The role of histopathology in the diagnosis of osteochondroma: our experience with eighty-five cases
Öz
Aim: Osteochondromas are the most common, benign, primary bone tumors with a medullary cavity, covered with hyaline cartilage arising from the juxtaepiphyseal region of the bone. Although they are often asymptomatic, they are operated on due to cosmetic unhappiness, symptoms of pressure on adjacent tissues, pain, and rarely malignant transformation. In this study, we aimed to retrospectively evaluate our cases diagnosed with osteochondroma, which presented with different localization and clinical findings, along with conventional cases, and present them in the light of the current literature.
Materials and methods: Hematoxylin-eosin and immunohistochemical stained preparations, if any, of the materials belonging to 88 patients diagnosed with osteochondroma between January 2010 and December 2023 in pathology department of faculty of medicine alwere evaluated. Age, gender, recurrence status, radiological findings and clinical results of the cases were obtained from hospital records. The localization and histopathological features of the tumor were evaluated retrospectively.
Results: Of the 88 cases, 50 (56.8%) were male and 38 (43.2%) were female, the ages ranged between 3 and 58, the average age was 22.83 and the median age was 20. It was determined that the cases most frequently applied to the clinic with the complaint of pain (n: 55, 62.5%). The tumors were most frequently localized in the distal femur (n: 33, 37.5%), and around the knee in most cases (47 cases, 53.4%). In 10 cases with multiple masses, the most common location was the distal femur (n:3, 33.3%), followed by the humerus and proximal tibia (n:2, 20%), followed by the proximal femur, fibula and foot phalanx (n:1, 10%) were watching. It was noted that grade II chondrosarcoma developed based on osteochondroma in only 1 case (1.1%). No malignant transformation or recurrence was observed in the other cases.
Conclusions: Osteochondroma is a primary benign tumor of the bone that is more common in males and is most commonly located in the distal femur. The most frequent admission to the clinic is with the complaint of pain, and preferred treatment method is surgical resection. Recurrence of osteochondroma is rarely observed. Although most osteochondromas are seen in long bones, they may present with different atypical localization and clinical findings. Most cases are solitary but multiple forms are seen. It should be kept in mind that, although rare, malignant transformation may develop based on osteochondroma.
Anahtar Kelimeler
Etik Beyan
This retrospective study was approved by the ethics committee of our institution with date and number 27/12/2023/20.478.486/2172.
Destekleyen Kurum
none
Teşekkür
none
Kaynakça
- 1. Er, M.S., H. Atmaca, and L. ALTINEL, 2014. Radius başında osteokondrom. Abant Tıp Dergisi, 3(1), 81-83.
- 2. Tepelenis, K., et al., 2021. Osteochondromas: An updated review of epidemiology, pathogenesis, clinical presentation, radiological features and treatment options. in vivo, 35(2), 681-691.
- 3. Yang, C., et al., 2019. Insights into the molecular regulatory network of pathomechanisms in osteochondroma. Journal of Cellular Biochemistry, 120(10), 16362-16369.
- 4. Mundy C, et al., 2022. Osteochondroma formation is independent of hepa ranase expression as revealed in a mouse model of hereditary multiple exostoses. J Orthop Res: (Epub ahead of print).
- 5. Tepelenis K, et al,. 2021. Osteochondromas: An updated review of epidemiology, pathogenesis, clinical presen tation, radiological features and treatment options. In Vivo 35: 681 691.
- 6. Bukowska Olech E, et al., 2021. Hereditary multiple exostoses a review of the molecular back ground, diagnostics, and potential therapeutic strategies. Front Genet 12: 759129.
- 7. Inubushi T, et al., 2018. Palovarotene inhibits osteochondroma formation in a mouse model of multiple hereditary exostoses. J Bone Miner Res 33: 658 666.
- 8. Ishimaru D, et al,. 2016. Large scale mutational analysis in the EXT1 and EXT2 genes for Japanese patients with multiple osteochon dromas. BMC Genet 17: 52.
