Kevin D. Plancher and Michael Bothwell
A 14-year-old boy presents with a growth on the end of his index finger. He notes that it has slowly been getting larger. He has had the growth for 3 years, but recently became concerned following his mother's battle with cancer. It is not painful unless he hits it hard on something. The patient has no history of cancer.
A cartilaginous growth is seen on the end of the index finger. The mass projects from the volar surface. There are no other growths on either of the patient's hand.
Radiographs reveal a peripheral bone projection or growth with flaring of the meta-physic of the bone (Fig. 89—1). There is also a communication of the cortical and cancellous bone, which may contain focal areas of calcification at the site of the osteo-chondroma. Covering the top of the tumor is a thin, sclerotic area of cartilaginous cells.
Histologically, the surface of the lesion reveals a thin smooth, translucent, bluish cartilaginous cap. The lesion may be pedunculated or sessile. When pedunculated the lesion projects away from its nearest joint (Fig. 89—2).
Inclusion cysts Giant cell tumors Chondrosarcoma
Osteochondroma is the most common benign tumor of bone. It originates in the metaphysis of long bones and may have multiple foci. The tumor typically appears in the second decade and has a male predominance of 1.7 to 1.0. In the upper extremity it is commonly located in the proximal humerus as well as the distal radius and ulna (Fig. 89-3).
Figure 89—1. Osteochondroma seen on the distal volar aspect of the index finger with flaring of the metaphysis.
A solitary osteochondroma is a stage 1 tumor that is asymptomatic and needs to be followed in the office. The indications for surgical treatment consist of functional limitations, cosmetic reasons, or pain. Surgical treatment in children should be withheld due to the unknown growth potential of the tumor in a growth plate. If surgical treatment is needed, then great care should be taken to complete a meticulous excision. Malignant degeneration in solitary osteochondromas is rare. Multiple osteochondro-mas cause significant forearm deformities, including ulnar angulation of the distal radius articular surface, ulnar translation of the carpus, and dislocation of the radial head.
Aggressive intervention is recommended when any deformity is present. Malignant degeneration in multiple osteochondromas is 10 to 20% per patient.
The mass should be removed surgically from the end of the finger. The bone is exposed by incising the periosteum, and a segment of bone is removed. The periosteum should not be elevated over the mass with an elevator. This may leave cartilaginous cells, which may lead to recurrence. The nail may also be removed if the mass is involved with the terminal tuft of the distal phalanx.
Complications following excision of an osteochondroma include fracture, bone deformity, vascular injury, pseudoaneurysm, nerve damage, bursa formation around the lesion, and malignant transformation.
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