Cartilage Cap Research Articles

Osteochondroma of the distal tibia with associated varus deformity of ankle

Osteochondroma or exostosis is a bony developmental anomaly, which arises from exophytic outgrowth on bone surfaces characteristically. The most common site is the distal femur followed by the proximal humerus and proximal tibia. It is made up of a bony protrusion that is covered by a cartilage cap. Osteochondroma is asymptomatic and grows away from the nearby joint. It is very common in kids and young adults. Sometimes patient comes in 2nd decade with complaints of pain and swelling. This paper reports a presentation of osteochondroma present over the right distal tibia.

Secondary Chondrosarcoma of the Rib in a Case of Diaphyseal Aclasis: A Rare Case Report

Hereditary multiple exostosis has a 3%–5% chance of converting into chondrosarcoma. It is a rare case report of a 32-year-old female with hereditary multiple exostosis who presented with pain and progressive swelling over her right chest wall for 3 months. A clinical examination revealed a large globular swelling over her right chest. Imaging revealed a large, ill-defined, aggressive, and exophytic lesion with a thick cartilage cap arising from the 8th rib. The lesion was hypermetabolic and avid on PET CT scan. She underwent a core needle biopsy which showed features of malignant transformation. En-bloc resection of the tumor with 7, 8, and 9 ribs followed by plate and mesh reconstruction was carried out.

Medial End Clavicular Osteochondroma- An Unusual Case

Abstract Osteochondroma is the most common benign bone tumor, which could present as a sessile or pedunculated type and, in solitary or multiples, hereditary multiple exostoses (a genetic disorder, autosomal dominant inheritance). Clinical presentation is mostly asymptomatic, but if symptomatic, it presents in a wide spectrum, such as compression of adjacent vessels, nerves, deformities, fractures, bursa formation, and malignant transformation. Cancerous transformation is indicated by the thickness of the cartilage cap of >3 cm in children, >2 cm in adults, sudden onset of pain, and sudden/rapid growth of lesion (after growth plate closure). Surgical management is indicated for typical symptomatic lesions, complications, malignant transformation, and cosmetic reasons. The common treatment of choice is the excision of a tumor with a significant free margin.

Can the Cartilaginous Thickness Determine the Risk of Malignancy in Pelvic Cartilaginous Tumors, and How Accurate is the Preoperative Biopsy of These Tumors?

Can the Cartilaginous Thickness Determine the Risk of Malignancy in Pelvic Cartilaginous Tumors, and How Accurate is the Preoperative Biopsy of These Tumors?

Subungual Osteochondroma of the Great Toe: A Case Report.

Bony outgrowths of the distal phalanx of the great toe have been described in the literature but rarely. These subungual bony outgrowths can be caused by subungual exostosis or subungual osteochondromas. Both of these abnormalities are bony outgrowths with differences in the cartilage cap wherein the exostoses have fibrocartilage, and osteochondromas have hyaline cartilage. The subungual exostosis and osteochondroma that are protruding present symptoms of pain, redness, and deformed nail bed, whereas the nonprotruding osteochondromas have only a lump as the presenting symptom. In both conditions, excision of the lesion and curettage of the base helps prevent a recurrence. Curettage at the end of the excision of the bony outgrowth is required to avoid recurrence. After excision, the specimen should be sent for histopathologic examination to differentiate between the exostosis and osteochondromas, which are underreported in subungual locations, and to rule out malignant transformation. We present a 13-year-old girl with an isolated subungual nonprotruding exostosis of the great toe that was treated by excisional biopsy. The histopathologic examination confirmed it as osteochondroma, which is underreported.

