www.jrpms.eu
JOURNAL OF RESEARCH AND PRACTICE
ON THE MUSCULOSKELETAL SYSTEM
Journal of Research and Practice
on the Musculoskeletal System
Case Report
Solitary osteochondroma of the scapula in
late adolescence. A case report
Themistoklis Vampertzis
1
, Efstathios Kalivas
1
, Ioannis K. Christou
1
, Christina Barmpagianni
2
,
Athanasios Fotiadis
1
, Georgios Nitis
1
, Stergios Papastergiou
1
1
Department of Orthopedics, Unit for Sports Medicine, Agios Pavlos G.H.Th., Thessaloniki, Greece;
2
Trauma and Orthopaedics,
Northwick Park Hospital, London North West University Health Care NHS Trust, UK
Introduction
Skeletal osteochondroma or osteocartilaginous exostosis
represent the most common tumor of all benign bone tumors
and 10-15% of all bone tumors
1
. It is a benign cartilage-
capped outgrowth, connected to bone by a stalk. It can be
either isolated or as part of a syndrome (Hereditary Multiple
Exostosis-HME) and its progression usually stops when the
skeleton is mature, after the closure of the growth plate
2
.
This lesion usually involves long bones 95%, especially
near the knee 36%. It can rarely be found on flat bones,
Abstract
Skeletal osteochondromas, also known as Osteocartilaginous exostosis are the most common benign bone tumors,
while they represent an overall of about 15% of all bone tumors. They can be isolated findings or part of syndromic
pathologies. They are typically seen on long bones, while their occurrence on flat bones is rare. The main concern
after their identification is malignant transformation therefore size and cartilage thickness are monitored until
the maturation of the skeleton and therefore seize of growth (unless malignant). This case report presents a 16
year old girl diagnosed with a benign isolated osteochondroma of the left scapula. X-Rays and MRI scans were
used for diagnosis and for monitoring the progression for one year, while a CT scan aided planning for surgical
excision for cosmetic purposes. The tumor was removed and histology confirmed its benign nature. Apart from
cosmetic proposes and malignancy indications for excision of benign osteochondromas include pressure effect on
surrounding tissue, pain and fracture of stalk. In our case the tumor had a typically benign appearance; nevertheless
histological examination is always the gold standard for diagnosis.
Keywords: Benign bone tumor, Osteochondroma, Scapula, Surgical treatment
The authors have no conflict of interest.
Corresponding author: Themistoklis Vampertzis, MD,
Department of Orthopedics - Unit for Sport Medicine,
Agios Pavlos G.H., Ethnikis Antistaseos 161, 55134,
Thessaloniki, Greece
E-mail: [email protected]
Edited by: Christos Yiannakopoulos
Accepted 25 March 2020
44JRPMS | June 2020 | Vol. 4, No. 2 | 44-47
Figure 1. Left Scapula Anteroposterior view.
Published under Creative Common License CC BY-NC-SA 4.0 (Attribution-Non Commercial-ShareAlike)
10.22540/JRPMS-04-044
45
Solitary osteochondroma of the scapula in late adolescence. A case report
JRPMS
although they are a relatively infrequent location for
osteochondroma with a 3-4,5% involvement of the scapula
3
.
Even though osteochondroma is the most common neoplasm
of the scapula, it occurs very rarely in the isolated form ie.,
not part of generalized disorders such as HME, especially in
the ventral aspect of the scapula
4
. Malignant transformation
of osteochondroma is the main concern and its incidence in
the solitary type is 1%. Malignant change is characterized
by sudden growth in tumor size after skeletal maturity is
completed. The thickening of the cartilaginous cap is another
suspicious criterion for malignant transformation
5
.
Case presentation
A 16 year old female visits the OPD complaining of
a palpable tumor on the left scapula growing over the
last 3 years. No history of antecedent trauma, weight
loss, loss of appetite or any other unusual symptom. The
left shoulder has full ROM and 5/5 strength, similarly
to the right unaffected side. No sign of inflammation or
swelling and the overlying skin was normal. X-Rays were
performed that showed a mass in the medial border
of the scapula (Figures 1, 2).A left scapula MRI using
paramagnetic contrast agents followed and revealed a
circularly shaped exostosis (Figure 3). The patient was
sent home and regular OPD follow-up was arranged in
order to monitor its development until skeletal maturity.
After a year of regular visits the patient reported no
difference in size and no new symptoms. Surgery was
considered for cosmetic reasons. A new MRI scan (Figure
4) was performed with no significant difference and a CT
scan with 3D reconstruction (Figure 5) was ordered for
pre-operative planning.
Surgery
A 5 cm incision was made parallel to the upper half of
the medial border of left scapula. The trapezius was incised
along with the skin and afterwards the supraspinatus
fossa. The mass was exposed by retraction of the soft
tissues and removed en block with osteotome. All divided
muscle was re-approximated and the wound was closed in
a standard fashion.
The size of the excised tissue (Figure 6) measured
5 cm * 2 cm* 2 cm and was sent for histological examination
(Figures 7, 8), which confirmed the diagnosis. Sutures
Figure 2. Left Scapula Y scapular view. Illustrated mass (yellow arrow).
Figure 3. Left scapula MRI with paramagnetic contrast agents.
Illustrated mass (yellow arrow).
Figure 4. Left scapula MRI with paramagnetic contrast agents.
Illustrated mass (yellow arrow).
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46
T. Vampertzis et al.
were removed on the 12
th
post-operative day. The left
shoulder had full ROM and no swelling or other pathology.
Discussion
Osteochondroma is the most common benign tumor
affecting usually long bones. Infrequently it can involve
flat bones such as the scapula. More often it is painless
but in case of size increase it can be painful due to soft
tissue compression, skin stretching or pressure effect
on nerves and muscles, as well as in the case of fracture
through the stalk
6
. An anterior posterior and a Y-view
X-Ray check is sufficient to demonstrate the lesion. MRI
check is useful to exclude malignancy and a CT scan can
be used for operative planning, for demonstrating the
margins and the thickness of the cartilaginous cap (>2
cm malignancy, <2 cm benign, 1-2 cm uncertain). In our
case it was 0.5 cm
7
. The patient did not have any signs of
malignancy. After surgical excision the mass must be sent
for biopsy no matter the benign appearance of the tumor.
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Figure 5. Left scapula CT. 3D reconstruction. Illustrated mass
(yellow arrow).
Figure 6. Mass excised.
Figure 7. Photomicrograph of hematoxylin- eosin stain of the excised
mass. Figure Magnification 200. Figure magnification 1000 Cartilage
cap thickness 0.5 cm.
Figure 8. Photomicrograph of hematoxylin- eosin stain of the excised
mass. Figure Magnification 200. Figure magnification 1000 Cartilage
cap thickness 0.5 cm.
47
Solitary osteochondroma of the scapula in late adolescence. A case report
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