Osteochondroma

Osteochondromas benign bone tumour, although they are more correctly thought of as developmental anomalies. Epidemiology childhood (period of skeletal growth) but once formed remain for the rest of the individual's life. They can present at any age and are most frequently found incidentally. They are usually sporadic, but can be part of:

hereditary multiple exostoses (HME) also !no"n as diaphyseal aclasis Trevor disease also !no"n as dysplasia epiphysealis hemimelica

Malignant transformation occurs in the cartilage cap, and is uncommon in sporadic solitary osteochondromas (# $ %), "hereas in the setting of hereditary multiple exostosis the rate is much higher (& ' (&%) &. linical presentation )ymptomatic presentation is either due to mechanical effects of the lesion, fracture, or malignant transformation. Mechanical symptoms include:

impingement upon nearby structures o nerve compromise o vascular compromise o reactive myositis palpable lump bursal formation and bursitis

*ractures occur typically through the nec! of pedunculated lesions. +ngoing gro"th and or pain after s!eletal maturity has been reached is suspicious for malignant degeneration. !athology +steochondromas are essentially a part of the gro"th plate "hich separates and continues gro"ing independently, "ithout an associated epiphysis, usually a"ay from the nearby

,oint. The medullary cavity is continuous "ith the parent bone, and they are capped by hyaline cartilage. +steochondromas can be congenital or occur as a result of previous trauma to the gro"th plate, including previous irradiation -'.. "ocation They most commonly arise from appendicular s!eleton, especially around the !nee -.

lo"er limb : &/% of all cases o femur (especially distal) : most common : -/% o tibia (especially proximal) : $& ' (/% o less common locations : feet, scapula upper limb o humerus : $/ ' (/% o less common locations : hands, pelvis spine : the posterior elements of spine are an uncommon, but not rare, site for these tumours

#adiographic features
!lain film

0n osteochondroma can be either sessile or pedunculated, and is seen in the metaphyseal region typically pro,ecting a"ay from the epiphysis. There is often associated broadening of the metaphysis from "hich it arises. The cartilage cap is variable in appearance. 1t may be thin and difficult to identify, or thic! "ith rings and arcs calcification and irregular subchondral bone. 2e" cortical irregularity or continued gro"th after s!eletal maturity has been reached, as "ell as fran!ly aggressive features (e.g. bony destruction, large soft tissue component, metastases) are all "orrying for malignant transformation.
T

3T demonstrates the same findings as on plain film, but is better able to demonstrate medullary continuity and the cartilage cap.
$ltrasound

4ltrasound is able to demonstrate the cartilage cap very accurately as a hypoechoic region bounded by bone on its deep surface and muscle 5 fat superficially.
%#&

M61 is best at assessing cartilage thic!ness (and thus assessing for malignant transformation), presence of oedema in bone or ad,acent soft tissues and visualising neurovascular structures in the vicinity.

The cartilage cap of osteochondromas appears the same as cartilage else"here, "ith intermediate to lo" signal on T$ and high signal on T( "eighted images. 0 cartilage cap of over $.&cm in thic!ness is suspicious for malignant degeneration.
7one scan

8uring gro"th osteochondromas demonstrate increased upta!e, but "ith time they become no more active than normal bone. 9resence of increased activity in adulthood should raise the possibility of a complication (fracture, malignancy). Treatment and prognosis 0s they represent normal gro"th of a gro"th plate in an abnormal direction, they often stop gro"ing "ith the rest of the s!eleton -. 1n most instances no treatment is re:uired. The osteochondroma can be locally resected for cosmetic or mechanical reasons. 1f malignant transformation occurs ( ; $% in solitary osteochondromas and ; & ' (&% "ith diaphyseal aclasis) then the resultant chondrosarcoma is usually of lo" grade (<= ' >&% of cases), and surgery is usually curative (=/ ' ?/%) -,&. @imb sparing "ide local excision usually suffices. @ocal recurrence is seen in both benign and malignant lesions, due to spillage of cartilage cells into the resection bed. 6ates are estimated at (% and up to $&% respectively -. 'ifferential diagnosis 1maging differential considerations include

hands : biAarre parosteal osteochondromatous proliferation (79+9) humerus : supracondylar spur : pro,ects to"ards the elbo" ,oint malunited fracture

http:55""".columbia.edu5itc5hs5medical5neuroanatomy5neuroanat5