previously been reported in association with stress fractures. We present this case, a literature review and a list of differential diagnoses highlighting the importance of considering soft-tissue osteochondroma when evaluating a well-defined, osseous, soft-tissue mass in the extremity, and the difficulties in making this diagnosis.

Soft-tissue osteochondroma of the heel pad: a case report and review of literature

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.

Arthroscopic removal of an intraarticular osteoid osteoma of the distal tibia

Intraarticular osteoid osteomas can simulate several other traumatic or degenerative pathologies of the joint with delay in diagnosis. We report the clinical features, radiographic and histopathological findings, the technical aspects of arthroscopic excision, and results of surgery in a 28-year-old woman who had an intraarticular osteoid osteoma of her left ankle, in whom the initial diagnosis was erroneous and delayed 1 year. Arthroscopy allowed minimally invasive complete excision of the osteoid osteoma, with a short postoperative rehabilitation and excellent functional results.

Resection and reconstruction of an osteochondroma of the hallux: a review of benign bone tumors and a description of an unusual case

Osteochondroma, which is also known as exostosis, is the most common benign bone tumor. Although foot and hand surgeons frequently encounter the subungual exostosis, exostoses commonly localize to other areas of the skeleton as well. In this review, we describe the clinical and diagnostic imaging characteristics of benign bone tumors and, in particular, the osteochondroma and its surgical management. We also report the case of a patient who experienced an unusual pedal digital osteochondroma-like lesion.

LEVEL OF CLINICAL EVIDENCE

4.