Secondary peripheral chondrosarcoma in multiple osteochondromas: a retrospective single-institution case series

BackgroundMultiple osteochondromas is genetic disorder characterized by the formation of multiple benign cartilage-capped bone tumors, named osteochondromas, during skeletal development. The most feared complication is the secondary peripheral chondrosarcoma, a malignant cartilaginous neoplasm that arises from the chondroid cap of pre-existent osteochondromas. We conducted a retrospective cohort study on patients diagnosed and followed up from 1960 to 2019 to describe the clinical and pathological features of individuals affected by peripheral chondrosarcoma in multiple osteochondromas, to evaluate follow up information and individual outcome and to compare the results with literature. Data, including age, gender, site, histological grade, cartilage cap thickness, surgical treatments, surgical margins, genotype mutational status as well as treatment details were captured from the hospital electronic health records and from Registry of Multiple Osteochondromas. In addition, a complete histological review of all hematoxylin and eosin (H&E)-stained sections has been performed by expert pathologists.ResultsOne hundred five of the screened cases were included in the present study. The age at diagnosis of SPC ranges from 13 to 63, with median age at diagnosis of 34 years. The site most frequently affected by malignant degeneration was the pelvis (46 patients, 44%) with higher incidence in male patients (32 males vs.14 females). The second one was lower limbs (including femur, fibula, or tibia), identified in 35 patients. Histological information - available for 103 patients – showed: 59 patients with grade 1; 40 patients had a grade 2 and 4 patients had a grade 3. The most common surgical treatment was the complete resection, followed by debulking, amputation and partial resection. Most of cases did not have recurrence of the disease. Outcome in disease-free survival highlights that a worse course of the disease was associated with histological grade 2 or 3, and partial resection surgery. In most of analyzed cases (94%) a pathogenic variant was identified.ConclusionsIn conclusion, the present study gives an overview of the secondary peripheral chondrosarcomas, confirming that this disease represents an impacting complication for multiple osteochondromas patients and suggests that malignant transformation can occur also in younger patient, in a not irrelevant number of cases.

Solitary Osteochondroma of Scapula: A Common Entity at an Uncommon Location

Introduction: Introduction: Osteochondroma are benign bone tumours that often affect the metaphysical region of long bones; the scapula is rarely affected. Owing to its bulk effect, scapular osteochondroma may frequently present with symptoms. These tumours typically damage the skeleton's developing ends and stop becoming larger once the skeleton reaches maturity.Suspicion of a cancer should be raised by any increase in size. Case Report: A female patient, age 25, complained of a hard lump on her shoulder posteriorly on further imaging it was confirmed as an osteochondroma of scapula. Discussion: Osteochondromas must exhibit continuity with the underlying parent bone cortex and medullary canal. They are made up of cortical and medullary bone with an overlaying hyaline cartilage cap. They have a very minimal potential for malignancy and are often asymptomatic. Conclusion: The cases of osteochondromas in the scapula are relatively rare, it is crucial to remain vigilant and consider the possibility of malignancy if there are concerning changes in symptoms or size.

Update in diagnosis, treatment, and prevention of osteochondritis dissecans of the capitellum.

Osteochondritis dissecans of the capitellum is debilitating and is a potentially sports career-ending injury in a young and athletic population. Osteochondritis dissecans typically occurs in patients between the ages of 10 and 24 years, and boys are more commonly affected than girls. Conventional radiographs have low diagnostic accuracy, and magnetic resonance imaging (with or without contrast) or computed tomography may aid in accurate diagnosis. The primary indication for non-operative treatment is the presence of an intact cartilage cap on magnetic resonance imaging, indicating a "stable lesion." However, if operative treatment is necessary, various surgical procedures are available when operative treatment for an osteochondritis dissecans of the capitellum is considered, including open or arthroscopic removal of loose bodies, with or without microfracturing, fragment fixation, osteochondral autograft transplantation, and osteochondral allograft transplantation. The decision-making process for selecting the appropriate treatment considers factors such as the patient's characteristics, functional limitations, and lesion morphology.

Articular Cartilage After Toe Amputation-Protective Barrier or Source of Infection?: A Retrospective Chart Review.