- 9. Weinschenk, R.C., W.-L. Wang, and V.O. Lewis, 2021. Chondrosarcoma. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 29(13), 553-562.
- 10. Dahlin, D.C., Charles C, 1996. Bone Tumors. General Aspect and Data on 11087 Cases. 451-463p. 11. Garcia, R.A., C.Y. Inwards, and K.K. Unni, 2011.Benign bone tumors—recent developments. in Seminars in diagnostic pathology. Elsevier.73-85p.
- 12. Lotfinia, I., et al., 2010. Neurological manifestations, imaging characteristics, and surgical outcome of intraspinal osteochondroma. Journal of Neurosurgery: Spine, 12(5), 474-489.
- 13. Garcia SA, et al., 2020. Understanding the Effect of RARγ Agonists on Human Osteochondroma Explants. Int J. Mol Sci. 21 (8).
- 14. Inubushi T, et al., 2018. Prevents Osteochondroma Formation in a Multiple Hereditary Exostoses Fee Model. J Bone Miner Res. 33 (4):658-666.
- 15. Bovée, J.V., 2008. Multiple osteochondromas. Orphanet journal of rare diseases, 3, 1-7.
- 16. Alabdullrahman LW, Mabrouk A, and Byerly DW. 2024. Osteochondroma. ls (Internet). Treasure Island (FL): StatPearls Publishing; PMID: 31335016.
- 17. Nazeri E, et al., 2023. Chondrosarcoma: an overview of behavior, treatment mechanism, clinical drug therapy, and potential therapeutic targets. Crit Rev Oncol Hematol. Nov; 131 :102-109.
- 18. Sarrion P, et al. 2013. Mutations in the EXT1 and EXT2 genes in Spanish patients with multiple osteochondromas. Scientic Reports 3:1346.
- 19. Limaiem F, Davis DD, and Sticco KL. 2023. Chondrosarcoma. Treasure Island (FL): PMID: 30844159.
- 20. Mehta, M., et al., 1998. MR imaging of symptomatic osteochondromas with pathological correlation. Skeletal radiology, 27, 427-433.
- 21. Hill, C.E., L. Boyce, and I.D. van der Ploeg, 2014. Spontaneous resolution of a solitary osteochondroma of the distal femur: a case report and review of the literature. Journal of Pediatric Orthopaedics B, 23(1), 73-75.
- 22. Chatzidakis, E., et al., 2007. A rare case of solitary osteochondroma of the dens of the C2 vertebra. Acta neurochirurgica, 149, 637-638.
- 23. Govender, S. and A. Parbhoo, 1999. Osteochondroma with compression of the spinal cord: a report of two cases. The Journal of Bone & Joint Surgery British Volume, 81(4), 667-669.
- 24. Tong, K., et al., 2017. Osteochondroma: Review of 431 patients from one medical institution in South China. Journal of bone oncology, 8,. 23-29.
- 25. Shapiro, F., S. SIMoN, and M.J. Glimcher, 1979. Hereditary multiple exostoses. Anthropometric, roentgenographic, and clinical aspects. JBJS, 61(6), 815-824.
- 26. Kitsoulis, P., et al., 2008. Osteochondromas: review of the clinical, radiological and pathological features. In vivo, 22(5), 633-646.
- 27. Souza, A.M.G.d. and R.Z. Bispo Júnior, 2014. Osteochondroma: ignore or investigate? Revista brasileira de ortopedia, 49, 555-564.
- 28. Bailescu, I., et al., 2022. Diagnosis and evolution of the benign tumor osteochondroma. Experimental and Therapeutic Medicine, 23(1), 1-6.
- 29. Genç B, et al., 2014. Distal tibial osteochondroma causing fibular deformity and deep peroneal nerve entrapment neuropathy: a case report. Acta Orthop Traumatol Turc. 48(4):463-6. doi: 10.3944/AOTT.2014.2741. PMID: 25230273
- 30. Güney B, Doğan E, and Özdemir MY. 2021. Osteochondroma as a Cause of Ischiofemoral Impingement - First Case Series. Acta Med Litu. 2021;28(1):189-194. doi: 10.15388/Amed. PMC8311847.
