Bizarre Parosteal Osteochondromatous Proliferation Research Articles

Bizarre parosteal osteochondromatous proliferation (Nora's lesion)

Bizarre parosteal osteochondromatous proliferation (BPOP; Nora's lesion) is the most common benign osteocartilaginous lesion. It is most commonly seen in hands followed by the long bones, feet, and skull. The clinical and pathological feature's of Nora's Lesion mimick malignant lesions. The recurrence rate of lesion is 20%–50%. We present a case of BPOP of the middle phalanx of the middle finger. The importance of the case is that involvement of hand may not rare, but it's present in the proximal phalanges is very rare. In our case, it is present in the middle phalanx of the right middle finger.

Bizarre Parosteal Osteochondromatous Proliferation (Nora Lesion)

Bizarre parosteal osteochondromatous proliferation, also known as Nora lesion, is a rare benign surface lesion of the bone commonly affecting the hands and feet. It has an aggressive local growth pattern and high rate of recurrence post-excision. The authors report a case of recurred Nora lesion involving thumb metacarpal neck. En bloc resection with immediate reconstruction using distal radius bone graft was provided as a treatment with no clinical or radiological recurrence at 2-year follow-up.

Bizarre parosteal osteochondromatous proliferation (Nora’s lesion) of middle phalanx in an adult female

Bizarre parosteal osteochondromatous proliferation (BPOP; also called Nora’s lesion) is a benign surface osteocartilaginous lesion. This condition seen in hands followed by the feet, long bones and the skull. The importance of the lesion lies in its clinical and pathological differentiation from malignant lesions mainly in osteosarcoma in children and chondrosarcoma in adults. The lesion is 20–50% recurrence rate. We present a case report of BPOP of the middle phalanx of the right middle finger.The importance of the case lies the involvement of phalanges is not rare, but if present it mainly in the proximal phalanges. In my case present in middle phalanx of the right middle finger.

Differences in molecular regulation between osteochondroma and bizarre parosteal osteochondromatous proliferation.

The differences in molecular mechanisms between osteochondroma and bizarre parosteal osteochondromatous proliferation (BPOP) remain to be fully elucidated. In the present study, the differentially expressed genes between BPOP and osteochondroma were obtained from the Gene Expression Omnibus online database, and the associations among these genes were analyzed using the Database for Annotation, Visualization, and Integrated Discovery (DAVID) online bioinformatics software. The results revealed several differentially expressed genes between human BPOP and osteochondroma. These differentially expressed genes were also enriched in different subgroups based on the analysis using DAVID online software, including ‘transforming growth factor β receptor signaling pathway’, ‘BMP signaling pathway’, ‘Wnt receptor signaling pathway’, ‘response to chemical stimulus’, ‘regulation of inflammatory response’, ‘response to stress’, ‘glycosaminoglycan binding’, ‘polysaccharide binding’, ‘extracellular matrix structural constituent’ and ‘growth factors binding’. Taken together, these findings led to the conclusion that different gene regulatory mechanisms exist between BPOP and osteochondroma. Environmental stimulation and inflammation may contribute to BPOP or osteochondroma, and differences in extracellular matrix may contribute to differences in biological characteristics between BPOP and osteochondroma.

Soft Tissue Chondroma—Result of Surgery in a Local Hospital and Review of the Literature: 軟組織軟骨瘤: 地區醫院之手術治療成效及文獻回顧

Background/PurposeThis was a retrospective case series that aimed to study the clinical features and results of surgery for soft tissue chondroma, which is a benign extraskeletal cartilage tumour. MethodsTen patients with a histological diagnosis of soft tissue chondroma were recruited between 2001 and 2012. Tumours involved the hand and wrist (n = 4), foot (n = 3), popliteal fossa (n = 2), and deltoid (n = 1). ResultsThe most common complaints were progressive enlargement of the size of the mass (50%) and pain (50%). Radiographs showed calcified soft tissue mass in 90% of cases. Marginal excision was performed. The mean follow-up duration was 27.6 months. There was one suspected recurrence case with a mass over the index finger. Surgical re-excision was performed and the second histological diagnosis was bizarre parosteal osteochondromatous proliferation. At final follow-up, nine out of ten cases were symptom free. One patient had residual finger joint stiffness and deformity. ConclusionThe results of marginal excisions for soft tissue chondroma is satisfactory with low complication and recurrence rates.

