Osteochondroma

Victor Febriant
(07120120116)
Pembimbing:
dr. Ratna Sutanto, SpRad

Foreword
Bone tumor is a neoplastic disorder
in the musculoskeletal system
Classified as benign or malignant
Osteochondroma is a benign tumor
that develops during the childhood
and teenage years.
Growth plate of a long bone in
children is a common site for
osteochondroma formation.

Anatomy
The Bone is differentiated into three
categories, long, short, and flat.
Histologically it is known as
immature (non-lamellar, woven,
fiber) and mature (cortical,
trabecular) bone

Function
Function of the bone is to
Form the skeleton of the body
As a place for muscles to attach
To protect and position vital organs
As a deposit of calcium, phosphor,
magnesium, and sodium
To function as a network of hemopoesis
in order to produce blood cells

Bone Growth
Lengthening growth
Endochondral ossification of the
cartilage
Takes place in the articular and
epiphyseal cartilage
The epiphyseal plate is composed of three
zones
Growth zone (Germinal, proliferation, palisade)
Transformation zone (Hypertrophy, calcification,
degeneration)
Ossification zone (Vascular entry, osteogenesis)

Bone Growth

Bone Growth
Widening growth
Caused by osteoblast aposition on the
inner layer of periosteum, and is an
intramembranous ossification process

Remodelling growth
Takes place during lengthening growth

Definition
Osteochondroma comes from the
word osteon meaning bone, and
chondroma meaning a benign tumor.
Osteochondroma can be defined as a
benign tumor on the bone composed
of a protrusion of mature bone
layered with cartilage that protrudes
from the lateral contour of the bone.

Epidemiology

Epidemiology
Commonly found in teenagers or
children, rarely on babies or
neonates
Hereditary Multiple Osteochondroma
is more common in men than
women, and more common in
Caucasians.

Etiology
The etiology is unknown. Based on
the closure of the cartilage against
the growth plate, a few hypothesis
has been proposed. This may be
caused by damage, rotation, and
abrasion of the growth plate or
herniation of the plate on the
metaphysis.

Pathophysiology
Osteochondroma is considered as a
growth disorder or a lesion
development produced by the
separation of a fragment from the
epiphyseal growth plate. The
fragment then herniated through the
periosteal bone manset and usually
forms around the growth plate.
Herniation may be caused by trauma
or deficiency of the perichondrial

Location
Lower extremity (50% of all cases)
Femur (mainly distal): 30%
Tibia (mainly proximal): 15-20%
Uncommon places: Cruris, Hip

Upper extremity
Humerus 10-20%
Uncommon places: Hand, Scapula

Posterior of the vertebrae

Classification
Solitary Osteochondroma
Most common benign bone tumor.
Found at the end of long bones that
forms a joint (knee, pelvis, shoulder)
If the tumor has a stag, it is called
pedunculata, if it attached to a wider
base of the bone, it is called sessile.

Classification
Multiple Hereditary Exostosis
Also known as multiple hereditary
osteochondromatosis, or diaphyseal aclasia.
Location and number of tumor varies, both types of
the tumor may form
In severe cases, bones may not grow normally and
may cause patients to have short stature or
deformities.
Patients are diagnosed commonly in early teenage
years
Patient may experience pain due to compression of
soft tissue around the tumor

Clinical Manifestations
Painful bump around the joint
Pain on movement (if the tumor is on
a tendon)
Numbness or paresthesia
Change in blood flow
Pain due to bursitis, fracture of tumor
base, khyphosis, spondylolisthesis,
etc.

Workup
History taking (Age, Onset, Duration,
Pain, Family History)
Clinical Examination
Location, Size, Shape, Borders,
Movement disorders, Muscle spasms,
Pathological fractures

Neurological exam (if needed)

Radiological exam
Biopsy (Fine Needle Aspiration,
Operation)

Radiological Examination
Bone Survey
Plain X-Ray photo of the bones in the
body

CT Scan
Ultrasound
Nuclear Medicine
MRI

X-Ray
Typical lesion on the right femur bone.

