• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Home
  • Online Consultation
  • About
  • Newsletter/Updates
  • Contact Us
  • Policies

Bone and Spine

Orthopedic health, conditions and treatment

  • General Ortho
  • Procedures
  • Spine
  • Upper Limb
  • Lower Limb
  • Pain
  • Trauma
  • Tumors

Solitary Osteochondroma- Symptoms and Treatment

By Dr Arun Pal Singh

In this article
    • Types of Solitary Osteochondroma
    • Causes and Pathophysiology
    • Locations
    • Clinical Presentation
    • Differential Diagnosis
    • Imaging
    • Treatment
    • Malignant Changes
    • References
      • Related

Solitary osteochondroma is a cartilage-capped bony projection on the external surface of a bone near the growth plate. It is considered a non-neoplastic anomaly similar to hamartoma. A neoplastic swelling means there is abnormal cell growth. However, it is a kind rather an overgrowth of the cartilage and bone.

These are located adjacent to growth plates and grow away from growth plate as natural bone growth occurs.

They stop growing after skeletal maturity.

It can occur as a  solitary lesion or as multiple hereditary exostoses.

Solitary osteochondroma is a developmental anomaly of bone that results in the formation of an outgrowth on the surface of the bone. Other terms applied include osteocartilaginous exostosis and simple exostosis.

Multiple hereditary exostoses is an autosomal dominant hereditary disorder characterized by the presence of multiple osteochondromas associated with deformities of the bones affected.

Osteochondromas are usually classified as benign bone tumors, but they are not neoplastic in nature. They appear to result from aberrant epiphyseal development with a displacement of physeal cartilage and subsequent growth at right angles to the long axis of the bone.

In the simplest definition,  osteochondroma is a cartilage-capped bony projection on the external surface of a bone.

The most common occurrences are around the knee and proximal humerus. Other bones where it is most commonly are seen in the bones ilium and scapula.

Rarely, these are present in the spine, typically in the posterior elements of the cervical spine.

Osteochondroma is are in small tubular bones of the hands and feet, in the ribs, and in the vertebral column

Osteochondroma makes up about 20-50% of benign bone tumors and about 10% of bone tumors making it the most common tumor.

Malignant changes occur in less than 1% of solitary osteochondromas.

Solitary osteochondroma affects males, almost twice as common, as females. Most of them are reported in the adolescent age group [less than 20 years]

Osteochondroma grows until skeletal maturity. The growth generally stops once the growth plates fuse.

Types of Solitary Osteochondroma

Solitary Osteochondroma is of two types

  • Pedunculated- the one that has a stalk
  • Sessile- the one with a broad base of attachment

Causes and Pathophysiology

The majority of solitary osteochondromas are sporadic lesions that occur.  Secondary osteochondromas also occur and can develop after external radiation.

These are also known to occur after Salter-Harris fractures and physeal surgeries.

The exact cause is not known. It is thought to result from herniation of the peripheral portion of the physis resulting in an abnormal extension.

These have been found to have EXT1 and EXT gene mutations. Abnormal micro RNA expression has also been reported.

The osteochondroma grows away from the growth plate. They respond to, various growth factors and hormones in the same manner as epiphyseal growth plates do.

When we look at it grossly, the lesion looks like a lobulated cartilage cap 2mm to 1cm thick, covered by a fibrous membrane that is continuous with the periosteum covering the stalk.

It grows during childhood and adolescence by endochondral calcification.

The bursa may form at the periphery and be lined by synovium.

It may show inflammatory changes and in some cases, chondroid metaplasia.

Chondroid metaplasia may cause numerous cartilaginous loose bodies. When calcified these may simulate secondary chondrosarcoma on radiographs.

Locations

The lower limb is responsible for about half of the cases.

Different bones account for the numbers as follows

  • Femur- 30% [distal femur most common]
  • Tibia- 20% [proximal tibia most common]
  • Humerus: 10-20% [Proximal humerus most common]
  • Cervical spine

Clinical Presentation

Small growths may remain unnoticed for a long period.

Solitary ones grow as skeletal growth occurs.

The typical presentation is painless hard swelling in the metaphyseal area that might have increased in size over a few years.

