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Age / Sex : 53 / F
Age/Sex: 53/F
C.C.: right shoulder pain during 7 months
1) What is your impression?
Courtesy : Myung Jin Shin, MD., Asan Medical Center
Diagnosis: osteochondroma
Discussion
Findings:
Plain radiography: about 3cm sized ossified mass in the mid portion of the right scapula
CT: Focal outpouching bone forming lesion with fat density in right scapula
MRI: About 4.3 x 1.3 x 3.3 cm sized ossified mass without contrast enhancement portion with focal fat component around the mass in midportion of scapula
Pathology: Osteochondroma with adjacent musculo-adipose tissue
Differential Diagnosis: osteochondrorma, most likely. parosteal osteosarcoma, less likely.
Diagnosis: Osteochondrorma
Discussion:
Osteochondroma is the most common primary benign neoplasm of the scapula with an incidence of 4.6%. Usually, it is a single lesion located on the anterior surface of the scapular body. Osteochondromas are usually painless but symptoms may result from complications such as mass effects that produce several mechanical problems, fracture of bony stalk, nerve-impingement syndromes, malignant transformation of the cartilaginous cap and large bursa formation. Clinical manifestation of osteochondroma in the scapula is strictly correlated to its size and location. It may manifest as a consequence of functional disorders caused by compression or by the impediment of movement of the overlying tendinous structures, which causes friction and subsequently the reactive bursitis that is the basis for the painful symptoms often involved. The localization in the higher, lower and along the medial borders of the scapula may appear early, because of the direct contact with the muscular tissue. Regarding the other regions of the scapula, the mass must be of a large size in order to interfere with the muscular and neurovascular structures. Cases in which scapula osteochondroma was accompanied by incomplete paralysis of the frontal compact muscle by compression of the long thoracic have also been described. Chondrosarcoma is the commonest malignancy of the scapula hence higher imaging is frequently required for differentiating from the benign exostosis. Treatment of scapular exostosis consists of surgical removal, which is useful in eliminating painful symptoms and avoids possible transformation of the neoformation.
References:
1. Kumar S, Shah AK, Patel AM, Shah UA. CT and MR images of the flat bone Osteochondromata from head to foot: A pictorial essay. IJRI 2006; 16:589-596
2. Salini V, Amicis DD, Guerra G, Iarussi T, Sacco R, Orso CA. Osteochondroma of the scapula: a case report. Journal of Orthopaedics and Traumatology 2007; 8:33–35
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