X-Ray
Anteroposterior of tibial osteochondroma

X-Ray
Sessile osteochondroma on distal of the femur

X-Ray
Multiple hereditary osteochondroma on distal of the femur
and proximal of the tibia/fibula

X-Ray
Osteochondroma on 1/3 proximal of the humerus shaped
like a cauliflower

X-Ray
Sessile osteochondroma on 1/3 distal of the tibia

X-Ray
Osteochondroma on the fibula

X-Ray
Protrusion on the metaphysis of proximal tibia with
calcification

X-Ray
Multiple Osteochondroma

X-Ray
Hereditary Multiple Exostosis

X-Ray
Pedunculated Osteochondroma

X-Ray
Sessile Osteochondroma

CT Scan
Used to depict osteochondroma on
the vertebral column, shoulder, and
hip.
If myelopathic compression has
taken place, CT Myelography is
suggested.
CT Scan may not be used to indicate
any metabolic activities, or any
serious indications of malignancy

CT Scan
Hip CT Scan shows a massive solitary osteochondroma

CT Scan
Sessile Osteochondroma on the humerus

CT Scan
Pedunculated osteochondroma on Cervical Spine 6

USG
Ultrasound is used to diagnose any
aneurysms or thrombosis as a
complication of osteochondroma
It is also used as a method to
observe the upper layer of the mass
that shows as a hypoechoic site on
top of a relevant cortex

USG
USG of a lump of the left thigh

Nuclear Medicine
Used to observe any metabolic
activities of the tumor.
Thalium 201 is used to observe any
malignant transformation of HME

Nuclear Medicine
Sclerotic exostosis in the left major trochanter.
Technetium-99m (99mTC) diphosphonate scintigram
shows an intense activity in the left major trochanter

MRI
MRI can show a better picture of the
tumors morphology, artery, veins,
and nerves compromised by the
tumor.
MRI is done in coronal, sagital,
paracoronal and parasagital slicing.

MRI
MRI of a sessile femur osteochondroma shows the
thickness of the cartilage cap

MRI
Sessile femur osteochondroma distal

Differential Diagnosis
Chondrosarcoma
Malignant tumor originating from the
cartilage tissue.
Tumor shows no osteoid tissue
Radiological finding shows a larger
tumor shadow and spreads outside of
the cortex into the soft tissue.

Chondrosarcoma
Left caput fibula shows a lesion consisting of chondroid
matrix. Low grade tumor

Differential Diagnosis
Osteosarcoma
Primary malignant bone tumor that is
commonly found
The tumor consists of osteoid tissue
The most common locations are the distal end
of the femur and proximal of the tibia. The most
common site is the knee
Radiological finding is the diffuse destruction of
bone matrix, infitrative in the the metaphysis.
Codmans triangle is a lifted periosteum in the
peripherals of the tumor, showing a triangle

Osteosarcoma
Lateral photo of the distal femur on a patient with
osteosarcoma involving the metaphysis and diaphysis.
Codmans triangle is the white arrow and the soft tissue
mass is the black arrow.

Pathology Anatomy Findings

Taken through Fine Needle Aspiration
Biopsy or after open surgery

Pathology Anatomy
Osteochondroma cap surrounded by fibrous cap (F),
Cartilage cap undergoes endochondral ossification (C), to
form bone (Arrow)

Pathology Anatomy
Cartilage cap of an osteochondroma (black arrow), and
bony stalk (white arrow)

Treatment
Treatment of choice is operation
Pre-operation diagnostic procedures involves
a CT scan, an MRI scan, and a biopsy of the
lesion.
Indication for operation is if the mass presents
a persistent pain or pain during activity.
Another indication is nerve compression
Common complications involve paresthesia,
paraplegia, peroneal neuropathy, and upper
extremity neuropathy

Prognosis
Osteochondroma excision is
commonly curative.
Recurrence may occur is excision is
incomplete.
Recurrence on a complete excision
may indicate malignancy.

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