International Journal of Advanced and Integrated Medical Sciences

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Pedunculated Osteochondroma arising from the MedialAspect of Proximal Femur: A Rare Presentation
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CASE REPORT
Pedunculated Osteochondroma arising from the MedialAspect of Proximal Femur: A Rare Presentation
1Fahad B Hamid, 2Gaurav Singh, 3T Somashekarappa, 4RP Jauhari, 5Somdutt Singh, 6Deepanshu Agarwal
1Assistant Professor, 2Junior Resident III, 3Professor, 4,5SeniorResident, 6Junior Resident
1-6Department of Orthopedics, Rohilkhand Medical College &Hospital, Bareilly, Uttar Pradesh, India
Corresponding Author:
Deepanshu Agarwal, Junior ResidentDepartment of Orthopedics, Rohilkhand Medical College &Hospital, Bareilly, Uttar Pradesh, India,
e-mail: deepanshu981992@yahoo.com
10.5005/jp-journals-10050-10073
 
ABSTRACT
Osteochondroma is a benign bony tumor arising as a bony outgrowthcovered by a cartilage cap and occurs most commonly inthe metaphysis of long bones (proximal tibia, distal femur, proximalhumerus) and pelvis. Osteochondroma grows eccentricallyinstead of centrifugally. This article reports a case of a 24-yearoldfemale, who presented with a painless bony hard irregularswelling over medial aspect of right groin. There was no distalneurovascular deficit. Site, nature, and extent of the lesion wereassessed by radiographs and magnetic resonance imaging. Tumorwas completely excised and on histopathology, osteochondromaconfirmed. No weight bearing was allowed for 1 week. Patientreturned to her normal routine activities in 1 month. On regularfollow-up, no evidence of recurrence of the lesion was seen.
Keywords: Benign, Metaphysis, Osteochondroma.
How to cite this article: Hamid FB, Singh G, Somashekarappa T,Jauhari RP, Singh S, Agarwal D. Pedunculated Osteochondromaarising from the Medial Aspect of Proximal Femur: A RarePresentation. Int J Adv Integ Med Sci 2017;2(1):44-46.
Source of Support: Nil
Conflicts of Interest: None
 
 

INTRODUCTION

Osteochondroma is a benign bony tumor arising as abony outgrowth covered by a cartilage cap and occursmost commonly in the metaphysis of long bones (proximaltibia, distal femur, proximal humerus) and pelvis.1Mostly, they are asymptomatic, but because of the bonypalpable mass, it can cause pain due to bursitis, compressionon an overlying structure, or fracture through thestalk. The effects of solitary exostoses of the proximalfemur have been described in cases involving sciaticnerve compression2 and trochanteric bursitis,3 leadingto surgical excision or local treatment.

CASE REPORT

A 24-year-old female presented to us with complaintsof swelling in medial aspect of right groin for a periodof around 3 years. Patient noted swelling, which was ofinsidious onset and gradually increased in size over aperiod of 3 years. She had a history of on-and-off painwhile doing her daily activities due to the mass effectof the tumor. There was no history of trauma or fever.Skeletal survey showed no other evidence of similarlesion in the patient. On examination, patient had noevidence of any systemic illness. Local examinationrevealed a diffuse, ill-defined, bony hard, globularswelling of about 5 × 3 cm found projecting into theright medial aspect of upper thigh near lesser trochanterbeneath a thick cover of muscles. Surface was irregular,hard in consistency with ill-defined borders. Skinover the swelling was normal. There was no localizedlymphadenopathy and distal neurovascular deficit. Therewas no evidence of any laboratory abnormalities. Plainradiographs were performed to confirm the site andorigin of tumor as shown in Figures 1 and 2. Thereafter,magnetic resonance imaging was done to exactly assessthe extent and nature of tumor and soft tissue extension,if any. Once the tumor was confirmed to be of benignnature, complete excision of tumor via medial approachwas performed (Figs 3 and 4). Postoperative radiographswere done and showed complete excision (Fig. 5). Thepatient was kept partial weight bearing for a period of1 week. At the end of 4 weeks, the patient had returned toher daily routine activities. The patient was followed upat monthly interval. At the end of follow-up of 6 months,patient is completely asymptomatic and the radiographsshowed no evidence of local recurrence.

 
Pedunculated Osteochondroma arising from the Medial Aspect of Proximal Femur: A Rare Presentation
Fig. 1: Preoperative X-ray of pelvis with bilateral hip-anteroposteriorview with large cauliflower-like growth arising from right medial aspectof proximal femur

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Pedunculated Osteochondroma arising from the Medial Aspect of Proximal Femur

Pedunculated Osteochondroma arising from the Medial Aspect of Proximal Femur: A Rare Presentation
Fig. 2: Preoperative X-ray of right hip with upper thigh - lateral view

Pedunculated Osteochondroma arising from the Medial Aspect of Proximal Femur: A Rare Presentation
Fig. 5: Postoperative X-ray of bilateral hip with upper thigh -anteroposterior view

DISCUSSION

Patients with osteochondroma usually present due tocosmetic reason or due to bursitis, vascular involvement,nerve compression, or fracture of the stalk; the symptomaticnature is usually due to the location and size ofthe tumor.4 Resection of the tumor is indicated in symptomaticlesion causing damage to the joints, surroundingsoft tissue irritation and inflammation, neurovascularcompression, lesion having characteristics of malignantchange, and the lesions which are prone to minortrauma.5-9 If radiograph and imaging technique show aslight evidence of malignant transformation, then earlysurgery is indicated, as it has got high risk of malignanttransformation.10,11 Medial approach, posterior approach,and extensive approach of Tschokanow (osteochondromaof femoral neck) have already been described to assessthe lesion.12,13 Humber et al14 reported recurrence of solitaryosteochondroma in two patients out of 114 patients,and suggested that cartilage cap incomplete removalis responsible for recurrence, while early surgery at anyoung age is an additional prognostic factor. Mostly allstudies concluded that mainstay of treatment of symptomaticosteochondroma is surgery, and complete resectionis needed for the lesion.

 
Pedunculated Osteochondroma arising from the Medial Aspect of Proximal Femur: A Rare Presentation
Fig. 3: Intraoperative photograph with large cauliflower-likegrowth arising from right medial aspect of proximal femur

Pedunculated Osteochondroma arising from the Medial Aspect of Proximal Femur: A Rare Presentation
Fig. 4: Excised mass

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Fahad B Hamid et al

CONCLUSION

Solitary osteochondroma can be effectively treated withcomplete excision. Local recurrence is rare, if excised verycarefully and precisely. High-risk patients should be followedup on regular basis with routine X-rays, imagingtechnique, and investigation to detect an early malignantchange and appropriate management needed, resultingin reduction in the mortality and morbidity.

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