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 Table of Contents  
CASE REPORT
Year : 2015  |  Volume : 12  |  Issue : 2  |  Page : 126-128

A case report of a rare location solitary osteochondroma: Scapula


Department of Orthopaedics, Dr. Shankarrao Chavan Goverment Medical College, Nanded, Maharashtra, India

Date of Web Publication10-Nov-2015

Correspondence Address:
Rajesh K Ambulgekar
Dr. Shankarrao Chavan Goverment Medical College, Nanded - 431 606, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0331-8540.169290

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  Abstract 

Osteochondromas are most common benign malignancy of skeletal and most common site being metaphysis. It arises from cartilage forming bone. As per literature search very few cases are reported of scapular osteochondroma. We are presenting one of such case in a 25 year female from remote place in Nanded district which was treated by excision.

Keywords: Exostosis, osteochondroma, scapula


How to cite this article:
Ambulgekar RK, Jaiswal N, Kandolkar PG, Thakkar RD, Rahul B. A case report of a rare location solitary osteochondroma: Scapula. Niger J Basic Clin Sci 2015;12:126-8

How to cite this URL:
Ambulgekar RK, Jaiswal N, Kandolkar PG, Thakkar RD, Rahul B. A case report of a rare location solitary osteochondroma: Scapula. Niger J Basic Clin Sci [serial online] 2015 [cited 2021 Jun 23];12:126-8. Available from: https://www.njbcs.net/text.asp?2015/12/2/126/169290


  Introduction Top


Osteochondromas (Exostosis) are most common benign tumour of skeleton consisting of 35–46% of benign bone neoplasm.[1] Usually, it arises from bones which are formed from cartilage and the most common site being metaphysis of long bone. It generally occurs at the end of the growth plates of long bones and most commonly near the joints such as shoulder or the knee or occur in the long bones of the forearm. These tumours usually stop to grow with the closure of growth plate. Literature on the involvement of other anatomic areas is limited. The scapula is involved rarely in 3–4.6% of cases.[2] These scapular tumours may present with winging of the scapula (Pseudowinging). Here, we report a very rare case of osteochondroma which arose from scapula in 25-year-old female (was present for 9 years) and was treated by excision biopsy.


  Case Report Top


A 25-year-old female from a remote place in Nanded district presented to us with swelling in the right scapular region for 9 years duration [Figure 1]. She presented for cosmetic reason. It was painless and non-progressive. There was no history of trauma or fever, weight loss or any other significant past or personal history. No other bony swelling in other parts of the body.
Figure 1: (a and b) Pre-operative clinical photo showing osteochondroma of right scapula

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On clinical examination, it was solitary large bony swelling on dorsum of right scapula, 15 cm × 15 cm × 3 cm in size, smooth surface and hard in consistency. Overlying skin was normal and the range of motion of shoulder was normal as compared to other side.

Plain radiograph [Figure 2]a shows mushroom shaped solitary mass of calcific density. Computed tomography [Figure 2]b scan confirmed the radiographic findings and showed intra-capsular mushroom such as osseous mass with calcification. Magnetic resonance imaging [Figure 3] confirmed the diagnosis of osteochondroma and showed cauliflower shaped heterogenous intensity lesion arising from the posteromedial border of scapula blade and extending in anteromedial compartment.
Figure 2: (a) Pre-operative radiograph showing osteochondroma arising from right scapula. (b) Pre-operative computed tomography scan showing osteochondroma

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Figure 3: Pre-operative magnetic resonance imaging showing scapular lesion

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She was treated with excision [Figure 4] and [Figure 5] of osteochondroma for cosmetic concern. Under general anaesthesia in the prone position, entire tumour was excised and sent for histopathological examination which confirms our pre-operative diagnosis of osteochondroma showing normal appearing chondrocytes which were covered by hyaline cartilage [Figure 6]. There is no evidence of any malignant transformation [Figure 7]. Post-operatively, she was put on physiotherapy.
Figure 4: (a and b) Intra-operative photo showing origin of osteochondroma from scapula

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Figure 5: (a and b) Osteochondroma and operative site after excision of tumour

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Figure 6: Histopathological slides shows chondrocytes covered with hyaline cartilage

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Figure 7: Post-operative X-ray after 6 months, showing no recurrence

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  Discussion Top


Osteochondromas are benign tumours arising from bone which are formed from cartilage and consist of 35–46% of benign bone tumours. They are of two types – sessile and pedunculated. Most lesions are found during the period of rapid skeletal growth, and their growth usually ceases by skeletal maturity. They are probably developmental malformations rather than true neoplasms and are believed to originate within periosteum as cartilaginous nodules.[3] Malignant transformation is present in 1% of cases and is of concern. Malignant transformation should be suspected when there is a sudden increase in the growth of tumour. In malignant transformation, the cartilage thickness is more than 2 cm. Most common site is metaphysis of long bone specially proximal femur. Scapula being a rare site consists only of 3–4.6%.


  Conclusion Top


Osteochandromas of scapula are a very rare bone tumour. Most common presenting complaints of scapular osteochondroma are swelling, pain, restricted movement of shoulder or pseudowinging of scapula. Excision of tumour relieves most of these symptoms immediately, recurrence of tumour and malignant transformation are very rare in osteochondroma.

In our case, indication for excision was mainly on the cosmetic ground. The patient was benefited and satisfied for near normal cosmetic look after excision of the tumour and there was no evidence of recurrence of tumour at follow-up after 6 months.[3]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Tomo H, Ito Y, Aono M, Takaoka K. Chest wall deformity associated with osteochondroma of the scapula: A case report and review of the literature. J Shoulder Elbow Surg 2005;14:103-6.  Back to cited text no. 1
    
2.
Danielsson LG, el-Haddad I. Winged scapula due to osteochondroma. Report of 3 children. Acta Orthop Scand 1989;60:728-9.  Back to cited text no. 2
    
3.
Weber KL, Buckwalter JA, editors. Musculoskeletal neoplasms and disorders that resemble neoplasms. In: Turek's Orthopaedics: Principles and Their Application. 6th ed. Philadelphia: Lippincott Williams and Wilkins; 2008. p. 268-319.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]


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