- 31. Douis, H. and A. Saifuddin, 2012. The imaging of cartilaginous bone tumours. I. Benign lesions. Skeletal radiology, 41, 1195-1212.
- 32. Roach, J.W., J.W. Klatt, and N.D. Faulkner, 2009. Involvement of the spine in patients with multiple hereditary exostoses. JBJS, 91(8), 1942-1948.
- 33. Murphey, M.D., et al., 2000. Imaging of osteochondroma: variants and complications with radiologic-pathologic correlation. Radiographics, 20(5), 1407-1434.
- 34. Unni, K.K. and C.Y. Inwards, 2010. Dahlin's bone tumors: general aspects and data on 10,165 cases. Lippincott Williams & Wilkins.
- 35. Alabdullrahman LW, Mabrouk A, and Byerly DW. 2024. Osteochondroma. ls (Internet). Treasure Island (FL): StatPearls Publishing; PMID: 31335016.
- 36. Wittesaele, W., L. Vanbecelaere, and M. Mombert, 2021. Excision of a bizarre parosteal osteochondromatous proliferation (“Nora lesion”) in the hand: A case report. Int J Case Rep Orthop, 3(1), 1-3.
- 37. Yildirim, C., et al., 2010. Giant solitary osteochondroma arising from the fifth metatarsal bone: a case report. J Foot Ankle Surg, 49(3), 298.e9-298.e15.
- 38. Rajappa, S., M.M. Kumar, and S. Shanmugapriya, 2013. Recurrent solitary osteochondroma of the metacarpal: a case report. Journal of Orthopaedic Surgery, 21(1), 129-131.
- 39. RC, M., 1971. Cartilaginous tumors of the ribs. Cancer, 27, 794-801.
- 40. Park, Y.-K., et al., 1995. Dedifferentiated chondrosarcoma arising in an osteochondroma. Skeletal radiology, 24, 617-619.
- 41. Bovée, J., et al., 2002. Intermediate grade osteosarcoma and chondrosarcoma arising in an osteochondroma. A case report of a patient with hereditary multiple exostoses. Journal of clinical pathology, 55(3), 226-229.
- 42. Lamovec, J., M. Špiler, and V. Jevtić, 1999. Osteosarcoma arising in a solitary osteochondroma of the fibula. Archives of Pathology and Laboratory Medicine, 123(9), 832-834.
- 43. Hudson, T.M., F.S. Chew, and B.J. Manaster, 1983. Scintigraphy of benign exostoses and exostotic chondrosarcomas. AJR Am J Roentgenol, 140(3), 581-6.
- 44. Horvai, A. and K.K. Unni, 2006. Premalignant conditions of bone. J Orthop Sci, 11(4), 412-23.
- 45. Ahmed, A.R., et al., 2003. Secondary chondrosarcoma in osteochondroma: report of 107 patients. Clin Orthop Relat Res, (411), 193-206.
- 46. Kullukçu Albayrak H, et al., 2021. Solitary thoracic osteochondroma causing spinal compression: Case report. Acta Orthop Traumatol Turc. Jan;55(1):76-79. PMID: 33650517; PMCID: PMC7932743.
Öz
Amaç: Osteokondrom, kemiğin jukstaepifizer bölgesinden ortaya çıkan hyalin kıkırdak ile kaplı, kendi medüller boşluğu bulunan, iyi huylu, en sık primer kemik tümörüdür. Sıklıkla asemptomatik olmakla birlikte kozmetik mutsuzluk, komşu dokulara bası semptomları, ağrı ve nadiren malign transformasyon nedeni ile opere edilirler. Bu çalışmada konvansiyonel olgular ile birlikte farklı yerleşim ve klinik bulgular ile prezente olan osteokondrom tanılı olgularımızın retrospektif olarak değerlendirip, güncel literatür ışığında sunmayı amaçladık.
