Solitary osteochondroma of the twelfth rib with intraspinal extension and cord compression in a middle-aged patient

Abstract

Background: Osteochondroma is a disease of growing bone and thus typically presents in younger patients. It has rarely been described in middle-aged and elderly patients. Data on the occurrence of osteochondroma show that the reported incidence of costal osteochondroma is very low. Moreover, costal osteochondroma arising at the costovertebral junction with neural foraminal extension and spinal cord compression is extremely rare.

Case presentation: This study reports the case of a 58-year-old patient with a solitary osteochondroma of the 12th rib with intraspinal extension and spinal cord compression. The clinical history, plain radiographs, computed tomography (CT), magnetic resonance imaging, and pathologic findings of the reported patient have been reviewed. The relevant medical literature has also been reviewed. The patient was treated with surgery for complete tumour excision to avoid tumour recurrence. After surgery, the patient's symptoms improved. An additional CT scan obtained at 1 year after surgery did not show any evidence of recurrence.

Conclusions: This patient is the oldest patient reported to have this rare form of costal osteochondroma. The age of the patient and the erosion of the adjacent bones raised clinical suspicion of malignancy; therefore, surgical management involved complete tumour excision with thoracolumbar fixation and fusion.

Figure 1

Anteroposterior thoracolumbar plain radiograph. The radiograph shows osseous exostoses on the right side of T12-L1.

Figure 2

Axial CT images. The images show an osseous mass arising from the head of the right 12th rib at the costovertebral junction with obliteration of the neural foramen and intraspinal extension.

Figure 3

Axial T2-weighted MR image. The image shows an intraspinal osseous mass causing compressive myelopathy (arrows). Note 2 areas of the thin cartilaginous cap (arrowheads) on both the posterior and the intraspinal aspects of the mass.

Figure 4

A: Intraoperative photograph of the tumour before its resection. A cartilaginous cap is evident (arrows). B: Macroscopic appearance of the tumour, with cartilaginous and osseous components.

Figure 5

Photomicrograph of the tissue specimen. A cartilage cap covering the cancellous bone is observed. Trabecular bone and lipomatous marrow spaces are easily recognised on the right side. There were abundant clones of chondrocytes without nuclear atypia. Hematoxylin and eosin (H & E) stain; original magnification, 20×.

Figure 6

Radiographs at 1-year follow-up. Axial CT scan at the level of the T12 pedicle showing complete bony fusion and no evidence of recurrence.