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Wu W, Liao S, Yang F. Minimally-invasive excision of a scapular osteochondroma on the ventral surface: A case report and literature review. Clin Case Rep 2024; 12:e9385. [PMID: 39206064 PMCID: PMC11349812 DOI: 10.1002/ccr3.9385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 08/03/2024] [Accepted: 08/16/2024] [Indexed: 09/04/2024] Open
Abstract
Key Clinical Message Osteochondroma on the ventral scapula is clinically rare and can incur pseudo-winged scapula and snapping syndrome if not treated. In this regard, surgical excision is suggested, if possible, with a minimally invasive approach to accelerate physical recovery. Abstract Osteochondroma is a common benign bone tumor, characterized by a cartilage-capped osseous protuberance with cortical and medullary continuity with the underlying native bone. Osteochondroma is commonly found in the long bones, such as the proximal humerus, distal femur, and proximal tibia, but rarely seen in flat bones. We report a case of pedunculated osteochondroma on the ventral surface of left scapula in a young adult woman. She presented with a slight pseudo-winged scapula, occasional pain, and snapping sound with motion of the left shoulder. The tumor was surgically resected using a minimally invasive approach, and an excellent outcome was obtained.
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Affiliation(s)
- Weifeng Wu
- Department of Orthopedic SurgeryThe First Affiliated Hospital of Guangxi Medical UniversityNanningChina
| | - Shijie Liao
- Department of Orthopedic SurgeryThe First Affiliated Hospital of Guangxi Medical UniversityNanningChina
| | - Fuchun Yang
- Department of Orthopedic SurgeryThe First Affiliated Hospital of Guangxi Medical UniversityNanningChina
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Ungemach A, Dannemiller N, Rasche B, Farber E, Griffin C, Ozawa S. Successful treatment of forelimb osteochondroma in a ferret (Mustela putorius furo). Top Companion Anim Med 2024; 62:100904. [PMID: 39122179 DOI: 10.1016/j.tcam.2024.100904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 07/16/2024] [Accepted: 08/03/2024] [Indexed: 08/12/2024]
Abstract
A 1-year-old male neutered ferret (Mustela putorius furo) was evaluated for an abnormal left cubital joint. Radiographs demonstrated a proliferative osseous lesion of the left proximal antebrachium. Computed tomography confirmed a large thin-walled expansile osseous lesion of the left proximal radius and identified multifocal proliferative lesions of the axial spine, two of which caused spinal cord compression. A left forelimb amputation with total scapulectomy was performed. Histopathology revealed a well-demarcated mass with a thin rim of mature lamellar bone and a discontinuous cartilage cap covered by a perichondrial/periosteal membrane continuous with the adjacent bone. Findings were most consistent with an osteochondroma or osteochondromatosis (i.e., multiple cartilaginous exostoses, hereditary multiple exostoses). No evidence of malignant transformation was observed within this specimen. Three months post-surgery, verbal correspondence with the owner confirmed return to normal activity level and no emergence of neurological signs. Repeat examination and imaging were recommended.
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Affiliation(s)
- Alyssa Ungemach
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - Nicholas Dannemiller
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - Brittany Rasche
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - Esther Farber
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - Chris Griffin
- Griffin Avian and Exotic Veterinary Hospital, Kannapolis, NC, USA
| | - Sarah Ozawa
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA.
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Jangir R, Kumar M, Berwal A, Muzahid M, Tailor RR, Dulhanani M. Dorsal Scapular Osteochondroma in a Young Male: A Case Report and Literature Review. J Orthop Case Rep 2024; 14:10-15. [PMID: 39157478 PMCID: PMC11327675 DOI: 10.13107/jocr.2024.v14.i08.4628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/11/2024] [Indexed: 08/20/2024] Open
Abstract
Introduction Osteochondromas are a unique group of benign bone tumors that are characterized by bony outgrowth covered by Cartilage. It has a peculiar micro-architecture as its cortices are extensions of those of parent bone and there is a continuity of medullary cavity; this is akin to branching in plants, rightly earning the name "Exostosis." Case Report We report a case of a 21-year-old male who presented with complaints of swelling on the upper back associated with mild discomfort. Examination confirmed a bony mass on the dorsal aspect of the scapula without any restricted range of motion of the shoulder joint. On the confirmation of diagnosis, en bloc excision was performed. Conclusion In conclusion, dorsal scapular osteochondromas are a rarity, and excision of the lesion is an effective management for symptomatic lesions.
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Affiliation(s)
- Rajat Jangir
- Department of Orthopaedics, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Mohit Kumar
- Department of Orthopaedics, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Ayush Berwal
- Department of Orthopaedics, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Mohammed Muzahid
- Department of Orthopaedics, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Rajat Raj Tailor
- Department of Orthopaedics, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Mohit Dulhanani
- Department of Orthopaedics, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
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Ma Y, Liu Y, Liu X, Li M, Cui J, Guan Z, Pei J, Gao Y. Fluoride exposure and prevalence of osteochondroma in drinking water Endemic fluorosis areas of Heilongjiang Province, China: a cross-sectional study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024; 34:2863-2876. [PMID: 37921081 DOI: 10.1080/09603123.2023.2277336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 10/26/2023] [Indexed: 11/04/2023]
Abstract
To investigate the relationship between fluoride exposure and Osteochondroma (OC) prevalence, a cross-sectional study was conducted in drinking water endemic fluorosis areas of Heilongjiang Province, China. Our study first reported that the prevalence of OC was 2.3% in drinking water endemic fluorosis areas of Heilongjiang Province, China, and no difference in gender. Logistic regression analysis found that compared to 1st quartile participants, the prevalence of OC was 73% lower in the 2nd quartile participants of WF (Water fluoride), and 3.4 times higher among the 2nd quartile UF (Urinary fluoride) participants. Our study suggests that 0.259-0.420 mg/L of WF may be considered an appropriate level for reducing OC prevalence, while UF (≥0.750 mg/L) could slightly increase the prevalence of OC. In summary, the link between fluoride and OC prevalence is complicated and needs to be further investigated in a cohort population.
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Affiliation(s)
- Yongzheng Ma
- Key Laboratory of Etiology and Epidemiology, National Health Commission & Education Bureau of Heilongjiang Province (23618504), Harbin Medical University, Harbin, Heilongjiang Province, China
- Heilongjiang Provincial Key Laboratory of Trace Elements and Human Health, Harbin Medical University, Harbin, Heilongjiang Province, China
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Yang Liu
- Key Laboratory of Etiology and Epidemiology, National Health Commission & Education Bureau of Heilongjiang Province (23618504), Harbin Medical University, Harbin, Heilongjiang Province, China
- Heilongjiang Provincial Key Laboratory of Trace Elements and Human Health, Harbin Medical University, Harbin, Heilongjiang Province, China
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Xiaona Liu
- Key Laboratory of Etiology and Epidemiology, National Health Commission & Education Bureau of Heilongjiang Province (23618504), Harbin Medical University, Harbin, Heilongjiang Province, China
- Heilongjiang Provincial Key Laboratory of Trace Elements and Human Health, Harbin Medical University, Harbin, Heilongjiang Province, China
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Mang Li
- Key Laboratory of Etiology and Epidemiology, National Health Commission & Education Bureau of Heilongjiang Province (23618504), Harbin Medical University, Harbin, Heilongjiang Province, China
- Heilongjiang Provincial Key Laboratory of Trace Elements and Human Health, Harbin Medical University, Harbin, Heilongjiang Province, China
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Jing Cui
- Key Laboratory of Etiology and Epidemiology, National Health Commission & Education Bureau of Heilongjiang Province (23618504), Harbin Medical University, Harbin, Heilongjiang Province, China
- Heilongjiang Provincial Key Laboratory of Trace Elements and Human Health, Harbin Medical University, Harbin, Heilongjiang Province, China
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Zhizhong Guan
- Department of Pathology and Key Lab of Endemic and Ethnic Diseases, Ministry of Education, Guizhou Medical University, Guiyang, Guizhou Province, China
| | - Junrui Pei
- Key Laboratory of Etiology and Epidemiology, National Health Commission & Education Bureau of Heilongjiang Province (23618504), Harbin Medical University, Harbin, Heilongjiang Province, China
- Heilongjiang Provincial Key Laboratory of Trace Elements and Human Health, Harbin Medical University, Harbin, Heilongjiang Province, China
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Yanhui Gao
- Key Laboratory of Etiology and Epidemiology, National Health Commission & Education Bureau of Heilongjiang Province (23618504), Harbin Medical University, Harbin, Heilongjiang Province, China
- Heilongjiang Provincial Key Laboratory of Trace Elements and Human Health, Harbin Medical University, Harbin, Heilongjiang Province, China
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, Heilongjiang Province, China
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Fuentes GOA, Fuentes EJA, Sonora SGE, Vertti RDAP. Intra-Articular Osteochondroma of the Hip. Total Hip Replacement After Tumor Resection in a Young adult - A Case Report. J Orthop Case Rep 2024; 14:42-47. [PMID: 39157469 PMCID: PMC11327684 DOI: 10.13107/jocr.2024.v14.i08.4640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/27/2024] [Indexed: 08/20/2024] Open
Abstract
Introduction Osteochondroma is the most common benign bone tumor (20-50%). It is located predominantly in the metaphysis of the long bones, and much less frequently, the proximal femur and acetabulum. Osteochondroma can eventually lead to hip osteoarthritis and limit patients' functional activities. Determining optimal treatment can be difficult due to the high risk of avascular necrosis in surgical resections. Case Report A 44-year-old male from Sabinas Coahuila, Mexico, a priest by profession, who presents for consultation with right inguinal pain of 18 months' duration. The patient had been treated conservatively with rest, non-steroidal anti-inflammatory drugs, and physical therapy without showing improvement in his symptoms. The anteroposterior radiograph of the pelvis and axial tomography showed an oval bone excrescence with well-defined margins in the acetabular and intra-articular region of the hip, which caused a decrease in joint space but without soft tissue infiltration. Tumor resection and total hip replacement were the treatment options. The histopathological study concluded an osteochondroma. After 25 months of post-operative follow-up, radiographic studies show no evidence of lesion recurrence. The functional improvement is 98 points on the Harris scale; the patient typically performs his daily living and work activities. Conclusion Treating intra-articular osteochondroma of the hip can be challenging for the orthopedic surgeon. For osteochondroma resulting in secondary osteoarthrosis of the hip joint, total hip replacement should be considered an effective method to restore function and assist in returning the patient to previous activities. Thorough pre-operative planning is mandatory to prevent intra- or immediate post-operative risk.
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Affiliation(s)
| | - Ernesto Javier Arizpe Fuentes
- Department of Orthopaedic Surgery, Autonomous University of Coahuila, Faculty of Medicine, Torreón, Coahuila, Mexico. Department of Anatomopathology, General Hospital of Múzquiz Coahuila, Carretera Múzquiz / Palau Km 9 s/n, Mexico
| | - Sergio Gilberto Esquivel Sonora
- Department of Orthopaedic Surgery, Autonomous University of Coahuila, Faculty of Medicine, Torreón, Coahuila, Mexico. Department of Anatomopathology, General Hospital of Múzquiz Coahuila, Carretera Múzquiz / Palau Km 9 s/n, Mexico
| | - Rubén Daniel Arellano Pérez Vertti
- Department of Orthopaedic Surgery, Autonomous University of Coahuila, Faculty of Medicine, Torreón, Coahuila, Mexico. Department of Anatomopathology, General Hospital of Múzquiz Coahuila, Carretera Múzquiz / Palau Km 9 s/n, Mexico
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Calogero V, Florio M, Careri S, Aulisa AG, Falciglia F, Giordano M. Paediatric Calcaneal Osteochondroma: A Case Report and a Literature Review. Diseases 2024; 12:167. [PMID: 39195166 DOI: 10.3390/diseases12080167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 07/18/2024] [Accepted: 07/23/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Heel pain in children is a common condition. The aetiology can be ascribed to fractures, osteochondrosis, tendinitis, calcaneal-navicular or talo-calcaneal coalition, osteomyelitis, rheumatic diseases, anatomic variants, malignant tumours (osteosarcoma, Ewing's sarcoma), and benign lesions (bone cyst, aneurismal bone cyst, osteoid osteoma, or exostosis). In particular, this manuscript focuses on a case of calcaneal exostosis in the paediatric age, aiming to highlight its rarity. Osteochondromas are benign tumours of the surface of the bone and the overlying cartilage. They grow until skeletal maturity and can cause stiffness, pain, cosmetic alterations, tendinitis, and neuro-vascular compression. The calcaneus is an extremely rare site for these tumours. Only two case reports of paediatric exostosis of the calcaneus bone are available. METHODS We describe a case of a girl of 16 years of age, affected by multiple cartilaginous exostosis, who presented with a painful mass on the inferior margin of the foot in the calcaneal region, which was diagnosed as an exostosis. The neoformation was excised, and the girl underwent clinical follow-up. RESULTS The patient was promptly discharged in good condition, and on the 25th postoperative day, she was completely pain-free and allowed weight bearing. CONCLUSIONS In the case of heel pain resistant to conservative treatment, the presence of an osteochondroma should be considered after excluding more common causes. If symptomatic, calcaneal osteochondromas could require surgical excision.
