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Benign cartilaginous tumors, known as chondrogenic tumors, show cartilage components in the microscopic diagnosis. We present two clinical cases with cartilaginous tumors of the toes showing distinctive clinical manifestations. Two juvenile patients visited our outpatient clinic due to tumors with toenail deformities. A 10-year-old girl presented with a palpable mass with a nail deformity on the left third toe. The initial pathology report was soft tissue chondroma until complete resection. Another 15-year-old male patient visited the dermatology department with a toenail deformity and underwent a punch biopsy. The pathology report was fibrosis with myxoid degeneration. Excisional biopsies were performed for both patients. In the operative field, we observed exophytic tumors connected to the distal phalangeal bones. The final pathology reports were subungual osteochondroma on both patients. The specimen exhibited mature bone trabeculae with a focal cartilaginous cap. Benign cartilaginous tumors have a slow, progressive course and do not show significant symptoms. However, tumors in subungual areas are accompanied by toenail deformities and they can cause pain. Their clinical characteristics lead to a delayed diagnosis. Surgeons can be confused between soft tissue and chondrogenic tumors. When they conduct physical examinations, these categories should be considered in the differential diagnosis. [ABSTRACT FROM AUTHOR]

Objective: Osteochondroma is a common benign skeletal disorder for which different molecular and histological features of long bones have been reported. We investigated cell‐of‐origin and molecular mechanisms of a rare condylar osteochondroma (CO). Methods: Human fibrocartilage stem cells (hFCSCs) isolated from CO and normal condyle tissue were used for RNA sequencing, real‐time PCR, Western Blotting, immunohistology, flowcytometry, as well as for chondrogenic differentiation, proliferation, and apoptosis detection assays. Results: HFCSCs were fewer in number with weaker proliferative capacity and higher apoptosis ratio in the CO group. During the chondrogenic inducing process, hFCSCs from CO were prone to form more mature and hypertrophic cartilage. The result of RNA sequencing of hFCSCs from CO and normal condyle revealed a correlation between the PI3K/AKT signalling pathway and CO. Activated PI3K/AKT signalling might lead to functional changes in hFCSCs by enhancing cell apoptosis in the developmental process of CO. Increased expression of BCL2‐like protein 11 (BIM) in CO tissue also supports this conclusion. Furthermore, the activation of the PI3K/AKT pathway in TMJ of mice induced histological disorder and increased apoptosis in condylar cartilage. Conclusion: We conclude that the activation of PI3K/AKT signalling in hFCSCs of CO suggests a new hypothesis for the cell‐of‐origin of human CO and another possible target to treat it. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate clinical outcomes of arthroscopic resection of extraarticular knee osteochondroma. Methods: A retrospective analysis was performed in 74 patients with extra-articular knee osteochondroma treated by arthroscopic resection between August 2011 and August 2021, including 43 males and 31 females. Overall, 26 Distal femur cases and 48 proximal tibia cases were involved, with an average age of 31.7 ± 11.3 (11–57) years. Preoperative routine knee X-ray, CT, and MRI were performed before the operation. The Lysholm knee score, International Knee Documentation Committee (IKDC) score, Tegner knee motor function score, and visual analogue scale (VAS) were used to evaluate symptoms and functions before surgery and 3, 6, 12, and ≥24 months after surgery. Results: The average course of disease was (7.9 ± 3.7) months (range, 3–14 months) in 74 patients. The average follow-up was (22.6 ± 6.4) months (range, 10–37 months). There were no cases of vascular or nerve injury or wound infection. Compared with the preoperative function, the average scores of VAS, Lysholm, IKDC, and Tegner joint motor function decreased or increased significantly compared with the last follow-up (3.6 ± 1.1 vs. 0.1 ± 0.02, 44.5 ± 2.3 vs. 91.3 ± 4.9, 53.7 ± 2.6 vs. 94.2 ± 5.1, 4.6 ± 1.2 vs. 9.4 ± 1.4, p < 0.001). There was no recurrence or metastasis during the follow up. Conclusions: With the advantages of less trauma, high precision, less pain, and rapid recovery, arthroscopic resection of extra-articular knee osteochondroma can significantly improve the function of knee. It can be gradually extended to the treatment of other benign bone tumors. [ABSTRACT FROM AUTHOR]

Osteochondroma arising from the rib is rare. They arise as bony outgrowths from the rib and extend either extrathoracically into the subcutaneous plane or intrathoracically compressing the lung or mediastinal structures. A 23-year-old male patient presented with complaints of breast lump since last year. On clinical examination, a hard bony projection with lobulated contour was palpable. Chest radiograph and contrast-enhanced CT showed a bony outgrowth arising from the anterior aspect of costochondral junction of the right fourth rib with displacement of pectoralis major muscle anteriorly. Osteochondroma should be considered as a differential diagnosis in the presentation of hard lump in the breast along with other chest wall tumors. [ABSTRACT FROM AUTHOR]

Osteochondroma arising from the rib is rare. They arise as bony outgrowths from the rib and extend either extrathoracically into the subcutaneous plane or intrathoracically compressing the lung or mediastinal structures. A 23-year-old male patient presented with complaints of breast lump since last year. On clinical examination, a hard bony projection with lobulated contour was palpable. Chest radiograph and contrast-enhanced CT showed a bony outgrowth arising from the anterior aspect of costochondral junction of the right fourth rib with displacement of pectoralis major muscle anteriorly. Osteochondroma should be considered as a differential diagnosis in the presentation of hard lump in the breast along with other chest wall tumors. [ABSTRACT FROM AUTHOR]