Digital and ray amputations are common surgical treatments for infected bone and traumatic injuries in the foot. When disarticulated, the exposed articular cartilage can be addressed by either leaving the cartilage cap as a "protective barrier" to infection or by remodeling the exposed bone, removing the cartilage to bleeding bone to better fight infection. Our objective is to provide the first study in the foot to determine whether leaving exposed articular cartilage after toe amputation results in more returns to surgery and delayed healing. We performed a review of the electronic database of patients who had undergone toe amputation and/or metatarsal head amputation with the inclusion criteria of Current Procedural Terminology codes 28825, 28820, and 28810. Excluded patients were those who had multiple osteomyelitic bones or more than one-digit amputations because of the difficulty of controlling the extent of infection. Sixty-three procedures were included in the study (group 1, n = 47; group, n = 216). The time to healing between group 1 (44.0 ± 40.6 days) and group 2 (51.7 ± 48.0 days) was not statistically significant (t test, 0.54392), with reinfection rate being low in both group 1 (8.51%) and group 2 (6.25%). Our study showed a low reinfection rate in both groups (8.51% vs 6.25%). Age, A1C, and BMI were also similar between both groups. The PAD difference (55.3% vs 81.3%) could have contributed to the time to heal (44.0 vs 51.7 days) but not to infection rate between both groups. Tobacco use did not seem to affect time to heal or infection rate between both groups. From our results, there doesn't seem to be a difference in infection rates between each group.

Is total-body MRI useful as a screening tool to rule out malignant progression in patients with multiple osteochondromas? Results in a single-center cohort of 319 adult patients.

To evaluate the results of total-body (TB) MRI used as a screening tool for assessment or exclusion of malignant transformation in patients with hereditary multiple osteochondromas (HMO). In a single-institute cohort of MO patients, 366 TB-MRI examinations, including T1-weighted and STIR images, were performed for screening and follow-up purposes to rule out the malignant transformation, and retrospectively analyzed. In each patient, the presence and location of osteochondromas in the axial and appendicular bones were recorded. Forty-seven patients underwent a second TB surveillance in this period. STIR sequences were used to identify sites of increased signal intensity that could represent suspicious thickened cartilage caps or indeterminate reactive changes related to osteochondromas. In 82% of patients, one or more OC locations were determined in one or more flat bones. In 366 exams, nine OC (2,5 %) with suspicious imaging features were identified. These proved to be peripheral chondrosarcomas after targeted MRI and resection were performed. All nine malignant lesions were in flat bones (pelvis 5, ribs 3, scapula 1). Three of these patients were 19 years of age. In 12 patients who had peripheral or intraosseous low-grade chondrosarcoma in their history, before their first TB-MRI, no new lesions were identified. Twenty-three additional TB-MRI exams, demonstrating focal high T2 signal intensity, also gave rise to performing additional targeted MRI. One OC of the distal femur was excised and appeared benign. No suspicious cartilage caps were depicted on the remaining 22 targeted MRI exams but instead increased T2 signal was clarified by reactive changes (frictional bursitis, soft tissue edema) in close relation with benign osteochondromas. No malignant lesions were found in 47 patients who had a second TB surveillance (mean interval between exams 3.2 years, range 2-5 years). TB-MRI can identify malignant transformation of osteochondromas in HMO patients. All peripheral chondrosarcomas occurred in flat bones (ribs, scapula, pelvis) in our study. TB-MRI might assist in triage between higher risk patients with a high burden of OC, including the location of OC in main flat bones vs lower risk patients without OC of the flat bones.

Giant Osteochondroma of Tibia in a Case of Hereditary Multiple Exostoses: A Case Report

Osteochondromas, aka exostoses, are benign neoplasms of the cartilage. Genetic mutations of the EXT1 and EXT2 genes leads to a syndrome causing multiple osteochondromas, namely the hereditary multiple exostoses. Among the complications related to multiple osteochondromas, malignant degeneration into chondrosarcoma has the worst prognosis. Sudden enlargement of size of an osteochondroma or sudden onset of pain at the site of previous osteochondroma in a skeletally mature patient is concerning for malignant transformation. However, the size criterion does not apply for skeletally immature individuals, as observed in the case report here. The imaging of an uncommonly large osteochondroma of the extremity in a skeletally immature patient with hereditary multiple exostoses has been described here. Normal thickness of the cartilage cap (<3cm) proved the benignity of the lesion on imaging, thereby nullifying the size criterion in the skeletally immature. Keywords: Hereditary multiple exostoses, Osteochondroma, Cartilage cap, Heparan sulphate, Bayonet deformity, Chondrosarcoma.