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Affiliation(s)
- Valeria Calogero
- U.O.C Traumatology, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Michela Florio
- U.O.C Traumatology, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Silvia Careri
- U.O.C Traumatology, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Angelo Gabriele Aulisa
- U.O.C Traumatology, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, 03043 Cassino, Italy
| | - Francesco Falciglia
- U.O.C Traumatology, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Marco Giordano
- U.O.C Traumatology, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
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Oh S, Won SH, Kim WS, Park MS, Sung KH. Lower extremity deformity and its risk factors in patients with solitary osteochondromas. J Orthop Surg Res 2024; 19:415. [PMID: 39030613 PMCID: PMC11264804 DOI: 10.1186/s13018-024-04908-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 07/09/2024] [Indexed: 07/21/2024] Open
Abstract
BACKGROUND This study aimed to demonstrate the occurrence of lower extremity deformities and their risk factors in patients with solitary osteochondromas. METHODS We retrospectively reviewed consecutive patients with solitary osteochondromas around the knee. The laterality (left or right), involved bone (femur or tibia), tumor type (pedunculated or sessile), and direction (medial or lateral) were examined. The whole limb length (WLL), mechanical lateral distal femoral angle (mLDFA), and medial proximal tibial angle (MPTA) were measured using teleroentgenogram. Lower limb deformity was defined as a difference of more than 5° in mLDFA or MPTA in both lower extremities or a difference in WLL of more than 1 cm. Patients were divided into two groups, with deformity and without deformity. RESULTS Lower extremity deformities were observed in 8 of 83 patients. Significant difference in the type of osteochondroma (p = 0.004) between the groups was observed. Differences in sex, age, laterality, involved bone, direction, and distance from the physis to the osteochondroma between groups were not statistically significant. The sessile type of osteochondroma was a risk factor for lower limb deformity with an odds ratio of 24.0 according to Firth's logistic regression analysis. CONCLUSION In our cohort with solitary osteochondroma, lower limb deformities were observed in 8 (9.6%) out of the 83 patients and these were significantly associated with sessile-type tumors. Therefore, patients with sessile-type solitary osteochondroma around the knee require careful surveillance of lower limb alignment with whole leg teleroentgenogram.
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Affiliation(s)
- Seungtak Oh
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Sungnam, Gyeonggi, 13620, Korea
| | - Seung Hyun Won
- Division of Statistics, Medical Research Collaborating Center, Seoul National University Bundang Hospital, Gyeonggi, Korea
| | - Woo Sub Kim
- Department of Orthopedic Surgery, Myongji Hospital, Hanyang University College of Medicine, Gyeonggi, Korea
| | - Moon Seok Park
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Sungnam, Gyeonggi, 13620, Korea
| | - Ki Hyuk Sung
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Sungnam, Gyeonggi, 13620, Korea.
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Zied M, Mohamed T, Islem C, Wajdi C, Ali H, Bacem Z. Vascular complications of tibial exostosis: A rare case of popliteal vein deep venous thrombosis. Int J Surg Case Rep 2024; 120:109839. [PMID: 38851065 PMCID: PMC11215099 DOI: 10.1016/j.ijscr.2024.109839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 05/24/2024] [Accepted: 05/29/2024] [Indexed: 06/10/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Tibial exostosis (osteochondroma) represents a prevalent benign bone tumor typically identified in young adults. Uncommonly, vascular complications can emerge, encompassing vessel perforation, thrombosis and arterial thromboembolic events. Rare instances of popliteal vein thrombosis resulting from tibial osteochondroma have been documented. CASE PRESENTATION We report a rare case of a 25-year-old patient who presented with a red and swollen leg, and the diagnosis of deep venous thrombosis (DVT) of the left popliteal vein was established. The patient also exhibited a painless, hard swelling in the popliteal fossa. Radiography revealed an exostosis on the posterior aspect of the proximal tibia. An angioscan demonstrated close relations with the popliteal vessels, leading to venous compression. The patient underwent resection through a posterior knee approach. Histopathological analysis of the exostosis ruled out malignant transformation. CLINICAL DISCUSSION The discussion emphasizes the need for prompt diagnostic measures when signs indicate a vascular concern in a young patient, initiating with a radiograph followed by Doppler ultrasound and/or angiography to diagnose complications and precisely delineate their relationships with the tumor. Surgical intervention is underscored as urgent, particularly in cases involving arterial thrombosis, where immediate measures such as thrombectomy or bypass with a venous graft may be necessary. CONCLUSION Vascular complications associated with bone exostoses are rare but require prompt surgical treatment. However, it should prompt the performance of an angioscan in the presence of any abnormalities during clinical examination or an appearance raising concerns about potential vascular conflict.
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Affiliation(s)
- Mansi Zied
- Department of Orthopedic Surgery, IBN EL JAZZAR University Hospital, Kairouan, Tunisia.
| | - Taghouti Mohamed
- Department of Orthopedic Surgery, IBN EL JAZZAR University Hospital, Kairouan, Tunisia
| | - Chneti Islem
- Department of Orthopedic Surgery, IBN EL JAZZAR University Hospital, Kairouan, Tunisia
| | - Chermiti Wajdi
- Department of Orthopedic Surgery, SAHLOUL University Hospital, Sousse, Tunisia
| | - Haggui Ali
- Department of Orthopedic Surgery, Hospital of Kasserine, Kasserine, Tunisia
| | - Zaidi Bacem
- Department of General Surgery, IBN EL JAZZAR University Hospital, Kairouan, Tunisia
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Mansi Z, Taghouti M, Chamakh M, Chneti I, Rbai H, Chermiti W, Haggui A, Zaidi B, Gazzah W. Vascular complications of tibial exostosis: A case of popliteal vein thrombosis. Radiol Case Rep 2024; 19:2781-2784. [PMID: 38680745 PMCID: PMC11046042 DOI: 10.1016/j.radcr.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/29/2024] [Accepted: 04/01/2024] [Indexed: 05/01/2024] Open
Abstract
Tibial exostosis, also known as osteochondroma, is a common benign bone tumor found predominantly in adolescents and young adults. Vascular complications associated with this tumor, such as arterial occlusion and pseudoaneurysm formation, are rare but can lead to significant morbidity if not promptly diagnosed and managed. We present a case of a 25-year-old patient who presented with thrombosis of the left popliteal vein and a painless swelling in the popliteal fossa. Radiographic and CT angiography revealed an exostosis on the proximal tibia causing arterial occlusion and venous compression. Surgical resection of the exostosis via a posterior knee approach resulted in successful resolution of symptoms and a favorable outcome at a 12-month follow-up. Histopathological examination confirmed the benign nature of the tumor with no evidence of malignant transformation. This case highlights the importance of prompt recognition and surgical intervention in managing vascular complications associated with tibial exostosis. A multidisciplinary approach involving orthopedic and vascular specialists is crucial for achieving optimal outcomes in such cases.
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Affiliation(s)
- Zied Mansi
- Department of Orthopedic Surgery, IBN EL JAZZAR University Hospital, Kairouan, Tunisia
| | - Mohamed Taghouti
- Department of Orthopedic Surgery, IBN EL JAZZAR University Hospital, Kairouan, Tunisia
| | - Mohsen Chamakh
- Department of Orthopedic Surgery, IBN EL JAZZAR University Hospital, Kairouan, Tunisia
| | - Islem Chneti
- Department of Orthopedic Surgery, IBN EL JAZZAR University Hospital, Kairouan, Tunisia
| | - Hedi Rbai
- Department of Orthopedic Surgery, IBN EL JAZZAR University Hospital, Kairouan, Tunisia
| | - Wajdi Chermiti
- Department of Orthopedic Surgery, SAHLOUL University Hospital, Sousse, Tunisia
| | - Ali Haggui
- Department of Orthopedic Surgery, Hospital of Kasserine, Kasserine, Tunisia
| | - Bacem Zaidi
- Department of General Surgery, IBN EL JAZZAR University Hospital, Kairouan, Tunisia
| | - Wael Gazzah
- Department of Urology, IBN EL JAZZAR University Hospital, Kairouan, Tunisia
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Sharma P, Bhrambhatt P, Kumar G, Saini M, Raj S. Osteochondroma With Odd Clinical and Radiological Presentation. Cureus 2024; 16:e65048. [PMID: 39165455 PMCID: PMC11335184 DOI: 10.7759/cureus.65048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2024] [Indexed: 08/22/2024] Open
Abstract
Osteochondroma is a cartilage-capped bony projection arising on the external surface of the bone, containing a marrow cavity continuous with that of the underlying bone. This benign tumor develops within the metaphysis of long bones. The growth is directed away from the growing end of long bones. We report a case of osteochondroma, also known as exostosis in a nine-year-old male child at the medial aspect of the right leg proximally. Marginal excision of the tumor was performed and sent for histopathological examination. The growth involved physis and epiphysis besides metaphysis and was directed toward the growing end of the tibia.
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Affiliation(s)
- Priyank Sharma
- Department of Orthopaedics, Jawaharlal Nehru Medical College, Ajmer, IND
| | - Purvesh Bhrambhatt
- Department of Orthopaedics, Jawaharlal Nehru Medical College, Ajmer, IND
| | - Gopal Kumar
- Department of Orthopaedics, Jawaharlal Nehru Medical College, Ajmer, IND
| | - Mahesh Saini
- Department of Orthopaedics, Jawaharlal Nehru Medical College, Ajmer, IND
| | - Sumit Raj
- Department of Orthopaedics, Jawaharlal Nehru Medical College, Ajmer, IND
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Heck HC, Poucke LV, Heck BE, Vasiloff J, Heck BE. Pedunculated Osteochondroma Presenting as Verruca Vulgaris: A Diagnosis Requiring a High Index of Suspicion: Case Report. J Orthop Case Rep 2024; 14:89-95. [PMID: 38910980 PMCID: PMC11189084 DOI: 10.13107/jocr.2024.v14.i06.4514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/04/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction Osteochondromas are the most common benign tumors of the bone and can be sessile or pedunculated. Although osteochondromas are typically seen in the long bones, they are rarely seen in the small bones of the hand or foot. Verruca vulgaris, also known as the common wart, is one of the most common skin conditions presenting to physicians and must be distinguished either clinically or histologically from other hyperkeratotic conditions, including bone conditions such as bone tumors that can place pressure on the skin and cause callus formation that can mimic a wart or create skin deformity. A high index of suspicion for underlying bone mass or tumor should be entertained when evaluating patients for skin conditions, particularly of the hand or foot, with failure to improve with treatment. Case Report This case report presents a 20-year-old male with a pedunculated osteochondroma of the left fourth distal phalanx with hyperkeratotic skin overlying the mass at the end of the toe. He was initially treated by a family doctor and podiatrist for verruca vulgaris for over 5 years with two treatments of liquid nitrogen cryotherapy and surgical excision of the mass when the treating podiatrist encountered bone and recommended radiographs. The family requested follow-up with our practice several days later after they were told the patient had a bone tumor. The patient requested surgical excision of the osteochondroma secondary to pain with activities and difficulties with his vocation as a pilot. Conclusion All physicians must be mindful of an underlying bone tumor or mass in patients presenting with skin changes, particularly about the foot or hand. Knowledge that an underlying bone tumor can present as a verruca vulgaris may prevent a delay in diagnosis or unnecessary treatment when evaluating and treating a patient with a skin lesion. Fortunately, our case was a benign osteochondroma; a malignant tumor with a delay in diagnosis could lead to loss of limb or life.
