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Alshehri A. Chest wall osteochondroma resection with biologic acellular bovine dermal mesh reconstruction in pediatric hereditary multiple exostoses: A case report and review of literature. World J Clin Cases 2023; 11:4123-4132. [PMID: 37388792 PMCID: PMC10303597 DOI: 10.12998/wjcc.v11.i17.4123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/02/2023] [Accepted: 05/12/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Hereditary multiple exostoses is a rare genetic disorder characterized by the growth of multiple osteochondromas affecting primarily long bones. Chest wall lesions may represent a challenge, particularly in pediatric patients. Pain is a common manifestation. However, life-threatening complications can result from direct involvement of adjacent structures. Surgical resection with appropriate reconstruction is often required.
CASE SUMMARY A 5-year-old male who was diagnosed with hereditary multiple exostoses presented with significant pain from a large growing chest wall exostosis lesion. After appropriate preoperative investigations, he underwent surgical resection with reconstruction of his chest wall using a biologic bovine dermal matrix mesh.
CONCLUSION Resection of chest wall lesions in children represents a challenge. Preoperative planning to determine the appropriate reconstruction strategy is essential.
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Affiliation(s)
- Abdullah Alshehri
- Department of Surgery, College of Medicine, King Saud University, Riyadh 11623, Saudi Arabia
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Mouradian GP, Hong S, Daon E. Ventral Scapular Osteochondroma in Hereditary Multiple Exostosis. ANNALS OF THORACIC SURGERY SHORT REPORTS 2023; 1:246-248. [PMID: 39790307 PMCID: PMC11708692 DOI: 10.1016/j.atssr.2023.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 01/12/2025]
Abstract
Hereditary multiple exostosis is a rare, autosomal dominant, highly penetrant genetic disorder characterized by the development of osteochondromas on the metaphysis of long and flat bones. The development of osteochondromas on the scapula is unusual but has been reported. Here, we present a case of an osteochondroma of the ventral scapula with preoperative concern for invasion into the second rib. Through an open approach, the lesion was found to be well isolated within a bursa, and it was resected without complication. The patient had a short hospital stay with good functional and cosmetic results.
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Affiliation(s)
- Gregory P. Mouradian
- The University of Kansas Medical Center, Kansas City, Kansas
- Department of Surgery, University of Kansas School of Medicine, Kansas City, Kansas
| | - Sam Hong
- The University of Kansas Medical Center, Kansas City, Kansas
- Division of Cardiothoracic Surgery, University of Kansas School of Medicine, Kansas City, Kansas
| | - Emmanuel Daon
- The University of Kansas Medical Center, Kansas City, Kansas
- Division of Cardiothoracic Surgery, University of Kansas School of Medicine, Kansas City, Kansas
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Doan M, Tschopp B, Binet A, Joseph JM, Bourgeois AB. Costal exostosis at risk of hepatic injury in a 10-year-old girl. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Nakamura K, Asanuma K, Shimamoto A, Kaneda S, Yoshida K, Matsuyama Y, Hagi T, Nakamura T, Takao M, Sudo A. Spontaneous pneumothorax in a 17-year-old male patient with multiple exostoses: A case report and review of the literature. World J Orthop 2021; 12:945-953. [PMID: 34888155 PMCID: PMC8613679 DOI: 10.5312/wjo.v12.i11.945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/07/2021] [Accepted: 09/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Multiple exostoses generally develop in the first decade of life. They most frequently arise from the distal femur, proximal tibia, fibula, and proximal humerus. Costal exostoses are rare, contributing to 1%–2% of all exostoses in hereditary multiple exostoses (HME). They are usually asymptomatic, but a few cases have resulted in severe thoracic injuries. Pneumothorax caused by costal exostoses is rare, with only 13 previously reported cases. We report a new case of pneumothorax caused by costal exostoses.
CASE SUMMARY A 17-year-old male with HME underwent surgery for removal of exostoses around his right knee. Four months following the operation, he felt chest pain when he was playing the trumpet; however, he did not stop playing for a week. He was referred to our hospital with a chief complaint of chest pain. The computed tomography (CT) scan revealed right pneumothorax and multiple exostoses in his right ribs. The CT scan also revealed visceral pleura thickness and damaged lung tissues facing the exostosis of the seventh rib. We diagnosed that exostosis of the seventh rib induced pneumothorax. Costal exostosis resection was performed by video-assisted thoracoscopic surgery (VATS) 2 wk after the onset. The patient’s postoperative course was uneventful, and there was no recurrence of pneumothorax for 2 years.
