Bizarre parosteal osteochondromatous proliferation (Nora's lesion) of the hand: management of a rare clinical entity

Abstract

Bizarre parosteal osteochondromatous proliferation, or Nora's lesion, is a rare benign tumour of the bone, most commonly described in the hands and feet. We present the case of a female patient in her 20s attending the hand clinic with a sudden onset, atraumatic swelling on the proximal phalanx of her right ring finger. The patient retains good hand function and remains asymptomatic 3 months after surgical excision. Our case highlights the importance of being aware of this diagnosis and differentiating it from other malignant, as well as benign tumours of the hand.

Keywords: Orthopaedic and trauma surgery; Pathology; Plastic and reconstructive surgery; Radiology.

Figure 1

Preoperative clinical photograph of patient’s finger with Nora’s lesion (highlighted by red arrow).

Figure 2

Plain AP radiograph of the patient’s right ring finger at presentation, showing calcified lesion (highlighted by arrow).

Figure 3

MRI scan of patient’s right hand, showing Nora’s lesion (highlighted by red arrow).

Figure 4

Macroscopic clinical photograph of excised lesion.

Figure 5

Clinical photograph of the patient’s right hand at 3-month follow-up, showing healing scar on radial border of right ring finger.

Figure 6

Plain AP radiograph of patient’s right ring finger at 3-month follow-up, showing normal skeletal architecture at the previous site of the lesion.