Osteochondromas: An Updated Review of Epidemiology, Pathogenesis, Clinical Presentation, Radiological Features and Treatment Options

Abstract

Osteochondroma, the most common benign bone tumor, is a projection on the external surface of the bone, which can be sessile or pedunculated. 85% of osteochondromas present as solitary lesions, while 15% occur in the context of hereditary multiple exostoses (HME), a genetic disorder that is inherited in an autosomal dominant manner. Although often asymptomatic, symptoms may eventuate from compression of adjacent vessels or nerves, fractures, osseous deformities, bursa formation, or malignant transformation. Cartilage cap thickness >2 cm in adults or >3 cm in children as well as new onset of pain or growth, or rapid growth of the lesion, especially after the closure of the growth plate, might reflect cancerous transformation. Surgical resection is indicated for symptomatic lesions, complications, cosmetic reasons or malignant transformation. Excision of the tumor with free margin is the treatment of choice. Local recurrence is less than 2% if complete resection is achieved.

Keywords: HME; Osteochondroma; chondrosarcoma; exostosis; imaging; review.

Figure 1. A typical femoral osteochondroma X-ray. Note the protuberance on the external surface of the right femoral bone. Linear calcifications inside the tumor are also apparent. Reprinted with permission from (4).

Figure 2. A typical tibial osteochondroma X-ray. Note the protuberance on the external surface of the tibial bone. Reprinted with permission from (4).