Background: Autologous matrix-induced chondrogenesis (AMIC) for the treatment of osteochondral lesions of the talus (OLT) results in favorable clinical outcomes, yet high reoperation rates. The aim of this study was to report and analyze typical complications and their risk factors after AMIC for OLT. Methods: A total of 127 consecutive patients with 130 AMIC procedures for OLT were retrospectively assessed. All AMIC procedures were performed in an open fashion with 106 (81.5%) cases requiring a malleolar osteotomy (OT) to access the OLT. Seventy-one patients (54.6%) underwent subsequent surgery. These cases were evaluated at a mean follow-up of 3.1 years (±2.5) for complications reviewing postoperative imaging and intraoperative findings during revision surgery. Six patients (8.5%) were lost to follow-up. Regression model analysis was conducted to identify factors that were associated with AMIC-related complications. Results: Among the 65 (50%) patients who required revision surgery, 18 patients (28%) demonstrated AMIC-related complications with deep fissuring (83%) and thinning (17%) of the AMIC graft. Conversely, 47 patients (72%) underwent subsequent surgery due to AMIC-unrelated reasons including isolated removal of symptomatic hardware (n = 17) and surgery addressing concomitant pathologies with (n = 25) and without hardware removal (n = 5). Previous prior cartilage repair surgery was significantly associated with AMIC graft-associated complications in patients undergoing revision surgery (P =.0023). Among age, body mass index, defect size, smoking, and bone grafting, smoking was the only factor showing statistical significance with an odds ratio of 3.7 (95% CI 1.24, 10.9; P =.019) to undergo revision surgery due to graft-related complications, when adjusted for previous cartilage repair surgery. Conclusion: The majority of revision surgeries after AMIC for OLT are unrelated to the performed AMIC graft but frequently address symptomatic hardware and concomitant pathologies. Both smoking and previous cartilage repair surgery seem to significantly increase the risk of undergoing revision surgery due to AMIC-related complications. Level of evidence: Level IV, case series. [ABSTRACT FROM AUTHOR]

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Background: Osteochondromas are the most common benign bone tumors occurring near the end of long bones. In this case report, we demonstrate the successful treatment of a proximal femoral osteochondroma in a pediatric patient excised through a dual medial and anterior approach with no hip dislocation. Case presentation: We present the case of a white Arab 14-year-old boy with chronic hip pain and inability to ambulate. He failed conservative treatment and was referred to us after X-rays revealed two osseous masses. He was diagnosed with an intra-articular hip osteochondroma confirmed on magnetic resonance imaging and computed tomography scan. He was treated surgically with excision using two incisions: Smith-Petersen approach and Ferguson approach. Conclusion: This case presents the successful resection of a symptomatic pediatric proximal femoral osteochondroma, using dual medial and anterior approaches without the need for hip dislocation. This was optimal for both the safety and accessibility of this unusual condition. [ABSTRACT FROM AUTHOR]

Background: In this study, we wanted to evaluate the bone tumours and tumour-like lesions as they have a very diverse morphology and overlapping patterns. Also, bone microenvironment is an ideal site for metastasis. Materials and methods: This was a hospital based retrospective and prospective study, conducted among 65 patients who presented with bone tumour and tumour-like lesions to the Department of Pathology, JJM Medical College, Davangere, over a period of 5 years with 3 years of retrospective from June 2014 to May 2017 and 2 years of prospective from June 2017 to May 2019 after obtaining clearance from Institutional Ethics Committee and written informed consent from the study participants. Results: Bone tumours and tumour-like lesions comprised of 0.7% of all the neoplasms diagnosed during the study period. Of which, benign bone tumours formed the majority (70.8%).Most of the cases were seen in 2nd decade, femur (43.1%) being the most common site. Osteochondroma was the most common tumour overall with 25 cases (38.6%) followed by giant cell tumour with 10 cases (15.4%). Osteosarcoma was the most common malignant tumour (6.2%). The histopathological and clinic-radiological correlation showed perfect agreement. Conclusion: Bone tumours and tumour-like lesions are mostly diagnosed on histopathology. Correlating with clinical and radiological data is of utmost importance. Benign bone tumours are most commonly encountered with propensity for long bones, especially femur. Immunohistochemistry is of limited value and no set makers are easily available for diagnosing and differentiating bone tumours. [ABSTRACT FROM AUTHOR]

Background: 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. Methods: 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). Results: 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. Conclusions: 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. [ABSTRACT FROM AUTHOR]

Osteochondroma is a benign bone tumour occurring at the age of 10 - 30 years with no gender predilection. These lesions arise as a result of epiphyseal growth plate separation and are considered as developmental lesions of growth plate rather than true neoplasms. Long standing solitary osteochondromas may change into osteosarcomas although most frequent malignant change occurring is the chondrosarcoma. The chance of recurrence is very minimal if the tumour is completely resected from its bed without any remnants of the perichondrium and cartilaginous cap left behind. In this case a 30 year old male with distal femur osteochondroma was managed with complete resection from the base of stalk along with the cartilaginous cap and perichondrium. [ABSTRACT FROM AUTHOR]

