Multiple osteochondromas

Presentation

Patient with progressive and chronic motor limitation, with a palpable mass of progressive and deforming growth of the hip associated with chronic pain.

Patient Data

Age: 25 years
Gender: Female
ct

Expansive pedunculated osteochondral lesions involving the proximal metaphysis of the right femur with involvement of adjacent soft tissues by friction syndrome. 

Lesions with similar characteristics of smaller size are visualized at the level of the lesser trochanter of the left femur. 

Abnormal morphology of both femoral head and neck regions with widening and coxa valga. 

Bilateral acetabular dysplasia. Subchondral geodes with cortical depression at the level of the right pubic ramus.  Marked asymmetry of the iliac crests. Cortical irregularity with small exostosis at the level of both articular facets of the symphysis pubis. Pedunculated lesions are visualized at the level of the posterior region of both iliac crests - larger lesion at the level of the right iliac crest. Exostosis projected original soft tissue of the posterior sector of S1.

pathology

Pathology report. 

Case Discussion

Osteochondroma (OC) is the most common benign cartilage tumor, accounting for 10%-15% of all bone tumors and 20%-50% of benign bone tumors. Its frequency is probably higher, but many OC, due to its small size and absence of symptoms, go undiagnosed. The tumor is more frequent in males than in females (2:1) and is usually diagnosed in the second decade of life.  

They are defined as exophytic tumors with continuity between the cortical and medullary of the lesion and that of the bone from which they originate, making it possible to establish the diagnosis and differentiate them from other lesions. 

Malignant transformation occurs at the cartilage cap and is uncommon in sporadic solitary osteochondromas (~1%), while in the context of multiple hereditary exostoses, the rate is much higher (5-25%). 

In this case, being a patient with low economic resources and without social security, the diagnosis has been delayed, demonstrating the findings described above, associated with the complications that this represents: neural impingement, deformity, ankylosis, and vascular impingement.

Case contributed by Dr Tito Alfredo Atencia Rincón and Dra. Rocio Soledad Garcia

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