Journal Article

Bizarre parosteal osteochondromatous proliferation in the distal ulna where the lesion is continuous with the medullary cavity: a case report

Wang, Tianyu, Guo, Xiaoning, Huang, Xiaoyi, Chen, Zhuzhong, Ouyang, Zhengxiao, Yang, Yuhui, Xiang, Cheng, Zhou, Peng, Ling, Lin

2024

Overview

Background Bizarre parosteal osteochondromatous proliferation (BPOP) is a rare benign bone tumor, it is also called “Nora’s lesion”. The lesion is characterized by heterotopic ossification of the normal bone cortex or parosteal bone. The etiology of BPOP is unclear and may be related to trauma. In most BPOPs, the lesion is not connected to the medullary cavity. Here we report an atypical case, characterized by reversed features compared to the typical BPOP, which demonstrated continuity of the lesion with the cavity. Case presentation An 11-year-old female child had a slow-growing mass on her right wrist for 8 months with forearm rotation dysfunction. Plain X-rays showed an irregular calcified mass on the right distal ulna, and computed tomography (CT) showed a pedunculated mass resembling a mushroom protruding into the soft tissue at the distal ulna. The medulla of this lesion is continuous with the medulla of the ulna. A surgical resection of the lesion, together with a portion of the ulnar bone cortex below the tumor was performed, and the final pathology confirmed BPOP. After the surgery, the child’s forearm rotation function improved significantly, and there was no sign of a recurrence at 1-year follow-up. Conclusion It is scarce for BPOP lesions to communicate with the medullary cavity. However, under-recognition of these rare cases may result in misdiagnosis or inappropriate treatment thereby increasing the risk of recurrence. Therefore, special cases where BPOP lesions are continuous with the medulla are even more important to be studied to understand better and master these lesions. Although BPOP is a benign tumor with no evidence of malignant transformation, the recurrence rate of surgical resection is high. We considered the possibility of this particular disease prior to surgery and performed a surgical resection with adequate safety margins. Regular postoperative follow-up is of utmost importance, without a doubt.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Bizarre parosteal osteochondromatous proliferation / Bone cancer / Bone mass / Bone Neoplasms - diagnostic imaging / Bone Neoplasms - pathology / Bone Neoplasms - surgery / Bone surgery / Bone tumors / Bones / Calcification / Care and treatment / Cartilage / Case Report / Child / Computed tomography / Continuity with the medullary cavity / Cortical bone / Development and progression / Diagnosis / Differential diagnosis / Disease / Epidemiology / Female / Forearm / Humans / Internal Medicine / Lesions / Magnetic resonance imaging / Medicine / Medicine & Public Health / Medulla oblongata / Medullary bone / Nora’s lesion / Orthopedics / Ossification (ectopic) / Osteochondroma / Osteochondroma - diagnostic imaging / Osteochondroma - pathology / Osteochondroma - surgery / Osteosarcoma / Rehabilitation / Rheumatology / Sports Medicine / Tomography, X-Ray Computed / Trauma / Treatment Outcome / Tumors / Ulna / Ulna - diagnostic imaging / Ulna - pathology / Ulna - surgery / Wrist / X-rays