Cartilaginous neoplasms hold considerable share in the routine diagnostics of bone tumor pathology. Benign cartilage forming tumors, that are in general more frequent than their malignant counterparts, may often pose diagnostic challenges. Distinction of a benign cartilaginous lesion from a low-grade malignant tumor can render difficulties especially in a small biopsy material. Considering the divergent therapeutic and prognostic implications, a careful assessment of histologic, radiologic and clinical findings/features is very important, and an experienced multidisciplinary team is indispensable to achieve an accurate diagnosis. This mini review focuses on the histomorphological findings of benign, locally aggressive and low-grade cartilaginous tumors referring to the latest edition of WHO Classification of Tumors of Soft Tissue and Bone Tumors (fifth edition, 2020). The focus of this article is on the differential diagnosis of benign cartilaginous lesions and their distinction from other cartilaginous lesions, especially their malignant counterparts. Histomorphology, in correlation with imaging findings, serve as the cornerstone in the diagnosis of cartilaginous tumors. Based on overlapping morphological and radiological features between the tumor types, including benign and malignant ones, their diagnosis can be challenging. Emerging molecular findings play a notable role in understanding the underlying mechanisms involved in their development, though their routine use in molecular diagnostics is limited to few indications. Likewise, the role of immunohistochemistry remains limited in the differential diagnosis of the cartilaginous tumors, emphasizing the need for joined histological and radiological evaluation. [ABSTRACT FROM AUTHOR]

A 2‐month‐old golden retriever was presented with a history of intermittent wheezing and inspiratory stridor. Previous thoracic radiographs revealed the presence of a discrete opacity partially obscuring the trachea at the level of the thoracic inlet. Through tracheoscopy, a smooth, broad‐based intratracheal mass was visualised just past the thoracic inlet that made up about 80% of the tracheal diameter. Histological examination of biopsies obtained during this procedure was consistent with tracheal osteochondroma. The mass was removed by resection and anastomosis of the trachea through a cervical approach. Histopathology of the excised mass confirmed the prior diagnosis of osteochondroma. Re‐evaluation and repeat thoracic radiographs 6 months postoperatively showed complete resolution of clinical signs and no evidence of recurrent disease. This case demonstrates that tracheal resection and anastomosis can be a viable and curative surgical procedure for some masses, including osteochondromas, within the trachea. [ABSTRACT FROM AUTHOR]

Vascular complications of osteochondromas of the humerus are extremely rare. Only 9 cases with pseudoaneurysms of the brachial artery complicating osteochondromas of the humerus were reported in 7 English articles. The computed tomography (CT) angiographic examination of all of them were positive for the diagnosis of the pseudoaneurysm. Up to our knowledge, this is the first case report in which the CT angiography misdiagnosed such lesion. In this article, we described a case with a pseudoaneurysm complicating a proximal humeral exostosis in a 27-year-old male patient with a known history of hereditary multiple osteochondromas since childhood that was unanticipatedly misdiagnosed by the CT angiographic imaging modality. The participating authors tried to infer reasoned possibilities behind this unreported phenomenon before.

Hereditary multiple osteochondromatosis is a genetic condition characterized by the appearance of numerous osteochondromas, which can cause pseudoaneurysms in rare cases. The following article describes a 15-year-old patient with a history of current massages as part of his gym routine, who arrived at the emergency department with 4 days of pain, and ecchymosis in the right popliteal region. Therefore, duplex ultrasonography and arteriography were performed, confirming the diagnosis of popliteal pseudoaneurysm, which was subsequently treated by open surgery, providing a satisfactory outcome.

Intraspinal osteochondroma causing neurological manifestations is a rare condition and can present as either solitary osteochondroma or more commonly as a part of multiple hereditary exostoses. We report a case of osteochondroma arising from lamina of C2 in a 21-year-old patient with multiple hereditary exostoses causing spinal cord compression and cervical myelopathy. The patient presented with worsening neurological deficit and an inability to walk. Immediate laminectomy and surgical decompression were done after accurately localizing the lesion through computed tomography and magnetic resonance images. Following excision of the lesion, the patient recovered completely. The case report is followed by a review of literature highlighting the incidence of spinal osteochondroma, location preferences, clinical presentation, diagnosis, and results of decompression.

Background: Our previous study in genetic mouse models found that NFATc1 and NFATc2 suppress osteochondroma formation from entheseal progenitors. However, it remains unclear whether NFAT signaling is also involved in human osteochondromagenesis. As the first step in addressing this question, the current study aimed to determine the expression patterns of NFATC1 and NFATC2 in human osteochondroma samples. Methods: Immunohistochemistry (IHC) was used to examine and analyze NFATC1 and NFATC2 expression in human osteochondroma samples. The human periosteum was used to map the expression of NFATC1 under physiological conditions by IHC. Furthermore, human periosteal progenitors were isolated and identified from the periosteal tissues of bone fracture healing patients. The expression of NFATC1 in human periosteal progenitors was characterized by Western blotting compared to human bone marrow stromal cells (BMSC). Results: The IHC results showed that the expression of NFATC1 was undetectable in most human osteochondromas cells, and only a small proportion of osteochondroma cells, especially clonally grown chondrocytes, showed positive staining of NFATC1. NFATC2 expression was also undetectable in most chondrocytes in human osteochondromas. The mouse and human periosteum showed a comparable ratio of NFATC1 positive cells (9.56 ± 0.80% vs 11.04 ± 2.05%, P = 0.3101). Furthermore, Western blotting analysis revealed that NFATC1 expression was highly enriched in human periosteal progenitors compared to BMSC. Conclusions: NFATC1 and NFATC2 are undetectable in most human osteochondroma chondrocytes. The expression pattern of NFATC1 in human osteochondromas and the normal periosteum suggests that NFAT signaling could be suppressed during human osteochondromagenesis.

