Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography for Osteochondromas Utilizing a Triple-Time Point Protocol

Purpose: The purpose of this study was to assess solitary osteochondroma and hereditary multiple osteochondral exostoses (HMOCE) utilizing FDG PET and a triple time point protocol. Methods: Seven patients were consented and recruited for PET evaluation of presumed benign osteochondroma. Following injection of 15 mCi of FDG, the lesion(s) of interest was imaged with PET-CT at 45 minutes post injection, whole body at 50 minutes post, and lesion of interest at 95 minutes post injection. A maximum standardized uptake value (SUVmax) was obtained for the lesion(s) of interest at each time point, and an SUVΔ was calculated for each lesion of interest from the first time point to the third time point. Results: 16 lesions from 7 patients were included in the study. Mean SUVmax for all 3 time points was 1.04 with a standard deviation of 0.50 (range 0.3 - 2.2). The mean SUV was 0.096 with a range of 0 - 0.4. Among the 3 patients with histologically confirmed osteochondromas, mean SUVmax was 0.67, with standard deviation of 0.23 and range of 0.3 to 1.0. The mean SUVΔ13 was 0.081 (range 0 - 0.4), mean SUVΔ12 was 0.10 (0 - 0.3), and mean SUVΔ23 was 0.11 (range 0 - 0.4) (p = 0.74). Conclusion: Benign lesions were found to not have progressively increasing uptake on multiple time point FDG PET. Until chondrosarcomas are evaluated using triple time point 18FDG PET, its applicability in the evaluation of osteochondroma versus malignant change remains uncertain.

Solitary Osteogenic Exostosis of the Femur Revealed by Recurring Acute Distal Thigh Pain: About a Case

Introduction: Solitary exostoses are the most common benign tumors of the fertile metaphyses of the long bones of children. Their radiological diagnosis of metaphyseal bone growth must be confirmed on pathological examination. These tumors can remain asymptomatic for a long time and reveal themselves during a particularly vascular complication. The objective of this study was to describe the epidemiological, diagnostic, therapeutic and evolutionary aspects of these tumors. Patient and Observation: We report the case of a 15-year-old adolescent girl, with no particular pathological history, received in the pediatric surgery department of the Donka National Hospital (HND) of the Conakry University Hospital for recurrent acute painful swelling of the lower third of the left thigh in an afebrile context accompanied by lameness and stopping school for a few days (2 - 3 days). The symptoms appear to have evolved over the past 3 years and after physical activities. It regresses with rest, analgesics and non-steroidal anti-inflammatory drugs. The notion of trauma and sickle cell disease was not reported in the patient's clinical history. It is the persistence of the symptomatology which motivates the said consultation. On palpation, a small hard mass is noted at the expense of the internal metaphysis of the left distal femur. Deep palpation of this area causes a tingling sensation and during rapid mobilization of the knee. The remainder of the orthopedic examination was unremarkable. Standard x-ray of the femur shows a bony growth with a pointed tip from the distal metaphysis of the left femur. On surgical exploration, we noted a wedge-shaped exostosis oriented towards the vastus medialis muscle. Histological examination of the surgical specimen confirms osteogenic exostosis. There is no recurrence after 2 years. Conclusion: The distal femoral metaphysis is the most common location of solitary osteochondromas in children. Their definitive diagnosis requires the histology of the surgical specimen. Only symptomatic exostoses should be operated on in children.

Mutation analysis and prenatal diagnosis of EXT1 gene mutations in Chinese patients with multiple osteochondromas

Background Multiple osteochondromas （MO）, an inherited autosomal dominant disorder, is characterized by the presence of multiple exostoses on the long bones. MO is caused by mutations in the EXT1 or EXT2 genes which encode glycosyltransferases implicated in heparin sulfate biosynthesis.Methods In this study, efforts were made to identify the underlying disease-causing mutations in patients from two MO families in China.Results Two novel EXT1 gene mutations were identified and no mutation was found in EXT2 gene. The mutation c.497T〉A in exon 1 of the EXT1 gene was cosegregated with the disease phenotype in family 1 and formed a stop codon at amino acid site 166. The fetus of the proband was diagnosed negative. In family 2, the mutation c. 1430-1431delCC in exon 6 of the EXT1 gene would cause frameshift and introduce a premature stop codon after the reading frame being open for 42 amino acids. The fetus of this family inherited this mutation from the father.Conclusions Mutation analysis of two MO families in this study demonstrates its further application in MO genetic counseling and prenatal diagnosis.