Materyal ve metod: Tıp fakültesi Patoloji anabilim dalında Ocak 2010-Aralık 2023 yılları arasında osteokondrom tanılı 88 hastaya ait hematoksilen&eozin ve varsa immünhistokimyasal boyalı preparatlar retrospektif olarak değerlendirildi. Olguların yaş, cinsiyet, nüks durumları, klinik sonuçları hastane kayıtlarından elde edildi. Tümörün lokalizasyonu, radyolojik görüntüleme bulguları ve histopatolojik özellikleri retrospektif olarak değerlendirildi.
Bulgular: Seksen sekiz olgunun, 50’si (%56,8) erkek, 38’i (%43,2) kadın olup olguların yaşlarının 3 ile 58 arasında değiştiği ve ortalama yaşın 22,83, ortanca yaşın ise 20 olduğu saptandı. Olguların en sık ağrı yakınması(n:55, %62,5) ile kliniğe başvurduğu tespit edildi. Tümörlerin en sık yerleşim yeri distal femur (n:33, %37,5) olup olguların büyük çoğunluğunda (47 olgu, %53,4) lezyon diz çevresinde lokalize idi. Multiple kitlesi olan 10 olguda en sık yerleşim yeri distal femur (n:3, %33,3) iken, onu humerus ve proksimal tibia (n:2, %20), proksimal femur, fibula ve ayak falanksı yerleşimi (n:1, %10) izlemekteydi. Yalnızca 1 olguda (%1,1) osteokondrom zemininde grade II kondrosarkomun geliştiği dikkati çekti. Diğer olgularda malign transformasyon veya nüks gözlenmedi.
Sonuç: Osteokondrom erkek cinsiyette daha sık görülen, en sık distal femurda yerleşen kemiğin primer benign tümörüdür. Kliniğe en sık ağrı yakınmasıyla başvuran olgularda tedavi seçeneği cerrahidir. Lezyonlarda nadiren nüks görülmektedir. Osteokondromların çoğunluğu uzun kemiklerde görülmekle birlikte farklı, atipik lokalizasyon ve klinik bulgular ile karşımıza çıkabilirler. Olguların çoğu soliter olup multipl formlar da görülebilmektedir. Nadir de olsa osteokondrom zemininde malign transformasyon gelişebileceği akılda tutulmalıdır.
Anahtar Kelimeler
Etik Beyan
Bu retrospektif çalışma kurumumuzun etik kurulu tarafından 27/12/2023/20.478.486/2172 tarih ve numarasıyla onaylandı.
Destekleyen Kurum
yok
Teşekkür
yok
Kaynakça
- 1. Er, M.S., H. Atmaca, and L. ALTINEL, 2014. Radius başında osteokondrom. Abant Tıp Dergisi, 3(1), 81-83.
- 2. Tepelenis, K., et al., 2021. Osteochondromas: An updated review of epidemiology, pathogenesis, clinical presentation, radiological features and treatment options. in vivo, 35(2), 681-691.
- 3. Yang, C., et al., 2019. Insights into the molecular regulatory network of pathomechanisms in osteochondroma. Journal of Cellular Biochemistry, 120(10), 16362-16369.
- 4. Mundy C, et al., 2022. Osteochondroma formation is independent of hepa ranase expression as revealed in a mouse model of hereditary multiple exostoses. J Orthop Res: (Epub ahead of print).
- 5. Tepelenis K, et al,. 2021. Osteochondromas: An updated review of epidemiology, pathogenesis, clinical presen tation, radiological features and treatment options. In Vivo 35: 681 691.
- 6. Bukowska Olech E, et al., 2021. Hereditary multiple exostoses a review of the molecular back ground, diagnostics, and potential therapeutic strategies. Front Genet 12: 759129.
