OSTEOCHONDROMA

Osteochondroma is a benign tumor of bone with the appearance of bony

prominence bordered firmly as eksostosis arising from metaphysical, this bony
protrusion is covered (covered) by hyaline cartilage. These tumors are derived
from bone components (osteocytes) and cartilage components (chondrocytes).
Osteokhondroma is the second most common benign tumor (32.5%) of all benign
bone tumors and is especially found in adolescents whose growth is active and in
young adults.

I. Definition
Osteochondroma is a benign tumor of bone with the appearance of bony
prominence bordered firmly as eksostosis arising from metaphysis, protrusion of
this bone covered (covered) by cartilago hyaline. These tumors are derived from
bone components (osteocytes) and cartilage components (chondrocytes).
Osteokhondroma is the second most common benign tumor (32.5%) of all benign
bone tumors and is especially found in adolescents whose growth is active and in
young adults.
Osteokondroma can grow solitary or multiple. Multiple osteocondromes are
hereditary (autosomal dominant) and will stop growing and undergoing repetition
after adulthood. Therefore this multiple exocytosis is no longer referred to as
neoplasm. Osteokondroma is solitary different from multiple because it will grow
steadily even though patient have adult and this kind is regarded as neoplasm.
Most osteochondromes are solitary but multiple lesions may develop in
individuals with a genetic predisposition.
Osteokondroma usually involves long bones, and the affected bone is the
distal end of the femur (30%), the proximal end of the tibia (20%), and the
humerus (2%). Osteokondroma can also affect the bones of the hands and feet
(10%) and flat bones such as the pelvis (5%) and scapula (4%) although rare.
Osteokondroma consists of 2 types of stemmed type (pedunculated) and type not
stemmed (sesile). The affected bone is usually stemmed while in the pelvis type
sesile.
II. Etiology
 Bone osteochondroma is most likely caused by either a congenital defect or
a perichondrium trauma that results in a herniation of the growth epiphyseal
fragment through the periosteal bone cuff. Although the exact etiology of this
growth is unknown, some peripheral physics are suspected of having herniation
from the growth plate. This herniation may be idiopathic or may result from
trauma or deficiency of the perichondrial ring. Whatever the cause, the result is an
abnormal extension of the metaplastic cartilage that responds to factors that
stimulate the growth plate and thereby produce an exostosis growth. The cartilage
clusters regulate into structures similar to epiphysis Because this metaplastic
cartilage is stimulated, bone enchondral, and development of the bone stalk. The
histology of cartilage reflects, defined classical zones observed in the growth of
darilempeng namely, the proliferation zone, columniation, hypertrophy,
calcification, and hardening. This theory is thought to explain the classic findings
ofosteochondroma associated with plate growth and develop away from the
physical to maintain its medullary continuity. Genetic karyotyping has suggested
that reproducible genetic disorders are associated with benign growth and that
they can actually represent true neoplastic processes, not the reactive ones . The
study is still at an early stage, and requires further investigation.

III. Pathophysiology
Tumors occur due to the abnormal growth of bone cells (osteocytes) and
cartilage cells (chondrocytes) in the metaphysis. Abnormal growth is initially only
will cause a picture of bone enlargement with the cortex and spongiosa are still
intact. If the tumor grows larger it will appear as a cauliflower-like lump of
cauliflower with the osteocyte component as its trunk and the chondrocytes
component as its flower. The tumor grows from the metaphysis, but the growth of
the bone increasingly prolonged the longer the tumor will lead to diafisis bone.
The location of osteochondroma is usually in the metaphysis of long bones
especially the distal femur, proximal tibia and proximal humerus, can also be
found in the bone scapula and illium.
IV. Clinical features
 These tumors do not produce symptoms that are often found by chance,
but the lumps grow very long and enlarged. When these tumors suppress the
nervous tissue or blood vessels will cause pain. It can also be pain induced by a
pathological fracture in the stalk of the tumor, especially in the thin stalk part.
Sometimes the bursa may grow above the tumor (exotica bursa) and when
inflamed the patient may complain of swelling and pain. If pain arises in the
absence of a fracture, bursitis, or emphasis on the nerves and tumors continue to
grow after the epiphyseal plate closes it must be suspected of malignancy.
Osteocondromes can cause pseudoaneurysm mainly in a.poplitea and
a.femoralis caused by fractures in the stem of a tumor in the distal region of the
femur or proximal tibia. Large osteocondromes in the vertebral columns can cause
cytoplasmic angulation and cause symptoms of spondylolithsis. In multiple
hereditary exoccose the complaint may be a multiple and painless mass near the
joint. Generally bilateral and symmetrical.

