Osteochondroma of the L-5 vertebra: a rare cause of sciatic pain. Case report

Unusual location of osteochondroma in the temporal region in a patient with functional pituitary adenoma

Osteochondromas are common in the long bones and relatively rare in the head and neck regions. We herein report a case of a solitary temporal bone osteochondroma associated with a functional pituitary adenoma hypersecreting prolactin. The patient was a 48-year-old man with progressive, painless temporal swelling associated with gradual visual loss, gynaecomastia, erectile dysfunction, and loss of libido. A brain computed tomography scan with bone windows showed right temporal sessile bony expansion and a pituitary tumour. A pituitary function test revealed hyperprolactinaemia. His symptoms resolved with medical management, and excisional biopsy of the temporal tumour confirmed an osteochondroma. To the best of our knowledge, this is the first reported case of a solitary temporal bone osteochondroma with a functional pituitary adenoma hypersecreting prolactin.

Osteochondromas: An Updated Review of Epidemiology, Pathogenesis, Clinical Presentation, Radiological Features and Treatment Options

Osteochondroma, the most common benign bone tumor, is a projection on the external surface of the bone, which can be sessile or pedunculated. 85% of osteochondromas present as solitary lesions, while 15% occur in the context of hereditary multiple exostoses (HME), a genetic disorder that is inherited in an autosomal dominant manner. Although often asymptomatic, symptoms may eventuate from compression of adjacent vessels or nerves, fractures, osseous deformities, bursa formation, or malignant transformation. Cartilage cap thickness >2 cm in adults or >3 cm in children as well as new onset of pain or growth, or rapid growth of the lesion, especially after the closure of the growth plate, might reflect cancerous transformation. Surgical resection is indicated for symptomatic lesions, complications, cosmetic reasons or malignant transformation. Excision of the tumor with free margin is the treatment of choice. Local recurrence is less than 2% if complete resection is achieved.

Treatment of spinal cord compression caused by C2 osteochondroma with reconstruction and fusion after total resection: Case report and literature review

Context: Osteochondroma is the most common benign tumor of the bone, but spinal osteochondroma is rare. We report a case of cervical osteochondroma in multiple exostoses arising from the lamina of the C2 vertebra, presenting with features of compressive myelopathy in a 22-year-old male. Total resection of the tumor and atlantoaxial fixation and fusion after reconstruction of the C1 posterior arch were performed.Findings: The patient recovered significantly. He was asymptomatic and no sign of recurrence was observed after one-year follow-up.Conclusions: Osteochondroma should be considered as a rare cause of spinal cord compression. Entire removal of the tumor will result in complete decompression and can reduce the risk of recurrence. We provide a new approach to reconstruct after resection.

A solitary osteochondroma of the cervical spine: a case report and review of literature

INTRODUCTION

Osteochondromas are usually found in the extremities and are rarely seen in the spine. They are most commonly found in the posterior elements of the spine, and intraspinal extension is uncommon. Compressive myelopathy as a presentation of vertebral osteochondroma in a child is a rare entity.

METHODS

We report a case of vertebral osteochondroma arising from the lamina of C3 vertebra, presenting with features of compressive myelopathyin a 15 year old boy.Total excision of the tumor was carried out along with lamina of C3 vertebra.Patient recovered significantly.

CONCLUSION

Spinal osteochondromas must be considered as rare etiology of spinal cord or root compression in the pediatric age group and utmost care should be taken while excising these benign lesions.

Spinous Process Osteochondroma as a Rare Cause of Lumbar Pain

We present a case of a 5th Lumbar Vertebra (L5) spinous process osteochondroma as a rare cause of lumbar pain in an old patient. A 70-year-old male presented with progressive and disabling lower lumbar pain. Tenderness over the central and left paraspinal area of the lower lumbar region and a palpable mass were evident. CT scan showed a mass arising from the spinous process of L5. Marginal resection of the tumor was performed through a posterior approach. The histological study revealed an osteochondroma. After surgery, pain was completely relieved. After one year there was no evidence of local recurrence or symptoms. Osteochondromas rarely involve the spine, but when they do symptoms like pain, radiculopathy/myelopathy, or cosmetic deformity may occur. The imagiologic exam of election for diagnosis is CT scan. When symptomatic the treatment of choice is surgical resection. The most concerning complication of osteochondromas is malignant transformation, a rare event.

Compressive Myelopathy due to Osteochondroma of the Atlas and Review of the Literature

We report a case of vertebral osteochondroma arising from the posterior C1 arch that presented with features of compressive myelopathy. Osteochondromas are usually found in extremities and are rarely seen in the spine. They are most commonly found in posterior elements in the spine, and intraspinal extension is uncommon. The most common presentation is incidental finding during routine imaging followed by palpation of painless swelling. Compressive myelopathy as a presentation of vertebral osteochondroma in a child is a rare entity. Surgical excision is the treatment of choice. Spinal osteochondromas should also be kept in mind as a cause of spinal cord or nerve root compression in children.

Solitary sacral osteochondroma without neurological symptoms: a case report and review of the literature

PURPOSE

To report a case of solitary sacral osteochondroma without neurological symptoms and describe the en bloc excision of the tumour, as well as review the literature on osteochondroma involving the sacrum.

