Presentation
A 18-year-old man presented with a lump, ulceration, and pain on his right big toe. This complaint was present for the past 2 years. Initially, lump and pain were present, and since the past 6 months ulceration and superadded infection occurred. [ncbi.nlm.nih.gov]
Entire Body System
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Soft Tissue Mass
The MRI depicted a small, sharp exostosis tip of the dorsal distal femur with a surrounding soft-tissue mass. After profuse bleeding occurred during biopsy of the soft tissue mass, angiography revealed a pseudoaneurysm of the right popliteal artery. [ncbi.nlm.nih.gov]
[…] may go on to form a fluid filled bursa; - bursal fluid may be mistaken for a soft tissue mass; - Diagnostic studies: - x-ray appearance of an exostosis is either flat, sessile lesion or a peduculated (stalk like) process; - peduncultaed osteochondromas [wheelessonline.com]
In addition, it also causes intrathoracic and extrathoracic soft tissue masses. [jotr.in]
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Collapse
A 72-year-old woman sustained a ureteric avulsion following circulatory collapse at home. Urosonographic imaging revealed hydronephrosis at the left kidney, and abdominal emergency computed tomography showed some fluid around it. [ncbi.nlm.nih.gov]
The thinned shell of bone collapses or is made to collapse using a thin elevator. The posterior canal skin is left intact over the thinned out shell of bone. [drtbalu.co.in]
We hypothesize that severe crushing force anteriorly and laterally caused collapse of the calcaneal body to the middle, also fracturing the inferior cortex and taking a large bony fragment plantarly which developed into large bony exostosis. [faoj.org]
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Intermittent Claudication
Here, we report the case of a 35-year-old male patient complaining of intermittent claudication over the previous 4 months, without history of trauma or hereditary multiple exostoses. Clinical examination found no popliteal or distal pulses. [ncbi.nlm.nih.gov]
Gastrointestinal
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Pelvic Mass
An 11-year-old, otherwise healthy, female was referred to our clinic for evaluation of a pelvic mass detected on a radiograph. [ncbi.nlm.nih.gov]
Skin
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Papule
An 18-year-old male presented with a protruding papule on the right great toenail. Diagnosis of subungual exostosis had been established and complete excision was performed. [ncbi.nlm.nih.gov]
A 1-cm firm, hyperkeratotic subungual papule on the right third toe. [mdedge.com]
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Hyperkeratosis
Among the dermoscopic features, vascular ectasia was the most common finding (70%), followed by hyperkeratosis (60%), onycholysis (40%), and ulceration (30%). [ncbi.nlm.nih.gov]
A shave biopsy was obtained of the visible portion of the lesion, which revealed hyperkeratosis, acanthosis, and a population of dermal spindle cells in a myxoid stroma that could not be definitively identified. Special stains were nondiagnostic. [mdedge.com]
Musculoskeletal
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Hip Pain
Ischiofemoral impingement is a rare cause of hip pain related to narrowing of the space between the ischial tuberosity and the lesser trochanter. It is usually seen in middle-aged women. [ncbi.nlm.nih.gov]
(OBQ07.18) A 50-year-old man with known Multiple Hereditary Exostoses complains of new onset right hip pain and an enlarging mass. Radiographs are shown in Figure A. [orthobullets.com]
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Ankylosis
Sydney, Australia. [email protected] Abstract Staged bilateral hip arthroplasties were carried out in two patients with osteoarthritis of the hip secondary to the development of hip dysplasia in Hereditary Multiple Exostosis (HME).Both patients had near ankylosis [ncbi.nlm.nih.gov]
Pemphigus Plasmoacanthoma Stomatitis Aphthous Denture-related Herpetic Smokeless tobacco keratosis Submucous fibrosis Ulceration Riga–Fede disease Verruca vulgaris Verruciform xanthoma White sponge nevus Teeth (pulp, dentin, enamel) Amelogenesis imperfecta Ankylosis [en.wikipedia.org]
Mandibular coronoid process osteochondromas can lead to formation of a pseudo joint and ankylosis. This causes limitation in mouth opening (14). Claudication pain can arise when osteochondromas cause compression of the popliteal artery (15). [jscimedcentral.com]
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Elbow Pain
An 11-year-old boy with known MHE presented 7 months after onset of left elbow pain and loss of flexion-extension to 40 to 120 . Radiographs showed a distal ulna osteochondroma, ulnar shortening, bowing, and radial head dislocation. [ncbi.nlm.nih.gov]
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Severe Osteoporosis