CONCLUSION Costal exostoses causing thoracic injuries should be resected regardless of age. VATS must be considered in cases with apparently benign and relatively small exostoses or HME.
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Affiliation(s)
- Koichi Nakamura
- Department of Orthopedic Surgery, Mie University Graduate School of Medicine, Tsu 514-8507, Mie Prefecture, Japan
| | - Kunihiro Asanuma
- Department of Orthopedic Surgery, Mie University Graduate School of Medicine, Tsu 514-8507, Mie Prefecture, Japan
| | - Akira Shimamoto
- Department of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine, Tsu 514-8507, Mie Prefecture, Japan
| | - Shinji Kaneda
- Department of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine, Tsu 514-8507, Mie Prefecture, Japan
| | - Keisuke Yoshida
- Department of Orthopedic Surgery, Mie University Graduate School of Medicine, Tsu 514-8507, Mie Prefecture, Japan
| | - Yumi Matsuyama
- Department of Orthopedic Surgery, Mie University Graduate School of Medicine, Tsu 514-8507, Mie Prefecture, Japan
| | - Tomohito Hagi
- Department of Orthopedic Surgery, Mie University Graduate School of Medicine, Tsu 514-8507, Mie Prefecture, Japan
| | - Tomoki Nakamura
- Department of Orthopedic Surgery, Mie University Graduate School of Medicine, Tsu 514-8507, Mie Prefecture, Japan
| | - Motoshi Takao
- Department of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine, Tsu 514-8507, Mie Prefecture, Japan
| | - Akihiro Sudo
- Department of Orthopedic Surgery, Mie University Graduate School of Medicine, Tsu 514-8507, Mie Prefecture, Japan
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Tepelenis K, Papathanakos G, Kitsouli A, Troupis T, Barbouti A, Vlachos K, Kanavaros P, Kitsoulis P. Osteochondromas: An Updated Review of Epidemiology, Pathogenesis, Clinical Presentation, Radiological Features and Treatment Options. In Vivo 2021; 35:681-691. [PMID: 33622860 DOI: 10.21873/invivo.12308] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/20/2020] [Accepted: 12/21/2020] [Indexed: 02/06/2023]
Abstract
Osteochondroma, the most common benign bone tumor, is a projection on the external surface of the bone, which can be sessile or pedunculated. 85% of osteochondromas present as solitary lesions, while 15% occur in the context of hereditary multiple exostoses (HME), a genetic disorder that is inherited in an autosomal dominant manner. Although often asymptomatic, symptoms may eventuate from compression of adjacent vessels or nerves, fractures, osseous deformities, bursa formation, or malignant transformation. Cartilage cap thickness >2 cm in adults or >3 cm in children as well as new onset of pain or growth, or rapid growth of the lesion, especially after the closure of the growth plate, might reflect cancerous transformation. Surgical resection is indicated for symptomatic lesions, complications, cosmetic reasons or malignant transformation. Excision of the tumor with free margin is the treatment of choice. Local recurrence is less than 2% if complete resection is achieved.
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Affiliation(s)
- Kostas Tepelenis
- Department of Surgery, University Hospital of Ioannina, Ioannina, Greece;
| | | | | | - Theodoros Troupis
- Department of Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandra Barbouti
- Anatomy - Histology - Embryology, University of Ioannina, Ioannina, Greece
| | | | | | - Panagiotis Kitsoulis
- Anatomy - Histology - Embryology, University of Ioannina, Ioannina, Greece.,Orthopaedics, University of Ioannina, Ioannina, Greece
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Versteegh VE, Welvaart WN, Oberink-Gustafsson E, Lindenholz A, Staaks G, Schaefer-Prokop CM. Non-traumatic complications of a solitary rib osteochondroma; an unusual cause of hemoptysis and pneumothorax. BJR Case Rep 2020; 6:20200015. [PMID: 32922844 PMCID: PMC7465744 DOI: 10.1259/bjrcr.20200015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 12/27/2022] Open
Abstract
Osteochondromas are a very common and usually asymptomatic entity which may originate anywhere in the appendicular and axial skeleton. However, the ribs are a rare site of origin and here they may prove symptomatic for mechanical reasons. In this case report, we describe an unusual case of a symptomatic osteochondroma of the rib secondary to its location and unique shape, ultimately requiring surgical intervention.