Paravertebral block for analgesia following excision of osteochondroma of the scapula:A case report

Scapular surgery has mainly been studied in the setting of fractures;regional anesthesia can be utilized as part of a multimodal analgesia regimen for postoperative pain relief.Previous studies are limited to scapular fracture pain.The available literature supports the use of various types of nerve blocks and even combinations of different blocks,of which the paravertebral nerve block is one such block that has been effective.We present a case of a patient undergoing excision of a scapular osteochondroma who received a single-shot paravertebral nerve block after surgery with an effective analgesia.

Multiple flexor tendon ruptures due to osteochondroma of the hamate:A case report

BACKGROUND Closed rupture of the little and ring finger flexor tendons caused by the hamate is mostly associated with a fracture or nonunion of the hamate hook.Only one case of a closed rupture of the finger flexor tendon caused by osteochondroma in the hamate has been reported.Here,we present a case study to highlight the possibility of hamate osteochondroma as a rare cause of finger closed flexor tendon rupture based on our clinical experience and literature review.CASE SUMMARY A 48-year-old man who had been a rice-field farmer for 7–8 h a day for the past 30 years visited our clinic due to the loss of right little finger and ring finger flexion involving both the proximal and distal interphalangeal joints.The patient was diagnosed with a complete rupture of the ring and little finger flexors because of the hamate and was pathologically diagnosed with an osteochondroma.Exploratory surgery was performed,and a complete rupture of the ring and little finger flexors due to an osteophyte-like lesion of the hamate was observed,which was pathologically diagnosed as an osteochondroma.CONCLUSION One should consider that osteochondroma in the hamate may be the cause of closed tendon ruptures.

Knee locking caused by osteochondroma of the proximal tibia adjacent to the pes anserinus:A case report

BACKGROUND Osteochondroma is one of the most common benign bone tumors,and it may cause bone and joint deformities and limited range of motion of an adjacent joint.The pes anserinus region is one of the most frequent sites of osteochondroma,but knee locking caused by osteochondromas in the pes anserinus region is extremely rare.CASE SUMMARY We describe a 13-year-old Japanese girl’s extra-articular knee locking that occurred when the semitendinosus tendon got caught in osteochondroma that had developed in the pes anserinus region.The osteochondroma was surgically resected.The postoperative outcome has been excellent,with no recurrence of knee locking or tumor one-year post-surgery.CONCLUSION When a young person develops knee locking,the possibility of extra-articular as well as intra-articular locking should be considered.Osteochondroma,one of the causes of extra-articular locking,can be treated with surgery with good postoperative results.

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.

Clinical Characteristics of Hereditary Multiple Exostoses: A Retrospective Study of Mainland Chinese Cases in Recent 23 Years

Hereditary multiple exostoses（HME） are an autosomal dominant skeletal disease with wide variations in clinical manifestations among different ethnic groups. This study investigated the epidemiology, clinical presentations, pathogenetic features and treatment strategies of HME in China's Mainland. We searched and reviewed the related cases published since 1990 by searching electronic databases, namely SinoMed database, Wanfang database, CNKI, Web of Science and PubMed as well as Google search engines. A total of 1051 cases of HME（male-to-female ratio 1.5：1） were investigated and the diagnosis was made in 83% before the age of 10 years. Approximately 96% patients had a family history. Long bones, ribs, scapula and pelvis were the frequently affected sites. Most patients were asymptomatic with multiple palpable masses. Common complications included angular deformities, impingement on neighbouring tissues and impaired articular function. Chondrosarcomas transformation occurred in 2% Chinese cases. Among the cases examined, about 18% had mutations in EXT1 and 28% in EXT2. Frameshift, nonsense and missense mutations represented the majority of HME-causing mutations. Diagnosis of HME was made based on the clinical presentations and radiological documentations. Most patients needed no treatment. Surgical treatment was often directed to remove symptomatic exostoses, particularly those of suspected malignancy degeneration, and correction of skeletal deformities. This study shows some variance from current literature regarding other ethnic populations and may provide valuable baseline assessment of the natural history of HME in China's Mainland.

