Case Of Osteochondroma Research Articles

A case of osteochondroma which was suspected as ectopic ossification after trauma

A case of osteochondroma which was suspected as ectopic ossification after trauma

Bone and soft tissue tumours of the foot: review of 83 cases.

To review cases of bone and soft tissue tumours of the feet managed at the Hyogo College of Medicine, Nishinomiya and Takarazuka Municipal Hospital, Takarazuka, Japan. Retrospective analysis of 83 patient records treated for bone and soft tissue tumours of the feet between 1974 and 2000. There were 33 benign bone tumours, one primary malignant bone tumour, and 2 metastatic bone cancer. Marginal resection was performed in cases of osteochondroma and curettage in cases of other benign bone tumour. Despite below-knee amputation in the case of chondrosarcoma, the patient died because of pulmonary metastasis. Two patients with metastatic cancer also died, and 2 cases of osteochondroma and one of benign chondroblastoma recurred. There were 47 cases of soft tissue tumour. Treatment for benign soft tissue tumours was marginal resection; no cases recurred. In contrast, all patients with soft tissue sarcoma died after surgery. The majority of bone tumours were located in the toe and hindfoot areas, in the first and second decades of life, whereas soft tissue tumours occurred mainly in the midfoot area and in patients aged between 20 and 50 years. The sex distribution was almost even for bone tumours (male: female ratio, 19:17), whereas about half as many males as females had soft tissue tumours (14:33). Bone and soft tissue tumours of the feet are uncommon. Most bone tumours are chondrogenic, but differential diagnosis of malignant from benign disease is difficult and prognosis is poor. Management of benign tumours by marginal resection has good prognosis, whereas prognosis of soft tissue sarcomas is very poor.

Osteochondroma of the mandibular condyle: a case report

Abstract.A case of osteochondroma of the right mandibular condyle in a 47-year-old woman is presented. Instead of condylectomy, surgical resection was performed, resulting in fewer functional changes and less dysfunction of the temporomandibular joint but recurrence within 12 months after surgery.

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

AbstractOsteochondroma 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-yearold 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.

Jacob disease: Report of a case and review of the literature

Jacob disease is a rare condition that affects the coronoid process; it was first described in 1899. Jacob disease involves the development of an osteochondroma of the coronoid process and leads to the formation of a pseudo joint between the zygoma and the coronoid process.1-9 A review of the literature reveals only 34 (including the present case) histologically proved cases of osteochondroma of the coronoid process (Table 1). The disease appears to involve males (73.5%) more often than females at a mean age of 35 years and an age range of 10 to 73 years. There is slight predilection for involvement of the left coronoid process. Initial signs and symptoms are a feeling of tightness in the joint region and a gradual reduction in mouth opening. Later stages show a total trismus and appreciable swelling at the malar prominence. Pain is not a feature of this disease. Radiographs taken in the initial stages do not show any significant abnormality, but the later stages show the enlarged coronoid process. The bilateral involvement has also been reported.18 The bilateral cases are self-limiting, but the unilateral cases enlarge progressively to form mushroom-shaped enlargement of the coronoid processes.3, 33 Coronoidectomy and excision of the tumor via an extraoral approach (50%), an intraoral approach (34.3%), and a combined intraoral and extraoral approach (15.7%) has been the most preferred treatment in the published reports. Because of its insidious clinical onset, Jacob disease is often overlooked and misdiagnosed as a temporomandibular joint disorder. Although it is a rare disorder, Jacob disease merits reporting to familiarize clinicians with a condition that may affect the evaluation of patients with restricted mouth opening.

