Journal articles: 'Multiple Osteochondromas'

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Sinha, Siddharth, Venkat Iyer, and K. Joshi George. "Foramen magnum osteochondroma causing myelopathy in a patient with hereditary multiple exostoses." Surgical Neurology International 11 (September 18, 2020): 296. http://dx.doi.org/10.25259/sni_378_2020.

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Background: Osteochondromas are commonly occurring benign bone tumors which may be either a solitary lesion or occur due to association with hereditary multiple exostoses (HMEs). There have been several reported cases of spinal osteochondromas, but intracranial lesions are rare. Case Description: A 51-year-old male with a history of multiple osteochondromas presented with myelopathy. He had an exostosis arising from the foramen magnum causing compression of the cervical spinal cord that was successfully removed. Genetic testing revealed that he had HMEs. Conclusion: Osteochondromas of the skull are extremely rare. However, parts of the foramen magnum ossify in cartilage and can give rise to an osteochondroma. Here, we present a patient with HMEs who developed cervical myelopathy due to an osteochondroma arising from the foramen magnum. Due to the cartilaginous ossification of the foramen magnum, clinicians should be aware that osteochondromas can occur in this location and potentially give rise to cervical myelopathy.

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Albrecht, Steffen, J. Stewart Crutchfield, and Gary K. SeGall. "On spinal osteochondromas." Journal of Neurosurgery 77, no. 2 (August 1992): 247–52. http://dx.doi.org/10.3171/jns.1992.77.2.0247.

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✓ Osteochondromas (or osteocartilaginous exostoses) make up about 30% to 40% of benign bone tumors. Most are solitary lesions but some are multiple, usually with autosomal dominant inheritance. From 1% to 4% of osteochondromas occur in the spine, where they can cause a variety of signs and symptoms, including those of spinal cord or spinal root compression. The authors present five patients with osteochondromas of the spine and review the findings together with those of over 130 cases reported since 1907. The cases were divided into: 1) spinal osteochondromas in patients with multiple osteochondromas, and 2) solitary osteochondromas occurring in the spine. The age (mean ± standard error of the mean) of patients in the first group was 21.6 ± 1.8 years compared to 30.0 ± 2.1 years for those in the second group (p < 0.02). There was a significant male predominance overall (M:F = 2.5:1; p < 0.0005). In both groups, one-half of the lesions involved the cervical spine. Symptoms are caused by pressure on adjacent structures. Spinal cord compression was reported more than twice as frequently in the multiple osteochondroma group as in the single osteochondroma group (77% vs 33%; p < 0.0005). Computerized tomography (CT) is the imaging procedure of choice. In both groups, the majority of surgically treated patients (90% and 88%, respectively) improve, with about three-quarters of the improved patients having no residual disease or only minor deficits.

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Tian, Ye, Wen Yuan, Huajiang Chen, and Xiaolong Shen. "Spinal cord compression secondary to a thoracic vertebral osteochondroma." Journal of Neurosurgery: Spine 15, no. 3 (September 2011): 252–57. http://dx.doi.org/10.3171/2011.4.spine10484.

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The authors describe a case of spinal cord compression due to an osteochondroma arising from the T-6 vertebral body in a patient with hereditary multiple exostoses. This 16-year-old boy presented with spastic paraparesis. Surgical decompression was followed by resolution of the neurological impairments. Osteochondroma is the most common bone tumor. The distribution of osteochondromas greatly favors the extremities and these lesions rarely arise in the vertebral column. Osteochondromas occur in 2 distinct clinical settings—as solitary or multiple tumors, the latter being often associated with hereditary multiple exostoses. Osteochondromas are more commonly found in the posterior elements of the vertebrae. Intraspinal presentation of these tumors is usually limited to the cervical regions, with few tumors reported in the thoracic vertebrae. Based on the presented case and literature review, the authors conclude that osteochondromas of the thoracic spine that cause myelopathy usually arise from the vertebral body and pedicle. Prompt and systematic radiological investigations are important in planning surgical management. Surgical excision usually yields good results.

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Raggio, Blake S., Samuel Ficenec, Thomas C. Flowers, Claire Lawlor, and Kimsey Rodriguez. "Osteochondroma of the Hyoid: First Pediatric Case and Literature Review." Clinical Pediatrics 57, no. 3 (July 21, 2017): 307–10. http://dx.doi.org/10.1177/0009922817722012.