Abstract Background Osteochondromas are a benign outgrowth of bone and cartilage and one of the most common bone tumors that usually occur in long bones, with only 1–4% being located in the spine, more frequently in the cervical and upper dorsal region, and rarely the lumbar spine. Here, we report a case of lumbar spine (L5) osteochondroma arising from the neural arch. Case presentation A 30-year-old man presenting with a solid painless mass at the lower lumbar region. No neurological symptoms. Radiological examinations revealed an exophytic lesion in the fifth lumbar articular process, and the spinous process appears to be a solitary osteochondroma. Lumbar spine magnetic resonance imaging showed a bony lesion covered by a 2-mm-thick cartilaginous cap. Surgical en bloc resection of the mass was performed, and the histopathological examination confirmed the diagnosis of osteochondroma. No evidence of recurrence at the end of 4-year follow-up. Conclusion Osteochondromas are benign tumors rarely present in the spine; diagnosis can be made by the typical appearance of the cartilaginous cap over the mass in the magnetic resonance imaging. Surgical excision is the best management option.

Thus, a histologically proven pathological condition to the coronoid process or malar bone may better point out some characteristics of the pathology and the single case. This definition summarizes Jacob's findings and the name of Jacob's disease given to this condition by Chemin and Bercher in 1958 [[3]]. As correctly specified by Mattei et al., JD is, therefore, limited to a pseudo-joint formation between the zygomatic bone and coronoid process, and this concept is clearly made explicit in our work. [Extracted from the article]

Introduction: Cartilaginous tumours comprise a large, heterogeneous group of mesenchymal neoplasms. They pose a challenge in terms of accurate diagnosis and management. Histopathological findings have direct implications for treatment outcomes. Aim: To determine the concordance between the radiological features and the histopathological diagnosis of cartilaginous lesions of bone. Materials and Methods: This was a retrospective study conducted in the Department of Pathology, Regional Cancer Centre, Trivandrum, Kerala, India, among 109 patients with histopathologically proven benign and malignant cartilaginous tumours, received in the laboratory between January 2012 and December 2021 for a duration of 10 years, were analysed. The study was conducted between September 2019 and January 2022. The demographic data for the study, including age, tumour site, clinical findings, and radiological diagnosis, were obtained from medical records. The cases were histopathologically graded based on the World Health Organization 2020 classification of tumours of soft tissue and bone. The concordance between histopathological diagnosis and radiological features was assessed. The Chi-square test was used to find the association between two categorical variables, and the Independent sample t-test was used to find the difference between two groups with respect to mean and standard deviation. results: There were a total of 109 cases of cartilaginous tumours, out of which 82 cases (75.22%) were diagnosed as malignant and 27 cases (24.77%) were diagnosed as benign. Among benign neoplasms, chondroblastoma and osteochondroma were the most common, with 10 cases (37.03%) each. Among malignant chondroid tumours, 73 (89.02%) were diagnosed as conventional chondrosarcoma. There were five cases (6.09%) of secondary chondrosarcomas (malignant transformation of a benign cartilaginous lesion). Among the secondary chondrosarcomas, three cases (60%) were malignant transformation in osteochondroma, 1 (20%) in enchondroma, and 1 (20%) in synovial chondromatosis. Among the 91 cases for which radiology was available, 86 (94.50%) had a concordance between radiological and histopathological diagnosis. Five cases (5.49%) had a discordant radiological diagnosis. conclusion: For histologically benign tumours, the radiological findings in the study were identical and concordant. For histologically malignant tumours, there were discrepancies with radiological findings in this study when the lesion had an associated cyst, absence of cortical destruction, or absence of a clear cartilaginous component and extra cortical expansion. For histologically suspicious cases in the study, the final diagnosis was made based upon radiological findings, with a particular interest in cortical destruction. [ABSTRACT FROM AUTHOR]

Background: Chronic mandibular hypomobility is characterized by a long-standing limitation of the mouth opening related to multiple etiologies, including elongation of the coronoid apophysis. Unlike the most frequent pathologies that cause coronoid elongation, such as hyperplasia, osteoma (OM), and osteochondroma (OC), the accessory mandibular condyle (AMC) is a rare entity. Clinical Presentation: The AMC shows a configuration similar to a normal mandibular condyle with an articular surface covered by fibrocartilage that articulates with the temporal wall of the zygomatic bone, and histologically, does not show neoplastic growth. The patient was treated with a coronoidectomy, removing the coronoid apophysis as well as the AMC.Clinical Relevance: This case report presents a case of an AMC to describe the clinical, imaging, surgical, and histological characteristics, establishing its differential diagnosis with hyperplasia, OM, and OC of the coronoid apophysis. [ABSTRACT FROM AUTHOR]