- 7. Inubushi T, et al., 2018. Palovarotene inhibits osteochondroma formation in a mouse model of multiple hereditary exostoses. J Bone Miner Res 33: 658 666.
- 8. Ishimaru D, et al,. 2016. Large scale mutational analysis in the EXT1 and EXT2 genes for Japanese patients with multiple osteochon dromas. BMC Genet 17: 52.
- 9. Weinschenk, R.C., W.-L. Wang, and V.O. Lewis, 2021. Chondrosarcoma. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 29(13), 553-562.
- 10. Dahlin, D.C., Charles C, 1996. Bone Tumors. General Aspect and Data on 11087 Cases. 451-463p. 11. Garcia, R.A., C.Y. Inwards, and K.K. Unni, 2011.Benign bone tumors—recent developments. in Seminars in diagnostic pathology. Elsevier.73-85p.
- 12. Lotfinia, I., et al., 2010. Neurological manifestations, imaging characteristics, and surgical outcome of intraspinal osteochondroma. Journal of Neurosurgery: Spine, 12(5), 474-489.
- 13. Garcia SA, et al., 2020. Understanding the Effect of RARγ Agonists on Human Osteochondroma Explants. Int J. Mol Sci. 21 (8).
- 14. Inubushi T, et al., 2018. Prevents Osteochondroma Formation in a Multiple Hereditary Exostoses Fee Model. J Bone Miner Res. 33 (4):658-666.
- 15. Bovée, J.V., 2008. Multiple osteochondromas. Orphanet journal of rare diseases, 3, 1-7.
- 16. Alabdullrahman LW, Mabrouk A, and Byerly DW. 2024. Osteochondroma. ls (Internet). Treasure Island (FL): StatPearls Publishing; PMID: 31335016.
- 17. Nazeri E, et al., 2023. Chondrosarcoma: an overview of behavior, treatment mechanism, clinical drug therapy, and potential therapeutic targets. Crit Rev Oncol Hematol. Nov; 131 :102-109.
- 18. Sarrion P, et al. 2013. Mutations in the EXT1 and EXT2 genes in Spanish patients with multiple osteochondromas. Scientic Reports 3:1346.
- 19. Limaiem F, Davis DD, and Sticco KL. 2023. Chondrosarcoma. Treasure Island (FL): PMID: 30844159.
- 20. Mehta, M., et al., 1998. MR imaging of symptomatic osteochondromas with pathological correlation. Skeletal radiology, 27, 427-433.
- 21. Hill, C.E., L. Boyce, and I.D. van der Ploeg, 2014. Spontaneous resolution of a solitary osteochondroma of the distal femur: a case report and review of the literature. Journal of Pediatric Orthopaedics B, 23(1), 73-75.
- 22. Chatzidakis, E., et al., 2007. A rare case of solitary osteochondroma of the dens of the C2 vertebra. Acta neurochirurgica, 149, 637-638.
- 23. Govender, S. and A. Parbhoo, 1999. Osteochondroma with compression of the spinal cord: a report of two cases. The Journal of Bone & Joint Surgery British Volume, 81(4), 667-669.
- 24. Tong, K., et al., 2017. Osteochondroma: Review of 431 patients from one medical institution in South China. Journal of bone oncology, 8,. 23-29.
- 25. Shapiro, F., S. SIMoN, and M.J. Glimcher, 1979. Hereditary multiple exostoses. Anthropometric, roentgenographic, and clinical aspects. JBJS, 61(6), 815-824.
- 26. Kitsoulis, P., et al., 2008. Osteochondromas: review of the clinical, radiological and pathological features. In vivo, 22(5), 633-646.
- 27. Souza, A.M.G.d. and R.Z. Bispo Júnior, 2014. Osteochondroma: ignore or investigate? Revista brasileira de ortopedia, 49, 555-564.
- 28. Bailescu, I., et al., 2022. Diagnosis and evolution of the benign tumor osteochondroma. Experimental and Therapeutic Medicine, 23(1), 1-6.