Osteochondroma of the servical spine causing occipital nerve neuralgia. Case report

Osteochondroma is a rare tumor of the cervical spine. The authors present a rare case of osteochondroma narrowing the C1/2 foramen and causing occipital neuralgia. Complete removal of the tumor was performed with release of the pain. The literature is reviewed and etiology, diagnosis, treatment and differential diagnosis are discussed. [Neurol Res 2001; 23: 777-779]

Expression of cyclin D1 and CDK4 in osteosarcoma of the jaws

Objective: To analyze cyclin D1 and cyclin-dependent kinase 4 (CDK4) expression and their significance in osteosarcoma of the jaws. Methods: Immunohistochemical ABC method was used to detect the expression of cyclin D1 and CDK4 in 20 cases of osteosarcoma and 8 cases of osteochondroma of the jaws. Results: The positive rates of cyclin D1 and CDK4 were 65% (13/20) and 60% (12/20), respectively. There was significant positive correlation between cyclin D1 and CDK4 expression (γs=0.48, P<0.05). Both cyclin D1 and CDK4 were present in 1/8 (12.5%) osteochondroma. The positive rate was remarkably different between osteosarcoma and osteochondroma (P<0.05). Conclusion: Cyclin D1 and CDK4 are overexpressed in osteosarcoma of the jaws and closely related to its occurrence and development.

左側下顎かより発生したと思われた骨軟骨腫の１例

Osteochondromas are outgrowths from the epiphyseal regions of bones, particularly the lower end of the femur and upper end of the tibia. In the jaws, solitary growths occur in the coronoid process of the mandible and in the mandibular condyle.An unusual case of osteochondroma of the mandibular fossa is reported. The patient was a 63-year-old man with recurrent luxation of the temporomandibular joint who had malocclusion, but symmetry of the mandible. A radiographic examination showed a well-circumscribed ovoid radiopacity in the left temporomandibular joint space. Computed and three-dimensional tomographic scans showed a loose body between the left mandibular fossa and the condylar head. On MR imaging, the loose body was found to be chondroid tissue, and the disk was dislocated anteriorly.Histological examination revealed a cartilage-capped overgrowth with cartilageous ossification, which had apparently arose in the left mandibular fossa.The patient was followed up for 1 year 3 months. There was no tumor recurrence or temporomandibular joint disorder.

Para-articular/extra-osseous osteochondroma of the knee

An unusual case of osteochondroma arising in the soft tissues adjacent to the knee is presented. The controversy arises from the confusion of this mass with giant synovial chondromatosis or the more dangerous chondrosarcomas. Preoperatively, CT scans can demonstrate that these lesions are isolated to the soft tissues, and there is no connection to bone; this can be confirmed at surgery. Detailed histological analysis is important to rule out malignant changes. The distinction is important to avoid unnecessary aggression in surgery, as these are benign lesions with a good prognosis after local excision.

Invited commentary to: „Osteochondroma of the cervical spine in combination with chronic posttraumatic bisegmental instability”

Vrabl (1) reports the case of a 32-year old female patient with hereditary multiple exostoses, one of which affected the C5 arch and, in concurrence with chronic posttraumatic C4-6 instability, caused a 2/3 stenosis of the spinal canal. Hereditary multiple exostoses (osteochondromas), an autosomal dominant disorder, also called diaphyseal aclasis, is one of the more frequent hereditary diseases of the skeleton. We registered and are following this disturbance of skeletal development in 111 cases who received treatment between 1966 and 1995. The disease individually varies in degree from just a few, small, and hardly apparent exostoses, mostly on long bones of the extremities, to very severe forms with extensive involvement of the skeleton, severe deformities of the extremities, and often an involvement of the axial skeleton. There exists no treatment that is directed against the causes of the disease, surgical removal of all lesions is impossible, removal of osteochondromas is indicated in large lesions limiting mobility, in case of compression of important structures (nerves, vessels), or if malignant change is suspected. Malignant transformation, mostly into chondrosarcoma, is rather frequent; different authors reported between 10 and 20%. In our series, malignant change occurred in 10 patients. Osteochondromas are extremely rarely located in the vertebrae; until 1995, 38 cases of osteochondromas were reported in the cervical spine (22 solitary exostoses and 16 multiple ones). The posterior parts of the vertebrae are more often affected. Removal is indicated in all osteochondromas invading the spinal canal before they cause serious compression of the spinal cord, especially in hereditary exostoses, in which growth activity of the lesions is uncertain. In the case Vrabl reported, the exostosis affected the C5 arch and exerted pressure on the C6 arch as well causing its deformation. In addition, the patient had a skiing accident that caused segmental instability of C4-C6, and damaged the intervertebral discs C4-5 and C5-6. Osteophytes developed at the level of the damaged intervertebral discs. The extent of pathological findings was exactly assessed by imaging methods: CT, MRI and discography. The double affection of the cervical spine caused a slow progression of tetraparetic symptoms and was a clear indication for surgical intervention. The exact diagnostic evaluation revealed the two etiologic factors of spinal cord compression and was of great importance for treatment. It would have been a serious mistake to concentrate only on the more obvious osteochondroma of C5. A biphasic operation with a 3 weeks' interval was performed. First the C5 osteochondroma and part of the deformed C6 arch were posteriorly removed. The degenerated discs C4-5 and C5-6 were excised anteriorly 3 weeks later, and foraminotomy and spondy!odesis of the unstable segments were carried out. The postoperative course was uneventful, and the neurological findings gradua1Iy no~-maiized. The author decided to perform the biphasic surgery in two sessions and not in one, with an initial posterior approach and an anterior approach after a time interval of 3 weeks. Even though the patient had to be operated on twice within three weeks, the chosen alternative seems to be preferable as there is a lower risk of additional damage to the spinal cord during surgery. Treatment results can be considered as excellent in this complicated case.