Multiple Osteochondroma of the Hand in a 6 Year Old Child- A Case Report

Osteochondromas are the most common benign tumors of the bone. However osteochondromas are very rare in the hand but seen frequently in patients with multiple hereditary exostoses [1]. Osteochondroma of the digit in paediatric patient is associated with angular deformity, splaying of fingers and/or restricted finger movements [2]. Phalangeal osteochondroma needs to be differentiated from bizarre parosteal osteochondromatous proliferation (BPOP) or Nora’s lesion, and other reactive lesions of the bone surface as treatment differs [3]. We report a case of multiple osteochondroma exclusively involving both the hands with restricted finger movements and splaying of fingers in a 6 year old boy. Patient was treated with excision of the osteochondroma of the phalanges on both the hands with good functional outcome.

Bizarre parosteal osteochondromatous proliferation on a phalanx with periosteal erosion

Summary Bizarre parosteal osteochondromatous proliferation (BPOP) is an uncommon benign hand tumor with a high rate of local recurrence, marked proliferative activity, and an atypical histological appearance. The aim of this paper is to present a rare and illustrative example of BPOP with periosteal erosion. A 64-year-old male presented with a 10-year history of a mass, measuring approximately 3 cm in diameter, on the dorsal aspect of the right index finger. On physical examination, the mass was hard, indolent, and located at the level of the proximal phalanx. Roentgenograms displayed a soft tissue mass over the right index finger with erosion of the periosteum. Magnetic resonance imaging revealed a few well-defined lobulated tumors over the right index finger proximal interphalangeal joint with periosteal reaction. The soft tissue tumors were excised and found to have soft consistencies. Pathological findings demonstrated that the tumor was compatible with BPOP. BPOP is a benign but locally aggressive fibro-osseous mass yielding radiographic findings that bear striking clinical similarities to those of other diseases, such as osteochondroma, osteosarcoma, and myositis ossificans. As the radiographic findings of BPOP are equivocal, the differential diagnosis must be based on the pathological results. With this case report, we aim to inform physicians that a hand tumor with an aggressive clinical picture may be benign in origin.

Nora's Lesion of The Anterior Maxilla: A rare case report and literature review

Bizarre parosteal osteochondromatous proliferation (BPOP), or eponymically Nora's lesion, is a rare growing, to a certain extent, exophytic lesion usually emanating from the periosteum or its adjacent layers. BPOP is idiopathically painful. Given its cartilage-producing nature and pain, BPOP is viewed with great suspicion. Regular post-surgical radiographs and clinical follow-up are mandatory. In the gnathic bones, the lesion is extremely rare. To the author's best knowledge, this paper reports the sophomoric appearance of BPOP in the anterior maxilla, in an adult female.

Nora's Lesion: A Rare Differential Diagnosis for Benign Peripheral Bone Tumours

We report on a bizarre parosteal osteochondromatous proliferation (BPOP), also known as Nora's lesion, in a 43-year-old female patient.

Congenital Bizarre Parosteal Osteochondromatous Proliferation (BPOP/Nora's lesion) in an unusual location and unusual age: A case report

Congenital Bizarre Parosteal Osteochondromatous Proliferation (BPOP/Nora's lesion) in an unusual location and unusual age: A case report

A bizarre parosteal osteochondromatous proliferation (Nora's lesion) of metatarsus, a histopathological and etiological puzzlement

Nora's lesion (bizarre parosteal osteochondromatous proliferation) is a rare, benign lesion that is composed of differing amounts of cartilage, bone, and spindle cells and an unusual form of calcified cartilage so-called “blue bone”. Whether it represents a reactive proliferation or a neoplastic lesion still remains controversial. We present a 24-year-old woman having a 4.5cm two lobulated mass attached to second metatarsus of her left foot. The lesion was hyperintense on magnetic resonance imaging and accompanied by an extensive soft tissue and bone marrow edema. In resection specimen, smaller lobule appeared stuck-on the cortex while the larger one had a broader base and a 0.4cm cartilaginous cap-like formation. The histological picture was best fit to Nora's lesion however showed less fibroblastic tissue and cartilaginous pleomorphism. The lesion also showed areas with cortical invasion and a small focus of fracture callus accompanied by adjacent medullary edema and fat necrosis. The case is presented with the comparative radiologic, macroscopic and microscopic findings for its diagnostic difficulties and etiopathogenetic considerations in favour of a maturation phenomenon in parosteal ostecartilaginous lesions irrespective of the cause.

