Osteochondroma of the cervical spine--a surprising finding in a liver transplanted patient with polyneuropathy and polyradiculitis: case report

BACKGROUND: Osteochondroma of the spine is a rare condition. We report a case of a patient with a cervical osteochondroma presenting with a polyneuropathy and polyradiculitis simultaneously. CASE DESCRIPTION: In a liver-transplant patient with progressive neurological deficits a polyneuropathy and a polyradiculitis were diagnosed. Eventually the patient became quadraparetic and an osteochondroma compressing the cervical spinal cord was found. The patient's neurological symptoms markedly improved after gross total tumor resection and antibiotic therapy. CONCLUSIONS: Review of the literature reveals this case to be an unusual presentation of a cervical osteochondroma, its diagnosis being delayed because of concomitant neurological diseases.     

Giant osteochondroma of proximal fibula in a skeletally mature patient

Osteochondroma are believed to be most common benign tumors. The growth of osteochondroma usually ceases when skeletal maturity is reached but becomes a matter of concern to the attending doctor if the lesion becomes painful and shows evidence of increased growth even after physeal closure, which may be an indication of sarcomatous change in the lesion. We present a case with substantial growth of an osteochondroma after attainment of skeletal maturity. The tumor turned out to be histologically benign, and patient had an uneventful recovery with no recurrence.     

Spontaneous healing of an osteochondroma fracture

Osteochondroma is the most common benign tumor of bone, usually asymptomatic. Fracture of an osteochondroma is a rare complication and has been recognized as a cause of pain. Treatment of this fracture is controversial and some authors suggest fracture as an indication for surgical excision. We present a case of fractured osteochondroma that healed without complication.     

Osteochondroma of the cervical spine—a surprising finding in a liver transplanted patient with polyneuropathy and polyradiculitis: case report

BACKGROUND

Osteochondroma of the spine is a rare condition. We report a case of a patient with a cervical osteochondroma presenting with a polyneuropathy and polyradiculitis simultaneously.

CASE DESCRIPTION

In a liver-transplant patient with progressive neurological deficits a polyneuropathy and a polyradiculitis were diagnosed. Eventually the patient became quadraparetic and an osteochondroma compressing the cervical spinal cord was found. The patient’s neurological symptoms markedly improved after gross total tumor resection and antibiotic therapy.

CONCLUSIONS

Review of the literature reveals this case to be an unusual presentation of a cervical osteochondroma, its diagnosis being delayed because of concomitant neurological diseases.     

Tetraparesis due to exostotic osteochondroma at upper cervical cord in a patient with multiple exostoses-mental retardation syndrome (Langer-Giedion syndrome)

STUDY DESIGN: Case report of a severe upper cervical cord compression and tetraparesis by a massive cervical exostotic osteochondroma in a patient with multiple exostoses-mental retardation syndrome (Langer-Giedion syndrome; LGS). OBJECTIVE: To describe this very rare pathological condition and the results of surgical intervention. SETTING: Gifu, Japan. METHODS: A 23-year-old man was referred to our clinic because of progressing tetraparesis. He had previously been diagnosed with hereditary multiple exostoses and mental retardation. As he had not complained of any symptoms, his family only noticed the tetraparesis after advanced deterioration. His face possessed the pathognomic features of LGS. A postmyelogram CT scan demonstrated an exostotic mass arising from the left-side C2 pedicle with associated severe spinal cord compression. He was diagnosed with LGS. Hemilaminectomy on the left side and resection of the osteochondroma were performed. RESULTS: At 5 years postoperatively, a neurological examination showed the full return of all motor functions. The CT scan revealed no intracanalar recurrence of the tumor. CONCLUSION: In this case of severe tetraparesis due to cervical osteochondroma, decompression by hemilaminectomy provided excellent results. In patients with LGS and intracanalar osteochondroma, the neurological deficit may be masked by mental retardation. Hence, awareness of this pathological condition will help clinicians diagnose it at an early stage.     

Valgus toe deformity of fourth proximal phalanx due to osteochondroma treated with closing wedge osteotomy

Osteochondroma is the most common benign tumor of all benign and primary bone tumors. It rarely occurs in the proximal phalanx of the lesser toe. The treatment of osteochondroma usually consists of simple resection. However, if other deformities remain, added procedures may be considered. We report a case of a valgus toe deformity of the fourth proximal phalanx due to osteochondroma. The patient was a 21-year-old man who noticed a valgus deformity of his fourth toe over 10 years earlier. He began to experience pain in his fifth toe because of crossover of the fourth toe when wearing formal shoes. Although resection of osteochondroma was performed, the valgus deformity was not sufficiently corrected. Therefore, closing wedge osteotomy of the proximal phalanx was performed at the same time. A good outcome was achieved for this patient.     

