Variants of Exostosis of the Bone in Children

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.

Imaging of solitary and multiple osteochondromas: From head to toe - A review

Osteochondromas account for 20%-50% of all benign bone lesions. These tumors may present as solitary non-hereditary lesions, which are the most common presentation, or as multiple tumors associated with hereditary conditions. Plain radiography is the imaging method of choice and demonstrates the typical cortical and medullary continuity of the tumor with the underlying bone. Magnetic resonance imaging is often performed to evaluate cartilage cap thickness, which correlates with malignant transformation. Other local complications include compression of adjacent neurovascular bundles, muscles, and tendons, bursitis, tendon tears, stalk fracture, and angular or rotational long bone deformities. Although the imaging features of osteochondromas are largely known, only a few papers in the literature have focused on their main complications and image-based follow-up. This paper aimed to illustrate the main complications of osteochondromas, suggest an image-based algorithm for management and follow-up and discuss differential diagnosis.

Benign incidental do-not-touch bone lesions

Benign bone lesions may occasionally be incidentally detected on radiographs and are also increasingly found on CT or MRI performed for other clinical indications. Although mostly asymptomatic or associated with minor symptoms, these lesions may simulate true pathological lesions, causing problems in diagnosis. For instance, asymptomatic benign bone lesions can be misinterpreted as metastasis when incidentally encountered in a patient with known cancer. Recognising these entities as "do-not-touch" lesions helps avoid unnecessary further investigation or harmful intervention. In this review, we highlight three groups of bone incidentalomas found in adults, namely: osteolytic lesions, osteoblastic lesions, and bone protuberances. We aim to review the key imaging features of selected common and less common conditions in these three groups, so as to help radiologists confidently identify these benign do-not-touch lesions and to distinguish them from more sinister pathological lesions.

Pediatric chest wall masses: spectrum of benign findings on ultrasound

A palpable finding along the chest wall is a frequent indication for pediatric US. Accurate identification of benign lesions can reassure families and appropriately triage children who need follow-up, cross-sectional imaging, or biopsy. In this pictorial essay, we review chest wall anatomy, illustrate US techniques and discuss key US imaging features of common benign lesions and normal variants.

Spontaneous shrinkage of solitary osteochondromas

OBJECTIVE

Osteochondromas are the most common benign bone tumors, and thus far, their spontaneous shrinkage is considered a rare phenomenon. This study was designed to investigate the exact ratio of remission to progressive or stable cases and analyze the mechanism of tumor regression on the basis of existing theories.

MATERIALS AND METHODS

We retrospectively collected images of solitary osteochondromas in patients from 1992 to 2013, excluding cases involving short-term follow-up periods and follow-up periods that ended before growth plate closure. A total of 121 patients were diagnosed and screened for study inclusion. Tumor shrinkage was measured by assessing three points on tumor contours to determine if they had regressed or vanished. Patterns of shrinkage were further divided on the basis of mechanisms described as incorporation, absorption, and fracture.

RESULTS

Seventeen patients (mean age at initial diagnosis 13.1 years) met the study inclusion criteria. Tumor morphological classifications were pedunculated (10 cases) and sessile (7 cases). Osteochondroma shrinkage was the most common outcome (8 cases), followed by stable osteochondromas (6 cases), and osteochondromas that had progressed (3 cases). Tumors with sessile morphology were more prone to shrinkage (6 of 7 cases) compared with those of pedunculated morphology (2 of 10 cases; p = 0.015). Among pedunculated cases, tumor shrinkage was via absorption. The timing of tumor growth cessation was related to the pattern of tumor shrinkage. Absorption mostly followed tumor growth cessation, whereas incorporation mostly preceded tumor growth cessation.

CONCLUSION

The shrinkage of osteochondromas appears less rare than was originally thought.

Identification of a new mutation in an Iranian family with hereditary multiple osteochondromas

BACKGROUND

Hereditary multiple osteochondromas (HMO), previously named hereditary multiple exostoses (HME), is an autosomal dominant skeletal disorder characterized by the growth of multiple osteochondromas and is associated with bony deformity, skeletal growth reduction, nerve compression, restriction of joint motion, and premature osteoarthrosis. HMO is genetically heterogeneous, localized on at least three chromosomal loci including 8q24.1 (EXT1), 11p11-p13 (EXT2), and 19p (EXT3). The median age of diagnosis is 3 years; almost all affected individuals are diagnosed by age 12. The risk for malignant degeneration to osteochondrosarcoma increases with age, although the lifetime risk of malignant degeneration is low (~1%).

METHODS AND RESULTS

This study was performed on an Iranian family with nine affected individuals from three consecutive generations. Here, the proband was an affected woman who received genetic counseling prior to pregnancy. All exons of the three genes were examined in the proband using polymerase chain reaction and sequencing methods (the last member of this family is a male with severe deformities and lesions, especially around his large joints). Exon 4 of EXT1 (c.1235 G>A) was changed in affected individuals. This mutation alters tryptophan to a premature stop codon on amino acid position 412 (p.Trp412x).

CONCLUSION

The outcome of this study has extended the genotypic spectrum of Iranian patients with HMO, revealing a way for improving detection and genetic counseling in carriers.

A Rare Case of Pubic Ramus Osteochondroma

Introduction:

Osteochondroma are benign neoplasms which arise from small cartilage nodules within the periosteum. They can be either pedunculated or sessile and are more common in the extremities. They rarely develop in bones like scapula, feet, hands and pelvis. Management of the lesion is by en-bloc excision.

Case Report:

We present a case of 18 year female, who came with a swelling in right groin since 2 years which was diagnosed to be osteochondroma on x-ray and magnetic resonance imaging. Excision biopsy was done as the patient wanted it to be removed for cosmetic purpose and confirmed it to be non-malignant osteochondroma. There has been no recurrence even after 1 year of follow up.

Conclusion:

Thus osteochondroma of the pelvis should be kept in mind as a differential diagnosis when evaluating mass in pelvis. Also these have to be removed when they pose cosmetic problems.

Imaging of lumps and bumps in pediatric patients: an algorithm for appropriate imaging and pictorial review

Superficial lumps and bumps are a common presenting complaint in the pediatric patient population. Although encountered frequently, the path to a definitive diagnosis is not always a straightforward one. Imaging offers a valuable tool to aid in this diagnostic challenge. Radiologists must be familiar with pediatric lumps and bumps, their imaging characteristics, and the best way to further evaluate challenging clinical presentations. This will not only allow the radiologist to serve as a valuable asset to the treating physician in choosing the most appropriate imaging modality but also help in accurate diagnosis, all while ensuring the "image gently" principle. An algorithm for imaging in the pediatric patient with lumps and bumps has been presented in this article and a few example entities along with their imaging findings have also been reviewed.

Solitary osteochondroma: spontaneous regression

Osteochondromas are the most common benign bone tumours. Nevertheless, their origin and biological behaviour are poorly understood. Rarely, spontaneous regression of osteochondromas may occur. We report the case of a 9-year-old girl with a solitary osteochondroma of the femur that regressed almost completely within 4 years, a fact that should be taken into account when deciding the management of these lesions, especially in young children.