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Osteochondromas, the most common benign bone tumors, are cartilaginous neoplasms of unknown origin with rare malignant potential. Osteochondromas rarely occur in the head and neck, and diagnosis relies on a combination of clinical, radiological, and histological criteria. Excision is often curative. We describe the first reported case of hyoid osteochondroma in an adolescent male with multiple osteochondroma, discuss its surgical management, and perform a review of the salient literature. Osteochondroma represents a rare diagnosis to include in the differential of any midline neck mass.

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Makhdom, Asim M., Fan Jiang, Reggie C. Hamdy, Thierry E. Benaroch, Martin Lavigne, and Neil Saran. "Hip Joint Osteochondroma: Systematic Review of the Literature and Report of Three Further Cases." Advances in Orthopedics 2014 (2014): 1–10. http://dx.doi.org/10.1155/2014/180254.

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The aim of this study is to systematically review the literature with regards to surgical treatment of patients with hip joint osteochondromas, and to report our surgical management of three paediatric patients who had femoral neck or acetabular osteochondromas in association with acetabular dysplasia. We performed a systematic review using PubMed and Embase databases for all studies that reported surgical treatments for patients with peritrochanteric or acetabular osteochondroma with or without acetabular dysplasia. We also retrospectively reviewed three patients who were diagnosed with a hip osteochondroma in association with actetabular dysplasia. These patients were known to have hereditary multiple exostoses (HME). The systematic review revealed 21 studies that met our inclusion criteria. All studies were case reports and retrospective in nature and failed to conclude a uniform treatment plan. The three reported cases illustrate successful excision of hip osteochondromas and treatment of acetabular dysplasia. Early excision of hip osteochondromas might prevent acetabular dysplasia in HME patients. Routine radiographic pelvic survey at the time of diagnosis of HME is recommended for early detection of hip osteochondromas and acetabular dysplasia in these children.

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Jones, Kevin B., Virginia Piombo, Charles Searby, Gail Kurriger, Baoli Yang, Florian Grabellus, Peter J. Roughley, et al. "A mouse model of osteochondromagenesis from clonal inactivation of Ext1 in chondrocytes." Proceedings of the National Academy of Sciences 107, no. 5 (December 22, 2009): 2054–59. http://dx.doi.org/10.1073/pnas.0910875107.

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We report a mouse model of multiple osteochondromas (MO), an autosomal dominant disease in humans, also known as multiple hereditary exostoses (MHE or HME) and characterized by the formation of cartilage-capped osseous growths projecting from the metaphyses of endochondral bones. The pathogenesis of these osteochondromas has remained unclear. Mice heterozygous for Ext1 or Ext2, modeling the human genotypes that cause MO, occasionally develop solitary osteochondroma-like structures on ribs [Lin et al. (2000) Dev Biol 224(2):299–311; Stickens et al. (2005) Development 132(22):5055–5068]. Rather than model the germ-line genotype, we modeled the chimeric tissue genotype of somatic loss of heterozygosity (LOH), by conditionally inactivating Ext1 via head-to-head loxP sites and temporally controlled Cre-recombinase in chondrocytes. These mice faithfully recapitulate the human phenotype of multiple metaphyseal osteochondromas. We also confirm homozygous disruption of Ext1 in osteochondroma chondrocytes and their origin in proliferating physeal chondrocytes. These results explain prior modeling failures with the necessity for somatic LOH in a developmentally regulated cell type.

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Oljaca, Ana, Daniela Hirzberger, Marko Bergovec, Kurt Tiesenhausen, Stephan H. Koter, Joerg Friesenbichler, Christian Viertler, and Andreas Leithner. "Osteochondroma of the scapula associated with a subclavian artery pseudoaneurysm: Case report." SAGE Open Medical Case Reports 7 (January 2019): 2050313X1882308. http://dx.doi.org/10.1177/2050313x18823089.

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Osteochondromas rarely induce vascular complications by mechanical compression. We present the case of a subclavian artery pseudoaneursym caused by an osteochondroma of the scapula in a 67-year-old male. The diagnosis was based on a previous history of multiple exostoses, computed tomography and magnetic resonance imaging, as well as the local vascular clinical status of the lesion. Surgical treatment consisted of vascular and orthopaedic intervention. First, the vascular surgeon implanted a bypass of the subclavian artery from the ventral aspect, enabling the orthopaedic surgeon to resect the osteochondroma from the dorsal aspect. The patient recovered with full function. Vascular pseundoaneurysms should be taken into consideration in patients with osteochondromas, especially with a known history of multiple hereditary exostoses.