The patient had history of severe osteoporosis with multiple fractures and was on teriparatide for 16 months. On examination, the right thumb was swollen and tender with no superficial erythema or signs of an infection. [ncbi.nlm.nih.gov]
Neurologic
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Abnormal Gait
We present a case of malunited calcaneal fracture with a rare complication of an exostosis in the middle 3rd of the plantar surface of calcaneus which clinically produced a large bony swelling on the sole of the foot causing pain and abnormal gait .This [faoj.org]
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Neurologic Manifestation
Neurological manifestations, imaging characteristics, and surgical outcome of intraspinal osteochondroma. J Neurosurg Spine. 2010 May. 12 (5):474-89. [Medline]. Levine AM, Crandall DG. [medscape.com]
Workup
Radiography of the digit is a noninvasive test that should be part of the initial workup whenever subungual exostosis is in the differential diagnosis. [ncbi.nlm.nih.gov]
Microbiology
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Human Papillomavirus
In 50% of cases, aetiology is unknown or indeterminate; in 22.3% of cases, aetiology is metastatic; and in 19.5% of cases, it is associated with human papillomavirus (HPV). [ncbi.nlm.nih.gov]
Prognosis
Cartilaginous Exostosis Prognosis This disease does not carry a deadly prognosis. However, the onset of cartilaginous exostosis can lead to serious health complications for the patient. [knowcancer.com]
What is the Prognosis of Subungual Exostosis? (Outcomes/Resolutions) With appropriate treatment, the prognosis of Subungual Exostosis is typically excellent, since the tumors are benign in nature The risk of recurrence is related to surgery. [dovemed.com]
The prognosis is good and depends on the degree of soft-tissue damage. 2018 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA) [merckvetmanual.com]
The prognosis is very good if surgically excised, and as with all growths or masses, a biopsy should be obtained to rule out a more serious condition. [lifootcare.com]
- the cartilaginous cap should not be traumatized during its removal; - prognosis for a solitary exostosis is excellent ( 5% recurrence following marginal excision) Pseudoaneurysm of the popliteal artery with an unusual arteriographic presentation. [wheelessonline.com]
Etiology
Hereditary/surgery Gait Disorders, Neurologic/etiology Humans Magnetic Resonance Angiography Male Peroneal Neuropathies/diagnosis Peroneal Neuropathies/etiology* Popliteal Artery*/diagnostic imaging Popliteal Artery*/surgery Tomography, X-Ray Computed [ncbi.nlm.nih.gov]
Etiology Although heredity is an acknowledged etiologic factor in exostosis, only four of the patients gave or admitted a positive history of this condition in the family. Twelve gave a history of arthritis; other incidental diseases were rare. [pubs.rsna.org]
Epidemiology
Epidemiological aspects of oral tori in a Ghanaian community. Int Dent J 2004; 54: 78–82. [nature.com]
Clinical and retrospective epidemiological surveys have revealed a strong positive correlation between EAE development and habitual exposure to cold water. [ncbi.nlm.nih.gov]
Epidemiology Affects 2 per 100,000 population. [ 2 ] More frequently found in Caucasians than in other races. Risk factors Inheritance is autosomal dominant, with near-complete penetrance. [patient.info]
Tavares G, Di-Chiacchio N, Di-Santis E, Alvarenga L, Stuhr P, de-Farias D, Tosti A, Di-Chiacchio NG: Onychomatricoma: epidemiological and clinical findings in a large series of 30 cases. Br J Dermatol 2015;173:1305-1307. [karger.com]
Design Cross-sectional epidemiological study. Setting General community. Patients Three hundred seven avid surfers (93.5% males and 6.5% females; age distributions: 11.2% were 20, 67.9% were 21 to 40, 17.5% were 41 to 50, and 3.3% were 50 years). [jamanetwork.com]
Pathophysiology
The pathophysiology is not clearly understood, but the lesion has base of trabecular bone with a proliferating fibrocartilaginous cap. Teriparatide can stimulate the trabecular bone formation. [ncbi.nlm.nih.gov]
Etiology and pathophysiology The pathogenesis of subungual exostosis is unknown, but current theories include trauma, infection, tumor, hereditary abnormality, or activation of a cartilaginous cyst. [clinicaladvisor.com]
Symptoms are more likely to be severe if the mutation is on the ext1 gene rather than ext2 or ext3; ext1 is also the most commonly affected gene in patients of this disorder.[14] Pathophysiology[edit] It is characterized by the growth of cartilage-capped [en.wikipedia.org]
Whether the neoplasm is sessile or pedunculated, the medullary canal of the stalk and the bone are in continuity by definition. [5] Pathophysiology Osteochondroma is a hamartoma, and patients most commonly present in the second decade of life. [emedicine.medscape.com]
Prevention
Surgical resection should be considered as a preventive measure when exostoses form sharp tips close to neurovascular structures regardless of total osteochondroma size. [ncbi.nlm.nih.gov]