A case of subungual osteochondroma

Subungual Exostosis Systematic Review and Meta-Analysis

BACKGROUND

The coexistence of deformity of the nail bed and subungual exostosis (SE) is a frequent finding in podiatric practice in the fourth and fifth decades of life. However, it has been described by other specialists as being an uncommon osteocartilaginous tumor most prevalent during the second and third decades of life. This study attempts to determine the causes of this discrepancy.

METHODS

Two authors independently conducted a systematic bibliographic review in multiple databases, podiatry sources and others, and key words were chosen to achieve a broad search strategy. Studies reporting on epidemiology and treatment of SE lesions in lower extremities in ten or more patients were selected. Initially, 197 articles were identified through database screening, with 23 meeting all inclusion and exclusion criteria. Seven articles with the ages of all of the patients were included in the analysis of age data. A comparison was then made between the diagnostic criteria for the selected 23 articles.

RESULTS

Model results reveal that, although there are some significant differences between individual studies, the main factor tested (patient's age) was clearly significant ( F_1,5.2 = 78.12, P < .001), showing that studies coming from the podiatry speciality were conducted on individuals with a mean age of 37 years higher than in studies from other specialties. Clinical and radiologic characteristics and treatment described in the podiatry literature also contrast with those in other specialties.

CONCLUSIONS

The SE described by podiatrists, in accordance with the parameters of true exostosis, is different from Dupuytren's SE and should be considered as a different pathologic entity. The authors are working on its histologic identification.

Nail neoplasms

Nail neoplasms include all tumors occurring in the nail or periungual apparatus tissue. While some nail tumors can be similar to tumors located on the skin, others are unique. Both benign and malignant lesions can affect the nail apparatus. In particular, early malignant tumors like melanoma and squamous cell carcinoma can present similarly to onychomycosis or benign melanonychia and frequently missed by clinicians. Therefore, physicians should be aware of nail structures and the characteristics of nail tumors. Our review covers the normal nail structure and the most common nail tumors from benign to malignant.

Two distinctive subungual pathologies: subungual exostosis and subungual osteochondroma

BACKGROUND

The purpose of this study was to present features that differentiate subungual exostosis from subungual osteochondroma.

METHODS

We treated 11 patients for subungual masses. All were confirmed by radiographic and histologic evaluations to be subungual exostosis or subungual osteochondroma. The study patients comprised eight female and three male patients with a mean age at presentation of 18.7 years (range 1.5 to 70.9). In the five patients with subungual exostosis, three (60%) had a toe lesion, and two (40%) had a finger lesion. In the six patients with subungual osteochondroma, four (67%) had a toe lesion, and two (33%) had finger lesions. We analyzed the clinical features, including trauma history, the existence of infection before surgery, tumor recurrence, and postoperative nail deformity.

RESULTS

In all patients, the lesions presented as an exophytic tumor of the nail apparatus, beneath the nail plate, which varied in size from 0.6 x 0.4 cm to 1.2 x 0.9 cm. Excision of these masses produced useful toes or fingers without pain, a tender scar, or nail deformity. Although nails were deformed preoperatively, they grew back without ridges or cracks within 3 to 5 months postoperatively. There were no recurrences based on clinical and radiographic evaluations, and both tumor types showed characteristic radiographic and histologic differences.

CONCLUSIONS

Subungual exostosis and subungual osteochondroma are benign but have distinct osseous pathologies. We concluded that subungual exostosis is clinically, developmentally, radiographically, and histologically distinct from subungual osteochondroma.

Common nail tumors

Nail abnormalities are varied and numerous. They include warts, keratoacanthomas, onychomatricomas, fibrokeratomas, osteochondromas, tumors (ie, glomus, giant cell, Koenen's, and others), and Bowen's disease. Although the gravity of these conditions may vary, prompt diagnosis and treatment is of the utmost importance. This article discusses the most common defects associated with the nail unit and its surrounding tissue, as well as the differential diagnosis and treatment of these conditions.

Subungual Osteochondroma: Clinical and Radiologic Features and Treatment

BACKGROUND

Subungual osteochondromas are relatively rare.

OBJECTIVE

The objective was to evaluate the clinical, histologic, radiologic, and therapeutic features of subungual osteochondroma.

METHODS

We retrospectively analyzed 27 cases of subungual osteochondroma evaluating the clinical manifestations, the radiologic and histologic features, and the treatment.

RESULTS

There were 20 females and 7 males. The first toe was the most commonly involved. Previous trauma was recalled in 40.7% of the cases. Subungual osteochondromas appeared as firm, exophytic tumors beneath the ungual plate. Twenty-five patients had pain. The radiologic films demonstrated the presence of a juxtaephiphyseal radiodense cap surrounded in some cases by cortical bone. A Dubois-like excision was performed to expose the tumor and cut it through the base, followed by curettage of the bony bed. Radiologic controls were taken 30 and 60 days after surgery and in cases of symptomatology. There were three cases of recurrence and two cases of incomplete excision.

CONCLUSIONS

Subungual osteochondroma should be distinguished from other subungual masses. The diagnosis of subungual osteochondroma is clinicoradiologic.