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Erickson, Lori A., and Carrie Y. Inwards. "Multiple Hereditary Osteochondromas." Mayo Clinic Proceedings 94, no. 7 (July 2019): 1388–89. http://dx.doi.org/10.1016/j.mayocp.2019.05.005.

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Ha, Thi Hien, Thi Minh Thi Ha, Mao Nguyen Van, Trong Binh Le, Nghi Thanh Nhan Le, Thao Nguyen Thanh, and Dac Hong An Ngo. "Hereditary multiple exostoses: A case report and literature review." SAGE Open Medical Case Reports 10 (January 2022): 2050313X2211037. http://dx.doi.org/10.1177/2050313x221103732.

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Osteochondroma is the most common bone tumor representing 20%–50% of all benign bone tumors and 10%–15% of all bone tumors. Osteochondroma has similar radiological appearance in both solitary and multiple forms; the latter is an autosomal dominant disorder termed hereditary multiple exostoses. Associated complications of osteochondroma include deformity, fracture, neurovascular compromise, bursa formation, and malignant transformation. Measurement of the cartilage cap thickness is an important index suggesting secondary malignancy of osteochondroma. The upper limit of cap thickness after skeletal maturation is 1.5 cm which can be reliably measured on ultrasound or magnetic resonance imaging. Hereditary multiple exostoses are linked to the mutations of different exostoses genes located on chromosome 8, 11, and 19. We reported cases of two siblings presented with multiple osteochondromas managed by surgical excision. We evaluated their clinical and radiological presentation, genetic correlations and compared with the literature.

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Szilasi, Anna, Zsófia Koltai, Lilla Dénes, Gyula Balka, and Míra Mándoki. "In Situ Hybridization of Feline Leukemia Virus in a Case of Osteochondromatosis." Veterinary Sciences 9, no. 2 (January 31, 2022): 59. http://dx.doi.org/10.3390/vetsci9020059.

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Osteochondromatosis, also known as multiple cartilaginous exostosis, polyostotic osteochondroma, and multiple osteochondromas, comprises one-fifth of all primary bone tumors in cats, with no breed or sex predisposition or hereditary pattern. Unlike in dogs, horses, and humans, it is predominantly seen in young cats (2–4 years old), after the maturation of the skeleton. Although the pathogenesis of osteochondromatosis is not fully understood, it is considered to be related to infection by feline leukemia virus (FeLV) or other retroviruses, such as the feline sarcoma virus. However, the presence of viral particles within tumor lesions has only been demonstrated by electron microscopy. The malignant transformation of osteochondromas, most typically to osteosarcoma or chondrosarcoma, has also been attributed to the viral infection. Here we report the case of osteochondromatosis in a 3.5-year-old male domestic European shorthair cat with concurrent FeLV infection confirmed by polymerase chain reaction. Viral RNA was visualized in representative tissues (spleen, mesenteric lymph node, liver, kidney, lung, brain) and in the osteochondromas with RNAscope in situ hybridization, which supports that FeLV infection may be involved in the pathogenesis of osteochondromatosis.

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Gupta, Sanjeev, Abdul Ghani, Bias Dev, Rahul Mahajan, John Mohd, Amarjeet Singh, and Zubair A. Lone. "Outcome analysis of solitary osteochondromas of femur managed surgically: a series of 32 patients." International Journal of Research in Orthopaedics 7, no. 1 (December 23, 2020): 82. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20205565.