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Affiliation(s)
- V E Versteegh
- Department of Radiology and Nuclear Medicine, Meander MC, Amersfoort, The Netherlands
| | - W N Welvaart
- Department of Surgery, Meander MC, Amersfoort, The Netherlands
| | | | - A Lindenholz
- Department of Radiology and Nuclear Medicine, Meander MC, Amersfoort, The Netherlands
| | - Gha Staaks
- Department of Pulmonology, Meander MC, Amersfoort, The Netherlands
| | - C M Schaefer-Prokop
- Department of Radiology and Nuclear Medicine, Meander MC, Amersfoort, The Netherlands
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Mazza D, Fabbri M, Calderaro C, Iorio C, Labianca L, Poggi C, Turturro F, Montanaro A, Ferretti A. Chest pain caused by multiple exostoses of the ribs: A case report and a review of literature. World J Orthop 2017; 8:436-440. [PMID: 28567348 PMCID: PMC5434351 DOI: 10.5312/wjo.v8.i5.436] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 12/19/2016] [Accepted: 03/02/2017] [Indexed: 02/06/2023] Open
Abstract
The aim of this paper is to report an exceptional case of multiple internal exostoses of the ribs in a young patient affected by multiple hereditary exostoses (MHE) coming to our observation for chest pain as the only symptom of an intra-thoracic localization. A 16 years old patient with familiar history of MHE came to our observation complaining a left-sided chest pain. This pain had increased in the last months with no correlation to a traumatic event. The computed tomography (CT) scan revealed the presence of three exostoses located on the left third, fourth and sixth ribs, all protruding into the thoracic cavity, directly in contact with visceral pleura. Moreover, the apex of the one located on the sixth rib revealed to be only 12 mm away from pericardium. Patient underwent video-assisted thoracoscopy with an additional 4-cm mini toracotomy approach. At the last 1-year follow-up, patient was very satisfied and no signs of recurrence or major complication had occured. In conclusion, chest pain could be the only symptom of an intra-thoracic exostoses localization, possibly leading to serious complications. Thoracic localization in MHE must be suspected when patients complain chest pain. A chest CT scan is indicated to confirm exostoses and to clarify relationship with surrounding structures. Video-assisted thoracoscopic surgery can be considered a valuable option for exostoses removal, alone or in addiction to a mini-thoracotomy approach, in order to reduce thoracotomy morbidity.
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Kwee RM, Fayad LM, Fishman EK, Fritz J. Multidetector computed tomography in the evaluation of hereditary multiple exostoses. Eur J Radiol 2015; 85:383-91. [PMID: 26781144 DOI: 10.1016/j.ejrad.2015.11.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 10/29/2015] [Accepted: 11/25/2015] [Indexed: 10/22/2022]
Abstract
Hereditary multiple exostoses (HME) is an autosomal dominant disorder characterized by the formation of multiple osteochondromas. Because of its superior soft tissue contrast and absence of ionizing radiation, magnetic resonance imaging is the first choice imaging technique for the evaluation of complex lesions and complications related to HME. However, multidetector computed tomography (MDCT) also can be of value in the evaluation of patients with HME, which is reviewed in this article. Topics outlined are low-dose MDCT technique, 3-dimensional visualization techniques, typical MDCT appearances, differential diagnostic considerations, and the usefulness of MDCT in the assessment of emergent and non-emergent complications related to HME, among which spinal cord compression, pneumothorax and hematothorax, pseudoaneurysms, fractures, growth disturbances, chondrosarcoma transformation, and muscular and peripheral nerve involvement.
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Affiliation(s)
- Robert M Kwee
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Radiology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Laura M Fayad
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Elliot K Fishman
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jan Fritz
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
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Abstract
BACKGROUND Chest wall osteochondroma is a rare tumor in children. Even though the potential for malignant transformation or serious intrathoracic complications is low, it has led some centers to advocate surgical management of these bony tumors. We present our experience of the surgical management of costal osteochondromata. METHODS Between January 1, 2006 and November 1, 2012 we saw 854 patients with solitary or multiple exostoses in our clinics. By reviewing our billing lists we found 7 children who had surgical management of chest wall osteochondromata. The indications for surgery were pain (3 patients), excision for confirmation of diagnosis (2 patients), recurrent pneumothorax (1 patient), and malignancy (1 patient). RESULTS All patients made a good postoperative recovery with a median hospital stay of 1.8 days (range, 0 to 4 d). There was no recurrence of exostosis on follow-up (range, 8 mo to 2.6 y). One patient required surgery for excision of another chest wall osteochondroma at an adjacent location. No patient reported scar-related pain symptoms. No malignant transformation or intrathoracic complications occurred. We found ribs as the first site of presentation of multiple hereditary exostoses in 2 young patients. CONCLUSIONS Surgical management of thoracic osteochondroma, with excision for painful, symptomatic, malignant lesions or lesions adjudged to be at risk of intrathoracic complications, yields good outcomes in terms of symptom control, establishing histologic diagnosis, and prevention of thoracic complications. LEVEL OF EVIDENCE Level IV-case series.