Ankle valgus is commonly reported in patients with multiple hereditary exostoses (MHE). We report the characteristics of mortise widening in MHE, its progression over time, and the resultant ankle pain and function at skeletal maturity. Mortise medial space (M), talocrural angle (TC), and tibiotalar angle (TT) measurements were collected on preoperative and last follow-up radiographs. Operative data and complications were recorded. American Orthopaedic Foot and Ankle Society (AOFAS) and short form-36 scores at skeletal maturity were collected. A total of 16 patients (19 ankles) had MHE and mortise widening. Thirteen patients had surgery. Preoperatively, no patient complained of instability. However, 11 ankles (57.9%) were painful and 15 (78.9%) were clinically in valgus. Patients underwent surgery at a mean age of 11.8 ± 2.2 y. Operative interventions included medial distal tibia hemiepiphysiodesis for the majority of patients. There were no statistically significant differences between pre and postoperative M, TC, TT angles. Operative patients showed an improved mean M (5.17 ± 1.17 to 4.63 ± 1.06 mm) and TT (8.71 ± 5.40° to 4.54 ±7.58°), however, neither angle reached normal values. TC representing fibular length-maintained measurements within normal limits (82.2 ± 5.3° to 84.8 ±5.8°). Questionnaires were obtained for 10 (52.6%) ankles. Mean age at questionnaires collection was 19.0 ± 3.6 y. Mean AOFAS score was 74.8 ± 17.6 out of 100. Patients scored 6.5 ± 4.1 out of 10 for alignment, 33.0 ± 6.7 out of 40 for pain, 35.3 ± 9.5 out of 50 for function. All short form-36 scores were above the national mean. Improvement of M and TT angles was modest. TC angle was within normal limits but showed an overall fibular shortening and decreased lateral buttress and potential for talar shift, as reflected in AOFAS score. The underwhelming amount of mortise widening correction achieved may not provide for a stable ankle joint. [ABSTRACT FROM AUTHOR]

Background: Osteochondroma (OC) is one of the most common benign tumors of the long bones, but it rarely occurs in the maxillofacial skeleton. However, mandibular condylar OC often leads to severe facial deformity in affected patients, including facial asymmetry, deviation of the chin, and malocclusion. This study aimed to explore the clinical application of individualized 3D-printed templates to accurately and effectively treat condylar OC. Methods: A total of 8 patients with mandibular condylar OC were treated from July 2015 to August 2021. The enrolled patients (5 women and 3 men) had a median age of 27 years (range: 21–32 years). All patients exhibited symptoms of facial asymmetry and occlusal disorders preoperatively. The digital software used to virtually design the process consisted of three-dimensional reconstruction, 3D-cephalometry analysis, virtual surgery, individualized templates, and postoperative facial soft-tissue prediction. A set of 3D-printed templates (DOS and DOT) were used in all cases to stabilize the occlusion and guide the osteotomy. Then, pre- and post-operative complications, mouth opening, clinical signs, and the accuracy of the CT imaging analysis were all evaluated. All the measurement data were presented as means ± SD; Bonferroni and Tamhane T2 multiple comparison tests were used to examine the differences between the groups. Results: All patients healed uneventfully. None of the patients exhibited facial nerve injury at follow-up. In comparing the condylar segments with T0p and T1, the average deviation of the condylar segments was 0.5796 mm, indicating that the post-operative reconstructed condyles showed a high degree of similarity to the reconstruction results of the virtual surgical plan. Conclusions: Individualized 3D-printed templates simplified surgical procedures and improved surgical accuracy, proving to be an effective method for the treatment of patients with slight asymmetric deformities secondary to condylar OC. [ABSTRACT FROM AUTHOR]

Hereditary multiple exostoses (HME) is a rare, pediatric disorder characterized by osteochondromas that form along growth plates and provoke significant musculoskeletal problems. HME is caused by mutations in heparan sulfate (HS)‐synthesizing enzymes EXT1 or EXT2. Seemingly paradoxically, osteochondromas were found to contain excessive extracellular heparanase (Hpse) that could further reduce HS levels and exacerbate pathogenesis. To test Hpse roles, we asked whether its ablation would protect against osteochondroma formation in a conditional HME model consisting of mice bearing floxed Ext1 alleles in Agr‐CreER background (Ext1f/f;Agr‐CreER mice). Mice were crossed with a new global Hpse‐null (Hpse−/−) mice to produce compound Hpse−/−;Ext1f/f;Agr‐CreER mice. Tamoxifen injection of standard juvenile Ext1f/f;Agr‐CreER mice elicited stochastic Ext1 ablation in growth plate and perichondrium, followed by osteochondroma formation, as revealed by microcomputed tomography and histochemistry. When we examined companion conditional Ext1‐deficient mice lacking Hpse also, we detected no major decreases in osteochondroma number, skeletal distribution, and overall structure by the analytical criteria above. The Ext1 mutants used here closely mimic human HME pathogenesis, but have not been previously tested for responsiveness to treatments. To exclude some innate therapeutic resistance in this stochastic model, tamoxifen‐injected Ext1f/f;Agr‐CreER mice were administered daily doses of the retinoid Palovarotene, previously shown to prevent ectopic cartilage and bone formation in other mouse disease models. This treatment did inhibit osteochondroma formation compared with vehicle‐treated mice. Our data indicate that heparanase is not a major factor in osteochondroma initiation and accumulation in mice. Possible roles of heparanase upregulation in disease severity in patients are discussed. [ABSTRACT FROM AUTHOR]