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Background: Osteochondroma is the commonest benign bone tumor in humans. This tumor may either be solitary or present as multiple lesions. Solitary osteochondromas are much more common. Femur is the single most common long bone involved followed by tibia and humerus. Osteochondromas may be either asymptomatic or may present as pain, pressure symptoms or functional impairment. Most of the symptomatic lesions need surgical excision.Methods: This was a prospective study which included 32 patients with solitary osteochondromas of femur, who were managed with surgical excision. Only the symptomatic cases were operated. Minimum follow-up period was 18 months after surgery.Results: This study involved 23 males (71.87%) and nine females (28.12%). 30 osteochondromas (93.75%) were located in the distal femoral metaphysis while as only two cases (6.25%) of proximal metaphyseal involvement were seen. The commonest indication for surgery was pain. Other indications included cosmetic causes, restricted joint movement, fracture of osteochondroma and paresthesia or numbness. The complications included post-operative hematoma formation which was seen in 2 patients (6.25%), infection which was seen in one patient (3.12%), post-operative hypoaesthesia in 2 patients (6.25%) and recurrence of the tumor occurred in one patient (3.12%).Conclusions: Surgical excision of the solitary symptomatic femoral osteochondromas is a rewarding and safe procedure with minimal complications.

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Raherinantenaina, Fanomezantsoa, Hery Nirina Rakoto-ratsimba, and Toky Mamin'Ny Aina Rajaonanahary. "Management of extremity arterial pseudoaneurysms associated with osteochondromas." Vascular 24, no. 6 (July 9, 2016): 628–37. http://dx.doi.org/10.1177/1708538116634532.

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Arterial pseudoaneurysms associated with osteochondromas are rare and most publications on this topic are case reports. The management of this double entity is not standardized. We wanted to update it. Literature searches on MEDLINE and EMBASE were performed using the keywords “artery pseudoaneurysm” and “osteochondroma”. Patient demographics, clinical presentations, diagnostic and therapeutic modalities were reviewed. In sum, 101 cases were analyzed. Overall, young adults represented the majority of the affected population with a masculine preponderancy (86%). Painful swelling (51%) was the most commonly physical finding. Distal femur was the most common site of the osteochondroma (86%). Multiple hereditary exostosis was seldom reported (36%). Diagnostic confirmation was dominated by arteriography (55%). Popliteal artery (77%) was the most commonly injured vessel. The treatment was open surgery with vascular repair and optimal exostectomy. Arterial repair was performed with saphenous vein grafting (40%) or lateral suture (39%). Postoperative courses were often uneventful (97%). Arterial pseudoaneurysms resulted from osteochondromas were dominated by those involving the popliteal artery. The use of arteriography to confirm the diagnosis may be limited to the benefit of non-invasive radiological methods because endovascular treatment is not relevant in the setting of osteochondroma-induced arterial pseudoaneurysm.

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Yagi, Mitsuru, Ken Ninomiya, Michiya Kihara, and Yukio Horiuchi. "Symptomatic osteochondroma of the spine in elderly patients." Journal of Neurosurgery: Spine 11, no. 1 (July 2009): 64–70. http://dx.doi.org/10.3171/2009.3.spine0912.

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Whereas osteochondroma is a common benign bone tumor in adolescence, it is rarely observed in elderly patients. It is unknown why osteochondromas, which usually develop during skeletal growth, rarely develop in elderly patients. The authors report 3 cases of symptomatic spinal osteochondroma in elderly patients and discuss the possible reasons for the onset of the enlargement of osteochondromas in elderly patients. Clinical history, radiographs, MR images, and CT myelography studies were obtained in each patient and are described. A review of the relevant literature is also presented. In the first case, the cervical osteochondroma caused spinal canal compression and occipital nerve irritation. It was totally excised, which successfully relieved the pain and allowed the patient to return to normal neurological function. In the second case, total removal of the tumor was effective in alleviating clinical symptoms. In the last case, ablation of the articular facet joint partially relieved the patient's lower-back pain. In the first 2 cases, the patients suffered from psoriasis and associated psoriatic arthritis and in the last case, the patient suffered from HIV-associated psoriatic arthritis. The psoriatic arthritis was characterized as asymmetric chronic multiple-joint arthritis and was HLA B27 positive. The pathology of psoriatic arthritis was the accelerating bone turnover and ankylosis. Symptomatic osteochondroma of the spine in elderly patients is extremely rare since it typically develops during skeletal growth. In this report, the authors show that pathological accelerating bone turnover such as psoriatic arthritis may be a possible mechanism for the onset of the enlargement of osteochondromas in elderly patients. The age of the patients in this report suggests that growth of the osteochondroma continues after skeletal development.

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Ismailoglu, Tahir. "A Family with Hereditary Multiple Exostoses." Eurasian Journal of Family Medicine 10, no. 1 (March 30, 2021): 28–32. http://dx.doi.org/10.33880/ejfm.2021100105.

