Benign Exostoses Research Articles

Femoral exostosis causing vastus anterialis pain and restriction of knee range of motion in an active young male: A case report

A 38 year old male presented with a painful non mobile, bony hard swelling of lower end of Right femur of 6 month duration. The swelling was present since 6 months with progressive increase in size of the swelling, size of swelling was peanut shape when the patient noticed it 1st time and it gradually increased to lemon size over the period of 6 months. Initially the swelling was painless nut since last 2 months patient started having pain which was aggravated by knee movements over anterior aspect of distal third of thigh.Clinical examination revealed a bony hard swelling arising from anterolateral aspect of lower end of femur away from the knee joint. The swelling was painful on knee movements.MRI revealed rounded bony outgrowth on anterior aspect of distal femur of size 20*12mm having mass effect on quadriceps tendon. A diagnosis of benign exostoses lower end femur was made. In view of sudden increase in size of the lesion and associated pain on knee movements, and mechanical obstruction Patient underwent surgical excision of the exostoses. Histopathology revealed osteochondroma & no malignant transformation.

Hypertrophic Mental Tubercles of the Mandible

Enlarged mental tubercles are rare benign exostoses that occur in children. The purpose of this study was to report a case series of patients with hypertrophic mental tubercles and propose a theory for their etiopathogenesis. In this retrospective case series of patients with hypertrophic mental tubercles, we reviewed patients' medical records for age, gender, clinical presentation, findings on physical examination and radiographic images, and management details. Descriptive data were summarized. The sample included 14 patients (71% of whom were male patients) who presented at a mean age of 12.9±4.8years (range, 6 to 21years). Most patients had bilaterally enlarged mental tubercles (n=8); unilateral cases were primarily on the left side (5 of 6 patients). On clinical examination, a bony prominence in the parasymphyseal region was noted on palpation and occasionally by visual inspection. No tenderness to palpation or overlying skin changes were noted. Typical radiographic features included asymmetry along the inferior border of the mandible in the parasymphyseal region on panoramic radiographs and prominence and/or enlargement of the mental tubercles on computed tomography scans. No evidence of cortical expansion, perforation, or periosteal reaction was found. Three patients requested contouring of the hypertrophied tubercles. Hypertrophic mental tubercles are rare bony exostoses that occur in children in a region where a confluence of facial muscles attach to the mandible. The etiology likely involves bone deposition occurring in an area of muscle pull.

What is the Proportion of Patients With Multiple Hereditary Exostoses Who Undergo Malignant Degeneration?

Multiple hereditary exostoses is an autosomal-dominant skeletal disorder that has a wide-ranging reported risk of malignant degeneration to chondrosarcoma. The aims of our study were to use a large, web-based survey approach to characterize (1) the demographic distribution of patients with multiple hereditary exostoses, (2) the number of surgeries performed related to one's diagnosis of multiple hereditary exostoses, and (3) the proportion of survey respondents who described experiencing malignant degeneration in a large international, heterogeneous cohort of patients with multiple hereditary exostoses. An anonymous web-based survey was distributed to several online support groups and social media networks designed to support and educate patients with multiple hereditary exostoses and their families. The survey collected demographic and epidemiologic data on 779 respondents. Data were recorded to assess respondents' disease burden and the rate of malignant degeneration. Females represented a slightly greater proportion of those with multiple hereditary exostoses who responded (56% female; 419 of 742 patients). Median age for all respondents was 28 years (range, < 1-85 years). Median age for males was 25 years (range, < 1-85 years), while median age for females was 29 years (range, < 1-82 years). The mean age at diagnosis of male and female respondents was in the mid-first decade (5.4 years ± 7.2 years). The mean number of surgeries a patient had undergone was 7.3 (± 7.1 surgeries). The proportion of respondents who experienced malignant transformation was 2.7% (21 of 757 respondents), at a mean age of 28.6 years (± 9.3 years). The most common sites of malignant change from benign exostoses included the pelvis (eight of 21 respondents) and scapula (four of 21 respondents). In the largest and most geographically diverse study of patients with multiple hereditary exostoses of which we are aware, we found the proportion of patients with multiple hereditary exostoses who have undergone malignant degeneration to be consistent with those reported in prior studies. Our study perhaps more accurately assessed the proportion of patients who undergo malignant transformation of multiple hereditary exostoses. As with prior studies on this topic, the proportion of malignant change may be expected to represent a high-end estimate as recruitment and selection bias likely predisposes for patients with more severe disease, whereas patients with lesser disease may be unaware of their diagnosis. In discussing the sequelae of multiple hereditary exostoses, clinicians perhaps might use this study to offer an unspecific statement of risk of malignant degeneration of multiple hereditary exostoses among the population at large. Level IV, prognostic study.

