Osteochondroma & Multiple Hereditary Exostosis - bone tumor in children

#osteochondroma #MHE #bonetumor
Osteochondroma & Multiple Hereditary Exostosis.
(osteocartilaginous exostosis)
it is a cartilage-capped bony spur arising on the external surface of a bone.
The cartilage cap is thick in the child,
narrows during adolescence,
and generally is less than1 cm in the adult.
hereditary multiple exostoses are characterized by two or more exostoses in the appendicular and axial skeleton.
Osteochondromas with a visible stalk are called pedunculated.
Flatter ones with a broader base are called sessile.
osteochondroma can occur in any bone.
It usually appears near the ends of long bones.
usually near a growth plate area.
but is seen most often around the knee or the proximal humerus.
The distal femur is the most common location.
This tumor generally grows with the child
and stops growing once the child completes puberty.
and remain static throughout adulthood.
Most cases do not cause symptoms.
They often go undiagnosed until they show up on an imaging test taken for an unrelated reason.
However, you might notice a small, hard, painless lump on one of your bones.
usually near the joints.
most commonly around the knee,
but almost all bones can be affected.
Pain with a particular movement if the tumor is rubbing against a tendon.
If the tumor puts pressure on a nerve, there may be numbness and tingling in the associated limb.
Circulation problems in a limb if the tumor is inhibiting a blood vessel.
In some cases, an injury can cause the stalk of a pedunculated osteochondroma to break.
This will cause immediate pain and swelling in the area of the tumor.
Osteochondromas can cause functional problems (decreased range of motion) by causing joint impingement.
In more severe cases,
multiple osteochondromas (HMO) can affect normal bone growth in children.
Children with this condition might have short stature,
crooked limb (angular deformities).
an arm or leg that is longer than the other.
In almost all cases, an osteochondroma can be diagnosed using an x-ray.
Magnetic resonance imaging (MRI) is warranted
when there is a concern for adjacent soft tissue impingement,
new focal pain at site,
or there is a concern for chondrosarcomatous transformation.
This test is particularly useful in identifying tumors in areas that are difficult to image on a plain x-ray.
The most dangerous complication of osteochondroma is cancerous transformation
which usually happens within the cartilage cap and leads to the development of secondary chondrosarcoma.
Most of these tumors are low to intermediate grade.
which is usually not an aggressive type but warrants removal regardless.
every patient with a new onset of unexplained pain near a preexisting osteochondroma,
or The tumor has continued to grow after the skeleton has stopped growing.
should undergo imaging, preferentially MRI, to exclude secondary chondrosarcoma.
the most reliable imaging finding is the thickness of the cartilage cap,
A cartilage cap thickness greater than 3 cm in children
or 2 cm in adults is a sign of malignant transformation.
malignant transformation is extremely unusual and is therefore not a reason to remove all osteochondromas.
It is estimated that It occurs in approximately 1% of solitary osteochondromas
and ~5-10% of hereditary multiple exostoses cases.
For this reason, the doctor may want to keep it under observation.
Most osteochondromas need no treatment.
Patients and their parents can be educated about the rare event of malignant transformation and its signs and symptoms with follow-up as needed.
Patients with hereditary multiple exostoses may need to be monitored for development of limb deformities.
Surgery is only necessary if the tumor is causing significant pain,
a fracture,
restricting movement of a joint,
putting pressure on blood vessels or nerves,
or affecting growth,
is very large in size,
or concern for malignant transformation.
Treatment for osteochondroma is generally a simple surgical removal of the lesion from the bone surface.
After surgery for osteochondroma, the patient should be able to go home the same day of surgery.
the recovery may be longer, four to six weeks, and may include use of crutches.
If correction of deformity is included as part of surgery, the recovery may take several months depending on the specifics of the surgery.
The likelihood of your child’s osteochondroma recurring after resection is extremely low, although more common if it is removed at a young age.