Atypical osteochondroma of the lumbar spine associated with suprasellar pineal germinoma:A case report

BACKGROUND Osteochondromas are the most common benign bone tumor,accounting for 36%of benign bone tumors.Often found within the appendicular skeleton,osteochondromas of the spine are rare,comprising 4%to 7%of primary benign spinal tumors.CASE SUMMARY We report a case of a solitary lumbar osteochondroma in an 18-year-old male with a history of a suprasellar pineal germinoma treated with combined chemotherapy and radiation.He underwent mass excision and partial laminectomy with the ultrasonic bone scalpel(Misonix,Farmingdale,NY,United States)at the L5 Level without the use of adjuvants.The patient returned to work and full activities without back pain at 3 mo postoperatively.CONCLUSION Osteochondromas are common tumors of the appendicular skeleton but rarely occur within the spine.This case discussion supplements current osteochondroma literature by describing an unusual presentation of this tumor.

Calcaneal osteochondroma masquerading as plantar fasciitis: An approach to plantar heel pain-A case report and literature review

BACKGROUND Heel pain is a common orthopaedic complaint,and if left untreated can be a source of chronic morbidity.Accurate diagnosis can be challenging,owing to the complex anatomy and multiple pain generators present in the foot.We aim to share our clinical experience managing an unusual case of chronic heel pain secondary to osteochondroma.CASE SUMMARY A 41-year-old obese male who works as a porter presented with a long-standing history of left plantar heel pain.He was assessed to have point tenderness over the plantar insertion of the calcaneus as well as a positive Silfverski?ld test.He was treated for plantar fasciitis and tight gastrocnemius but failed conservative therapies as well as surgical intervention.Magnetic resonance imaging revealed the presence of a pedunculated bony protrusion over the plantar aspect of the calcaneus.The decision was made for excision of the osteochondroma,and the patient has been pain-free since.CONCLUSION Osteochondromas are rarely symptomatic in skeletally mature patients.While most are benign with a very low risk of malignant transformation,surgical excision can yield excellent results and significant pain relief in symptomatic patients.

Comparison of computed tomography and magnetic resonance imaging for the detection of mandibular condylar osteochondroma

Objective The purpose of this study was to compare computed tomography(CT) and magnetic resonance imaging(MRI) for the detection of mandibular condylar osteochondroma.Methods Preoperative CT and MRI of 33 patients with unilateral condylar osteochondroma were reviewed. The morphology, location, continuity with the parent bone, cartilage cap, perichondrium of tumors, and changes in soft and hard tissues adjacent to the lesions were investigated by two reviewers. Data were analyzed using Mc Nemar test. A P value < 0.05 was considered significant.Results Among the 33 condylar osteochondromas, 11 were of the diffuse type, 10 were of the sessile type, and 12 were of the pedunculated type. Continuity with the cortex and marrow of the host condyle was observed on both CT and MRI. Both modalities had identical detection rates of surface reconstruction of the temporal bone joint, condylar dislocation, and pseudarthrosis formation. However, MRI showed significantly higher detection rates of the cartilage cap and perichondrium than CT(P < 0.05). Furthermore, MRI showed ipsilateral and contralateral temporo-mandibular joint(TMJ) disc displacement in 4 cases and 6 cases, respectively, and ipsilateral and contralateral TMJ effusion in 20 cases and 14 cases, respectively.Conclusion CT can intuitively display the morphology and spatial location of condylar osteochondromas through three-dimensional reconstruction. MRI may be superior to CT in the detection of cartilage cap, perichondrium of the condylar osteochondroma, and changes in the TMJ and adjacent soft tissues.

Unusual Case of Pneumothorax Caused by Costal Osteochondroma

Osteochondroma is the most common benign cartilage tumor. Although, most lesions are asymptomatic, life-threatening conditions caused osteochondromas have been reported in the literature such pneumothorax, hemothorax, diaphragmatic rupture, and lung injury. We report a case of a thirty year old male who presented with shortness of breath and was found to have a pneumothorax on chest X-ray. Subsequent Computed Tomography of the chest revealed a 1.3 cm growth on the posterior portion of the fourth right rib protruding into the right middle lobe. The patient underwent thoracoscopic resection of the lesion along with a wedge resection of the right middle lobe. The rib was reconstructed using a metal plate. He remains asymptomatic without recurrence on a one year follow up.