First recorded case of transformation of parosteal osteochondromatous proliferation (BPOP)to sarcoma: case report and literature review

Bizarre parosteal osteochondromatous proliferation (BPOP) is a rare benign lesion that tends to occur within the bones of the hands and feet. Described first in 1983, only 3 cases have been reported in the head and neck region. It can be confused with other bony lesions, and has a high rate (up to 50%) of recurrence when resected. Aetiology is unclear and diagnosis is made on specific radiological and histopathological features. No reported cases have given rise to malignancy. Oral presentations for BAOMS Annual Scientific Meeting 2-4 July 2014, Edinburgh International Conference Centre, ScotlandBritish Journal of Oral and Maxillofacial SurgeryVol. 52Issue 8Preview Full-Text PDF

Bizarre Parosteal Osteochondromatous Proliferation of Long Bones: Two New Cases and Literature Study

In research on tumors of mesenchymal origin, although the type localized in the short, tubular bones has been evaluated in detail, there have been no reports to date regarding the clinical, radiological and treatment characteristics of the type localized in the long bones. In this study, Nora’s lesions localized in the long bones were investigated in terms of their characteristics and behavior. An extensive literature review was performed using PubMed, MEDLINE (1983 - 2012) and Google Scholar. Search terms included ‘‘bizarre parosteal osteochondromatous proliferation’’ (BPOP) and ‘‘Nora’s lesion’’. The literature search yielded 88 articles and a total of 43 patients. The median age of the cases was 26 years. BPOP occurred with equal frequency in men and women. The most frequent sites of involvement were the femur (25%) and the ulna (23%). Plain radiographs of 20 cases were available, but only a small number of cases had CTs (n = 11) and MRIs (n = 12) performed. It was determined that 66% of the lesions led to cortical changes, while 23.5% led to medullary invasion or soft tissue infiltration. As to treatments, “simple excision” (intralesional) was performed on seven lesions, marginal resection was performed in nine patients, wide resection was performed in two patients, “shark-bite” surgery was performed in one patient and “shave excision” was performed in one patient. The mean follow-up period was 30.9 months. Local recurrence rate was 18.75%. Clinically and in terms of radiological images, we believe that this lesion observed in the long bones consists of four phases: stages I, II, III and IV. We believe this type of lesion demonstrates no spontaneous recovery, and that it is a progressive lesion involving cortical destruction and medullary infiltration. As such, we consider marginal resection to be the appropriate technique for treating this lesion. J Med Cases. 2014;5(6):315-325 doi: http://dx.doi.org/ 10.14740 / jmc1624w

Bizarre Parosteal Osteochondromatous Proliferation of Long Bones: Two New Cases and Literature Study

In research on tumors of mesenchymal origin, although the type localized in the short, tubular bones has been evaluated in detail, there have been no reports to date regarding the clinical, radiological and treatment characteristics of the type localized in the long bones. In this study, Nora’s lesions localized in the long bones were investigated in terms of their characteristics and behavior. An extensive literature review was performed using PubMed, MEDLINE (1983 - 2012) and Google Scholar. Search terms included ‘‘bizarre parosteal osteochondromatous proliferation’’ (BPOP) and ‘‘Nora’s lesion’’. The literature search yielded 88 articles and a total of 43 patients. The median age of the cases was 26 years. BPOP occurred with equal frequency in men and women. The most frequent sites of involvement were the femur (25%) and the ulna (23%). Plain radiographs of 20 cases were available, but only a small number of cases had CTs (n = 11) and MRIs (n = 12) performed. It was determined that 66% of the lesions led to cortical changes, while 23.5% led to medullary invasion or soft tissue infiltration. As to treatments, “simple excision” (intralesional) was performed on seven lesions, marginal resection was performed in nine patients, wide resection was performed in two patients, “shark-bite” surgery was performed in one patient and “shave excision” was performed in one patient. The mean follow-up period was 30.9 months. Local recurrence rate was 18.75%. Clinically and in terms of radiological images, we believe that this lesion observed in the long bones consists of four phases: stages I, II, III and IV. We believe this type of lesion demonstrates no spontaneous recovery, and that it is a progressive lesion involving cortical destruction and medullary infiltration. As such, we consider marginal resection to be the appropriate technique for treating this lesion. J Med Cases. 2014;5(6):315-325 doi: https://doi.org/10.14740/jmc1624w

Bizarre parosteal osteochondromatous proliferation of humerus with unusual presentation: a report of one atypical case

Bizarre Parosteal Osteochondromatous Proliferation (BPOP) as defined by Nora and colleagues in 1983 (called Nora lesion) is a rare benign, bony lesion and found mostly in metacarpals and metatarsals. BPOP in long bones are very rare. It is an exophytic outgrowth from the cortical surface comprising of bone, cartilage and fibrous tissue. The key radiological features to describe such lesions as calcified and osseous masses. We describe a case of BPOP in a 26 year old female involving the shaft of humerus. The radiological picture is a trabeculated osteolytic lesion. FNA revealed chondroma and histologic picture showed disordered pattern of cartilage, bone and fibrous tissue. This case is reported as the lesion is at a rare site (shaft of Humerus) unusual X-ray picture for the lesion and diagnostic histopathologic picture.