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Abstract
This report outlines the management of a large intrathoracic lesion found in a 2-year-old girl with hereditary multiple exostosis. The lesion arose from the right eighth rib and comprised two separate osteochondromata that had coalesced into a single lesion and caused significant deformity to the chest wall. Aside from the deformity, the lesions were asymptomatic. Further growth of the lesions could cause respiratory complications, worsening of the visible deformity and, being lesions of the axial skeleton, bear an increased risk of malignant change. The lesions and the attached eighth rib were removed operatively and the patient recovered without complications. We demonstrate a place for the operative management of asymptomatic lesions in anticipation of future difficulties or malignant changes.
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Liu W, Kong D, Tang J, Yu F. Giant costal osteochondroma in a man with multiple exostoses. Ann Thorac Surg 2013; 96:675-7. [PMID: 23910108 DOI: 10.1016/j.athoracsur.2012.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 11/14/2012] [Accepted: 12/03/2012] [Indexed: 10/26/2022]
Abstract
We report the case of a 42-year-old man who presented with kyphosis resulting from a giant symptomatic costal osteochondroma around the left fourth rib. The osteochondroma on the left side of the back was 56 cm × 47 cm × 33 cm and was painful. The size and growth of the tumor suggested a malignant transformation of a large costal osteochondroma. Multiple osteochondromas were also found on the legs. The patient's family history revealed hereditary characteristics. This patient was clinically diagnosed as a case of multiple familial osteochondromatosis. Complete removal of the tumor relieved the symptoms, and histopathologic examination confirmed malignant transformation of chondrosarcoma. There was no recurrence after 16 months of follow-up.
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Niedźwiecka M, Kaczmarek P, Krawczyk T, Oszukowski P, Maroszyńska I. Benign but fatal. A case of a newborn with congenital osteochondroma. Bone 2013; 54:169-71. [PMID: 23416845 DOI: 10.1016/j.bone.2013.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 02/05/2013] [Accepted: 02/06/2013] [Indexed: 10/27/2022]
Abstract
Osteochondroma is one of the most frequent benign bone tumors in children. Its incidence is hard to determine because this tumor usually is asymptomatic. These tumors may present as solitary, nonhereditary lesions or as hereditary multiple osteochondromas that are inherited in an autosomal dominant manner. Although osteochondromas are usually asymptomatic, significant symptoms may occur because of complications such as bone fracture, bone deformation, or joint problems. The tumor may also mechanically compress nerves or vessels. Osteochondromas growing inwardly may cause injury to internal organs. The authors present a preterm (34 weeks of corrected gestational age) neonate in whom osteochondroma, although histologically benign, caused death because of its size and location. Prenatal ultrasound imaging performed during the third trimester of pregnancy showed bilateral hydrothorax and hydroperitoneum as well as heterogeneous parenchymal area on the right side of the thorax. After birth, the neonate's condition was extremely severe. Although intensive and multidirectional treatment was applied, the condition of the infant continued to deteriorate and he died 26 h after birth. The autopsy confirmed presence of the tumor - osteochondroma - that caused total mediastinal shift with significant hypoplasia of both lungs and with signs of significant compression of the superior and inferior vena cava.
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Affiliation(s)
- Marta Niedźwiecka
- Department of Intensive Care and Congenital Malformations of the Neonates and Infants, Polish Mother's Memorial Hospital Research Institute, ul. Rzgowska 281/289, 93-338 Lodz, Poland.