Excision of a Superior Ramus Osteochondroma Through the Modified Stoppa Approach

Excision of a Superior Ramus Osteochondroma Through the Modified Stoppa Approach

A case of osteochondroma arising at the articular tubercle of the temporal bone

Osteochondroma is a benign bone tumor covered by a cartilage cap, arising at the external surface of the bone. In the oral and maxillofacial regions, this lesion is known to develop in the mandibular condyle; however, involvement of the temporal bone is rare. We present a case of osteochondroma arising at the articular tubercle of the temporal bone. A 32-year-old man visited our department for evaluation of a mass in the right temporal bone. Radiographic examination revealed a pedunculated exophytic mass continuous with the articular tubercle of the right temporal bone, and the patient was clinically diagnosed with a temporal bone tumor. We performed surgical resection through a preauricular incision under general anesthesia. A histopathological evaluation revealed formation of bone covered by a cartilage cap, which confirmed the diagnosis of osteochondroma. The residual lesion showed no growth two years postoperatively.

A Unique Case of Hereditary Multiple Osteochondromas in the Feet

This report describes the differential diagnosis of osseous growths in the first metatarsals of an adult male previously unreported in the literature. Examination of the remains via macroscopic analysis and conventional radiography identified unusual bilateral growths arising from the lateral aspects of the first metatarsals with growth directed towards the tarsometatarsal joint. Two exostoses in the ribs were also observed. Using the available evidence, hereditary multiple osteochondromas (HMO) was determined the likely causative disorder for the pedal growths based on the presence of cartilage caps on the ends of the growths, a lack of articular morphology, and the presence of a rib exostosis consistent with HMO. The potential bilateral expression of HMO in the first metatarsals in this case challenges the dominating diagnostic criteria that HMO growths are directed away from the growth plate and only occur in the metaphysis, expanding the spectrum of HMO’s manifestation in the human skeleton. Medical records for the decedent provided no indication of a disorder associated with the development of osteochondromas, nor any indication that medical treatment was undertaken to manage the growths.

Hereditary Multiple Exostoses (HME) with Peroneal Nerve Compresion: A Case Report

Introduction: Hereditary multiple exostosis (HME) is a hereditary disorder characterized by multiple osteochondromas. Clinical symptoms can result from compression of adjacent structures such as peripheral nerves. In Indonesia, HME with nerve compression cases have rarely reported. Presentation of Case: An eleven-year-old female with complaining of left knee joint pain and progressive masses in left lower leg since 6 years ago. This complains followed by numbness and difficulty to dorso flexion motion on left ankle joint since four months ago. Physical examination showed of the bony masses was detected at the left lateral upper third lower leg with measuring about six into eight centimeters. Range of motion of left ankle joint patient had difficult to dorso flexion. X-ray imaging viewed demonstrates multiple exostosis appearance involving distal femoral, proximal fibula, proximal tibia and distal fibula bone. MR Imaging revealed cartilage cap of head fibula is thin less 1.5 cm and the axially specimen showed peroneal nerve compression. The patient underwent left head fibula wide resection. Intraoperative findings peripheral nerve peroneal compression and was decompression. Medical rehabilitation for physiotherapy was advised. The results of the follow-up after 2 years, no pain feels and the patient was able to dorso flexion of left ankle joint and no additional bumps in other areas of the body. These lesions may arise from any bone which was pre-formed in the cartilage. Nerve compression syndromes are the neurological complex symptom caused by the mechanical or dynamic compression of a specific single segment. MRI was excellent demonstration of blood vessels compromise and represents choices with peripheral nerves structures and to measuring cartilage cap thickness for criterion of osteochondromas differentiation and exostotic grade. Complete resection was importance of the cartilaginous cap to prevent recurrence. The decompressing the peroneal nerve that pressured by the masses and vascular problems occured. Conclusion: Hereditary multiple exostosis is an inherited disorder characterized by multiple osteochondromas. It is important to monitor all cases of HME especially if the patient complains of pain or growth of an osteochondroma. The surgical excision, with complete resection of the cartilaginous cap of the tumor, is important in preventing recurrence.