The most common symptom of osteochondroma is a painless lump near the joint.
Knees and shoulders are more often involved. An osteochondroma may lie
beneath the tendon. At that time, tissue fracture of the tumor may cause activity
related to pain. An osteochondroma can be located near the nerve or blood
vessels, such as behind the knee. At that time, there may be numbness and
tingling in the extremities. A tumor suppressing the blood vessels can cause
periodic changes in the bloodstream. This can cause loss of pulsation or changes
in the color of the extremities. Changes in blood flow resulting from an
osteochondroma are rare. A hard clot can be found in the area around the lesion.
Stageosteochondromabases
Osteochondromasis a benign lesion and can be grouped based on stagingbased on
the musculoskeletal Tumor Society (MSTS) for benign lesions, as follows:
• Stage I - active or static lesions
• Stage II - active lesions grow
• Stage III - active lesions developed that locally destructive / aggressive.
The average Osteochondromas are in stage I or II. However, significant secondary
deformities for mass effects can occur in areas such as joint and tibiofibular joint
joints. Although this classification is not perfect, the lesion may be considered a
stage III lesion.
V. Radiological
Features There are two types of osteochondromes: pedunculated / narrow
base and sesile / broad base. In the pedunculated type, in plain photographs the
protrusion of the bone away from the joint with the cortex and spongiosa is still
normal. This protrusion is shaped like a cauliflower with osteocyte components as
the stalk and the chondrocytes component as the flower. Inhomogene bone
protrusion density (opaq on the stalk and flower on the flower). Sometimes the
presence of calcification in the form of opaq spots due to the component condals
that have calcified. There is a prominent bone protrusion that exacerbates as the
esophageal arising from metaphysis but which appears smaller than that found on
physical examination because most of these tumors are covered by cartilage.
Tumors can be single or multiplet dependent of its kind.
See the picture below:
a. Solitary benign pedunculated osteochondroma of the
femur in a 22-year-old man
b. Benign solitary sessile osteochondroma of the fibula
in a 19-year-old man
CT SCAN
In certain bones, such as pelvis and shoulder blades, CT scan is a useful adjunct to
localized lesions. CT localization can be useful when planning
MRI magnetic resonance imaging () is
MRIrequired only in cases of suspicion of malignancy or relevant soft tissue
anatomy needs to be described. MRI is the modality of choice to assess the
thickness of the cartilage closure, as shown below. Although not an absolute
indication, the thickness of the stamp image is associated with malignancy. Thick
cartilage cap> 4 cm12
Diagnosis of appeal
Chondrosarkoma
Is a malignant tumor of bone and cartilage. Most commonly found in pelvic bone,
femur, ribs, humerus, and scapula. But it can also be found in all bones, including
small bones in the hands and feet.
Radiological features: large, irregular lesions with bony edges of bone. The tumor
contains a calcified area with a picture like popcorn.