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Cheng PG, Chen CC, Wu SK, Hsu SM, Wang MN. Thorn-like costal osteochondroma presenting as hemothorax in an adult. FORMOSAN JOURNAL OF SURGERY 2012. [DOI: 10.1016/j.fjs.2012.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Mann E, Kaafarani HM, Cassidy C, Chwals WJ, Jackson CC. Spontaneous Hemothorax in Multiple Exostoses: A Case Report and Review of Literature. J Laparoendosc Adv Surg Tech A 2011; 21:575-7. [DOI: 10.1089/lap.2010.0494] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Elizabeth Mann
- Tufts University School of Medicine, Boston, Massachusetts
| | - Haytham M.A. Kaafarani
- Tufts University School of Medicine, Boston, Massachusetts
- Division of Pediatric Surgery, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts
| | - Charles Cassidy
- Tufts University School of Medicine, Boston, Massachusetts
- Department of Orthopedics, Tufts Medical Center, Boston, Massachusetts
| | - Walter J. Chwals
- Tufts University School of Medicine, Boston, Massachusetts
- Division of Pediatric Surgery, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts
| | - Carl-Christian Jackson
- Tufts University School of Medicine, Boston, Massachusetts
- Division of Pediatric Surgery, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts
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Oudyi M, David M, Blondel B, Bosdure E, Gorincour G, Launay F, Dubus JC. Hémothorax et maladie exostosante multiple héréditaire chez un enfant de 9 ans. Arch Pediatr 2011; 18:170-5. [PMID: 21190817 DOI: 10.1016/j.arcped.2010.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Revised: 07/07/2010] [Accepted: 11/25/2010] [Indexed: 01/01/2023]
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Belhocine K, Baiod N, Oussalah A, Cazals-Hatem D, Sauvanet A, Castier Y, Guigui P, Dauzac C, Benayoun L, Pease S, Panis Y, Bellier C, Boucekkine T. [Digestive obstruction: an unusual complication of hereditary multiple exostoses]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2008; 32:601-5. [PMID: 18462899 DOI: 10.1016/j.gcb.2008.02.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Revised: 02/18/2008] [Accepted: 02/24/2008] [Indexed: 10/22/2022]
Abstract
Hereditary multiple exostoses is an autosomal dominant bone disorder characterized by multiple cartilaginous tumors growing outward from metaphyses of long bones. These tumors are usually located in long bones of the limbs. Exostosis also called osteochondroma can cause many complications, the most serious being malignant transformation as chondrosarcoma. We report a rare phenotype of this disease in a young male patient who presents digestive symptoms caused by a voluminous degenerated lumbar exostosis with anterior abdominal development.
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Affiliation(s)
- K Belhocine
- Service d'hépato-gastroentérologie, hôpital Mustapha, CHU Alger-Centre, Alger, Algérie.
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Maheshwari AV, Jain AK, Dhammi IK. Osteochondroma of C7 vertebra presenting as compressive myelopathy in a patient with nonhereditary (nonfamilial/sporadic) multiple exostoses. Arch Orthop Trauma Surg 2006; 126:654-9. [PMID: 16906423 DOI: 10.1007/s00402-006-0211-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2006] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Osteochondromas are most commonly found in the appendicular skeleton. They occur less frequently in the spine and compression of the spinal cord is very rare. To the best of our knowledge, this is the first report of an osteochondroma arising from C7 vertebra presenting with compressive myelopathy in a patient with nonhereditary multiple exostoses. Our purpose is to report this rare presentation and its successful management, and to highlight the clinico-radiological features of this treatable condition. MATERIALS AND METHODS A 20-year-old male with nonhereditary exostoses presented with gradual onset weakness in bilateral lower limbs, which had rapidly progressed to complete paraplegia over 1 month. The tumor was effectively treated by surgical excision along with spinal decompression. The diagnosis was confirmed by histopathological evidence complemented by clinico-radiological studies. RESULTS There has been a complete functional recovery without any evidence of recurrence at last follow-up at 2 years. CONCLUSION Compressive myelopathy due to an osteochondroma arising from C7 vertebra in a case with nonhereditary multiple exostoses is being reported for the first time. Both CT and MRI demonstrated the origin, size, extent and relationship of the tumor to the vertebral and neural elements. Complete recovery of functions after surgical decompression was achieved in this case. An osteochondroma of spine must always be considered in all patients with multiple exostoses who have spine pain or develop neural deficit.
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Affiliation(s)
- Aditya V Maheshwari
- Dorr Institute of Arthritis Research and Education, Arthritis Institute, Centinela Freeman Regional Medical Center, 501, East Hardy Street, Suite 300, Inglewood, CA 90301, USA.
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