Acquired Spur-Like Bony Growth Over the Previous Fibulectomy Site Following the Management of Both Bone Leg Fracture Nonunion: A Case Report

Abstract Exophytic bony outgrowths have many differential diagnoses, with osteochondroma being the most common. The de novo development of a well-defined bony growth over the location of a previous surgery is a rare occurrence. Here, we describe a case of gradual development of a small bony exophytic lesion over the fibula diaphysis as a delayed complication of the previous fibulectomy. The index surgical procedure of fibulectomy was coupled with bone grafting at the tibial nonunion site following failed conservative management of the tibia fracture. The tibia fracture eventually united after the bone graft procedure. However, there was a gradual development of the aforementioned bony outgrowth noted in serial radiographs at the site of the previous fibulectomy. The growing lesion was also palpable on deep palpation over the corresponding site, and the excision of the lesion revealed a solid bony mass. Histopathology showed the lesion to be composed of mature bony tissue without any evidence of a cartilage cap. No recurrence or complication was noted in the fourteen-month follow-up. The diagnosis of an acquired exostosis was established based on clinical, radiological, and histopathological evaluation.

OSSICULOPLASTY: AUTOGRAFT VS ALLOGRAFT

Background: Chronic otitis media (COM) is defined as a perforation of the tympanic membrane with persistent drainage of pus from the middle ear lasting at least two weeks. Tympanoplasty is a surgical procedure in ENT practice which aims at removal of diseased pathology from middle ear along with reconstruction of sound conducting mechanism by reconstructing the ossicular chain with various materials. Methods:All the cases of CSOM with ossicular chain deformity were included. Ear examination was done in detail, Preoperative hearing assessment was done and Hearing loss was calculated by average air bone gap on PTA.For Auto graftstragal cartilage or incus was used andfor allograft Teflon TORP/PORP with cartilage cap was used. Results: Comparison forossiculoplasty was done by comparing its advantages and disadvantages in the terms of extrusion rate and hearing restoration in postoperative period. Overall failure rate for autologous material was 8% and for alloplastic material was 12%. Conclusion: the use of autologous graft is more advantageous in terms of surgical outcome, extrusion rate, and postoperative hearing gain.

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

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. 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). 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. 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.

Right foot – osteochondroma - A case report

Osteochondromas are thought of as benign bone tumours, however they are actually developmental defects.A long tubular bone that may be sessile or pedunculated has an outgrowth with cartilage covering it that is visible on radiographs. Additionally, the cartilage cap can harden. Any changes in radiological appearance are strongly indicative of chondrosarcoma, particularly those with ill-defined border development and thickening of the cartilage cap >15 mm.: An insidious onset, slow progression, and lack of aggravating or alleviating variables were all complaints made by a 21-year-old male patient with swelling and pain across the right foot dorsal side for the past two years Upon examination, there was a firm, irregularly shaped, 5 to 6 cm swelling over the dorsal part of the right foot that was attached to the underlying bone.: The majority of benign bone tumours, or 36% to 41% of all benign bone tumours, are conventional osteochondromas. Osteochondromas are uncommon in the foot and ankle regions, but if a big osteochondroma develops in these areas and is interfering with function, it should be removed. The amount of the lesion, any soft tissue involvement, and the depth and placement of the cartilage cap can all be seen on an MRI, which is helpful in the workup of an osteochondroma that is symptomatic or worrisome.According to histology, the osteochondroma's cap is made of hyaline cartilage, with well-differentiated cells abundantly spaced out by cartilage matrix and oriented in columns that mimic the epiphyseal growth plate in the deepest levels of the cap.

New bone formation over dehiscent semicircular canal with cartilage cap.

Cartilage cap resurfacing is a method to seal a superior semicircular canal dehiscence. The purpose of this study was to evaluate the detection of new bone formation after surgical placement of a cartilage cap over a dehiscent semicircular canal. In this retrospective review, two neuroradiologists blinded to each other's interpretation reviewed the temporal bones of 20 patients, five of which had a pre-operative computed tomography (CT) exam which was interpreted as unilateral superior semicircular canal dehiscence and with new bone formation following repair on follow-up CT. There were also 15 control subjects. Each neuroradiologist was blinded to history, including post-operative changes, and asked to determine if there was a dehiscence or no dehiscence. Out of the 15 controls, there was 100% inter-observer agreement. On the five post-operative patients, there was agreement in 4/5 that there was no dehiscence post-operatively and 1/5 agreement of dehiscence post-operatively, but ectopic bone adjacent to the dehiscence. Our results indicate that new bone formation can be seen at the site of cartilage cap placement over the dehiscence and be interpreted as bony closure of the dehiscence.