Osteochondroma of the coronoid process of the mandible

A case of osteochondroma of the coronoid process with histological confirmation is presented. CT scan was used for diagnosis and resection was by the intraoral approach.

Osteochondroma of the mandibular angle: Report of a case

Osteochondroma is most often observed near the ends of the long bones. 1,2 In the oral and maxillofacial region, cases of osteochondroma have been reported in the condyle or the coronoid process of the mandible. However, osteochondroma of other areas of the mandible is rare. Only one case of osteochondroma arising in the symphyseal region has been reported by Allan et al. 3 This is the first known reported case of osteochondroma of the inner aspect of the mandibular angle.

Osteochondroma of the mandibular condyle: Report of a case

Osteochondromas are frequently found in the general skeleton but are rare in the condylar area of the mandible. Most reported condylar outgrowths have been classified as osteochondromas, 1-20 osteomas, 21 giant cell tumors, 22 malignant tumors, 23 exostoses, 24 and hyperplasias. 25 The pathogenesis of osteochondroma is still controversial, and Thoma's description of the differentiation between an osteoma, osteochondroma, and hypertrophy is not always easy to apply. 26 The largest review in the literature known to us comprises 27 cases. 15 In that report, the difficulty in differentiation between an osteochondroma and other condylar lesions, particularly chondroma, was pointed out. Accordingly, 7 of the 27 reported cases had to be excluded because of false or inaccurate information and diagnosis. This further reduction in the number of cases underscores how uncommon this lesion is. The classic histologic appearance of an osteochondroma is similar to that of the mandibular condyle during the period of endochondral ossification. The lesion consists of proliferating chondrocytes with overlying periosteum. Cancellous bone is being formed by enchondral ossification and remodeled under a cartilaginous cap. 19 The most common clinical symptoms are malocclusion, with a lateral open bite on the affected side and a crossbite on the contralateral side, as well as progressive facial asymmetry. 19 We present a case of osteochondroma of the mandibular condyle with detailed imaging findings. In contrast to this, the previously mentioned reports included only plain radiographs and computed tomography (CT). In this case, magnetic resonance imaging (MRI) proved to be a significant factor in establishing the diagnosis. The treatment in this case was also unusual. The typical treatment involves complete condylectomy, with removal of the tumor. Yet, despite a relatively large extension of the osteochondroma, this case was treated with selected tumor removal without condylectomy.

Osteochondroma of the cervical spine MR findings

We report two cases of osteochondroma in the region of the cervical spine. The magnetic resonance (MR) images well demonstrated the relationship of the tumor, the spinal cord, and adjacent soft tissue, but correct diagnosis by MR imaging was difficult in one patient due to unusual gadolinium enhancement. Computed tomography played an important role in these patients by demonstrating the exact origin and nature of the tumor.

