Tumours and Tumour - Like Lesions of Scapula

Solitary Osteochondroma of the Ventral Scapula Associated with Large Bursa Formation and Pseudowinging of the Scapula: A Case Report and Literature Review

Osteochondroma (OC) is the most common benign bone tumor and may occur on any bone in which endochondral ossification develops. Although scapular OC accounts for less than 5% of the cases of solitary OC, OC is the most common lesion among the tumors and tumor-like lesions of the scapula. OC that develops near the medial scapular border easily causes friction with the ribcage; hence, almost half the number of cases of OC associated with marked bursa formation develops in the ventral scapula. We report a case of a 27-year-old female with a painful OC of the ventral scapular surface associated with large bursa formation and pseudowinging of the scapula. After l2 years of follow-up with magnetic resonance imaging, we confirm that the accompanied bursa left at surgery disappears.

Advanced Imaging of the Scapula: What Every Radiologist Needs to Know

The scapula plays a central role in shoulder motion and stability. A wide variety of anatomic variants as well as traumatic, neoplastic, and infectious pathologies can involve the scapula. Detection of scapular lesions using radiography can be challenging because of the obscuration by the overlying structures or incomplete imaging during shoulder magnetic resonance imaging or computed tomography examinations. Familiarity with imaging characteristics of these abnormalities will allow radiologists to better diagnose and characterize scapular disorders.

An epidemiological survey of tumour or tumour like conditions in the scapula and periscapular region

Introduction: The scapula is not an uncommon site for bone and soft tissue tumours and can be difficult to delineate on examination. Furthermore, these lesions can be potentially challenging to biopsy due to its close anatomical relationship with important structures. We present an epidemiological survey of all the scapular and periscapular lesions presenting to our institution.

Methodology: This was a retrospective study with data obtained from a prospectively held electronic database over a 30-year period. Demographic and clinical data was obtained and various subgroup analyses were performed.

Results: A total of 418 scapular lesions were included in the study where 132 lesions were found to be of soft tissue origin and 286 were osseous. Fifty-eight percent (n = 241) of all these lesions were malignant, of which 47% (n = 113) were primary sarcomas. The commonest malignant lesions were bone sarcomas (n = 96) followed by metastases (n = 88). The commonest primary bone sarcoma was chondrosarcoma (45%), whereas the commonest soft tissue sarcoma was high grade undifferentiated pleomorphic sarcoma (18%). The most common benign osseous and soft tissue lesions were osteochondroma (70%) and lipoma (26%), respectively. We noted that the incidence of malignancy increased with increasing age, however, the incidence of primary bone sarcomas was fairly consistent across different age groups.

Conclusion: Based on our findings we recommend that suspicious lesions arising from the scapula should be dealt with in a specialist sarcoma unit with involvement of a multidisciplinary team to offer appropriate management and advice for optimum outcome.

Tumors of the coracoid process: clinical evaluation of twenty-one patients

OBJECTIVE

We present the incidence and management of bone tumors of the coracoid process and discuss the related clinical and imaging findings and treatment.

MATERIALS AND METHODS

We present 21 patients (7 males and 14 females; mean age, 39 years) treated for bone tumors of the coracoid process from 1900 to 2010. Mean follow-up was 44 months (range, 12-132 months). Clinical presentation, imaging, surgical treatment, complications, range of shoulder motion, and Musculoskeletal Tumor Society (MSTS) function were evaluated.

RESULTS

Bone tumors were benign in 7 (33%) and malignant in 14 (67%). The most common were chondrosarcomas, osteoblastomas, and chondroblastomas. The most common presentation was pain and palpable mass for a mean duration of 11 months. Limb salvage, with or without megaprosthetic reconstruction, was achieved in 20 patients. One patient required forequarter amputation. One patient with chondroblastoma and 2 with chondrosarcoma had local recurrence. The range of shoulder motion varied according to the type of resection: patients with curettage and limited resections without involvement of the abductor mechanism had better shoulder motion, and patients with scapulectomy and proximal humeral resections had significant limitations of motion. The mean MSTS score was 80% (range, 50%-100%).

CONCLUSIONS

Chondrosarcomas, osteoblastomas, and chondroblastomas are the most common bone tumors of the coracoid process. Limited resections are associated with nearly normal range of motion and excellent function; however, limited resections are acceptable in only in a small number of patients. In patients with malignant and recurrent lesions, wide resection is required, which is associated with significant limitations of shoulder function.