Exostoses as a Long-Term Sequela After Pediatric Hematopoietic Progenitor Cell Transplantation: Potential Causes and Increase Risk of Secondary Malignancies from Ann & Robert H. Lurie Children's Hospital of Chicago

Allogeneic hematopoeitic progenitor cell transplantation (HPCT) is a curative therapy for pediatric patients with both malignant and nonmalignant diseases. Single or multiple benign exostoses or osteochondromas have been reported after total body irradiation (TBI), as well as after focal irradiation. Patients exposed to TBI at a young age are at highest risk of developing exostoses. The objective of this institutional review board–approved study was to look at potential factors, besides radiation, that may play a role in development of exostoses. All patients who underwent allogeneic and autologous HPCT at a single institution between March 1992 and December 2003 and who developed an exostosis identified by clinical findings or as an incidental finding on a radiologic study were included. A case-control design matched patients with controls who had the same stem cell source.

ACR Appropriateness Criteria® on Metastatic Bone Disease

Appropriate imaging modalities for screening, staging, and surveillance of patients with suspected and documented metastatic disease to bone include (99m)Tc bone scanning, MRI, CT, radiography, and 2-[(18)F]fluoro-2-deoxyglucose-PET. Clinical scenarios reviewed include asymptomatic stage 1 breast carcinoma, symptomatic stage 2 breast carcinoma, abnormal bone scan results with breast carcinoma, pathologic fracture with known metastatic breast carcinoma, asymptomatic well-differentiated and poorly differentiated prostate carcinoma, vertebral fracture with history of malignancy, non-small-cell lung carcinoma staging, symptomatic multiple myeloma, osteosarcoma staging and surveillance, and suspected bone metastasis in a pregnant patient. No single imaging modality is consistently best for the assessment of metastatic bone disease across all tumor types and clinical situations. In some cases, no imaging is indicated. The recommendations contained herein are the result of evidence-based consensus by the ACR Appropriateness Criteria((R)) Expert Panel on Musculoskeletal Radiology.

The acrophysis: a unifying concept for enchondral bone growth and its disorders. I. Normal growth.

In order to discuss and illustrate the common effects on normal and abnormal enchondral bone at the physes and at all other growth plates of the developing child, the term "acrophysis" is proposed. Acrophyses include the growth plates of secondary growth centers including carpals and tarsals and apophyses, and the growth plates at the non-physeal ends of small tubular bones. The last layer of development of both physes and acrophysis is the cartilaginous zone of provisional calcification (ZPC). The enchondral bone abutting the ZPC shares similar properties at physes and acrophyses, including the relatively lucent metaphyseal bands of many normal infants at several weeks of age. The bone-in-bone pattern of the normal vertebral bodies and bands of demineralization of the tarsal bones just under the ZPC are the equivalent of those bands. The growth arrest/recovery lines of metaphyses similarly have equivalent lines in growth centers and other acrophyseal sites. Nearly the same effects can also be anticipated from the relatively similar growth plate at the cartilaginous cap of benign exostoses ("paraphysis"). The companion article will explore abnormalities at acrophyseal sites, including metabolic bone disease and dysplasias.

Surgical Risk for Elective Excision of Benign Exostoses

The surgical risk and complication rates for the elective excision of benign osteochondromas and associated surgical procedures is presented. Eighty patients had excision of 285 osteochondromas and underwent 22 other related surgical procedures. There were 10 complications in the group (12.5% per patient population); the most common were peroneal neurapraxias. Other complications included an arterial laceration, a compartment syndrome, and a fibula fracture. The surgical risk for the management of osteochondromas is low and is comparable to the risk of other related, elective procedures. However, osteochondromas should not be routinely excised unless proper indications exist for their removal.