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Affiliation(s)
- Holly C Heck
- Department of Medicine College of Medicine and Life Sciences, University of Toledo College of Medicine, Toledo, Ohio, USA
| | - Logan Van Poucke
- Department of Medicine, College of Medicine, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Benjamin E Heck
- Department of Medicine College of Medicine and Life Sciences, University of Toledo College of Medicine, Toledo, Ohio, USA
| | - Joseph Vasiloff
- Department of Engineering Technologies, College of Technology and Applied Engineering, Bowling Green State University, Bowling Green, Ohio, USA
| | - Bruce E Heck
- Department of Orthopedic Surgery, University of Toledo Medical Center, Toledo, Ohio, USA
- Department of Orthopedic Surgery, Northwest Ohio Orthopedics and Sports Medicine, Findlay, Ohio, USA
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12
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Pisal T, Gurnani S, Kuity K. A Unique Presentation of Vertebral Body Osteochondroma of Sixth Cervical Spine Causing Myelopathic Symptoms: Management with En bloc Excision and Cervical Fusion. J Orthop Case Rep 2024; 14:35-39. [PMID: 38910983 PMCID: PMC11189065 DOI: 10.13107/jocr.2024.v14.i06.4494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/21/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction Vertebral body osteochondroma presenting with myelopathic symptoms is exceptionally rare entity of spinal osteochondroma which arises from the posterior surface of vertebral body and leading to spinal canal stenosis and cord compression. Early definitive diagnosis and subsequent successful treatment is necessary in such cases to prevent life threatening complications. Case Report In this context, we report a case of a 20-years old female presented with mechanical neck pain, unsteady gait, giddiness with neurological deficit for the past 3 months. An MRI of the cervical spine revealed a mass growing from the posterior aspect of the C6 vertebral body and extending toward the vertebral canal, causing marked spinal cord compression. Conclusion The following case report not only describes the rare presentations of vertebral body osteochondroma but also emphasizes on surgical management by en bloc resection of tumor and anterior cervical fusion, resulting in a favorable outcome without any recurrence.
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Affiliation(s)
- Tushar Pisal
- Department of Orthopaedic Surgery, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil University, Pimpri, Pune, Maharashtra, India
| | - Sagar Gurnani
- Department of Orthopaedic Surgery, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil University, Pimpri, Pune, Maharashtra, India
| | - Kaman Kuity
- Department of Orthopaedic Surgery, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil University, Pimpri, Pune, Maharashtra, India
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13
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Laitinen MK, Parry MC, Morris GV, Kurisunkal V, Stevenson JD, Jeys LM. Can the Cartilaginous Thickness Determine the Risk of Malignancy in Pelvic Cartilaginous Tumors, and How Accurate is the Preoperative Biopsy of These Tumors? Clin Orthop Relat Res 2024; 482:1006-1016. [PMID: 38901841 PMCID: PMC11124656 DOI: 10.1097/corr.0000000000003065] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 03/06/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Peripheral osteochondral tumors are common, and the management of tumors presenting in the pelvis is challenging and a controversial topic. Some have suggested that cartilage cap thickness may indicate malignant potential, but this supposition is not well validated. QUESTIONS/PURPOSES (1) How accurate is preoperative biopsy in determining whether a peripheral cartilage tumor of the pelvis is benign or malignant? (2) Is the thickness of the cartilage cap as determined by MRI associated with the likelihood that a given peripheral cartilage tumor is malignant? (3) What is local recurrence-free survival (LRFS), metastasis-free survival (MFS), and disease-specific survival (DSS) in peripheral chondrosarcoma of the pelvis and is it associated with surgical margin? METHODS Between 2005 and 2022, 289 patients had diagnoses of peripheral cartilage tumors of the pelvis (either pedunculated or sessile) and were treated at one tertiary sarcoma center (the Royal Orthopaedic Hospital, Birmingham, UK). These patients were identified retrospectively from a longitudinally maintained institutional database. Those whose tumors were asymptomatic and discovered incidentally and had cartilage caps ≤ 1.5 cm were discharged (95 patients), leaving 194 patients with tumors that were either symptomatic or had cartilage caps > 1.5 cm. Tumors that were asymptomatic and had a cartilage cap > 1.5 cm were followed with MRIs for 2 years and discharged without biopsy if the tumors did not grow or change in appearance (15 patients). Patients with symptomatic tumors that had cartilage caps ≤ 1.5 cm underwent removal without biopsy (63 patients). A total of 82 patients (63 with caps ≤ 1.5 cm and 19 with caps > 1.5 cm, whose treatment deviated from the routine at the time) had their tumors removed without biopsy. This left 97 patients who underwent biopsy before removal of peripheral cartilage tumors of the pelvis, and this was the group we used to answer research question 1. The thickness of the cartilage cap was recorded from MRI and measuring to the nearest millimeter, with measurements taken perpendicular in the plane that best allowed the greatest measurement. Patient survival rates were assessed using the Kaplan-Meier method with 95% confidence intervals as median observation times to estimate MFS, LRFS, and DSS. RESULTS Of malignant tumors biopsied, in 49% (40 of 82), the biopsy result was recorded as benign (or was considered uncertain regarding malignancy). A malignant diagnosis was correctly reported in biopsy reports in 51% (42 of 82) of patients, and if biopsy samples with uncertainty regarding malignancy were excluded, the biopsy identified a lesion as being malignant in 84% (42 of 50) of patients. The biopsy results correlated with the final histologic grade as recorded from the resected specimen in only 33% (27 of 82) of patients. Among these 82 patients, 15 biopsies underestimated the final histologic grade. The median cartilage cap thickness for all benign osteochondromas was 0.5 cm (range 0.1 to 4.0 cm), and the median cartilage cap thickness for malignant peripheral chondrosarcomas was 8.0 cm (range 3.0 to 19 cm, difference of medians 7.5 cm; p < 0.01). LRFS was 49% (95% CI 35% to 63%) at 3 years for patients with malignant peripheral tumors with < 1-mm margins, and LRFS was 97% (95% CI 92% to 100%) for patients with malignant peripheral tumors with ≥ 1-mm margins (p < 0.01). DSS was 100% at 3 years for Grade 1 chondrosarcomas, 94% (95% CI 86% to 100%) at 3 years for Grade 2 chondrosarcomas, 73% (95% CI 47% to 99%) at 3 and 5 years for Grade 3 chondrosarcomas, and 20% (95% CI 0% to 55%) at 3 and 5 years for dedifferentiated chondrosarcomas (p < 0.01). DSS was 87% (95% CI 78% to 96%) at 3 years for patients with malignant peripheral tumors with < 1-mm margin, and DSS was 100% at 3 years for patients with malignant peripheral tumors with ≥ 1-mm margins (p = 0.01). CONCLUSION A thin cartilage cap (< 3 cm) is characteristic of benign osteochondroma. The likelihood of a cartilage tumor being malignant increases after the cartilage cap thickness exceeds 3 cm. In our experience, preoperative biopsy results were not reliably associated with the final histologic grade or malignancy, being accurate in only 33% of patients. We therefore recommend observation for 2 years for patients with pelvic osteochondromas in which the cap thickness is < 1.5 cm and there is no associated pain. For patients with tumors in which the cap thickness is 1.5 to 3 cm, we recommend either close observation for 2 years or resection, depending on the treating physician's decision. We recommend excision in patients whose pelvic osteochondromas show an increase in thickness or pain, preferably before the cartilage cap thickness is 3 cm. We propose that surgical resection of peripheral cartilage tumors in which the cartilage cap exceeds 3 cm (aiming for clear margins) is reasonable without preoperative biopsy; the role of preoperative biopsy is less helpful because radiologic measurement of the cartilage cap thickness appears to be accurately associated with malignancy. Biopsy might be helpful in patients in whom there is diagnostic uncertainty or when confirming the necessity of extensive surgical procedures. Future studies should evaluate other preoperative tumor qualities in differentiating malignant peripheral cartilage tumors from benign tumors. LEVEL OF EVIDENCE Level III, diagnostic study.
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Affiliation(s)
- Minna K. Laitinen
- Department of Orthopedics and Traumatology, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
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14
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Boarini M, Tremosini M, Di Cecco A, Gnoli M, Brizola E, Mordenti M, Pedrini E, Locatelli M, Lanza M, Antonioli D, Gallone G, Rocca G, Staals EL, Trisolino G, Sangiorgi L. Health-related quality of life and associated risk factors in patients with Multiple Osteochondromas: a cross-sectional study. Qual Life Res 2024; 33:1323-1334. [PMID: 38457053 PMCID: PMC11045590 DOI: 10.1007/s11136-024-03604-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE To evaluate the health-related quality of life and associated risk factors for Multiple Osteochondromas patients. METHODS A cross-sectional, observational study was conducted from May to December 2022 during the routine visit to the referral center for rare skeletal disorders. All patients with Multiple Osteochondromas aged ≥ 3 years were included. EuroQol 5-dimension questionnaires, and demographic, clinical, and surgical history data were collected. Descriptive statistics, Fisher's exact test, One-sample t-test, Spearman's correlation, and multiple linear and logistic regression were performed to analyze the data. Results are reported following STROBE guidelines. RESULTS A total of 128 patients were included in the study, with a mean age of 14 [SD, 10] years. The mean EQ-5D Index Value was 0.863 [SD, 0.200] and the EQ-VAS was 84 [SD, 19] with a positive correlation between two scores [r = 0.541, p < 0.001]. Patients frequently referred problems in pain/discomfort [78.8%], anxiety/depression [50%], and usual activities [38.8%] dimensions. Increasing age was the common risk factor for health-related quality of life [p < 0.000], as well as Index Value and VAS scores were significantly lower in surgical patients [p = 0.001 and p < 0.001, respectively]. CONCLUSION Increasing age and surgical procedures were found highly associated with reduced health-related quality of life in Multiple Osteochondromas patients. Our findings provide relevant information to support the establishment of patient-centered healthcare pathways and pave the way for further research into medical and non-medical therapeutic strategies for these patients.
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Affiliation(s)
- Manila Boarini
- Department of Rare Skeletal Disorders, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Morena Tremosini
- Department of Rare Skeletal Disorders, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Alessia Di Cecco
- Department of Rare Skeletal Disorders, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Maria Gnoli
- Department of Rare Skeletal Disorders, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Evelise Brizola
- Department of Rare Skeletal Disorders, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Marina Mordenti
- Department of Rare Skeletal Disorders, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Elena Pedrini
- Department of Rare Skeletal Disorders, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Manuela Locatelli
- Department of Rare Skeletal Disorders, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy.
| | - Marcella Lanza
- Department of Rare Skeletal Disorders, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Diego Antonioli
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giovanni Gallone
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Gino Rocca
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Eric L Staals
- 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giovanni Trisolino
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Sangiorgi
- Department of Rare Skeletal Disorders, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
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15
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Xie V, Yan Y, Lu M, Perrin D, Garvin G, Stillwater L. Tibial osteochondroma with thick cartilage which mimicked a chondrosarcoma: A case report. Radiol Case Rep 2024; 19:1685-1691. [PMID: 38384709 PMCID: PMC10877103 DOI: 10.1016/j.radcr.2024.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/10/2024] [Accepted: 01/16/2024] [Indexed: 02/23/2024] Open
Abstract
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.
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Affiliation(s)
- Victoria Xie
- Department of Health Science, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Yi Yan
- Department of Diagnostic Radiology, University of Manitoba, Room O2055, St Boniface General Hospital, 409 Tache Avenue, Winnipeg, Manitoba R2H 2A6, Canada
- Department of Medical Imaging, St. Joseph's Health Care London, 268 Grosvenor St, London, Ontario N6A 4V2, Canada
| | - Miao Lu
- Department of Pathology, Rady Faculty of Health Sciences, University of Manitoba, 820 Sherbrook Street, Winnipeg, Manitoba R3A1R9, Canada
| | - David Perrin
- Department of Surgery, Section of Orthopedic Surgery, Max Rady College of Medicine Radiology, University of Manitoba. AD-401 820 Sherbrook Street, Winnipeg, Manitoba, Canada R3A 1R9
| | - Gregory Garvin
- Department of Medical Imaging, St. Joseph's Health Care London, 268 Grosvenor St, London, Ontario N6A 4V2, Canada
| | - Laurence Stillwater
- Department of Diagnostic Radiology, University of Manitoba, Room O2055, St Boniface General Hospital, 409 Tache Avenue, Winnipeg, Manitoba R2H 2A6, Canada
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16
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Katz A, Cohen J, Lishchynovska T, Alberton J, Peyser A. A unique presentation of the rare Nora's lesion, symptomatic bizarre parosteal osteochondromatous proliferation: A case report. SAGE Open Med Case Rep 2024; 12:2050313X241249608. [PMID: 38680596 PMCID: PMC11047234 DOI: 10.1177/2050313x241249608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 04/05/2024] [Indexed: 05/01/2024] Open
Abstract
Bizarre parosteal osteochondromatous proliferations, also known as Nora's lesions, are rare benign tumors with a high recurrence rate. They are often difficult to identify because of their similar appearance to other tumors. We describe a 25-year-old healthy female patient with bizarre parosteal osteochondromatous proliferations in an uncommon location on the pelvic ilium, presenting with unique clinical findings of abdominal pain and femoral paresthesia and showing atypical radiographic findings. To the best of our knowledge, this is one of the very few cases ever reported in the literature of Nora's lesion in this particular location and possibly the first case ever with this specific presentation. The lesions' radiographic images, combined orthopedic and general surgery procedures, and histological analysis are detailed. The patient's continued 4-year follow-up has demonstrated no symptoms or evidence of recurrence.
