PMC7276577_01
Case 1, a34-year-old female with an exophytic growth (a) with progression of lesion after 10 months (b). Biopsy showing histopathological signs of bizarre parosteal osteochondromatous proliferation (c). Computed tomography axial section showing discontinuous outgrowth from fibula (d). Magnetic resonance imaging scans showing a focal mature osteocartilaginous mass on lateral surface of fibula showing heterogenicity (e and f).
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F1
A 34-year-old female was referred to our hospital after undergoing an excision of a distal lateral fibular swelling in another hospital which was reported to be an osteochondroma (Fig. 1a). The patient had a local recurrence with the mass recurring at the same site within 10 months of initial presentation(Fig. 1b). T1 with hyperintensity on the surface on T2 scans and a deep heterogeneous areas(Fig. 1e and f). The mass was rebiopsied at our hospital revealing proliferative and irregular osteocartilaginous interface with bizarre nuclei of the chondrocytes suggestive of BPOP (Fig. 1c).
Case 1 continued, intraoperative specimen of the lateral mass post-excision with hemicortical excision (a and b).
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F2
The final histopathological mass measured 3.1cmx2.2 cmx2 cm (Fig. 2a and b).
Case 1 continued, post-operative anteroposterior and lateral X-rays on (a) immediate post-operative day, (b) 1-year post-operative, and (c) 6-year post-operative.
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F3
No complications were seen postoperatively with the patient being recurrence and pain free at the last follow-up of 6 years (Fig. 3).
PMC7276577_02
Case 2, a 21-year-old male with (a) pre-operative X-ray showing an ossified nodule on the surface of the phalanx (arrow) and a separate ossified mass in the soft tissue. (b) Post-operative X-ray showing the excised cortex. (c) Excised specimen as seen from the surface. The bony cortex is on the far side and not visible in this picture. (d) Clinical photo at presentation. Note the swelling and scar of the previous surgery. (e) Intraoperative photograph showing the lesion on the phalanx.
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F4
On examination(Fig. 4d), a firm, immobile, non-tender discreet swelling was felt on the anterolateral aspect of proximal phalanx of the left little finger. X-rays showed two bony projections in the proximal phalanx of the left little finger (Fig. 4a). The patient was operated with wide excision of the involved cortex with no apparent corticomedullary continuity with the mass (Fig. 4b, Fig. 4c and e).
PMC7276577_03
Case 3, a31-year-old male with (a and b) pre-operative X-ray, the X-ray showed large calcific lesion arising from the upper end of tibia and likely from fibula. The calcification was chunky and irregular in nature and appeared to be a secondary sarcomatous change in a case of long existing osteochondroma and magnetic resonance imaging (c and d) suggested of an irregular osteochondromatous lesion extending toward the posterior neuromuscular bundle but not invading it. (e and f) Excised specimen consisting of tibia and fibula.
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F5
The X-ray showed large calcific lesion arising from the upper end of tibia and likely from fibula(Fig. 5a and b). The MRI suggested of an irregular osteochondromatous lesion extending toward the posterior neuromuscular bundle but not invading it (Fig. 5c and d). The tumor was lobulated with a cartilaginous cap and measured 10 cmx9cmx6 cm(Fig. 5e and f).
Case 3 continued, post-operative X-rays in anteroposterior and lateral view after wide excision and proximal tibia megaprosthesis replacement immediate post-operative (a and b) and a follow-up after 5 years (c and d).
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F6
No signs of recurrence were seen on a 7-year follow-up (Fig. 6.)
PMC7276577_04
Case 4, a 26-year-old male with X-rays showing a large osseous mass over the lateral end of the clavicle (a and b). Operative specimen of the excised lateral end of clavicle showing a lobulated osseous exophytic growth (c). The patient on a yearly follow-up showed no signs of recurrence and had good clinical function (d).
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F7
On X-ray (Fig. 7a and b), there was a large, irregular osseous mass arising from distal end of clavicle extending anteriorly, posteriorly, and inferiorly. The patient underwent a planned excision of lateral end of clavicle with wide margins(Fig. 7c). Postoperatively, no recurrence was seen with the patient having full function of the limb (Fig. 7d).
PMC7276577_05
Case 5, a36-year-old female who presented with a pre-operative X-ray showing a large osseous growth (a) arising from the 4th metatarsal and a clinical picture showing swelling and scars of the previous unsuccessful surgery (b). This patient refused surgery and was lost to follow up.
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F8
A 36-year-old female came with recurrent swelling of base of the 4th metatarsal for which she had undergone curettage at a local hospital (Fig. 8).