Bizarre parosteal osteochondromatous proliferation: a new cytogenetic subgroup characterized by inversion of chromosome 7

Bizarre parosteal osteochondromatous proliferation (BPOP) is a rare, benign osteocartilaginous lesion characterized by a mixture of immature bone, bland spindle cells, and irregular, hypercellular cartilage undergoing calcification. A t(1;17)(q32;q21) has been reported as a unique recurring translocation identified in seven cases. Inversion of chromosome 7, inv(7)(q22q32), has also recently been described in one case of BPOP. We report an additional case of inv(7) in a BPOP occurring on the distal radius in a 36-year-old woman who presented with a slow-growing mass on the right wrist. Metaphase karyotype analysis of fresh tissue from tumor taken at resection revealed an inv(7)(q22q32). A review of the literature identified two additional cases of inv(7) (q21.1q31.3 and q22.1q31.3), both paired with inv(6)(p25q15), bringing the total number of cases of inv(7) in BPOP to four. These data suggest inv(7) may be another characteristic cytogenetic abnormality associated with and possibly contributing to the development of BPOP.

Nora’s lesion: description of a case

The article describes a rare case of bizarre parosteal osteochondromatous proliferation (Nora’s lesion) on a finger in three patients, treated by the authors. The aetiology of the disease has not been found out yet. Diagnosis is made on the basis of clinical, radiological and histological examinations. The method of treatment of this lesion is surgical.

Bizarre Parosteal Osteochondromatous Proliferation of the Skull in a Young Male

Bizarre parosteal osteochondromatous proliferation (BPOP), as defined by Nora and colleagues in 1983 (also called Nora lesion), is a rare lesion. About 160 cases of BPOP have been presented in the literature to date. The lesion is an exophytic outgrowth from the cortical surface consisting of bone, cartilage and fibrous tissue. These types of lesions have been reported mostly in the hands and feet. Localization at the level of the skull is extremely rare. We report a case of a young man with multiple Nora’s lesions with atypical localization in the skull and mandible.

Popliteal pseudoaneurysm caused by Nora's lesion of the femur in a young child: A rare presentation and first report

Bizarre parosteal osteochondromatous proliferation (BPOP), or Nora's lesion, was first described by Nora et al. in 1983 as a rare, tumor-like lesion involving the bones of the hands and feet. Popliteal artery pseudoaneursyms in the pediatric population are also unusual. Here, we present a case of a young male with a popliteal artery pseudoaneurysm and distal femur lesion originally thought to be an osteochondroma. A 10-year old, Caucasian male was referred to our facility following an MRI concerning for a popliteal artery pseudoaneurysm. On physical exam, there was a palpable 5×5-cm pulsatile mass in the upper popliteal fossa with a normal pulse exam bilaterally. A computed tomographic angiogram demonstrated a 4.5-cm by 1.8-cm by 3.6-cm pseudoaneurysm adherent to a 3.5-cm thick, exostotic lesion of the posterior right femur. He was taken to the operating room for repair of the popliteal pseudoaneurysm and resection of his bone lesion. The final pathology was consistent with a popliteal pseudoaneurysm, osteochondroma, and bizarre parosteal osteochondromatous proliferation (BPOP), otherwise known as Nora's lesion. The location of the lesion and the age of our patient were both atypical for BPOP and to our knowledge, this represents the first report of a resulting popliteal artery pseudoaneurysm.

Metacarpal solitary osteochondroma—case report of a rare condition

Histologically, osteochondromas are hamartomas developed from endochondral ossification which are coated with a thin cartilage layer [1]. Epidemiologically, these are the most frequent benign tumor, after nonossifying fibromas and metaphyseal lacunae, representing, in the Unni series [2], about 40 % of all benign tumors, and they are located preferentially at the metaphyseal level of long bones. Their location in the hand is extremely rare, except in cases of multiple hereditary exostoses. The following differential diagnoses should be considered: bizarre parosteal osteochondromatous proliferation (Nora's lesion) [3], florid reactive periostitis [4], and turret exostosis [5].