Solitary osteochondroma of the trapezium: case report

Osteochondroma of the carpal is rare. We found only 1 case of osteochondroma of the trapezium in the literature. We present a case of a 52-year-old woman with an osteochondroma of the left trapezium and trapeziometacarpal arthritis.     

Rib osteochondroma in the adolescent: case report and survey of complications

Abstract Osteochondroma of the rib is not frequent and usually small and asymptomatic. Complications result from mechanical interference with neighboring anatomical structures. Only 5 cases of spinal cord compression, 2 of brachial plexus paralysis and 7 of hemothorax in the pediatric and adolescent age have been reported in the literature. Malignant transformation is also possible. We report the case of a 17-year-old boy with osteochondroma of the third rib developing into the thoracic cavity. The irregular radiographic appearance of the lesion and the presence of local pain after the patient had reached skeletal maturity gave us the indication for surgical resection.     

A case report of winged deformity caused by osteochondroma arising from the ventral side of the scapula

Winged deformity of the scapula is defined as prominence of the medial border of the scapula. Osteochondroma arising from the ventral side of the scapula has been demonstrated to cause the mechanical symptoms of winged deformation. We present a 22-year-old man with winged deformity of the left scapula due to osteochondroma. Complete removal of the tumor relieved the symptoms, and histopathologic examination confirmed benign osteochondroma. There were no signs of recurrence on radiological images at the last follow-up of 10 months.     

Osteochondroma of the Tibial Sesamoid: A Case Report and Review of the Literature

Osteochondroma, one of the most common benign bone tumors, frequently occurs in the metaphysis of the long bones. We report an extremely rare case of osteochondroma that occurred in the tibial sesamoid. The patient was a 62-year-old Japanese male. He presented with a 1-year history of pain and a hard mass on the plantar aspect of the right forefoot sole. The osteochondroma protruded toward the sole from the tibial sesamoid, leading to pain on weightbearing. After tibial sesamoidectomy, the patient's symptoms were eliminated, and no pain or complications such as hallux valgus occurred after the surgery. Although a potential risk exists of postoperative hallux valgus deformity, tibial sesamoidectomy seems to be an appropriate surgical option for both osteochondroma and bizarre parosteal osteochondromatous proliferation to avoid residual pain or local recurrence.     

Para-articular osteochondroma: a case report

Para-articular osteochondroma, a benign osteoarticular tumor which develops near joints, is, unlike classical osteochondroma, extremely rare. We present the case of a 59-year-old woman who developed a calcified mass in the infrapatellar region. The differential diagnosis between chondrosarcoma, synovial chondromatosis, and para-aticular osteochondroma was only possible after resection and pathology examination of the surgical specimen.     

Vascular compression caused by solitary osteochondroma: useful diagnostic methods of magnetic resonance angiography and Doppler ultrasonography

 Osteochondroma is a common benign bone tumor that sometimes causes vascular complications when the lesion is situated near the knee. Venous complications are seen less frequently. We report two cases of solitary osteochondroma that arose in the distal femur. The patients were an 11-year-old boy and a 16-year-old boy, both of whom were suffering from bone protuberance and lower leg swelling due to congestion. In both patients, magnetic resonance imaging (MRI) revealed dilated popliteal veins at a site distal from the tumors or superficial veins. MR angiography (MRA) showed compressed popliteal arteries, and Doppler ultrasonography revealed weaker blood flow in the dorsalis pedis arteries in the lower leg with the tumor than in the other lower leg. The former patient complained of pain due to swelling in the lower leg, and for this reason the patient underwent resection of the tumor. After resection, both the swelling and the pain were decreased, and Doppler ultrasonography also revealed normal blood flow in the artery. The latter patient had swelling, but no pain, in the lower leg, and accordingly this patient has been followed carefully without resection, since there is always the possibility of irreversible vascular damage caused by osteochondroma, such as arterial or venous occlusion. We present two patients with osteochondroma, both of whom suffered from swelling of the lower leg due to venous compression by the tumor. In both cases, MRI and MRA were useful to show the presence of vascular compression. Doppler ultrasonography could also reveal the blood flow disturbance objectively, even in current osteochondroma cases in which there were no arterial symptoms. Received: November 26, 2001 / Accepted: March 7, 2002     