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Affiliation(s)
- Alan Katz
- Department of Orthopedic Surgery, Shaare Zedek Medical Center, The Hebrew University School of Medicine, Jerusalem, Israel
| | - Joshua Cohen
- Department of Orthopedic Surgery, Shaare Zedek Medical Center, The Hebrew University School of Medicine, Jerusalem, Israel
| | - Tanya Lishchynovska
- Department of Pathology, Shaare Zedek Medical Center, The Hebrew University School of Medicine, Jerusalem, Israel
| | - Joseph Alberton
- Surgical Hospitalization Department B, General Surgery, Shaare Zedek Medical Center, The Hebrew University School of Medicine, Jerusalem, Israel
| | - Amos Peyser
- Department of Orthopedic Surgery, Shaare Zedek Medical Center, The Hebrew University School of Medicine, Jerusalem, Israel
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17
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Patel R, Shames A, Sarkodieh J. Ultrasound features of benign paediatric lumps: radiology-pathology correlation. Clin Radiol 2024; 79:255-262. [PMID: 38320943 DOI: 10.1016/j.crad.2023.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 12/12/2023] [Accepted: 12/31/2023] [Indexed: 02/08/2024]
Abstract
Ultrasonography is an appropriate first-line imaging technique for the characterisation of paediatric lumps, given its relative accessibility and absence of radiation exposure. Together with a thorough history and examination, ultrasonography can help to distinguish benign lesions from malignancy. It can also aid further characterisation of benign lesions to inform onward investigation and management. This review features the evaluation of common benign paediatric lumps together with their characteristic sonographic features, following correlation with histopathology results or clinical follow-up.
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Affiliation(s)
- R Patel
- Whipps Cross Hospital, Barts Health NHS Trust, Whipps Cross Road, London, UK.
| | - A Shames
- Whipps Cross Hospital, Barts Health NHS Trust, Whipps Cross Road, London, UK
| | - J Sarkodieh
- Whipps Cross Hospital, Barts Health NHS Trust, Whipps Cross Road, London, UK
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18
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Dureja K, Suvarna PP, Sahu AK. Extensive Osteochondroma of the Talus Presenting As Syndesmotic Joint Extension and Posterior Inferior Tibiofibular Ligament Rupture: A Reportof a Rare Case and a Review of the Literature. Cureus 2024; 16:e55339. [PMID: 38559502 PMCID: PMC10981921 DOI: 10.7759/cureus.55339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2024] [Indexed: 04/04/2024] Open
Abstract
This case report describes a rare occurrence of talar osteochondroma extending into syndesmosis, causing disruption of the interosseous membrane and the posterior inferior tibiofibular ligament (PITFL). This type of presentation for a talar osteochondroma is the first of its kind reported in the literature based on current knowledge. A detailed preoperative radiological assessment was crucial in planning the surgical approach and preparing for syndesmotic stabilization during the excision. The patient underwent successful and complete excision of the osteochondroma, and the syndesmosis was stabilized using a cortical screw along with anatomical repair of the PITFL. Apart from delayed wound healing, the patient exhibited good functional outcomes in terms of gait and ankle range of motion at the six-month follow-up. This case serves as a valuable reference for similar presentations in the future, emphasizing the importance of thorough preoperative assessment and appropriate treatment planning.
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Affiliation(s)
- Kamal Dureja
- Department of Foot and Ankle Orthopedics, Max Smart Super Speciality Hospital, Saket, New Delhi, IND
| | - Pratheeksh P Suvarna
- Department of Foot and Ankle Orthopedics, Max Smart Super Speciality Hospital, Saket, New Delhi, IND
| | - Amit K Sahu
- Department of Radiology, Max Smart Super Speciality Hospital, Saket, New Delhi, IND
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Shao J, Lin H, Ding L, Li B, Xu D, Sun Y, Guan T, Dai H, Liu R, Deng D, Huang B, Feng S, Diao X, Gao Z. Deep learning for differentiation of osteolytic osteosarcoma and giant cell tumor around the knee joint on radiographs: a multicenter study. Insights Imaging 2024; 15:35. [PMID: 38321327 PMCID: PMC10847082 DOI: 10.1186/s13244-024-01610-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/21/2023] [Indexed: 02/08/2024] Open
Abstract
OBJECTIVES To develop a deep learning (DL) model for differentiating between osteolytic osteosarcoma (OS) and giant cell tumor (GCT) on radiographs. METHODS Patients with osteolytic OS and GCT proven by postoperative pathology were retrospectively recruited from four centers (center A, training and internal testing; centers B, C, and D, external testing). Sixteen radiologists with different experiences in musculoskeletal imaging diagnosis were divided into three groups and participated with or without the DL model's assistance. DL model was generated using EfficientNet-B6 architecture, and the clinical model was trained using clinical variables. The performance of various models was compared using McNemar's test. RESULTS Three hundred thirty-three patients were included (mean age, 27 years ± 12 [SD]; 186 men). Compared to the clinical model, the DL model achieved a higher area under the curve (AUC) in both the internal (0.97 vs. 0.77, p = 0.008) and external test set (0.97 vs. 0.64, p < 0.001). In the total test set (including the internal and external test sets), the DL model achieved higher accuracy than the junior expert committee (93.1% vs. 72.4%; p < 0.001) and was comparable to the intermediate and senior expert committee (93.1% vs. 88.8%, p = 0.25; 87.1%, p = 0.35). With DL model assistance, the accuracy of the junior expert committee was improved from 72.4% to 91.4% (p = 0.051). CONCLUSION The DL model accurately distinguished osteolytic OS and GCT with better performance than the junior radiologists, whose own diagnostic performances were significantly improved with the aid of the model, indicating the potential for the differential diagnosis of the two bone tumors on radiographs. CRITICAL RELEVANCE STATEMENT The deep learning model can accurately distinguish osteolytic osteosarcoma and giant cell tumor on radiographs, which may help radiologists improve the diagnostic accuracy of two types of tumors. KEY POINTS • The DL model shows robust performance in distinguishing osteolytic osteosarcoma and giant cell tumor. • The diagnosis performance of the DL model is better than junior radiologists'. • The DL model shows potential for differentiating osteolytic osteosarcoma and giant cell tumor.
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Affiliation(s)
- Jingjing Shao
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Hongxin Lin
- Medical AI Lab, School of Biomedical Engineering, Health Science Centre, Shenzhen University, Shenzhen, Guangdong, China
| | - Lei Ding
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Bing Li
- Medical AI Lab, School of Biomedical Engineering, Health Science Centre, Shenzhen University, Shenzhen, Guangdong, China
| | - Danyang Xu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yang Sun
- Department of Radiology, Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong, China
| | - Tianming Guan
- Department of Radiology, Hui Ya Hospital of The First Affiliated Hospital, Sun Yat-Sen University, Huizhou, Guangdong, China
| | - Haiyang Dai
- Department of Radiology, People's Hospital of Huizhou City Center, Huizhou, Guangdong, China
| | - Ruihao Liu
- Medical AI Lab, School of Biomedical Engineering, Health Science Centre, Shenzhen University, Shenzhen, Guangdong, China
| | - Demao Deng
- Department of Radiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Guanxi Academy of Medical Science, Nanning, Guangxi, China
| | - Bingsheng Huang
- Medical AI Lab, School of Biomedical Engineering, Health Science Centre, Shenzhen University, Shenzhen, Guangdong, China
| | - Shiting Feng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.
| | - Xianfen Diao
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Medicine, Shenzhen University, Shenzhen, Guangdong, China.
| | - Zhenhua Gao
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.
- Department of Radiology, Hui Ya Hospital of The First Affiliated Hospital, Sun Yat-Sen University, Huizhou, Guangdong, China.
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20
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Huang H, Zhang X, Wang Y, Tang H, Huang X, Zhang H, Li D. Popliteal artery pseudoaneurysm and secondary ipsilateral deep vein thrombosis caused by an exostosis in a mature adult. J Vasc Surg Cases Innov Tech 2024; 10:101375. [PMID: 38130363 PMCID: PMC10731611 DOI: 10.1016/j.jvscit.2023.101375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/06/2023] [Indexed: 12/23/2023] Open
Abstract
Exostosis (also known as osteochondroma) is the most common benign bony lump of young people, usually arising at the distal femur. Vascular complications associated with exostoses are rare and include true aneurysm or pseudoaneurysm formation, deep vein thrombosis, arteriovenous fistula, and arterial insufficiency of the limbs. Few case reports describe pseudoaneurysms resulting from exostoses in mature adults, and no consensus has been reached regarding the optimal therapy. We report the case of a 51-year-old male patient complaining of persistent right thigh pain with a pulsatile mass and right calf swelling, without a history of trauma or hereditary multiple exostoses. The diagnosis was confirmed by computed tomography angiography, which showed a pseudoaneurysm of the popliteal artery resulting from an exostosis on the lateral aspect of the distal femur. A Doppler ultrasound examination confirmed popliteal vein thrombosis caused by the compression of the pseudoaneurysm. Surgical treatment consisted of removing the exostosis, excision of the pseudoaneurysm, and an end-to-end anastomosis. The deep vein thrombosis was treated with rivaroxaban for 3 months. The patient was discharged after 6 days and followed up for 6 months with satisfactory results.
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Affiliation(s)
- He Huang
- Department of Vascular Surgery, The First People's Hospital of Lianyungang, Lianyungang, China
| | - Xiaosong Zhang
- Department of Vascular Surgery, The First People's Hospital of Lianyungang, Lianyungang, China
| | - Yusheng Wang
- Department of Vascular Surgery, The First People's Hospital of Lianyungang, Lianyungang, China
| | - Hao Tang
- Department of Vascular Surgery, The First People's Hospital of Lianyungang, Lianyungang, China
| | - Xiaoming Huang
- Department of Vascular Surgery, The First People's Hospital of Lianyungang, Lianyungang, China
| | - Honggang Zhang
- Department of Vascular Surgery, The First People's Hospital of Lianyungang, Lianyungang, China
| | - Da Li
- Department of Vascular Surgery, The First People's Hospital of Lianyungang, Lianyungang, China
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Skogsberg A, Downs A, Hoshaw R, Kiiza F, Garnett M. Delayed surgery of elbow Osteochondroma: A case of overcoming barriers in rural Uganda. Int J Surg Case Rep 2024; 115:109223. [PMID: 38244375 PMCID: PMC10831267 DOI: 10.1016/j.ijscr.2024.109223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/28/2023] [Accepted: 01/02/2024] [Indexed: 01/22/2024] Open
Abstract
INTRODUCTION Osteochondromas are the most common benign bone tumours in children. They typically manifest near the knee, proximal humerus, or distal femur. While often asymptomatic, they can lead to pain, functional impairments, deformities, and pathologic fractures. Involvement of the growth plates can result in severe deformities during childhood growth. CASE PRESENTATION A 15-year-old Ugandan female with no prior medical conditions presented to a mobile clinic with a mass on the left elbow. This mass showed a histopathologically confirmed case of osteochondroma. The distinctive aspect of this case is the location of the mass and the delay in patient care due to surgical inaccessibility and financial constraints, allowing a 13-year growth period for the mass. DISCUSSION While osteochondromas are benign, this mass's location and early onset warranted early biopsy and surgical excision to prevent future complications. The delay in care resulted in emotional distress, eliciting the patient's withdrawal from school and hindering her ability to fulfil culturally significant household duties in Uganda. Proximity to surgical care and cost are the most significant barriers in rural Uganda. CONCLUSION Following complete excision, the persistence of postoperative pain under heavy loads underscores the critical importance of early diagnosis and treatment in mitigating psychological trauma, anxiety, and discomfort associated with large masses.