Osteochondromatosis is a benign proliferative disorder characterized by cartilage‐capped bony protuberances. In humans and most mammals, variants in the EXT1 or EXT2 gene are strongly correlated with the etiology of osteochondromatosis. However, in cats, osteochondromatosis has only been associated with feline leukemia virus infection. In this study, to explore other factors involved in the etiology of feline osteochondromatosis, we examined the EXT1 and EXT2 genes in a feline leukemia virus‐negative cat with osteochondromatosis. Genetic analysis revealed a heterozygous single base pair duplication in exon 6 of the EXT1 gene (XM_023248762.2:c.1468dupC), leading to a premature stop codon in the EXT1 protein. Notably, this frameshift variant is recognized as one of the most common pathogenic variants in human osteochondromatosis. Our data suggest for the first time that genetic variants can have etiologic roles in osteochondromatosis in cats, as in humans and other animals. [ABSTRACT FROM AUTHOR]

Hereditary multiple exostosis (HME) is an inherited disease characterized by the development of multiple osteochondromas in the long bones and squamous bones. Vertebral osteochondroma associated with HME that causes myelopathy is rare. We report a 12-year-old boy with HME and a thoracic spine osteochondroma who presented with progressive gait disturbance. Treatment with surgical tumor resection was successful. Although rare, clinicians should be aware that patients with HME may develop symptomatic spinal lesions. Patients and their families should know the signs and symptoms of myelopathy. [ABSTRACT FROM AUTHOR]

Cases: Two women presented with newly growing callosities beneath the first and second metatarsal heads, initially believed to reflect gastrocnemius tightness and plantar plate pathology. In another man, swelling at the posterolateral aspect of the heel was mistaken for a Haglund deformity. Subsequent imaging of each patient led to delayed diagnosis of extraskeletal osteochondroma (ESO). Surgical excision resolved symptoms in all 3 with no recurrence over 12 months later. Conclusions: Whenever bony prominences newly develop in soft tissues of the foot, ESO should be suspected and appropriate imaging obtained. We describe physical features to help differentiate ESO from other common causes of foot overload. [ABSTRACT FROM AUTHOR]

Aim of the study: The aim of the present paper is to determine the diagnostic features of the rare presentation of osteochondroma in the mandible. The unusual aspect in this case is that the diagnosis was not established with cone beam computer tomography, which is a commonly used radiographic technique in dentistry, but with the use of ultrasonography. Case description: Ultrasonography is very useful for initial examinations, avoiding patient exposure to additional radiation and setting the diagnosis in debatable soft tissue involvement of various lesions. In the presented case, even though the clinical presentation was indicative, the cone beam computer tomography evaluation could not confirm the diagnosis, so the final diagnosis was made by ultrasonography. Conclusions: With the latest advances in the applications of ultrasonography in the maxillofacial region, an examination of lesions on the floor of the mouth or in the neck area may set the diagnosis in cases where hard tissue imaging does not provide enough information. [ABSTRACT FROM AUTHOR]

To identify the pathogenic gene variation in a Chinese family with Hereditary Multiple Exostoses (HME). By examining blood‐sourced DNA and clinical manifestations of the proband and his family members, the whole exome sequencing (WES) and Sanger sequencing were used to detect possibly pathogenic mutations. A novel heterozygous mutation (c.325dup) was identified in exon 1 of the exostosin 1 (EXT1) gene from the proband and the affected family members. And we found this mutation was absent in all the unaffected family members. This c.325dup mutation is in the exon 1 domain of the EXT1 gene and the change of p.C109Lfs*80 cause the early termination of protein translation. The identification of the novel frameshift insertion mutation (c.325dup) expands the mutation spectrum of HME, which provides new evidence for HME diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: Osteochondroma is a long bone benign tumor presenting at the metaphysis. Most of the occurrences are isolated lesions with very rare intra-articular extensions. Some occur as part of multiple hereditary exostoses. Isolated lesions are typically asymptomatic and diagnosed incidentally but, in some cases, present with bursa inflammation, pain, decreased range of motion and neurovascular deficit due to the mass effect of the tumor. Osteochondroma of the femur neck presents as an intra-articular pathology., Case Report: A 41-year-old lady presented with right inguinal pain and swelling for 7 years, with an associated decreased range of movements of the right hip. Clinical examination revealed gross bony hard swelling, non-tender, and no local warmth. ROM was restricted, particularly internal rotation with additional abduction contracture and anterior joint line tenderness. A plain radiograph revealed a bony mass over metaphyseal-diaphyseal swelling over the medial aspect of the proximal femur with loss of femur head morphology and joint space narrowing. MRI confirmed the lesion as osteochondroma and a provisional diagnosis of Sessile solitary osteochondroma with probable sarcomatous with secondary degenerative osteoarthritis of the right hip was made. The patient underwent right total hip replacement with wide excision of the entire proximal femur using a REEF stem. The samples sent for histopathology confirmed the diagnosis as osteochondroma with no sarcomatous changes. Over a 10-year period of follow up, the patient showed no evidence of recurrence with improvement of hip movements assessed by Modified Harris Hip Score., Conclusion: By planning and executing total hip replacement with REEF stem and wide excision of the tumor in a single sitting, both the progress of the tumor and the secondary degenerative arthritis were met with, in a single procedure., Competing Interests: Conflict of Interest: Nil, (Copyright: © Indian Orthopaedic Research Group.)