Other presenting symptoms are

  • a fracture of the osteochondroma
  • Pressure on an adjoining structure like a vessel or nerve.
  • A bursa may be present over the cap.

Sometimes, the bursa may become inflamed or accumulate synovial fluid or loose bodies and leading to painful swelling.

Pain might occur due to pressure on adjacent tissues like tendon, muscle, nerve, bursal inflammation, or a fracture of the osteochondroma.

A palpable mass is usually the only finding on clinical examination.  Long-standing lesions may lead to angular deformities of the bone or limb-length discrepancies.

Lesions that occur near the joint may cause restriction of motion. In the spine, the symptoms secondary to cord or root compression may occur.

Differential Diagnosis

  • Parosteal osteosarcoma [in c/o sessile type]
  • Juxtacortical myositis
  • Periosteal chondroma

Imaging

X-ray

On radiographs, osteochondromas can be sessile or pedunculated (have a stalk). The lesion typically arises from the metaphysis of a long bone, with a stalk that is continuous with the adjacent cortex and is oriented away from the epiphysis [the nearest joint].

osteochondroma of femur

Sessile lesions demonstrate a flat, plateau-like protuberance.

The rest of the bone is typically normal. Often slight localized distortion of the contour at stalk’s base end is visible [compare with changes of growth disturbance ] in multiple hereditary exostoses.

Usually, clinical examination and x-ray are sufficient to diagnose these lesions.

CT/MRI

In cases of doubt, CT and MRI are excellent imaging modalities.

MRI can help to measure the thickness of the cartilaginous cap but it is often not required.

MRI may be needed in large sessile osteochondromas difficult to distinguish from other cartilage-containing bone surface lesions.

Treatment

Osteochondromas are benign lesions with self-limited growth that ceases after skeletal maturity.

Most of them are left as such as they do not cause any symptoms. This lesion is almost always needs to be operated on for its complications [and not because lesion is there] which include

  • Painful lesion
  • Pressure effects
  • Restriction of motion
  • Compression on adjacent structures
  • Deformity of the bone
  • Fracture
  • Bursitis
  • Malignancy.

In such cases, complete removal of the lesion is sought.

An incomplete removal may lead to recurrence.

Recurrence after surgical excision is rare but may develop when a portion of cartilage cap or attached, perichondrium is left.

Malignant Changes

Malignant change in osteochondroma almost never occurs in growing age. As such malignant change is not very common but it does occur in adulthood to an incidence of 1%.

The most common associated malignancy is chondrosarcoma, although malignant fibrous histiocytoma and osteosarcoma have been reported.

High-grade sarcomas develop rarely in multiple hereditary exostoses

Lesions in the pelvis, scapula, ribs, and spine (Central Lesions)  carry a higher risk of malignant transformation.

The reported risk for solitary osteochondromas is 1- 2% and  5-25% for multiple.

Signs suggestive of malignancy are

  • A sudden increase in size
  • Sudden onset of pain at the site
  • Radiographic signs
    • Areas of lucency
    • Calcification in overlying soft tissue mass
    • Destruction of the base or adjacent bone [Definite sign]

Radiographic changes may be difficult to ascertain in large sessile osteochondromas.

Most secondary tumors show the features of grade 1 to 2 chondrosarcoma. High-grade sarcomas may develop in the stalk or base of the lesion and invade adjacent bone and soft tissue.

Treatment is wide excision of the entire lesion with a surrounding rim of normal tissue.

References

  • Mavrogenis AF, Papagelopoulos PJ, Soucacos PN. Skeletal osteochondromas revisited. Orthopedics. 2008 Oct. 31 (10). [Link]
  • Heinritz W, Hüffmeier U, Strenge S, Miterski B, Zweier C, Leinung S, et al. New mutations of EXT1 and EXT2 genes in German patients with Multiple Osteochondromas. Ann Hum Genet. 2009 May. 73 (Pt 3):283-91.
  • Tepelenis K, Papathanakos G, Kitsouli A, Troupis T, Barbouti A, Vlachos K, et al. Osteochondromas: An Updated Review of Epidemiology, Pathogenesis, Clinical Presentation, Radiological Features and Treatment Options. In Vivo. 2021 Mar-Apr. 35 (2):681-691.