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Affiliation(s)
- Amanda Skogsberg
- Pacific Northwest University of Health Sciences, 200 University Parkway Yakima, WA 98901, United States.
| | - Alex Downs
- Pacific Northwest University of Health Sciences, 200 University Parkway Yakima, WA 98901, United States
| | - Rebecca Hoshaw
- Pacific Northwest University of Health Sciences, 200 University Parkway Yakima, WA 98901, United States
| | - Frankline Kiiza
- Pacific Northwest University of Health Sciences, 200 University Parkway Yakima, WA 98901, United States
| | - Mike Garnett
- Pacific Northwest University of Health Sciences, 200 University Parkway Yakima, WA 98901, United States
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22
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Sampath K, Rajagopal S, Chintanpalli A. A comparative analysis of CNN-based deep learning architectures for early diagnosis of bone cancer using CT images. Sci Rep 2024; 14:2144. [PMID: 38273131 PMCID: PMC10811327 DOI: 10.1038/s41598-024-52719-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 01/23/2024] [Indexed: 01/27/2024] Open
Abstract
Bone cancer is a rare in which cells in the bone grow out of control, resulting in destroying the normal bone tissue. A benign type of bone cancer is harmless and does not spread to other body parts, whereas a malignant type can spread to other body parts and might be harmful. According to Cancer Research UK (2021), the survival rate for patients with bone cancer is 40% and early detection can increase the chances of survival by providing treatment at the initial stages. Prior detection of these lumps or masses can reduce the risk of death and treat bone cancer early. The goal of this current study is to utilize image processing techniques and deep learning-based Convolution neural network (CNN) to classify normal and cancerous bone images. Medical image processing techniques, like pre-processing (e.g., median filter), K-means clustering segmentation, and, canny edge detection were used to detect the cancer region in Computer Tomography (CT) images for parosteal osteosarcoma, enchondroma and osteochondroma types of bone cancer. After segmentation, the normal and cancerous affected images were classified using various existing CNN-based models. The results revealed that AlexNet model showed a better performance with a training accuracy of 98%, validation accuracy of 98%, and testing accuracy of 100%.
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Affiliation(s)
- Kanimozhi Sampath
- Department of Sensor and Biomedical Technology, School of Electronics Engineering, Vellore Institute of Technology, Vellore, 632014, India
| | - Sivakumar Rajagopal
- Department of Sensor and Biomedical Technology, School of Electronics Engineering, Vellore Institute of Technology, Vellore, 632014, India.
| | - Ananthakrishna Chintanpalli
- Department of Communication Engineering, School of Electronics Engineering, Vellore Institute of Technology, Vellore, 632014, India
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23
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Lixa J, Pinho A, Vieira P, Vieira da Silva N, Silva MR, Marques A, Veludo V. Medullary Compression by a Cervical Osteochondroma in a Patient with Multiple Hereditary Exostoses: A Case Report. JBJS Case Connect 2024; 14:01709767-202403000-00006. [PMID: 38207085 DOI: 10.2106/jbjs.cc.23.00429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
CASE A 19-year-old man with Multiple Hereditary Exostoses presented with cervical pain without neurological symptoms and/or signs. Magnetic resonance revealed a large C2 osteochondroma, occupying a part of the medullary canal. He was submitted to an en bloc resection with hemilaminectomy without fusion. At the 1-year follow-up, he presented resolution of pain and no neurological symptoms or signs, without cervical instability or radiological signs of disease recurrence. CONCLUSION Cervical osteochondroma is usually asymptomatic. Neurological compression and differentiation to chondrosarcoma are the main concerns. Surgical excision allows the local cure of the disease and is usually performed without fusion.
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Affiliation(s)
- João Lixa
- Department of Orthopedics and Traumatology, São João University Hospital Centre, Porto, Portugal
| | - André Pinho
- Department of Orthopedics and Traumatology, São João University Hospital Centre, Porto, Portugal
| | - Paula Vieira
- Department of Orthopedics and Traumatology, São João University Hospital Centre, Porto, Portugal
| | - Nuno Vieira da Silva
- Department of Orthopedics and Traumatology, Tâmega e Sousa Hospital Centre, Penafiel, Portugal
| | - Miguel Relvas Silva
- Department of Orthopedics and Traumatology, São João University Hospital Centre, Porto, Portugal
| | - Ana Marques
- Department of Anatomical Pathology, São João University Hospital Centre, Porto, Portugal
| | - Vitorino Veludo
- Department of Orthopedics and Traumatology, São João University Hospital Centre, Porto, Portugal
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24
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Solooki S, Yazdanpanah B, Akbarzadeh A. Management of Distal Tibial Interosseous Osteochondroma: A Case Series and Review of Literature. THE ARCHIVES OF BONE AND JOINT SURGERY 2024; 12:69-74. [PMID: 38318302 PMCID: PMC10838572 DOI: 10.22038/abjs.2023.73288.3395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/04/2023] [Indexed: 02/07/2024]
Abstract
The interosseous part of the distal tibia is one of the regions in which osteochondroma can occur. Osteochondroma typically occurs among growing children and causes gradual ankle deformity by its pressure effect on the fibula. We presented six patients (Five boys and one girl with median age of 13 years old) with distal tibial interosseous osteochondroma. They were treated by a 180̊ fibular osteotomy around its longitudinal axis just proximal and distal to the lesion. All patients were treated without any complication except for one who developed non-union of the site of the fibular osteotomy. In the last follow-up, all the patients were pain-free, and no recurrence was reported. Various methods have been described for resecting interosseous osteochondroma of the distal tibia, with or without fibular osteotomy and with or without acute correction of ankle deformity during resection surgery. Still, there is no consensus over the best method for resecting such lesions.
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Affiliation(s)
- Saeed Solooki
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bagher Yazdanpanah
- Department of Surgery, School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Armin Akbarzadeh
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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25
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Sood A, Naseri S, Parihar P, Mishra GV. Solitary ulnar diaphyseal osteochondroma in an early adolescent female. BMJ Case Rep 2023; 16:e258681. [PMID: 38081748 PMCID: PMC10728946 DOI: 10.1136/bcr-2023-258681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Affiliation(s)
- Anshul Sood
- Radiodiagnosis, Datta Meghe Institute of Higher Education & Research, Wardha, Maharashtra, India
| | - Suhit Naseri
- Pathology, Datta Meghe Institute of Medical Sciences-Wardha Campus, Wardha, India
| | - Pratapsingh Parihar
- Radiodiagnosis, Datta Meghe Institute of Higher Education & Research, Wardha, Maharashtra, India
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26
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Goel S, Dhaniwala N, Singh R, Suneja A, Jadawala VH. Exostosis of Ulna With Developmental Deformity of the Left Forearm: A Rare Case. Cureus 2023; 15:e50528. [PMID: 38226087 PMCID: PMC10788317 DOI: 10.7759/cureus.50528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 12/14/2023] [Indexed: 01/17/2024] Open
Abstract
This case report presents a rare occurrence of exostosis of the ulna associated with a developmental deformity of the left forearm in a 15-year-old female. The patient reported a history of trauma resulting in a supracondylar humerus fracture managed conservatively eight years prior. The patient presented with a two-year history of pain and swelling over the left forearm. Clinical examination revealed a firm, non-tender, immobile swelling closely associated with the ulna, accompanied by a 20-degree cubitus varus deformity and forearm shortening. Radiographs and computed tomography scans confirmed the presence of a solitary external bony protuberance over the ulna shaft, communicating with the medullary cavity. A preliminary diagnosis of osteochondroma was established based on clinical and imaging findings. The patient underwent extraperiosteal en bloc resection of the lesion under supraclavicular nerve block anesthesia. A histopathological examination confirmed the diagnosis. Postoperative physiotherapy was initiated, and at the one-month follow-up, the patient reported being pain-free. This case highlights the rarity of exostosis of the ulna with associated developmental deformity, emphasizing the importance of a comprehensive diagnostic approach. Early surgical intervention resulted in a successful outcome, underscoring the significance of timely management in improving patient outcomes and quality of life.
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Affiliation(s)
- Sachin Goel
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nareshkumar Dhaniwala
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Rahul Singh
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anmol Suneja
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Vivek H Jadawala
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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27
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Dhungel D, Rastogi V, Maddheshiya N, Chaurasia S, Ramalingam K. Osteochondroma of the Mandibular Condyle: A Rare Case Presentation With Literature Review. Cureus 2023; 15:e50355. [PMID: 38213345 PMCID: PMC10781615 DOI: 10.7759/cureus.50355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 01/13/2024] Open
Abstract
Osteochondromas (OCs) are benign bone tumors characterized by their growth with a cartilage cap and typically occurring at the ends of long bones. Their occurrence in the head and neck region is infrequent, accounting for only around 1% of head and neck tumors. Notably, the mandibular coronoid process and the mandibular condyle are the primary sites where an OC is reported. Patients often exhibit facial asymmetry, limited mouth opening, and malocclusion. Possible treatment options depending on the condition include partial or total condylectomy, vertical ramus osteotomy, and supplementary orthognathic surgery. The recurrence rate of under 1%- 2% is reported after local resection. In this case report, we present a unique case of an OC in a 27-year-old woman. It involved the mandibular condyle, resulting in a left-sided mouth deviation while opening and closing her mouth. The purpose of this article is to detail the clinical and radiographic features, histopathological aspects, and treatment strategies and differentiate potential diagnoses, for such OCs.
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Affiliation(s)
- Dilasha Dhungel
- Department of Oral Pathology, Universal College of Medical Sciences and Teaching Hospital, Bhairahawa, NPL
| | - Varun Rastogi
- Department of Oral Pathology, Universal College of Medical Sciences and Teaching Hospital, Bhairahawa, NPL
| | - Nisha Maddheshiya
- Department of Oral Medicine and Radiology, Faculty of Medical Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Sandhya Chaurasia
- Department of Oral Pathology, Universal College of Medical Sciences and Teaching Hospital, Bhairahawa, NPL
| | - Karthikeyan Ramalingam
- Department of Oral Pathology and Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
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28
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Pontes ÍCDM, Leão RV, Lobo CFT, Paula VT, Yamachira VS, Baptista AM, Helito PVP. Imaging of solitary and multiple osteochondromas: From head to toe - A review. Clin Imaging 2023; 103:109989. [PMID: 37778187 DOI: 10.1016/j.clinimag.2023.109989] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/05/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023]
Abstract
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.
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Affiliation(s)
- Írline Cordeiro de Macedo Pontes
- Radiology Department, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, R. Ovidio Pires de Campos, 65 São Paulo, Brazil
| | - Renata Vidal Leão
- Radiology Department, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, R. Ovidio Pires de Campos, 65 São Paulo, Brazil; Radiology Department, Hospital Sírio-Libanês, R Adma Jafet, 101 São Paulo, Brazil.
| | - Carlos Felipe Teixeira Lobo
- Radiology Department, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, R. Ovidio Pires de Campos, 65 São Paulo, Brazil
| | - Vitor Tavares Paula
- Radiology Department, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, R. Ovidio Pires de Campos, 65 São Paulo, Brazil
| | - Viviane Sayuri Yamachira
- Radiology Department, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, R. Ovidio Pires de Campos, 65 São Paulo, Brazil; Radiology Department, Hospital Sírio-Libanês, R Adma Jafet, 101 São Paulo, Brazil
| | - Andre Mathias Baptista
- Institute of Orthopaedics and Traumatology, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Paulo Victor Partezani Helito
- Radiology Department, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, R. Ovidio Pires de Campos, 65 São Paulo, Brazil; Radiology Department, Hospital Sírio-Libanês, R Adma Jafet, 101 São Paulo, Brazil
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29
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Graham P. Osteochondroma of Tibia. Orthop Nurs 2023; 42:398-400. [PMID: 37989161 DOI: 10.1097/nor.0000000000000990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Affiliation(s)
- Patrick Graham
- Patrick Graham, MSN, RN, APRN/ANP-BC, Banner University Medical Center Tuscon, Tuscon, AZ
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30
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Alghamdi FA, Aljabri NK, Jafar HM, Almatari AH, Bajuifer SA. Solitary Osteochondroma at Unusual Sites: A Case Report and Literature Review. Cureus 2023; 15:e49582. [PMID: 38156180 PMCID: PMC10754374 DOI: 10.7759/cureus.49582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 12/30/2023] Open
Abstract
Osteochondromas (OCs) are bone lesions composed of cartilaginous and medullary bone capped with hyaline cartilage. OCs result from the separation of epiphyseal growth plate cartilage, pushing through the periosteal bone cuff. They commonly appear as pedunculated or sessile masses in the metaphysis of long bones and are the most common benign bone tumors. While rare in the scapula, OCs can occur there. Symptoms may arise from fractures, osseous abnormalities, or potential malignant transformation, especially in the presence of hereditary multiple exostoses (HME). The estimated rate of malignant transformation in solitary lesions is 1%, whereas in hereditary multiple OCs, it can reach up to 3-5%. We report a case of a 10-year-old female who presented with a gradually progressive swelling on the back of her right scapula. This progressive growth has been observed over the course of the past two years accompanied by mild pain. The pain was intermittent and did not affect her daily activities. On examination, a hard, tender, non-mobile swelling of approximately 2 × 2 cm was found over the right scapula. The patient had a normal range of motion in the shoulder and scapulothoracic regions. In conclusion, since solitary scapular OCs are extremely rare, they are quite common when associated with HME. This study aimed to increase awareness of the unusual site of OCs. Furthermore, we have included a full account of the surgical therapy we administered to this patient in order to assist future surgeons who may come across similar conditions.