METHODS

SUMMARY OF THE BACKGROUND DATA

although osteochondromas are among the most common benign tumours of the bone, they uncommonly involve the spine. Its occurence in the sacrum is rare, accounting for only 0.5 % of the osteochondromas involving spine. All previous cases of sacral osteochondroma have reported neurological symptoms on presentation.

CASE REPORT

A 21-year-old male presented with a palpable, painless mass in the left side of the sacral region of 1 year duration, without neurological symptoms. Radiological studies showed a well-circumscribed lesion with bony osteoid within arising from the sacrum at S3-S4 level left to midline, with features suggestive of osteochondroma. The tumour was excised en bloc through posterior approach. A literature review of sacral osteochondroma was conducted using MEDLINE search of English Literature and bibliographies.

RESULTS

Histopathological studies showed the lesion to consist mature bone trabeculae with active enchondral ossification with cap of normal hyaline cartilage. Literature review yielded only 8 cases of sacral osteochondroma reported earlier.

CONCLUSION

This is the 9th case of solitary osteochondroma of the sacrum to be reported, the first to be reported without any neurological symptoms, and third case reported for which en bloc excision was performed.

Long-term outcomes in primary spinal osteochondroma: a multicenter study of 27 patients

OBJECT Clinical outcomes in patients with primary spinal osteochondromas are limited to small series and sporadic case reports. The authors present data on the first long-term investigation of spinal osteochondroma cases. METHODS An international, multicenter ambispective study on primary spinal osteochondroma was performed. Patients were included if they were diagnosed with an osteochondroma of the spine and received surgical treatment between October 1996 and June 2012 with at least 1 follow-up. Perioperative prognostic variables, including patient age, tumor size, spinal level, and resection, were analyzed in reference to long-term local recurrence and survival. Tumor resections were compared using Enneking appropriate (EA) or Enneking inappropriate surgical margins. RESULTS Osteochondromas were diagnosed in 27 patients at an average age of 37 years. Twenty-two lesions were found in the mobile spine (cervical, thoracic, or lumbar) and 5 in the fixed spine (sacrum). Twenty-three cases (88%) were benign tumors (Enneking tumor Stages 1-3), whereas 3 (12%) exhibited malignant changes (Enneking tumor Stages IA-IIB). Sixteen patients (62%) underwent en bloc treatment-that is, wide or marginal resection-and 10 (38%) underwent intralesional resection. Twenty-four operations (92%) followed EA margins. No one received adjuvant therapy. Two patients (8%) experienced recurrences: one in the fixed spine and one in the mobile spine. Both recurrences occurred in latent Stage 1 tumors following en bloc resection. No osteochondroma-related deaths were observed. CONCLUSIONS In the present study, most patients underwent en bloc resection and were treated as EA cases. Both recurrences occurred in the Stage 1 tumor cohort. Therefore, although benign in character, osteochondromas still require careful management and thorough follow-up.

Symptomatic osteochondroma of lumbosacral spine: report of 5 cases

We describe 5 cases of osteochondroma (OC) originating from lumbosacral spine which caused radiculopathy. Four cases originated from the lumbar spine; all from L4 inferior articular process and presented L5 radiculopathy, the other one case originated from the sacrum; the case from S1 superior articular process presented L5 radiculopathy. In all cases, definitive diagnosis was made with histopathological findings; typical cartilaginous capping was confirmed. The functional recovery was completed in all 5 cases. As for imaging study, postmyelography computed tomography revealed the most diagnostic tool for understanding the relationship between nerve tissue and the tumor. In all 5 patients, the tumors contained a high signal intensity on T₂-weighted images in the central medullary area. OCs are sometimes difficult to diagnose because they mimic other conditions like bony spur formation due to osteoarthritis, so we should never fail to confirm the histopathological diagnosis of such lesions when suspected.

Malignant degeneration of a lumbar osteochondroma into a chondrosarcoma which mimicked a large retropertioneal mass

We report a case of a lumbar spinal osteochondroma that transformed into a large chondrosarcoma in a 39-year-old male who presented with an abdominal mass and back pain. This mass was also associated with a fracture of the stalk, which on cross-sectional imaging mimicked a mass of retroperitoneal origin. The diagnosis of chondrosarcoma transforming from a lumbar osteochondroma became apparent when comparison was made with previous studies.

Solitary osteochondroma of the atlas causing spinal cord compression: a case report and literature review

Solitary osteochondroma (SOC) of the spine is very rare, though OC is the commonest benign tumour of the bone. Only about 1-4% of SOCs occur in the spine. And solitary ostechondroma of spine causing cord compression is even rarer. These tumours slowly enlarge, creating insidious but progressive symptoms of myelopathy or radiculopathy or both. Clinical histories, routine radiographs, CT studies, MRI studies and histopathological studies are the adjuncts for a definitive diagnosis. Surgical intervention can lead to functional and neurologic improvement with very little chance of recurrence. The authors present a case of a C1 posterior arch intraspinal SOC with cord compression who recovered very well after surgery and was doing well without recurrence after 1 year of surgery. The authors are reporting this case with English language medical literature review as it is quite rare among the SOCs of the cervical spine.