Osteochondroma of the coronoid process of the mandible: Report of a case and review of the literature

A review of the literature and the addition of one case have revealed that, on the basis of strict histologic criteria, there are presently 30 published cases of osteochondroma of the coronoid process of the mandible. Twenty-one cases (70%) were men. Most osteochondromas developed before the age of 40 years. The lesions were mushroomlike in more than two thirds of the cases. Deformity of surrounding structures and facial deformity was found in most cases. The surgical approach was intraoral in the majority of cases. None of the reported cases showed a recurrence.

Osteochondroma in laboratory rats: a report of 3 cases in a Fischer-344, a Sprague-Dawley, and a Wistar rat.

Three cases of osteochondroma in a male Sprague-Dawley (SD) rat, a female Fischer (F344) rat, and a male Wistar rat are described. The rats were aged between 26 and 30 months. All osteochondromas were considered to be of spontaneous origin. The Wistar rat had multiple osteochondromas on both hind legs, the skull base, and a lumbar vertebra, whereas each of the F344 and SD rats was affected by a solitary osteochondroma, also on a lumbar vertebra. The lumbar osteochondromas were similar in appearance in all rats and consisted of a central core of trabecular bone, interspersed with fatty marrow and covered by a cap of hyaline cartilage. The additional tumors in the Wistar rat represented different developmental stages of osteochondroma with or without endochondral activity. The osteochondromas in the rats were morphologically similar to those described in humans and some domestic animal species.

Thoracic osteochondroma with spinal cord compression

A case of osteochondroma at T5 level, impinging on the spinal cord in a patient previously diagnosed of hereditary osteochondromatosis, is presented. Spinal compression is an infrequent event in the course of this disease. Nevertheless, one must consider this possibility in the follow-up of the patients with this relatively common bone dysplasia. Se presenta un caso de osteocondroma espinal, a nivel T5, en una paciente previamente diagnosticada de osteocondromatosis hereditaria. Aunque la aparición de un cuadro de compresión medular por osteocondromas raquídeos es relativamente infrecuente en el curso de la osteocondromatosis hereditaria, su posibilidad debe ser tenida en cuenta en el control evolutivo de los pacientes con esta displasia ósea.

Post-traumatic osteochondroma of the calcaneus

Osteochondroma is the most common bone and cartilage tumor. It is usually congenital but may be related to trauma. A case of osteochondroma affecting the calcaneus, an unusual location for this lesion, is presented. Surgical excision appears to be as effective a cure in this location as in others.

A Case of Osteochondroma which Arised form Right Side lamina of 5th Lumbar Vertebra

A Case of Osteochondroma which Arised form Right Side lamina of 5th Lumbar Vertebra

顎関節陳旧性脱臼をきたした下顎頭部骨軟骨腫の１例と文献的考察

In this paper, a case of osteochondroma originated in the left mandibular condyle of a 56-year-old man is reported.Clinical examination revealed marked lower facial asymmetry and malocclusion with the mandible deviated 18 mm to the right. Radiograms revealed an oval, pedunculate, radioopaque mass attached to the anteromedial aspect of the condyle. The condyle head was displaced forward under the articular tubercle. The patient was surgically treated in a temporal approach by resecting zygomatic arch temporarily and resecting the tumor protruded into the medial side of lateral pterygoid muscle from the condyle head. The patient has been followed for three years. The symmetry of the face and occlusion was greatly improved.Excessive unilateral growth of the mandibular condyle with occlusal disturbances and facial asymmetry has been reported in patients with hyperplasia, hyperostosis, hypertrophy, osteoma, osteochondroma, and so on. The differences between these disease entities are still obscure. Therefore, cases of these diseases in the literatures concerned have been collected and the clinical features analyzed.As the result, these cases could be classified into hypertrophic type and nodular type. The former is characterized by morphological feature of elongation or hyperplasia of the condyle itself. In contrast, the latter shows a morphological feature of nodular protrusion from the condyle head into the lateral pterygoid muscle without elongation of the condyle itself. The onset age of the lesion and several clinical characteristics differ between the two types, therefore, different treatment methods should be considered.