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Affiliation(s)
| | | | - Hasan M Jafar
- Orthopedic Surgery, Al-Noor Specialist Hospital, Makkah, SAU
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31
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Leveille CF, Zhu XM, Chen J, Burrow SR, Wang Y, Tarnopolsky M, Barkho JO. Pediatric Peroneal Nerve Palsy Secondary to Fibular Osteochondroma. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202310000-00005. [PMID: 37856702 PMCID: PMC10589584 DOI: 10.5435/jaaosglobal-d-23-00123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/21/2023] [Indexed: 10/21/2023]
Abstract
Peripheral nerve injuries due to mass effect from bony lesions can occur when the nerve exists in an anatomically constrained location, such as the common peroneal nerve at the fibular head which passes into the tight fascia of the lateral leg compartment. We report a case of a pediatric patient who developed a common peroneal nerve palsy secondary to an osteochondroma of the fibular head and describe the clinical evaluation, radiographic findings, and surgical approach. Rapid diagnosis and nerve decompression after the onset of symptoms restored full motor function at the 8-month postoperative mark.
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Affiliation(s)
- Cameron F Leveille
- From the Department of Surgery, Division of Plastic Surgery (Dr. Leveille, Dr. Zhu, Dr. Barkho), the Michael G. DeGroote School of Medicine (Mr. Chen), the Department of Pediatric Orthopedic Surgery (Dr. Burrow), the McMaster Children's Hospital (Dr. Burrow, Dr. Barkho, and Dr. Tarnopolsky), the Department of Pediatric Radiology, McMaster Children's Hospital (Dr. Wang), McMaster University, Hamilton, Ontario
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32
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Du X, Xia A, Sun J, Ye Y. Localized tenosynovial giant cell tumor in children. J Child Orthop 2023; 17:420-427. [PMID: 37799313 PMCID: PMC10549694 DOI: 10.1177/18632521231186795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/01/2023] [Indexed: 10/07/2023] Open
Abstract
Background To investigate the clinical characteristics and surgical efficacy of localized tenosynovial giant cell tumors in children. Methods The clinical data, surgery, and follow-up results of 17 children with localized tenosynovial giant cell tumors who visited our hospital from 2011 to 2021 were collected for statistical analysis. Results The median patient age was 7 years and 8 months, and the ratio of males to females was 1.43 (10/7). The predilection of disease was similar in hands and feet, and the common presenting symptom was mass. One patient experienced recurrence after surgery, and one child had postoperative functional limitations. Conclusion Extremities are common sites of localized tenosynovial giant cell tumors in children. Complete surgical resection helps reduce the recurrence rate. Level of evidence Level III.
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Affiliation(s)
| | - Anning Xia
- Anning Xia, Department of Orthopedics, Shenzhen Children’s Hospital, No. 7019 Yitian Road, Futian District, Shenzhen 518000, Guangdong, China.
| | - Junying Sun
- Department of Orthopedics, Shenzhen Children’s Hospital, Shenzhen, China
| | - Yinting Ye
- Department of Orthopedics, Shenzhen Children’s Hospital, Shenzhen, China
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33
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Morales LC, Cardona Ortegón JD, Pinzón Valderrama BA, Jiménez Uribe AM, Mora Bendeck NG, Fierro Ávila F. Osteochondroma of the Rib: A Potentially Life-Threatening Benign Tumor. Cureus 2023; 15:e45449. [PMID: 37859900 PMCID: PMC10583481 DOI: 10.7759/cureus.45449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
Osteochondroma is the most common benign bone tumor. It can be classified as isolated or multiple. While the majority of osteochondromas are asymptomatic and found incidentally, they can become symptomatic during adolescence or adulthood due to mechanical irritation, nerve compression, spinal cord compression, or vascular injury. In this article, we present a case of a 14-year-old patient who experienced spontaneous hemothorax caused by bleeding from a diaphragmatic laceration incurred by a costal exostosis on the right eighth rib. A preoperative chest CT scan revealed a bony projection from the rib and bloody effusion in the thoracic cavity, highlighting the possibility of bloody pleural effusion due to costal exostosis. It is important to note that costal osteochondromas are a rare cause of thoracic injury and can lead to laceration of the lung, diaphragm, and/or pericardium. Surgical intervention should be considered for symptomatic rib osteochondroma, and we advocate for prophylactic surgical removal of intrathoracic exostosis even in asymptomatic patients, in order to prevent potential complications.
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Affiliation(s)
- Laura C Morales
- Radiology, University Hospital Fundación Santa Fe de Bogotá, Bogotá, COL
| | | | | | - Ana M Jiménez Uribe
- Pediatric Surgery, University Hospital Fundación Santa Fe de Bogotá, Bogotá, COL
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34
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Ariyaratne S, Jenko N, Iyengar KP, James S, Mehta J, Botchu R. Primary Benign Neoplasms of the Spine. Diagnostics (Basel) 2023; 13:2006. [PMID: 37370901 DOI: 10.3390/diagnostics13122006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/30/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Benign tumours comprise the majority of primary vertebral tumours, and these are often found incidentally on imaging. Nonetheless, accurate diagnosis of these benign lesions is crucial, in order to avoid misdiagnosis as more ominous malignant lesions or infection. Furthermore, some of these tumours, despite their benign nature, can have localised effects on the spine including neural compromise, or can be locally aggressive, thus necessitating active management. Haemangiomas and osteomas (enostosis) are the commonest benign tumours encountered. Others include osteoid osteoma, osteoblastoma, fibrous dysplasia, osteochondroma, chondroblastoma, haemangioma, simple bone cysts, aneurysmal bone cysts, giant cell tumours, eosinophilic granuloma and notochordal rests. The majority of lesions are asymptomatic; however, locally aggressive lesions (such as aneurysmal bone cysts or giant cell tumours) can present with nonspecific symptoms, such as back pain, neurological deficits and spinal instability, which may be indistinguishable from more commonly encountered mechanical back pain or malignant lesions including metastases. Hence, imaging, including radiography, computed tomography (CT) and magnetic resonance imaging (MRI), plays a critical role in diagnosis. Generally, most incidental or asymptomatic regions are conservatively managed or may not require any follow-up, while symptomatic or locally aggressive lesions warrant active interventions, which include surgical resection or percutaneous treatment techniques. Due to advances in interventional radiology techniques in recent years, percutaneous minimally invasive techniques such as radiofrequency ablation, sclerotherapy and cryoablation have played an increasing role in the management of these tumours with favourable outcomes. The different types of primary benign vertebral tumours will be discussed in this article with an emphasis on pertinent imaging features.
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Affiliation(s)
- Sisith Ariyaratne
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham B31 2AP, UK
| | - Nathan Jenko
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham B31 2AP, UK
| | - Karthikeyan P Iyengar
- Department of Orthopedics, Southport and Ormskirk Hospital NHS Trust, Southport PR8 6PN, UK
| | - Steven James
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham B31 2AP, UK
| | - Jwalant Mehta
- Department of Spinal Surgery, Royal Orthopedic Hospital, Birmingham B31 2AP, UK
| | - Rajesh Botchu
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham B31 2AP, UK
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35
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Futani H, Kawaguchi T, Sawai T, Tachibana T. Treatment Strategy of Fractured Osteochondroma in the Young Athlete's Knee. J Clin Med 2023; 12:jcm12113615. [PMID: 37297809 DOI: 10.3390/jcm12113615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/21/2023] [Accepted: 05/07/2023] [Indexed: 06/12/2023] Open
Abstract
Purpose: The main purpose of this study was to compare the clinical outcome of surgery versus observation in young athletes with fractured osteochondromas in the knee. The secondary aim was to evaluate displacement versus non-displacement fractures with regards to functional recovery. Methods: A retrospective analysis was performed in young athletes with fractures of osteochondromas in the knee. In the surgery group, resection of the osteochondromas was performed due to pain persisting at 4 weeks after injury. In contrast, patients with pain diminishing within 4 weeks after injury were observed without surgery. Displacement was defined as a gap widening of ≥1 mm between fragments, or translation of >50% of the distal fragment in relation to the proximal fragment. The time to return to the original sport was compared between groups. Results: The study sample was composed of 21 patients with a mean age of 12 years (range 9-16 years). There were 14 patients in the surgery group and 7 patients in the observation group. There were 10 patients (71%) with displacement and 4 patients (29%) with non-displacement fractures in the surgery group. Surgery was required more frequently in displacement than in non-displacement fracture patients (p = 0.01). The mean time to return to the original sport was 2.1 ± 1.1 and 7.2 ± 4.1 weeks in the surgery and observation groups, respectively (p < 0.01). Conclusions: Surgical excision is preferable in a young athlete's knee presenting with displacement of fractured osteochondromas due to disabling symptoms and in order to allow them to return faster to original sports activities.
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Affiliation(s)
- Hiroyuki Futani
- Department of Orthopaedic Surgery, Hyogo Medical University, 1-1 Mukogawa Nishinomiya, Hyogo 663-8501, Japan
| | - Takayuki Kawaguchi
- Department of Orthopaedic Surgery, Hyogo Medical University, 1-1 Mukogawa Nishinomiya, Hyogo 663-8501, Japan
| | - Tatsuo Sawai
- Department of Orthopaedic Surgery, Hyogo Medical University, 1-1 Mukogawa Nishinomiya, Hyogo 663-8501, Japan
| | - Toshiya Tachibana
- Department of Orthopaedic Surgery, Hyogo Medical University, 1-1 Mukogawa Nishinomiya, Hyogo 663-8501, Japan
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36
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Laliotis N, Konstantinidis P, Chrysanthou C, Zarampoukas T. Solitary Extraskeletal Giant Osteochondroma of the Ankle in a Four-Year-Old Boy. Cureus 2023; 15:e39442. [PMID: 37362493 PMCID: PMC10289278 DOI: 10.7759/cureus.39442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 06/28/2023] Open
Abstract
Solitary extraskeletal osteochondromas are rare benign lesions usually located close to a joint and are characterized by the absence of continuity with the adjacent bone. They are usually found in the hand and feet and are extremely rarely reported in the growing skeleton. In this paper, we describe a four-year-old boy who presented with a solitary calcified tumor in the posterior part of his ankle. We performed a detailed evaluation using plain X-rays, a CT scan, and an MRI, which revealed a well-demarcated calcified tumor that had the characteristics of an osteochondroma but without any continuity with the bones of the ankle joint. The lesion was treated surgically with the excision of a giant osteochondral lesion. Pathological examination revealed mature cartilage at the periphery with cancellous bone in the central part. Thus, we present the clinical and laboratory investigation of a solitary extraskeletal osteochondroma in the ankle of a four-year-old boy, which is an extremely rare case.