Osteochondroma of C7 vertebra presenting as compressive myelopathy in a patient with nonhereditary (nonfamilial/sporadic) multiple exostoses

Introduction Osteochondromas are most commonly found in the appendicular skeleton. They occur less frequently in the spine and compression of the spinal cord is very rare. To the best of our knowledge, this is the first report of an osteochondroma arising from C7 vertebra presenting with compressive myelopathy in a patient with nonhereditary multiple exostoses. Our purpose is to report this rare presentation and its successful management, and to highlight the clinico-radiological features of this treatable condition.Materials and methods A 20-year-old male with nonhereditary exostoses presented with gradual onset weakness in bilateral lower limbs, which had rapidly progressed to complete paraplegia over 1 month. The tumor was effectively treated by surgical excision along with spinal decompression. The diagnosis was confirmed by histopathological evidence complemented by clinico-radiological studies.Results There has been a complete functional recovery without any evidence of recurrence at last follow-up at 2 years.Conclusion Compressive myelopathy due to an osteochondroma arising from C7 vertebra in a case with nonhereditary multiple exostoses is being reported for the first time. Both CT and MRI demonstrated the origin, size, extent and relationship of the tumor to the vertebral and neural elements. Complete recovery of functions after surgical decompression was achieved in this case. An osteochondroma of spine must always be considered in all patients with multiple exostoses who have spine pain or develop neural deficit.     

A rare anterior sacral osteochondroma presenting as sciatica in an adult: a case report and review of the literature

Background contextOsteochondroma is the most common primary benign bone tumor and is usually located in the metaphyses of long bones and rarely in the spine or anterior sacrum. To the best of our knowledge, en bloc excision of a solitary osteochondroma of the anterior sacrum in an adult patient has not been previously reported in a peer-reviewed journal.PurposeThe purposes of this study were to document the first report of an osteochondroma of the anterior sacrum along with the clinical course and operative management and review the literature on solitary osteochondroma of the sacrum.Study design/settingThe study setting is an academic institution. This is a case report and review of the literature.Patient sampleThe patient is an adult female.Outcome measuresThe outcome measure is the visual analog score for pain.MethodsA 54-year-old woman presented with 9/10 disabling low back and radicular pain in the left lower extremity. Radiologic studies showed a pedunculated mass occurring from the anterior sacrum thought to be causing nerve root compression. The patient received en bloc excision of the mass through an abdominal retroperitoneal approach. We also conducted a literature review of solitary sacral osteochondroma in peer-reviewed journals.ResultsHistologic studies confirmed the mass to be an osteochondroma without pathologic signs of malignant transformation. The patient complained of dysesthesia in the left leg after surgery, which progressively improved completely over 8 months after the operation. At the 2-year follow-up, there was no evidence of local recurrence and she was pain free. A literature review revealed one previous case of en block resection of a solitary osteochondroma, but it involved the posterior sacrum.ConclusionsSolitary osteochondroma can rarely present in the sacrum as low back pain and sciatica. In general, when osteochondroma causes pain in an adult, we should think that some structure is impinged or that it could have initiated a malignant transformation, so en bloc excision should be used to remove the tumor and histologic studies performed to assess for malignant transformation. Battered nerve root syndrome may take up to 8 months to resolve.     

Ganglioneuroma with scoliosis of the thoracic spine: a case report.

BACKGROUND CONTEXT: Ganglioneuroma is a benign tumor of neural crest origin that may provoke a scoliosis as well as neurological symptoms. Treatment includes resection with possible spinal fusion for instability and close follow-up for many years. PURPOSE: The purpose is to report an invasive ganglioneuroma that was successfully treated by resection without spinal fusion. STUDY DESIGN/SETTING: Case report. PATIENT SAMPLE: A 15-year-old white female. OUTCOME MEASURES: Resolution of the patient's back pain with radiographic and clinical follow-up for recurrence of the tumor. METHODS: Not applicable. RESULTS: The patient experienced resolution of her back pain without recurrence of the tumor. CONCLUSIONS: This is a rare benign tumor that was effectively treated with surgical resection and without spinal fusion.     