Introduction: Benign bone tumors like osteochondroma are common during skeletal maturity occurring usually at the ends of long bones, such as the distal femur, proximal humerus, and proximal tibia. The tumor can occur in sessile or pedunculated forms. Mass lesions occurring around the ankle can lead to chronic pain, pathological fractures, progressive erosion, and scalloping of adjacent bone. This report highlights a case of a progressively enlarging bony swelling around the distal tibia with uncommon radiological and histological presentation managed with en bloc excision., Case Report: A 30-year-old male with 3 years of progressive bony enlargement without any history of significant trauma presented to our tertiary care hospital. The radiological and histological investigations were performed and many varied differentials were proposed. The lesion was provisionally diagnosed to be a case of an uncommon form of osteochondroma and en bloc excision was done. The patient followed up for a period of 6 months and the patient had uneventful recovery with no recurrence., Conclusion: Osteochondromas in the distal tibia are infrequent occurrences among common skeletal tumors. Timely surgical intervention is recommended for symptomatic lesions or those causing compression or mass effects., Competing Interests: Conflict of Interest: Nil, (Copyright: © Indian Orthopaedic Research Group.)

Introduction: Osteochondroma is a benign bone tumor, commonly seen as a bony outgrowth from the metaphysis of long bones, having a stalk and cartilage cap. They may be sessile or multiple and usually arise before 20 years of age with no growth beyond puberty. Malignant transformation is a rare complication seen in 1% of solitary cases and 3-5% in the hereditary multiple enchondromatosis variety. Here, we report a rare case of atypical benign osteochondroma with clinical and radiological features suggestive of a malignant transformation., Case Report: A 17-year-old boy presented to us with a complaint of swelling in his right thigh for 12 years. Radiological features were suggestive of malignant transformation, with bony outgrowth exhibiting heterogeneous calcification, local invasion, and a cartilage cap of size 2.5 cm. Bilateral lung nodules were detected on high-resolution computed tomography. Positron emission tomography scan showed no evidence of metastasis. The patient underwent a wide excision of the tumor and the histopathology revealed it to be a benign osteochondroma. It is an atypical presentation of osteochondroma in which we had a discrepancy in radio-histopathological correlation., Conclusion: In instances of diagnostic uncertainty concerning atypical osteochondroma, opting for an excisional biopsy serves as a prudent next step for the planning of subsequent management. The patient needs to be followed up regularly to look for recurrence or any other signs of metastasis., Competing Interests: Conflict of Interest: Nil, (Copyright: © Indian Orthopaedic Research Group.)

Background: Congenital cartilage masses can cause pain and restrict joint movement. This mass can be used in the differential diagnosis of osteomyelitis and other benign cartilage masses, such as osteochondroma and chondroma. Case description: In this report, a 51-day-old boy with a pathological diagnosis of cartilage mass in the proximal tibia is introduced. The patient had normal growth and development and was referred due to presence a mass below his right knee. Based on the pathological findings, the final diagnosis was congenital cartilage mass. Conclusion: The presence of a cartilage mass can mimic the symptoms of osteomyelitis, and since treatment for osteomyelitis must be performed promptly, it is important to distinguish between congenital cartilage masses and osteomyelitis. In addition, the presence of the cartilage mass in the patient affected joints movement and caused pain, indicating the importance of the need for intervention.

Introduction: Cartilaginous tumours comprise a large, heterogeneous group of mesenchymal neoplasms. They pose a challenge in terms of accurate diagnosis and management. Histopathological findings have direct implications for treatment outcomes. Aim: To determine the concordance between the radiological features and the histopathological diagnosis of cartilaginous lesions of bone. Materials and Methods: This was a retrospective study conducted in the Department of Pathology, Regional Cancer Centre, Trivandrum, Kerala, India, among 109 patients with histopathologically proven benign and malignant cartilaginous tumours, received in the laboratory between January 2012 and December 2021 for a duration of 10 years, were analysed. The study was conducted between September 2019 and January 2022. The demographic data for the study, including age, tumour site, clinical findings, and radiological diagnosis, were obtained from medical records. The cases were histopathologically graded based on the World Health Organization 2020 classification of tumours of soft tissue and bone. The concordance between histopathological diagnosis and radiological features was assessed. The Chi-square test was used to find the association between two categorical variables, and the Independent sample t-test was used to find the difference between two groups with respect to mean and standard deviation. Results: There were a total of 109 cases of cartilaginous tumours, out of which 82 cases (75.22%) were diagnosed as malignant and 27 cases (24.77%) were diagnosed as benign. Among benign neoplasms, chondroblastoma and osteochondroma were the most common, with 10 cases (37.03%) each. Among malignant chondroid tumours, 73 (89.02%) were diagnosed as conventional chondrosarcoma. There were five cases (6.09%) of secondary chondrosarcomas (malignant transformation of a benign cartilaginous lesion). Among the secondary chondrosarcomas, three cases (60%) were malignant transformation in osteochondroma, 1 (20%) in enchondroma, and 1 (20%) in synovial chondromatosis. Among the 91 cases for which radiology was available, 86 (94.50%) had a concordance between radiological and histopathological diagnosis. Five cases (5.49%) had a discordant radiological diagnosis. Conclusion: For histologically benign tumours, the radiological findings in the study were identical and concordant. For histologically malignant tumours, there were discrepancies with radiological findings in this study when the lesion had an associated cyst, absence of cortical destruction, or absence of a clear cartilaginous component and extra cortical expansion. For histologically suspicious cases in the study, the final diagnosis was made based upon radiological findings, with a particular interest in cortical destruction.