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Affiliation(s)
| | | | - Chrysanthos Chrysanthou
- Orthopaedics, Interbalkan Medical Center, Thessaloniki, GRC
- Anatomy and Surgical Anatomy, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Thomas Zarampoukas
- Pathology and Laboratory Medicine, Interbalkan Medical Center, Thessaloniki, GRC
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Riccomi G, Aringhieri G, Serritella A, Giuffra V. Solitary osteochondromas in paleo-oncology: A case report from 4th-century BCE Pontecagnano (southern Italy). INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2023; 41:101-109. [PMID: 37075693 DOI: 10.1016/j.ijpp.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 04/08/2023] [Accepted: 04/09/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE This study presents a new case of solitary osteochondroma (SOC) identified on the proximal tibia of a 4th-century BCE individual from Pontecagnano (Salerno, Italy) with an aim to contribute to differential diagnosis of bone tumors in archeological contexts. MATERIALS Paleopathological assessment of a male individual with an estimated age-at death of 45.9-62.9 years brought to light during the archaeological excavations in the funerary sector of 'Sica de Concillis' within the necropolis of Pontecagnano. METHODS Macroscopic and radiographic analyses were performed for diagnostic purposes. RESULTS The proximal portion of the right tibia exhibited a large exophytic bone formation extending from the anteromedial to the posteromedial portion of the diaphysis. The x-ray confirmed the lesion being characterized by regular trabecular bone tissue with cortico-medullary continuity. CONCLUSIONS The lesion observed is diagnostic of sessile SOC, a neoplasm that must have had aesthetic and, possibly, neurovascular complications due to its large size. SIGNIFICANCE By offering a detailed description of a case of tibial osteochondroma and discussing the possible complications the individual might have experienced during life, this study highlights the role and importance of benign bone tumors in paleo-oncology. LIMITATIONS Histological analysis was not carried out in order to preserve the integrity of the affected tibia. SUGGESTIONS FOR FURTHER RESEARCH More attention should be devoted to benign tumors in paleopathology as their occurrence and manifestations in the past will lead to a better understanding of their impacts on the quality of life of affected individuals and to greater knowledge of their natural history.
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Affiliation(s)
- Giulia Riccomi
- Division of Paleopathology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy.
| | - Giacomo Aringhieri
- Diagnostic and Interventional Radiology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Antonia Serritella
- Dipartimento di Scienze del Patrimonio Culturale, University of Salerno, Italy
| | - Valentina Giuffra
- Division of Paleopathology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
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Benign Bone Lesions Found in Childhood. Orthop Clin North Am 2023; 54:59-74. [PMID: 36402511 DOI: 10.1016/j.ocl.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Benign bone tumors are a wide variety of usually asymptomatic neoplasms, which in most cases are diagnosed due to secondary causes. As such, their real incidence is unknown. In the majority of cases, plain radiographs are enough for diagnosis; more advanced imaging, such as CT scan or MRI is sometimes performed for equivocal lesions. Treatment approach depends on whether the lesion is symptomatic and the risk of further progression, or development of secondary malignancies. When non expectant management is decided, treatment options include minimally invasive methods and surgery.
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Adachi R, Nakamura T, Asanuma K, Hagi T, Uchiyama T, Sudo A. Thin Cartilage Cap May Be Related to the Spontaneous Regression in Pediatric Patients with Osteochondroma. Curr Oncol 2022; 29:9884-9890. [PMID: 36547191 PMCID: PMC9777135 DOI: 10.3390/curroncol29120777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/10/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The spontaneous regression of osteochondromas is rare, and only a few cases have been reported. Furthermore, the precise mechanism underlying spontaneous regression is unknown. This study aimed to examine the radiological findings of osteochondromas that had spontaneous regression and to identify potential indicators of this uncommon phenomenon in skeletally immature patients with osteochondromas. METHODS We included 28 patients (15 males and 13 females) who met the eligibility criteria between 2002 and 2019. The mean age at initial diagnosis was 9.7 years old (2-16 years). The mean follow-up period was 6.4 years (3-16 years). RESULTS Of the 28 patients, 10 (35.7%) had osteochondroma resolution. The osteochondroma resolved in one patient and regressed in nine. Tumor shrinkage is related to the thickness of the cartilage cap. The thickness of the cartilage cap did not correlate with age. CONCLUSIONS Tumor shrinkage is associated with a thinner cartilage cap on magnetic resonance imaging. The thickness of the cartilage cap may be an important predictor of spontaneous regression in pediatric patients with osteochondroma.
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Trager RJ, Prosak SE, Getty PJ, Barger RL, Saab ST, Dusek JA. Ischial osteochondroma as an unusual source of pregnancy-related sciatic pain: a case report. Chiropr Man Therap 2022; 30:45. [PMID: 36253863 PMCID: PMC9575271 DOI: 10.1186/s12998-022-00451-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/23/2022] [Accepted: 09/07/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND While most cases of sciatica result from degenerative conditions of the low back, some cases result from conditions of the hip and pelvic region. Sciatica developing in relation to pregnancy or labor also presents unique considerations. CASE PRESENTATION A 37-year-old African American woman with a history of hypertension and polycystic ovary syndrome presented to a chiropractor at a hospital-based outpatient clinic with a seven-week history of low back pain with radiation into the right lower extremity which began during labor. The chiropractor performed a brief trial of care, yet when the patient's symptoms worsened, ordered lumbar spine radiographs, followed by lumbar magnetic resonance imaging (MRI), which were both normal. The chiropractor then ordered hip radiographs, which were suggestive of ischial osteochondroma, and referred the patient to an orthopedic oncologist. MRI findings were compatible with an osteochondroma with associated adventitial bursitis and mass effect on the sciatic nerve. The patient initially chose conservative management with bursa aspiration and therapeutic injection. Despite initial relief, there was eventual return of symptoms. The patient elected to undergo surgical removal, with a positive outcome. CONCLUSION The key distinguishing features that led to a diagnosis of osteochondroma in this case included attention to the patient-reported symptoms and history, worsening of symptoms despite conservative care, and lack of explanatory findings on lumbar imaging. This case highlights the benefit of evaluating the hip and pelvis when the clinical features of sciatica cannot be ascribed to a lumbar etiology. This case also illustrates the role of a chiropractor working in an integrative health system to facilitate timely imaging and referrals to resolve a challenging diagnosis.
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Affiliation(s)
- Robert J. Trager
- grid.443867.a0000 0000 9149 4843Connor Whole Health, University Hospitals Cleveland Medical Center, 44106 Cleveland, OH USA
| | - Sarah E. Prosak
- grid.443867.a0000 0000 9149 4843Connor Whole Health, University Hospitals Cleveland Medical Center, 44106 Cleveland, OH USA
| | - Patrick J. Getty
- grid.443867.a0000 0000 9149 4843Musculoskeletal Surgical Oncology, University Hospitals Cleveland Medical Center, 44106 Cleveland, OH USA ,grid.67105.350000 0001 2164 3847Orthopaedic Surgery, Case Western Reserve University, 44106 Cleveland, OH USA
| | - Richard L. Barger
- grid.443867.a0000 0000 9149 4843Division of Musculoskeletal Radiology, University Hospitals Cleveland Medical Center, 44106 Cleveland, OH USA
| | - Shahrazad T. Saab
- grid.67105.350000 0001 2164 3847Department of Pathology, Case Western Reserve University School of Medicine, 44106 Cleveland, OH USA
| | - Jeffery A. Dusek
- grid.443867.a0000 0000 9149 4843Connor Whole Health, University Hospitals Cleveland Medical Center, 44106 Cleveland, OH USA ,grid.67105.350000 0001 2164 3847Department of Family Medicine and Community Health, School of Medicine, Case Western Reserve University, 44106 Cleveland, OH USA
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Teodoreanu RN, Grosu-Bularda A, Liţă FF, Hodea FV, Enache V, Frunză A, Lăzărescu AL, Muraru D, Lascăr I, Hariga CS. Benign cartilaginous tumors of the hand, a five-year retrospective study. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2022; 63:625-632. [PMID: 36808197 PMCID: PMC10026922 DOI: 10.47162/rjme.63.4.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Benign and malignant cartilaginous bone tumors of the hand are rare findings, however representing a particular pathology due to the capacity to induce significant functional impairment. Even though a large proportion of tumors of the hand and wrist are benign, these may present destructive characteristics, deforming adjacent structures until compromising function. The most appropriate surgical approach for most benign tumors is intralesional lesion resection. Malignant tumors often require wide excision, up to segment amputation to obtain tumor control. A five-year retrospective study was performed on patients admitted in our Clinic with benign cartilaginous tumors of the hand, in which 15 patients were admitted within this period, 10 presenting with enchondroma, four presenting with osteochondroma, and lastly one with chondromatosis. After clinical and imaging evaluation, all the aforementioned tumors were surgically removed. Definitive diagnosis for all bone tumors, either benign or malignant, was established by tissue biopsy and histopathological examination, dictating therapeutic strategy.
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Affiliation(s)
- Răzvan Nicolae Teodoreanu
- Clinic of Plastic Surgery and Reconstructive Microsurgery, Emergency Clinical Hospital Bucharest, Romania;
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Muacevic A, Adler JR. Osteochondroma of the Scapula: A Case Report and Literature Review. Cureus 2022; 14:e30558. [PMID: 36311482 PMCID: PMC9595258 DOI: 10.7759/cureus.30558] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2022] [Indexed: 11/05/2022] Open
Abstract
Osteochondromas are bone lesions composed of medullary and cartilaginous bone covered by a cap of hyaline cartilage. The presence of medullary and cortical bone with the continuity of the tumor is pathognomonic for osteochondroma and aid in establishing the diagnosis. We report a case of a two-year-old girl who presented to our clinic following her mother noticing a palpable, growing, and painful mass on her left scapula. There was no limitation in the range of motion. A clear-cut mass was seen on the dorsal aspect and palpated measuring around 2.5x3 cm. Surgical excision of the mass followed by histologic examination confirmed osteochondroma. Upon follow-up, the patient had no pain and had a full range of left shoulder motion without discomfort or pain. In conclusion, scapular exostoses are very rare and more so when they present dorsally. Symptomatic lesions can be managed effectively with surgical excision of exostosis.
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Ma Z, Yang Q, Liu X, Li Z. Application of allograft and absorbable screws in the reconstruction of a massive bone defect following resection of giant osteochondroma: A retrospective study. Front Surg 2022; 9:938750. [PMID: 36211287 PMCID: PMC9535078 DOI: 10.3389/fsurg.2022.938750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 08/29/2022] [Indexed: 11/19/2022] Open
Abstract
Background This study aims to introduce a reconstruction method of applying allografts and absorbable screws to repair large bone defects caused by the resection of giant osteochondroma. Methods A retrospective study of a series of patients who underwent the resection of giant osteochondroma reconstructed by allografts and absorbable screws was conducted from February 2020 to September 2021. Their demographic data, location site, area of bone defect, and pertinent operative details were recorded. The reconstruction modality of allografts was elaborated on. In the follow-up, radiographic images were utilized to determine bone union, and the Musculoskeletal Tumor Society score was used to evaluate postoperative limb function. Results A total of seven patients were included, including three males and four females with an average age of 16.6 ± 6.5 years. Among them, three cases of tumors occurred in the humerus and four cases occurred in the femur. The average follow-up time was 11.3 ± 3.0 months. The average area of bone defect was 25.9 ± 8.3 cm2. No complications such as infection, nonunion, and allograft bone fracture were found during the follow-up period. Six months after the operation, the average Musculoskeletal Tumor Society score was 26.4 ± 1.6, with acceptable postoperative function. Conclusions The cooperative application of absorbable screw fixation and allografts including mixed cortical bone and cancellous bone, which yielded satisfactory functional outcomes and acceptable postoperative complications, is an effective reconstruction method for a massive bone defect after the resection of giant osteochondroma.
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Affiliation(s)
| | | | - Xinyu Liu
- Correspondence: Zhenfeng Li Xinyu Liu
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Pan R, Lu X, Wang Z, Duan L, Cao D. Hemothorax caused by costal exostosis injuring diaphragm: a case report and literature review. J Cardiothorac Surg 2022; 17:230. [PMID: 36068632 PMCID: PMC9450418 DOI: 10.1186/s13019-022-01984-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/26/2022] [Indexed: 11/25/2022] Open
Abstract
Background Osteochondromas, also known as exostoses, are the most common benign tumors of bone and can be classified into isolated and multiple osteochondromas. A great majority of osteochondromas is asymptomatic, painless, slow-growing mass, and incidentally found. However, osteochondromas occurring in adolescence or in adult patients can grow in size and become symptomatic as a result of mechanical irritation of the surrounding soft tissues or peripheral nerves, spinal cord compression, or vascular injury. Case presentation We present a case of a 13-year-old girl with spontaneous hemothorax, the cause of which was identified by limited thoracotomy with the aid of video-assisted thoracic surgery to be bleeding from a diaphragmatic laceration incurred by a costal exostosis on the left sixth rib. Preoperative chest computed tomography (CT) depicted a bony projection arising from the rib and bloody effusion in the intrathoracic cavity, but was unable to discern the bleeding cause from the lung or the diaphragm. This case will highlight our awareness that costal exostosis possibly results in bloody pleural effusion. Meanwhile, English literatures about solitary costal exostosis associated with hemothorax were searched in PubMed and nineteen case reports were obtained. Combined our present case with available literature, a comprehensive understanding of this rare disease entity will further be strengthened. Conclusions Injury to the diaphragm is the primary cause of hemothorax caused by costal osteochondroma, including the present case. Thoracic CT scan can help establish a diagnosis of preoperative diagnosis of costal osteochondroma. Surgical intervention should be considered for those patients with symptomatic osteochondroma of the rib. Combined with our case and literature, prophylactic surgical removal of intrathoracic exostosis should be advocated even in asymptomatic patients with the presentation of an inward bony spiculation.