Subungual Osteochondroma: Clinical and Radiologic Features and Treatment

BACKGROUND: Subungual osteochondromas are relatively rare. OBJECTIVE: The objective was to evaluate the clinical, histologic, radiologic, and therapeutic features of subungual osteochondroma. METHODS: We retrospectively analyzed 27 cases of subungual osteochondroma evaluating the clinical manifestations, the radiologic and histologic features, and the treatment. RESULTS: There were 20 females and 7 males. The first toe was the most commonly involved. Previous trauma was recalled in 40.7% of the cases. Subungual osteochondromas appeared as firm, exophytic tumors beneath the ungual plate. Twenty-five patients had pain. The radiologic films demonstrated the presence of a juxtaephiphyseal radiodense cap surrounded in some cases by cortical bone. A Dubois-like excision was performed to expose the tumor and cut it through the base, followed by curettage of the bony bed. Radiologic controls were taken 30 and 60 days after surgery and in cases of symptomatology. There were three cases of recurrence and two cases of incomplete excision. CONCLUSIONS: Subungual osteochondroma should be distinguished from other subungual masses. The diagnosis of subungual osteochondroma is clinicoradiologic.     

Osteochondroma of the high cervical spine--a case report (author's transl)]

Osteochondroma is one of the most common benign bone tumors, but it is rare in the spine. A woman aged 54 was admitted for investigation of left nuchal pain with radiation to the occipital region for one and a half years duration. Physical and neurological examinations revealed no objective abnormalities. The cervical spine film showed the presence of a calcified mass in the left articulation between atlas and axis. Myelogram outlined a left sided filling defect at the level of a calcified mass. The tumor was totally removed using operating microscope technique through transcervical approach. This calcified mass was confirmed as the benign osteochondroma by histological examination. The patient became completely symptom-free after the operation.     

Osteochondroma of the scapula: a case report

Osteochondroma is one of the most common benign tumors of the axial skeleton. Location of a solitary exostosis in the scapula is relatively rare. We report the case of an osteochondroma of the scapula in a 13-year-old boy. Because of the atypical location with nonspecific shoulder pain, the diagnosis is often made late. CT is necessary to determine the correct position of the osteochondroma. Despite the young age of the patient, surgical excision of the exostosis was performed, because of an arising thoracic pressure pain. The outcome was good, the patient noticed disappearance of previous painful symptoms, and a normal profile of the scapula was gained.     

Subacromial osteochondroma

The most common cause of impingement syndrome is mechanical irritation of the subacromial bursa and rotator cuff by the coracoacromial arch. Offending structures include the undersurface of the anterolateral acromion, coracoacromial ligament, and the undersurface of the distal clavicle. We present a case of impingement syndrome caused by mechanical irritation of the rotator cuff by a subacromial osteochondroma that was successfully treated with arthroscopic resection. Osteochondroma is the second most common benign bone tumor following nonossifying fibroma. These lesions are thought to arise from aberrant growth of normal epiphyseal growth plate cartilage. Ninety percent of osteochondromas arise from the metaphyseal regions of long bones (eg, distal femur, proximal tibia, or proximal humerus). Scapular involvement accounts for 3.0% to 4.6% of all reported osteochondromas. These lesions represent 14.4% of all tumors of the scapula and 49% of benign scapular tumors, making them the most common benign bone tumors of the scapula. Our patient failed nonoperative management of his subacromial osteochondroma. The concern for malignant transformation was low, as the patient's pain had been consistent for the past 15 years. Although his pain had been largely unchanged for more than a decade, he elected to undergo resection so that he could resume the hobbies that his pain had forced him to abandon. He reported substantial pain relief and restoration of function following arthroscopic resection and subacromial decompression, reinforcing mechanical irritation of the rotator cuff as the source of his shoulder pain and dysfunction. To our knowledge, this is the first report of arthroscopic resection of a subacromial osteochondroma.     

Osteochondroma of the thoracic spine and scoliosis

STUDY DESIGN: The case of a 16-year-old patient with an osteochondroma in T11 and scoliosis is reported. OBJECTIVE: To describe the treatment of an osteochondroma with scoliotic deformity and the imaging methods used for the diagnosis. SUMMARY OF BACKGROUND DATA: Osteochondromas arising in the vertebral column are rare. However, spinal involvement is found with some regularity because osteochondromas are among the most common benign tumors of bone. METHODS: The clinical history, plain radiographs, computed tomography, and magnetic resonance imaging, and pathologic findings of the reported patient were reviewed. The medical literature also was reviewed. RESULTS: The patient was treated with surgery in an attempt to remove the tumor and correct the aesthetic deformity. The results were satisfactory, with an improvement of the thoracolumbar scoliosis from 45 degrees to 18 degrees. CONCLUSIONS: Osteochondromas of the vertebral column may cause scoliosis. Computed tomography and magnetic resonance imaging are necessary for evaluating the origin, size, and characteristics of the tumor. In this case, surgical management involved resection of the tumor and correction of the scoliotic deformity.