Osteochondroma - tibia

Case contributed by Rob Foley
Diagnosis almost certain

Presentation

1.5 cm x 3 cm hard lump on medio-proximal end of tibia, non-mobile, has been there in the last 6 months at least

Patient Data

Age: 11 years
Gender: Female

Medial proximal tibia

ultrasound

The clinically palpated lump correlates to a bony overgrowth from the medial proximal tibia with a cartilage cap measuring 4 mm in maximal thickness. This is in keeping with an osteochondroma.

Left knee joint

x-ray

Bony exostosis arising from the medial aspect of the proximal tibial metaphysis in keeping with an osteochondroma. 

Case Discussion

It is essential to measure the thickness of the cartilaginous cap in cases of osteochondroma. This can be performed with ultrasound or MRI. A thickness of >1.5 cm is a worrying feature for malignancy (low-grade chondrosarcoma). Other features suspicious for malignant degeneration can be remembered with the mnemonic GLAD PAST

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