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Year : 2006  |  Volume : 16  |  Issue : 3  |  Page : 339-340
Solitary osteochondroma of rib: A case report


From the Honorary Asst Prof. Radio-Diagnosis IGMC and Mayo Hospital, Nagpur, India

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Keywords: Solitary osteocartilagenous exostosis, Rib exostosis, Bone tumors, Bone lesions

How to cite this article:
Phatak S V, Kolwadkar P K, Rajderkar D. Solitary osteochondroma of rib: A case report. Indian J Radiol Imaging 2006;16:339-40

How to cite this URL:
Phatak S V, Kolwadkar P K, Rajderkar D. Solitary osteochondroma of rib: A case report. Indian J Radiol Imaging [serial online] 2006 [cited 2014 Aug 1];16:339-40. Available from: http://www.ijri.org/text.asp?2006/16/3/339/29011

   Case report Top


A seventeen-year-old boy presented with a hard painless, swelling on right chest wall which was slowly growing in size. Chest radiograph (right oblique) revealed bony outgrowth from anterior right sixth rib most likely an osteochondroma. CT scan was performed which confirmed it to be osteocartilagenous exostosis. No other lesion was seen in this patient.


   Introduction Top


Neoplasms of anterior and posterior chest wall present diagnostic and therapeutic problems, which are often unique to the region of body. Of all intrinsic bone tumors Primary neoplasms of the bony chest are 5-10%, neoplasm of ribs being far more common than those of strernum. Malignant neoplasms in form of metastatic carcinoma are more common than benign lesions. Benign cartilagenous tumors found in thorax include osteochondroma, chondroma, chondromyxoid fibroma and chondroblastomas. Osteochondromas are neoplasms of young adults. Males are affected approximately 1.5 times as frequently as females. [1] It develops during the period of most active enchondral bone growth and is most often detected during second decade of life. [2] Osteochondromas actually represent a developmental physical growth defect. The defect occurs in circumferential ring of fibrous tissue (Perichondrium), the ring of Ranvier covering the epiphyseal plate. Result of such a defect is lateral growth of epiphyseal cartilage plate instead of normal downward growth towards the metaphysis; this abnormal growth gives rise to a lateral cartilage protuberance. Whether a stalk or sessile all osteochondromas have a direct communication with the cortex and marrow cavity of underlying bone [3] They are also reported as a result of radiation therapy in children [4]. The osteochondromas stop growing at the time the nearest epiphyseal plate fuses. [4],[5]


   Discussion Top


These are benign bone tumors characterized by cartilage capped bony outgrowths that project from the surface of the affected bone. They may be found in any bone that is performed in cartilage but are seen mostly in metaphyseal portions of long bones. When the lesion is seen only in a single bone it is called solitary osteocartilagenous exostosis or osteochondromas. When two or three exostosis are encountered and there is no history of familial or hereditary background they are referred to as multiple exostosis or osteochondromas. When the tumors are distributed over the skeleton there is usually a familial history and they are designated as hereditary multiple exostosis. The individual lesions of solitary and multiple exostosis are basically identical roentgenologically and pathologically. In solitary form however the tumor tends to be less extensive and in long bones it is limited to one portion of circumference of the shaft. [6] Microscopically the bony component of tumor is similar to underlying cancellous bone. At chondro-osseous junction endochondral ossification takes place. The cartilagenous cap often has a relatively acellular appearance. However especially in those tumors of children focal areas of increased cellularity may be present.[1]. The radiologic appearance is that of a pedunculated or sessile bony excrescence with a sharply defined margin .Mottled calcification is commonly evident within cartilagenous cap[7]. They are predominantly anterior.[4],[6]. Plain films are usually sufficient to diagnose the condition. Sessile lesions cover a wider area and cause metaphyseal widening.CT is useful in determining the marrow and cortices of the lesion which are continuous with bone.The thickness of cartilage cap can be delineated on MR.The cartilage cap ranges from 1-6 m.m. in thickness.Over 2 cms.of cartilage or renewed growth is a sign of possible malignant transformation.[4]The radiologists contribution lies chiefly in recognizing signs suggestive of malignant transformation. These include irregularity of cartilagenous cap,a soft tissue mass projecting beyond expected confines of the lesion ,flecks of calcification in the soft tissue beyond the lesion and rapid growth of the lesion revealed on serial films.[2]Osteochondromas in areas other than knee are more likely to undergo malignant transformation.Secondary chondrosarcoma occurs in .5-1 %of patients with a solitary osteochondroma.Chondrosarcoma transformation is more common in hereditary form.Dynamic gadolinium enhanced MR can be useful to differentiate benign from low grade malignant cartilagenous tumor.Both early and exponential enhancement being predictors of malignancy.Gadolinium enhanced MR can further help in tumor mapping in case a biopsy is indicated.[4]D/D of rib lesions include enchondroma,osteoblastoma,osteoid osteoma,chondroblastoma and hemangioma. Spontaneous hemothorax and pneumothorax and fractures are also reported in rib lesions.[4]Those rib exostosis that project externally are palpable on the chest wall.Internal exostosis is asymptomatic.[8]These lesions are benign lesions and can be staged under the musculoskeletal tumor society staging for benign lesions as follows.

Stage I:-Inactive or static lesions.

StageII: - Actively growing lesions.

Stage III: -Actively growing lesions that are locally destructive/aggressive.[9]

 
   References Top

1.Steven L Teitebaum Tumors of chest wall J Surg,Obstetrics and gynecology Nov 1969:1059-1073.  Back to cited text no. 1    
2.James R Stewart, David C Dahlin, David G Pugh The pathology and radiology of solitary benign bone tumors Seminars in Roentgenology vol 1,No.3 (July) 1966:268-291.  Back to cited text no. 2    
3.David Karasick,MarkESchweitzer,David J Eschelman Symptomatic osteochondromas :Imaging features AJR 1997;168:1507-1512.  Back to cited text no. 3    
4.N Ramesh, M Odowd, B Hogan Osteochondroma of rib www.eurorad.org/case 1799.  Back to cited text no. 4    
5.Gary H Omell, Larry S.Anderson, Robert T Bramson Chest wall tumors RCNA vol XI No.1 1973: 197-213.  Back to cited text no. 5    
6.Daniel Wilner Radiology of bone tumors and allied disorders 1982,WBSaunders vol 1 Osteochondroma: 272.  Back to cited text no. 6    
7.Grainger and Allisons diagnostic Radiology A Textbook of medical imaging Churchill Livingstone vol. l, 1997:254.  Back to cited text no. 7    
8.Ronald B T Glass, Karen I Norton, Sandra A Mitre, Eugene Kang Radiographics 2002; 22:87-104.  Back to cited text no. 8    
9.Www.emedicine.com/orthoped/topics/528 Ian D Dickey last updated January 2,2004  Back to cited text no. 9    

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Correspondence Address:
S V Phatak
Consultant Radiologist, R 203,Devashish Apartments, 1,Bajaj Nagar, Nagpur 440010 Maharashtra State
India
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DOI: 10.4103/0971-3026.29011

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    Figures

[Figure - 1], [Figure - 2]

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