- 29. Genç B, et al., 2014. Distal tibial osteochondroma causing fibular deformity and deep peroneal nerve entrapment neuropathy: a case report. Acta Orthop Traumatol Turc. 48(4):463-6. doi: 10.3944/AOTT.2014.2741. PMID: 25230273
- 30. Güney B, Doğan E, and Özdemir MY. 2021. Osteochondroma as a Cause of Ischiofemoral Impingement - First Case Series. Acta Med Litu. 2021;28(1):189-194. doi: 10.15388/Amed. PMC8311847.
- 31. Douis, H. and A. Saifuddin, 2012. The imaging of cartilaginous bone tumours. I. Benign lesions. Skeletal radiology, 41, 1195-1212.
- 32. Roach, J.W., J.W. Klatt, and N.D. Faulkner, 2009. Involvement of the spine in patients with multiple hereditary exostoses. JBJS, 91(8), 1942-1948.
- 33. Murphey, M.D., et al., 2000. Imaging of osteochondroma: variants and complications with radiologic-pathologic correlation. Radiographics, 20(5), 1407-1434.
- 34. Unni, K.K. and C.Y. Inwards, 2010. Dahlin's bone tumors: general aspects and data on 10,165 cases. Lippincott Williams & Wilkins.
- 35. Alabdullrahman LW, Mabrouk A, and Byerly DW. 2024. Osteochondroma. ls (Internet). Treasure Island (FL): StatPearls Publishing; PMID: 31335016.
- 36. Wittesaele, W., L. Vanbecelaere, and M. Mombert, 2021. Excision of a bizarre parosteal osteochondromatous proliferation (“Nora lesion”) in the hand: A case report. Int J Case Rep Orthop, 3(1), 1-3.
- 37. Yildirim, C., et al., 2010. Giant solitary osteochondroma arising from the fifth metatarsal bone: a case report. J Foot Ankle Surg, 49(3), 298.e9-298.e15.
- 38. Rajappa, S., M.M. Kumar, and S. Shanmugapriya, 2013. Recurrent solitary osteochondroma of the metacarpal: a case report. Journal of Orthopaedic Surgery, 21(1), 129-131.
- 39. RC, M., 1971. Cartilaginous tumors of the ribs. Cancer, 27, 794-801.
- 40. Park, Y.-K., et al., 1995. Dedifferentiated chondrosarcoma arising in an osteochondroma. Skeletal radiology, 24, 617-619.
- 41. Bovée, J., et al., 2002. Intermediate grade osteosarcoma and chondrosarcoma arising in an osteochondroma. A case report of a patient with hereditary multiple exostoses. Journal of clinical pathology, 55(3), 226-229.
- 42. Lamovec, J., M. Špiler, and V. Jevtić, 1999. Osteosarcoma arising in a solitary osteochondroma of the fibula. Archives of Pathology and Laboratory Medicine, 123(9), 832-834.
- 43. Hudson, T.M., F.S. Chew, and B.J. Manaster, 1983. Scintigraphy of benign exostoses and exostotic chondrosarcomas. AJR Am J Roentgenol, 140(3), 581-6.
- 44. Horvai, A. and K.K. Unni, 2006. Premalignant conditions of bone. J Orthop Sci, 11(4), 412-23.
- 45. Ahmed, A.R., et al., 2003. Secondary chondrosarcoma in osteochondroma: report of 107 patients. Clin Orthop Relat Res, (411), 193-206.
- 46. Kullukçu Albayrak H, et al., 2021. Solitary thoracic osteochondroma causing spinal compression: Case report. Acta Orthop Traumatol Turc. Jan;55(1):76-79. PMID: 33650517; PMCID: PMC7932743.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Patoloji |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 25 Nisan 2025 |
| Gönderilme Tarihi | 9 Mayıs 2024 |
| Kabul Tarihi | 4 Kasım 2024 |
| Yayımlandığı Sayı | Yıl 2025 Cilt: 16 Sayı: 1 |