Over-expression of Sox4 and β-catenin Is Associated with a Less Favorable Prognosis of Osteosarcoma

The purpose of this study was to examine the association of the expression of Sox4 and β-catenin with the prognosis of osteosarcoma. A total of 108 cases of conventional osteosarcoma were involved in this study and 28 cases of osteochondroma served as controls. The expression of Sox4 and β-catenin was detected by using immunohistochemical staining and Western blotting. The results showed that Sox4 and β-catenin were over-expressed in 67（62.03%） and 62（57.41%） of 108 osteosarcoma cases, while in only 3（10.71%） and 5（17.86%） of 28 controls, respectively（P〈0.05 for all）. The expression of Sox4 and β-catenin was associated with the distant metastasis, pathological grade and Enneking stage of patients with osteosarcoma（P〈0.05 for all）. The mean overall survival time and the 5-year-survival rate in osteosarcoma patients with Sox4 and β-catenin over-expressed were significantly reduced as compared with those in Sox4 and β-catenin low-expression group（P〈0.05 for all）. Cox multifactor regression analysis revealed that the distant metastasis, Enneking stage, and the expression of Sox4 and β-catenin were independent risk factors of patients with osteosarcoma（P〈0.05 for all）. The findings indicated that overexpression of Sox4 and β-catenin is associated with a poor prognosis of osteosarcoma.

Osteochondroma formation after avulsion fracture of anterior inferior iliac spine:A case report

BACKGROUNDHip avulsion fractures occur mostly during adolescence when actions such askicking or running cause forceful contraction of attached muscle.Osteochondroma is benign tumor that mostly occurs at the metaphysis of a longbone, being usually asymptomatic.CASE SUMMARYA 15-year-old patient experienced feeling and sound of a break while kicking aball in soccer game three years prior to his visit to our hospital. A simple X-rayrevealed an avulsion fracture of the apophysis of the anterior inferior iliac spine(AIIS). Later in the follow-up X-ray, a palpable mass was found and demonstratedby magnetic resonance imaging to be a pedunculated osteochondroma in thesuperolateral aspect of the AIIS. For surgical treatment, we performed osteotomyfor surgical excision and excisional biopsy. A mass with smooth surface and anunclear superolateral AIIS border was found intraoperatively. Pathologic examshowed definite diagnosis of osteochondroma. Postoperatively, discomfort duringhip flexion was improved, and the hip joint range of motion during walking wasrecovered at the last follow-up, which was three weeks after the surgery.CONCLUSIONThis is a rare case to demonstrate relevant previous trauma history prior to theformation of osteochondroma.

Complete recovery of severe tetraparesis after excision of large C1-osteochondroma

Severe tetraparesis resulting from cervical cord compression due to osteochondroma of the Atlas is a rare condition, especially in young children. In this report, the author discusses the clinical presentation, and outcome of surgical excision of a large C1 osteochondroma presenting with severe myelopathic tetraparesis, in a 10-year-old girl. Computed tomography and magnetic resonance images revealed a large bony lump arising from the posterior arch of atlas, filling most of the spinal canal, and compressing the cervical spinal cord. Another histologically proven exostosis was incidentally found at the spinous process of T1. There was no history of exostosis in the family, and the patient improved dramatically after removal of the C1 osteochondroma.

Synovial Hemangioma in a 2 Year Old Mimicking Synovial Osteochondromatosis

We describe a rare synovial mass arising from the elbow of a 2 year old female. It was growing slowly for three months and there was no history of trauma or fever. Plain radiographs showed a soft tissue mass around the elbow with scattered nodular intraarticular calcifications. Ultrasound and MRI confirmed the synovial location of the mass and again showed the multiple calcifications, some of which suggested intraarticular loose bodies. The imaging findings were thought to represent synovial osteochondromatosis but subsequent biopsy revealed a synovial hemangioma and it is for this reason that we present our case.

The Impact of Subungual Osteochondroma Deformans on Severely Mycotic Toenails

Background: We examined 94 toenails exhibiting clinical signs of severe onychomycosis taking into account multiple contributing factors, not the least of which was Subungual Osteochondroma Deformans (SOD). We hypothesize that SOD plays a significant role in both the etiology and treatment of onychomycosis. Methods/Results: A retrospective post-treatment outcome analysis was performed comparing two groups of severely mycotic toenails. The first group of 25 fungal nails showed 54.31% improvement following treatment by both surgical nail avulsion and a 1064 YAG laser-based Nail Restoration algorithm. The second group of 69 fungal nails was not only treated using the same nail avulsion/laser-based algorithm but was also evaluated for SOD lesions which were surgically removed when present, resulting in 95.31% improvement. The overall incidence of SOD lesions in the second group of severely mycotic toenails was 73.91%. Conclusion: We submit that at 73.91% Subungual Osteochondroma Deformans has an under-reported and under-appreciated association with toenail fungus. Generally, we find that our success rates in treating severe toenail fungus using our laser-based Nail Restoration Protocols are much higher when SOD lesions are surgically removed.