I managed to reach a very involved and helpful orthopedic resident who just sent me these screenshots…. I wonder about osteolysis along the superior aspect of the osteochondroma in the 2nd image….which corresponds to the area of marrow signal alteration on MRI
The resident is still trying to book the appointment with the orthopedic oncologist….but it will happen and I’m optimistic we’ll get follow up
Most of the comments were concerned about malignant transformation
2 thought probably not and ascribed pain to the large size predisposing to trauma that the patient was not aware of
One mentioned that the rate of malignancy in a solitary osteochondroma is rare, and it is much higher in Multiple Hereditary Osteochondromatosis…..I told the resident that screening XRs of the arms, legs, chest and pelvis should be performed at some point to explore this possibility
Thanks to everyone who commented
Hilary
On Tue, Jun 11, 2024 at 1:23 PM hilary umans <hilary.umans> wrote:
This was referred by a Resident from a local hospital with multiple sites…I cannot reach him and do not have XRs
Although the image planes are not perpendicular to the cartilage cap, it measures up to 0,8cm at its thickest point
This is the only T1 series…should I be concerned about the dark T1 marrow signal deep to the cartilage cap?
I do not see an adventitial bursa or fracture to explain pain
There is no neuropathic muscle atrophy or edema
His growth plates are fused
Is this suspicious for secondary osteosarcoma?
I will request XRs to compare, but I suspect it is unlikely that it will happen.