Osteosarcoma
Is a primary malignant tumor in the bone. The location of most tumors is distal,
femur, proximal tibia, and proximal humerus. Tumors can also attack flat bones
such as pelvis, skull, and mandible.
Radiological features:
● Bone deterioration features
 ● Sunburst appearance
● Codman triangle

Therapy
If there are symptoms of suppression of soft tissue such as blood
vessels or surrounding nerves or suddenly enlarged tumors accompanied by
pain, surgery is required immediately, especially if this occurs in adults.
Medical Therapy
No medical therapy currently exists for osteochondromas. The mainstay of
nonoperative treatment is observation because lesions are mostly asymptomatic.
The accidentally discovered lesion can be observed, and the patient can be
reassured.
Surgical Therapy The
treatment for osteochondromas symptoms is resection. Care should be taken to ensure
that no cartilage or perichondrium lids are left, otherwise there may be a
recurrence. Ideally, the line must be through the base of the handle, thus, the
entire lesion is deleted by block. Atypical or very large lesions should be fully
investigated to exclude the possibility of isolated malignancy. MRI is useful in
measuring the thickness of the cartilage cap.
If osteochondroma is not found complaints, make observations

● Surgical
Indications:
o Pain The
o size grows larger and abnormal
o There is emphasis on the nerves and blood vessels
 o Pathological fracture
o Malignant suggestive radiological features
Preoperative details
Local anatomic constraints should be carefully considered so that the approach
and resection are not damaging structures nearby. CT scans and MRI can be
useful for lesions arising from flat bones or those located in difficult areas, such as
lesions around the hips or shoulder blades.
Details during surgery
After an osteochondroma is exposed, the dissection is limited to the base of the
lesion, so the osteotome may be used to separate the basis of the bone cortex. The
upper exchange should be left intact, and the loose adhesive tissue should be
dissected away so that the lesions and bursa are removed vertically. The resected
surface of the host bone can be husky smooth, and if necessary, bone wax can be
packed on the cut surface to stop the bleeding. Once the specimen is removed and
pathological confirmation is received, the lather should be irrigated with and can
be given drain when necessary.
Details Postoperative
Osteochondromas most allow patients to return to normal activity. However, after
resection of a large osteochondroma, activity restriction should be considered
because excessive movement may lead to an increased risk of fracture.
Complications
1. Emphasis on nerves (more often n.poplitea)
2. Emphasis on blood vessels, causing pseudoaneurism in a.poplitea and
a.femoralis)
3. Bone suppression around
4. pathological fracture
5. Inflammation of the bursa in the lesion area
6. Malignant changes
A. Fractures
Fractures in osteochondroma are unusual complications which is the result of
localized daritrauma and usually involves the base of the lesion.
Osteochondromas peduncle in the knee is most likely for the occurrence of
fracture. Furthermore, callus formation causes bandlike sclerosis on radiographs
to occur with healing. No significant nonunion incidents were reported.
Interestingly, the solitary regression or resorptionosteochondroma that occurs both
spontaneously and after fractures has been reported.
B. Vascular Complications Vascular
complications associated with osteochondroma include vascular abnormalities,
stenosis, occlusion, and pseudoaneurysm formation. Clinical symptoms in cases
of vascular compromise including pain, swelling, and infrequent claudication or
palpable pulse mass usually affect young patients. Blood vessel thrombosis or
occlusion can affect either the artery or venous system and is most often seen in
the vessels of the knee, especially the popliteal or venous artery. The
pseudoaneurysm formation associated withosteochondroma was first reported by
Paul in 1953. The location of these complicational disorders mainly concerns the
femoral artery, brachialis, and posterior arteritibialis, the popliteal artery. This
complication affects young patients near the end of normal bone growth and
occurs with solitary lesions and some with the same frequency.
C. NeurologicalNeurological
sequelaecompromise can be attributed to the second (base of the spine or skull) of
the osteochondromas occurring in the vertebrae or in the bran- krani. Peripheral
lesions can suppress nerves, cause dop foot, and peroneal perineal involvement of
osteochondromal fibula has been reported most frequently. Radial nerve
involvement has also been described. Osteochondromas occurring at the base of
the skull, spine, rib or head may cause cranial nerve deficits, radiculopathy, spinal
stenosis, caudaequina syndrome, and myelomalacia.