Benign exostoses and exostotic chondrosarcomas: evaluation of cartilage thickness by CT.

Computed tomograms of 16 benign exostoses and 15 exostotic chondrosarcomas were generally accurate in delineating anatomy for purposes of planning surgery, but they were inaccurate in the detection and measurement of the cartilage caps of the lesions. CT studies of 14 of the benign exostoses failed to show any cartilage cap, although the maximum cartilage thickness of these 14 lesions ranged from 0.1 to 2.5 cm pathologically. CT did demonstrate thick cartilage in 14 of the 15 chondrosarcomas, but the CT measurements of maximum thickness often were imprecise. Altogether, 15 CT studies failed to show any cartilage cap; 14 of these lesions were benign. CT did not reliably detect cartilage caps less than 2.5 cm in maximum thickness, and CT measurement of cartilage thickness was imprecise when the cartilage was 1.5 to 2.5 cm thick. For this reason, CT did not solve the difficult problem of distinguishing between benign exostoses with relatively thick cartilage caps and exostotic chondrosarcomas with relatively thin cartilage.

Scintigraphy of benign exostoses and exostotic chondrosarcomas.

Technetium-99m diphosphonate scintigraphy of 11 benign exostoses and nine exostotic chondrosarcomas was correlated with pathologic macrosections of the resected tumors. Increased uptake in benign exostoses occurred in areas of enchondral ossification, and uptake in chondrosarcomas occurred in areas where ossification, osteoblastic activity, and hyperemia were found. Uptake was not related to amorphous cartilage calcification. Radiopharmaceutical uptake, therefore, correlated with areas of ossification visible radiographically, and large masses of nonossifying cartilage were not detected. Radionuclide bone imaging did not contribute to the preoperative anatomic evaluation of these tumors, and it did not always distinguish benign from malignant lesions.

Soft-tissue effects following 224Ra injections into humans.

Following the Second World War, repeated intravenous injections of 224Ra (ThX) were given to German children and adults for the intended treatment of tuberculosis, ankylosing spondylitis, and a few other diseases. We have ascertained the health status of 204 juveniles and 612 adults for whom both dosage and injection span are known. 224Ra is known as a “skeletal-seeker”, and has induced malignant bone sarcomas, benign exostoses, tooth breakage, and growth retardation. But because of its short 3.62-day half-life, 224Ra also decays to an appreciable extent in soft tissues, as do the injected atoms of its decay products. In the present article we present evidence suggesting that some, but certainly not all, of the observed cases of soft-tissue neoplasms, kidney diseases, liver cirrhosis, and cataracts may be related to the 224Ra therapy. Of particular interest are the 8 cases of cataracts reported at 14–46 years of age (33 yr average) among the 204 patients injected with 224Ra as juveniles. Due to the rarity of “naturally-occurring” cataracts at young ages, perhaps all of these 8 cases can be regarded as induced.

Skeletal Effects Following 224Ra Injections Into Humans

Repeated injections of 224Ra into German patients have produced tooth breakage, growth retardation, benign exostoses, and malignant bone sarcomas. Tooth breakage was most frequent in adolescents 1120 yr old at 224Ra injection. Growth retardation and exostoses were most frequent in the very young children and were not induced in adults. Bone sarcomas have occurred in 54 of the 897 traced patients of known and unknown dose, with appearance times ranging from 3.5 to 22 yr after 1st 224Ra injection. For patients of known dose and injection span, bone sarcomas occurred in 35 of 204 juveniles (1110 rad average skeletal dose and 11 months average injection span), and in 13 of 612 adults (210 rad average skeletal dose and 6 months average injection span). For equal injection spans, the juveniles were only slightly more sensitive per rad than the adults to 224Ra-induced bone sarcomas. The incidence of bone sarcomas from a given dose of 224Ra increased as the span of the injection series increased, and this effect in humans has been confirmed in the Neuherberg mice.