Review of the principal extra spinal pathologies causing sciatica and new MRI approaches

In this paper we illustrate the principal extraspinal pathologies causing sciatica and new approaches for the study of structures such as the lumbosacral plexus (LSP). Visualisation of the LSP in its entirety is difficult with conventional two-dimensional MRI sequences owing to its oblique orientation. In our institution, we have found that the utilisation of three-dimensional short tau inversion-recovery sampling perfection with application-optimised contrasts using different flip angle evolutions sequence is helpful, allowing multiplanar and maximum intensity projection reconstructions in the coronal oblique plane and curvilinear reformats through the plexus. Diffusion tensor imaging enables the observation of microstructural changes and can be useful in surgical planning. The normal anatomy of the LSP, its different extraspinal pathologies and differential diagnoses are thoroughly presented.

Lumbar osteochondroma arising from spondylolytic l3 lamina

Osteochondromas are common, benign tumors in the long bones, but osteochondromas are rare in the vertebrae. Most vertebral osteochondromas arise from the cervical or upper thoracic spine. However, lumbar osteochondromas have rarely been reported. In this report, a rare case of a lumbar osteochondroma arising from the spondylolytic L3 lamina in a 57-year-old woman is presented. She also had a ruptured disc and lumbar canal stenosis at L4-5-S1. The osteochondroma was completely removed and a posterior lumbar interbody fusion and instrumentation were performed. Considering the rarity of osteochondromas in the lumbar vertebrae, especially the L3 vertebra, it is possible that the pre-existing lumbar spondylolysis or spondylolisthesis was one of the factors affecting the occurrence or progression of the osteochondroma.

Solitary lower lumbar osteochondroma (spinous process of L3 involvement): a case report

Solitary osteochondromas, which are the most common benign bone tumors of long bones, are rarely found in the vertebral column. A 16-year-old female patient presented with a hard palpable mass at lower lumbar region like a congenital deformity. Plain radiography illustrated a well-defined solid mass arising from the posterior elements of the L3 and ruled out any congenital anomalies. A computed tomography scan further determined a mass that arose from the spinous process of L3. The tumor was excised en bloc through a posterior approach and histopathological examination verified the diagnosis of osteocondroma.Osteochondromas are rarely found in the spine, when present in the spine, however, have a predilection for cervical or upper thoracic region arising usually from lamina of vertebrae and are rare in lumbosacral region and very rare at spinous process of the vertebrae.We present a case of osteochondroma locates in lumbar region and spinous process of vertebrae with unusual presentation and was considered clinically as congenital lumbar kyphosis.

Sciatica in the female patient: anatomical considerations, aetiology and review of the literature

The principal author was confronted few years ago with the case of a 38-year-old woman with a 5-month history of ill-defined L5 sciatic pain that was referred to an orthopaedic department for investigation and eventual surgical treatment for what was suspected to be herniated disc-related sciatica. Removal of her enlarged uterus found unexpectedly close to the sacroiliac joint upon lumbar MRI abolished her symptoms. Review of the literature showed that the lumbosacral trunk is vulnerable to pressure from any abdominal mass originating from the uterus and the ovaries. Physiological processes in the female patient and gynaecological diseases may be the source of sciatica, often not readily searched for, leading to fruitless investigations and surgical treatments. The aim of the paper is to highlight gynaecological and obstetrical causes of sciatica and sciatica-like symptoms. To prevent unproductive expenses and morbidity, a thorough gynaecological examination should be done even though neurological examination may be suggestive of a herniated intervertebral disc, and the cyclic pattern of pain related to menses should be routinely asked for.

Imaging of osteochondroma: variants and complications with radiologic-pathologic correlation

Osteochondroma represents the most common bone tumor and is a developmental lesion rather than a true neoplasm. It constitutes 20%-50% of all benign bone tumors and 10%-15% of all bone tumors. Its radiologic features are often pathognomonic and identically reflect its pathologic appearance. Osteochondromas are composed of cortical and medullary bone with an overlying hyaline cartilage cap and must demonstrate continuity with the underlying parent bone cortex and medullary canal. Osteochondromas may be solitary or multiple, the latter being associated with the autosomal dominant syndrome, hereditary multiple exostoses (HME). Complications associated with osteochondromas are more frequent with HME and include deformity (cosmetic and osseous), fracture, vascular compromise, neurologic sequelae, overlying bursa formation, and malignant transformation. Malignant transformation is seen in 1% of solitary osteochondromas and in 3%-5% of patients with HME. Continued lesion growth and a hyaline cartilage cap greater than 1.5 cm in thickness, after skeletal maturity, suggest malignant transformation. Variants of osteochondroma include subungual exostosis, dysplasia epiphysealis hemimelica, turret and traction exostoses, bizarre parosteal osteochondromatous proliferation, and florid reactive periostitis. Recognition of the radiologic spectrum of appearances of osteochondroma and its variants usually allows prospective diagnosis and differentiation of the numerous potential complications, thus helping guide therapy and improving patient management.