Spontaneous regression of solitary osteochondromas in children: An option to consider in clinical practice

Paediatric Calcaneal Osteochondroma: A Case Report and a Literature Review

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.

Spontaneous resolution of proximal humerus sessile osteochondroma: A report of case and literature review

Key Clinical Message

In managing a child with a solitary osteochondroma, the most advisable course of action involves vigilant observation and regular follow-up, given the potential for spontaneous resolution.

Abstract

The most frequent benign cartilage tumors in children are osteochondromas, which develop when the growth plate herniates during bone development. Treatment depends on the symptoms, with asymptomatic cases requiring monitoring and symptomatic patients requiring surgical intervention. Rarely, an asymptomatic osteochondroma may spontaneously disappear. We report the case of a 3-year-old male who presented with left arm swelling and pain due to trauma while playing football. X-rays revealed a proximal humerus posterolateral sessile osteochondroma. After 6 months of observation, the boy tolerated activity and had no pain. Five years later, the osteochondroma was resolved spontaneously both clinically and radiologically. Our study suggests that annual observation of child patients with osteochondroma is more effective than surgical intervention due to the possibility of spontaneous resolution.

Vanishing solitary osteochondroma of humerus following trauma: A case report

Osteochondromas are the most common benign tumors of the bone. Mainly these lesions affect the long-bone metaphysis and usually are asymptomatic. When complications develop from these lesions, then they become symptomatic and surgical resection may become indicated. Spontaneous resolution of osteochondroma is rare. There have been fewer case reports about this condition. We are reporting 16 years old, male, who sustained direct trauma to his shoulder and presented with fracture at the base of a solitary osteochondroma. Complete resolution of the lesion occurred without any surgical intervention 18 months following the fracture.

Spontaneous Resolution of an Osteochondroma

A 13-year-old girl presented with an apparent classic osteochondroma. Because she was skeletally immature, the decision was made to observe the lesion. She returned to the clinic at age 17 for unrelated reasons and was noted to no longer have the palpable mass. Magnetic resonance imaging confirmed resolution of the osteochondroma. The age range of this case fits with reported cases of childhood osteochondromas. The mechanism of resolution has been theorized to be incorporation of the lesion back into the bone during remodeling, fractures, or pseudoaneurysms. An initial period of observation is thus recommended with new patients.

Thin Cartilage Cap May Be Related to the Spontaneous Regression in Pediatric Patients with Osteochondroma

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.