Osteochondroma is the most common primary benign bone tumour frequently affecting the appendicular skeleton and rarely involves the spine and even more rarely involves the lower lumbar region. The present case report was a rare case of osteochondroma arising from spinous process of L2 vertebra. A 12-year-old male visited with his parents with complaints of progressive painless swelling in the lower back for six months. After thorough evaluation, osteochondroma arising from L2 spinous process was diagnosed. The patient was operated with extraperiosteal enbloc excision of the tumour along with L2 spinous process. Enbloc excision of axial exostosis should be considered owing to the risk factor of neurological involvement and rare malignant transformation.

BackgroundThis study aims to introduce a reconstruction method of applying allografts and absorbable screws to repair large bone defects caused by the resection of giant osteochondroma.MethodsA retrospective study of a series of patients who underwent the resection of giant osteochondroma reconstructed by allografts and absorbable screws was conducted from February 2020 to September 2021. Their demographic data, location site, area of bone defect, and pertinent operative details were recorded. The reconstruction modality of allografts was elaborated on. In the follow-up, radiographic images were utilized to determine bone union, and the Musculoskeletal Tumor Society score was used to evaluate postoperative limb function.ResultsA total of seven patients were included, including three males and four females with an average age of 16.6 ± 6.5 years. Among them, three cases of tumors occurred in the humerus and four cases occurred in the femur. The average follow-up time was 11.3 ± 3.0 months. The average area of bone defect was 25.9 ± 8.3 cm2. No complications such as infection, nonunion, and allograft bone fracture were found during the follow-up period. Six months after the operation, the average Musculoskeletal Tumor Society score was 26.4 ± 1.6, with acceptable postoperative function.ConclusionsThe cooperative application of absorbable screw fixation and allografts including mixed cortical bone and cancellous bone, which yielded satisfactory functional outcomes and acceptable postoperative complications, is an effective reconstruction method for a massive bone defect after the resection of giant osteochondroma.

Benign tumours comprise the majority of primary vertebral tumours, and these are often found incidentally on imaging. Nonetheless, accurate diagnosis of these benign lesions is crucial, in order to avoid misdiagnosis as more ominous malignant lesions or infection. Furthermore, some of these tumours, despite their benign nature, can have localised effects on the spine including neural compromise, or can be locally aggressive, thus necessitating active management. Haemangiomas and osteomas (enostosis) are the commonest benign tumours encountered. Others include osteoid osteoma, osteoblastoma, fibrous dysplasia, osteochondroma, chondroblastoma, haemangioma, simple bone cysts, aneurysmal bone cysts, giant cell tumours, eosinophilic granuloma and notochordal rests. The majority of lesions are asymptomatic; however, locally aggressive lesions (such as aneurysmal bone cysts or giant cell tumours) can present with nonspecific symptoms, such as back pain, neurological deficits and spinal instability, which may be indistinguishable from more commonly encountered mechanical back pain or malignant lesions including metastases. Hence, imaging, including radiography, computed tomography (CT) and magnetic resonance imaging (MRI), plays a critical role in diagnosis. Generally, most incidental or asymptomatic regions are conservatively managed or may not require any follow-up, while symptomatic or locally aggressive lesions warrant active interventions, which include surgical resection or percutaneous treatment techniques. Due to advances in interventional radiology techniques in recent years, percutaneous minimally invasive techniques such as radiofrequency ablation, sclerotherapy and cryoablation have played an increasing role in the management of these tumours with favourable outcomes. The different types of primary benign vertebral tumours will be discussed in this article with an emphasis on pertinent imaging features.

Background: Osteochondromas are a relatively common primary bone tumor, which may share common clinical features with Osgood-Schlatter disease (OSD). A limited number of cases have described tumors misdiagnosed as OSD. Case Presentation: We report the case of an 11-year-old male with a sessile osteochondroma of the tibial tubercle and concomitant involvement of the distal extension and attachment of the patellar tendon into the tibial periosteum. A prior diagnosis OSD had been made. The lesion was resected and repair of the extensor mechanism was required at the time of surgery. The patient was followed for 20 months postoperatively and had restoration of knee function with minimal pain, as demonstrated by a PEDI-IKDC score of 94.6 at 19-month. Conclusion: This is a rarely reported case of benign tumor masquerading as OSD requiring excisional biopsy with extensor mechanism repair. [ABSTRACT FROM AUTHOR]