Related

Spread the Knowledge
1
Share
 
1
Share
1    

Filed Under: Tumors

About Dr Arun Pal Singh

Arun Pal Singh is an orthopedic and trauma surgeon, founder and chief editor of this website. He works in Kanwar Bone and Spine Clinic, Dasuya, Hoshiarpur, Punjab.

This website is an effort to educate and support people and medical personnel on orthopedic issues and musculoskeletal health.

You can follow him on Facebook, Linkedin and Twitter

Primary Sidebar

Browse Articles

whiplash injury of cervical spine

Whiplash Injury of Cervical Spine [Strain and Sprain]

The term whiplash injury is used for a neck injury caused by a sudden movement of the head forwards, backwards or sideways. It is a term that describes mechanism of injury as well as the injury per se. It covers both ligament injuries [sprain] and other muscles, tendons, and soft tissue injuries [strain]. The injury […]

Trigger finger as a cause of hand pain

Trigger Finger Presentation and Treatment

This article mainly focuses on the adult trigger finger, for pediatric condition go to Pediatric Trigger Thumb Trigger finger is a common problem causing hand pain and disability. Trigger finger is due to abnormal gliding of thickened tendon at the distal aspect of palm within tendon sheath. This thickened tendon gets caught at the edge […]

kyphosis in tubercular spine

Kyphosis in Spinal Tuberculosis

Kyphosis in spinal tuberculosis is one of the most common complication of spinal tuberculosis. Neurological complications (paraplegia or quadriplegia) and spinal deformity especially kyphotic deformity are the most dreaded complications of tuberculosis of the spine. The sequelae of these two complications affect the quality and span of life. Almost all tuberculosis of the spine, even […]

rib-cage

Rib Fractures – Causes, Presentation and Treatment

Rib fractures are the most common injury sustained after blunt chest trauma. Rib fractures are more common in elderly and adults [older people are more prone than young adults] than children. Elderly are more likely to have associated injuries and complications. Rib fractures can be associated with injury to internal organs. This includes injury to […]

Fungal Arthritis Causes and Treatment

Fungal arthritis is an infection of a joint by a fungus. A normal person is quite resistant to fungal infection. Fungal infection is known to be an opportunistic infection. Alteration of human flora, disruption of mucocutaneous membranes and impairment of the immune system may predispose to the fungal infection. Fungi may enter the joint by […]

Cyst formation in lunate following Ulnar Impaction Syndrome

Ulnar Impaction Syndrome or Ulnocarpal Abutment

Ulnar Impaction Syndrome is a degenerative wrist condition caused by the ulnar head impacting upon the ulnar-sided carpus and triangular fibrocartilage complex resulting in degeneration of these structures and a spectrum of symptoms. It is also called ulnocarpal abutment, ulnocarpal loading, and impingement syndrome. Ulnar impaction syndrome is a common cause of ulnar sided wrist […]

Lysholm Knee Scoring Scale

Lysholm Knee Scoring Scale is used to  evaluate the outcomes of knee ligament surgery  in patients The first version of this was published in 1982. The present scale includes  8 items Limp Support Locking Instability Pain Swelling Stair climbing Squatting Apart from knee ligament injury, the score can be used for meniscal tears, knee cartilage […]

© Copyright: BoneAndSpine.com
Manage Cookie Consent
The site uses cookies. Please accept cookies for a better visiting experience.
Functional Always active
The technical storage or access is strictly necessary for the legitimate purpose of enabling the use of a specific service explicitly requested by the subscriber or user, or for the sole purpose of carrying out the transmission of a communication over an electronic communications network.
Preferences
The technical storage or access is necessary for the legitimate purpose of storing preferences that are not requested by the subscriber or user.
Statistics
The technical storage or access that is used exclusively for statistical purposes. The technical storage or access that is used exclusively for anonymous statistical purposes. Without a subpoena, voluntary compliance on the part of your Internet Service Provider, or additional records from a third party, information stored or retrieved for this purpose alone cannot usually be used to identify you.
Marketing
The technical storage or access is required to create user profiles to send advertising, or to track the user on a website or across several websites for similar marketing purposes.
Manage options Manage services Manage vendors Read more about these purposes
View preferences
{title} {title} {title}
 

Loading Comments...