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Affiliation(s)
- Ruonan Pan
- Department of Radiology, the First Hospital of Jilin University, No. 71 of Xinmin Street, Changchun, Jilin, 130021, China
| | - Xiaoqian Lu
- Department of Radiology, the First Hospital of Jilin University, No. 71 of Xinmin Street, Changchun, Jilin, 130021, China
| | - Zhijun Wang
- Pediatric Surgery, the First Hospital of Jilin University, Changchun, 130021, China
| | - Lijun Duan
- Department of Radiology, the First Hospital of Jilin University, No. 71 of Xinmin Street, Changchun, Jilin, 130021, China
| | - Dianbo Cao
- Department of Radiology, the First Hospital of Jilin University, No. 71 of Xinmin Street, Changchun, Jilin, 130021, China.
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When a Pilar Cyst Is Not a Pilar Cyst: Answer. Am J Dermatopathol 2022; 44:611-612. [PMID: 35830700 DOI: 10.1097/dad.0000000000002165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Jindal V, Khandekar A, Gupta P, Binyala S. Solitary Osteochondroma of the Scapula in a Young Male: A Case Report. J Orthop Case Rep 2022; 12:34-37. [PMID: 36659891 PMCID: PMC9826679 DOI: 10.13107/jocr.2022.v12.i07.2906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/05/2022] [Indexed: 01/22/2023] Open
Abstract
Introduction Osteochondroma is a type of cartilaginous tumor. It is the most common benign tumor of axial skeleton usually arising around the knee, proximal humerus, and pelvis. Solitary osteochondroma of the scapula is relatively rare and usually incidental finding accompanied by pain and dysfunction. These lesions can easily be followed radiographically with plain radiograph. Computed tomography (CT) is used to determine the precise location and its relationship with the surrounding soft tissues and enable accurate surgical removal. Case Report In this report, we present a rare case of a symptomatic scapular osteochondroma in a 18-year-old male who presented with the complaints of swelling over the left scapula. X-ray showed a bony outgrowth along the posteromedial border of the left scapula. CT scan was done to know extent of the growth. MRI was performed to rule out soft-tissue involvement. Despite the young age of the patient, surgical excision was performed. The outcome was good, the patient noticed disappearance of swelling and a normal profile of the scapula was gained. Conclusion We have described a rare case of scapular osteochondroma associated with different signs, symptoms, and positive radiological findings. This lesion was removed surgically, and a follow-up indicated complete symptom relief with no history of recurrence. By reporting this case, we aim to increase the awareness of unusual manifestations of osteochondroma, particularly in terms of site, age of onset, and atypical presenting signs and symptoms.
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Affiliation(s)
- Vasu Jindal
- Department of Orthopaedics, MGM Hospital, Navi Mumbai, Maharashtra, India,Address of Correspondence: Dr. Vasu Jindal, Department of Orthopaedics, MGM Hospital, Navi Mumbai - 410 209, Maharashtra, India. E-mail:
| | - Anil Khandekar
- Department of Orthopaedics, MGM Hospital, Navi Mumbai, Maharashtra, India
| | - Parag Gupta
- Department of Orthopaedics, MGM Hospital, Navi Mumbai, Maharashtra, India
| | - Shrey Binyala
- Department of Orthopaedics, MGM Hospital, Navi Mumbai, Maharashtra, India
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Angelini A, Cerchiaro M, Maturi C, Ruggieri P. Vascular Complications Caused by Tibial Osteochondroma: Focus on the Literature and Presentation of a Popliteal Artery Thrombosis with Acute Lower Limb Ischemia. Diagnostics (Basel) 2022; 12:diagnostics12051191. [PMID: 35626346 PMCID: PMC9140494 DOI: 10.3390/diagnostics12051191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 11/24/2022] Open
Abstract
Osteochondromas are common benign bone tumors, frequently found in adolescents or young adults. Most often asymptomatic and discovered by accidental findings, they may be diagnosed because of compression or dislocation. Vascular complications are an atypical presentation of osteochondromas, and include vessel perforation and thrombosis, arterial thromboembolic events and pseudoaneurysm formation. Popliteal artery thrombosis and acute lower limb ischemia caused by a tibial osteochondroma are rarely observed. Starting from a case of temporary lower extremity ischaemia caused by thrombosis of the subarticular popliteal artery due to an osteochondroma of the proximal tibial protruding in popliteal fossa, we focused a literature analysis on diagnostic and management aspects. A combined vascular-orthopedic approach was performed with intra-arterial locoregional thrombolytic therapy and then a surgical tangential resection of the tibial osteochondroma. The adequate approach for these patients includes clinical evaluation, plain radiographs, CT scan and MRI. The purpose of the present review article is to underline the importance of a combined vascular-orthopedic approach to correct diagnosis and prompt surgical management of vascular complications caused by tibial osteochondromas.
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Affiliation(s)
- Andrea Angelini
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padova, Italy; (M.C.); (P.R.)
- Correspondence:
| | - Mariachiara Cerchiaro
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padova, Italy; (M.C.); (P.R.)
| | - Carlo Maturi
- Department of Vascular, Endovascular Surgery, University of Padova, 35128 Padova, Italy;
| | - Pietro Ruggieri
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padova, Italy; (M.C.); (P.R.)
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Madoki A, Tuerlinckx C, Rausin G, Guiraud K, Docquier PL. Lower limb deformities and limb length discrepancies in hereditary multiple exostoses. Acta Orthop Belg 2022; 88:198-205. [PMID: 35512172 DOI: 10.52628/88.1.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
There is a high rate of lower limb deformity and limb length discrepancy in patients with hereditary multiple exostoses (HME). The aim of this study was to evaluate the type and frequency of lower limbs axial deviation and limb length discrepancy and the type of exostoses being risk factors for theses deformities. We retrospectively reviewed standing full-length radiograph of 32 HME patients (64 limbs) followed in our institution between October 2009 and December 2020. Patient demographics were recorded. Radiographic analysis of the coronal limb alignment was performed, limb length discrepancy was measured and topography of the exostoses was recorded. We propose a classification of lower legs in 2 groups and 4 types according to the presence and the location of exostoses. In group I, there is an intertibio- fibular exostose with fibular origin at the level of the tibiofibular joints. In type IA, at the level of the distal tibiofibular joint with ascension of the distal fibula; in type IB at the level of the proximal tibiofibular joint with a bracketing effect on the proximal tibia and a lateral slope of the proximal tibial growth plate; the type IC is combining features of both IA and IB. In group II, there is no intertibio-fibular exostose coming from the fibula and no growth abnormality is obvious. A clinically notable lower limb discrepancy (LLD) of ≥2 cm was found in 19% of our patients. Approximately 33% of patients had a knee valgus deformity and 44% had an ankle valgus deformity. The knee valgus deformity was due to fibular growth anomalies and not to distal femur anomalies. The majority of lower legs had fibular growth anomalies (72%) which was a significant risk factor for knee valgus deformity and leg length discrepancy. On the contrary, we found no correlation between number, location and volume of distal femoral exostoses and genu valgum nor leg length discrepancy. Presence of intertibio-fibular exostoses is a risk factor for knee valgus deformity and leg length discrepancy. The presence of these exostoses should lead to a close follow-up of the patient.
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Wang W, Yang M, Shen Y, Chen K, Wu D, Yang C, Bai J, He D, Gao J. Clinical survey of a pedigree with hereditary multiple exostoses and identification of EXT‑2 gene deletion mutation. Mol Med Rep 2022; 25:141. [PMID: 35211766 PMCID: PMC8915398 DOI: 10.3892/mmr.2022.12657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/10/2022] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to report a clinical survey of hereditary multiple exostoses (HME) in a large Chinese pedigree, and the identification of a novel deletion mutation of exostosin glycosyltransferase 2 (EXT‑2) gene. A patient with multiple exostoses with huge cartilage‑capped tumors in scapula, knees and ankles received surgery in Department of Orthopedics (Shanghai Changhai Hospital). A total of 20 family members were recruited to the study, with seven members (five male; two female) diagnosed as HME. The family members of the patients with HME were examined, clinical data and peripheral blood samples were collected, and their DNA was sequenced. The incidence of HME in this family pedigree was 35%. Exostoses were most frequently in the tibiae with occurrence in six patients, followed by ribs, femurs, radii, fibulae, scapulae and humeri. DNA sequencing of peripheral blood revealed a novel deletion mutation, c.824‑826delGCA, in exon 5 of the EXT‑2 gene, which was observed in all the patients with HME, but not in the healthy family members. Several characteristics of HME in the pedigree were observed, such as susceptibility of male gender, decreased average age of onset and height and increased severity of clinical symptoms with generations.
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Affiliation(s)
- Wentao Wang
- Department of Orthopedics, Shanghai Changhai Hospital, Shanghai 200433, P.R. China
| | - Mingyuan Yang
- Department of Orthopedics, Shanghai Changhai Hospital, Shanghai 200433, P.R. China
| | - Yuhang Shen
- Department of Orthopedics, Shanghai Changhai Hospital, Shanghai 200433, P.R. China
| | - Kai Chen
- Department of Orthopedics, Shanghai Changhai Hospital, Shanghai 200433, P.R. China
| | - Donghua Wu
- Department of Orthopedics, Shanghai Changhai Hospital, Shanghai 200433, P.R. China
| | - Changwei Yang
- Department of Orthopedics, Shanghai Changhai Hospital, Shanghai 200433, P.R. China
| | - Jinyi Bai
- Department of Orthopedics, Shanghai Changhai Hospital, Shanghai 200433, P.R. China
| | - Dawei He
- Department of Orthopedics, Shanghai Changhai Hospital, Shanghai 200433, P.R. China
| | - Jun Gao
- Department of Orthopedics, Shanghai Changhai Hospital, Shanghai 200433, P.R. China
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Zhang Y, Wang X, Jiang C, Chen Z, Wang B, Sun H, Hao D. Novel techniques for solitary atlas osteochondroma: a case report and literature review. Am J Transl Res 2022; 14:1114-1122. [PMID: 35273715 PMCID: PMC8902569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 12/09/2021] [Indexed: 06/14/2023]
Abstract
Osteochondroma is a common benign bone tumor that is rarely seen in the spine, especially in the atlas. Although most solitary atlas osteochondromas have no symptoms, some exostosis may cause severe clinical symptoms that need treatment within the spine. Here, we report a 21-year-old male who presented with apsychia as well as numbness in his right upper and lower limbs for 2 months. The patient reported a history of neck trauma 10 years ago. He received a posterior laminectomy without reconstruction later, and the symptoms improved immediately. During a 32 month follow-up, there was no recurrence of the osteochondroma. Novel techniques for the treatment of this case were applied: simulated surgical resection using 3-Matic 9.0 software, 3D printed model, 3D Digital Image Microscopy, and piezoelectric surgery. These novel techniques provided significant benefits to the patients, the surgeon, and medical education.
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Affiliation(s)
- Yongyuan Zhang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine Xi'an 710054, Shaanxi, China
| | - Xiaohui Wang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine Xi'an 710054, Shaanxi, China
| | - Chao Jiang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine Xi'an 710054, Shaanxi, China
| | - Zhe Chen
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine Xi'an 710054, Shaanxi, China
| | - Biao Wang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine Xi'an 710054, Shaanxi, China
| | - Honghui Sun
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine Xi'an 710054, Shaanxi, China
| | - Dingjun Hao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine Xi'an 710054, Shaanxi, China
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