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Hereditary multiple exostoses is a rare autosomal dominant genetic disorder characterized by multiple exostoses (osteochondromas), mostly diagnosed in childhood. It may manifest with a wide spectrum from asymptomatic to skeletal deformities or neurovascular complications. Pain and/or swelling are often the first symptoms for patients to consult a doctor. Although no medical treatment is currently available, lesions can be removed with surgical excision in case of aesthetic anxiety or complications such as deformities or rarely, malign transformation. In this article, three individuals from the same family with hereditary multiple exostoses are described who were evaluated within the core competencies of family medicine. Keywords: exostoses, multiple hereditary, osteochondroma, scoliosis

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Garcia, Sonia A., Hongying Tian, Yuka Imamura-Kawasawa, Aidan Fisher, Ashley Cellini, Casey Codd, John E. Herzenberg, et al. "Understanding the Action of RARγ Agonists on Human Osteochondroma Explants." International Journal of Molecular Sciences 21, no. 8 (April 13, 2020): 2686. http://dx.doi.org/10.3390/ijms21082686.

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Osteochondromas are cartilage-capped growths located proximate to the physis that can cause skeletal deformities, pain, limited motion, and neurovascular impingement. Previous studies have demonstrated retinoic acid receptor gamma (RARγ) agonists to inhibit ectopic endochondral ossification, therefore we hypothesize that RARγ agonists can target on established osteochondromas. The purpose of this study was to examine the action of RARγ agonist in human osteochondromas. Osteochondroma specimens were obtained during surgery, subjected to explant culture and were treated with RARγ agonists or vehicles. Gene expression analysis confirmed the up-regulation of RARγ target genes in the explants treated with NRX 204647 and Palovarotene and revealed strong inhibition of cartilage matrix and increased extracellular matrix proteases gene expression. In addition, immunohistochemical staining for the neoepitope of protease-cleaved aggrecan indicated that RARγ agonist treatment stimulated cartilage matrix degradation. Interestingly, cell survival studies demonstrated that RARγ agonist treatment stimulated cell death. Moreover, RNA sequencing analysis indicates changes in multiple molecular pathways due to RARγ agonists treatment, showing similarly to human growth plate chondrocytes. Together, these findings suggest that RARγ agonist may exert anti-tumor function on osteochondromas by inhibiting matrix synthesis, promoting cartilage matrix degradation and stimulating cell death.

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Kim, Dong Wan, Ki Cheor Bae, Eun Seok Son, Chung Sin Baek, and Chul Hyun Cho. "Osteochondroma of the Distal Clavicle: A Rare Cause of Impingement and Biceps Tear of the Shoulder." Clinics in Shoulder and Elbow 21, no. 3 (September 1, 2018): 158–61. http://dx.doi.org/10.5397/cise.2018.21.3.158.

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Hereditary multiple exostosis (HME) is an autosomal dominant disorder manifested by the presence of multiple osteochondromas. Although the lesions are benign in nature, exostoses are often associated with characteristic progressive skeletal deformity and displaying clinical symptoms such as mechanical irritation or impingement. We present the successful arthroscopic resection in a 24-year-old HME male with impingement syndrome and long head tendon tear of the biceps caused by osteochondroma arising from the distal clavicle.

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Fiumara, Ettore, Tommaso Scarabino, Giuseppe Guglielmi, Michele Bisceglia, and Vincenzo D'Angelo. "Osteochondroma of the L-5 vertebra: a rare cause of sciatic pain." Journal of Neurosurgery: Spine 91, no. 2 (October 1999): 219–22. http://dx.doi.org/10.3171/spi.1999.91.2.0219.

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✓ Solitary or multiple osteochondromas, which are benign bone tumors that usually occur in the long bones, are rarely found in the vertebral column. When present in the spine, however, they have a predilection for the cervical or upper thoracic regions. The authors present the case of a solitary osteochondroma arising from the left L-5 articular process that contributed to sciatica; complete cure was achieved following its removal. It is possible to speculate that the cartilage of secondary ossification centers can be the origin of aberrant islands of cartilaginous tissue that cause the osteochondroma to form. The more rapid the ossification process of these centers, the greater the probability that aberrant cartilage will form. Therefore, the fact that osteochondromas are more frequently located in the higher segments of the vertebral column could be explained by the different durations of the ossification processes in these centers, which increase gradually below the cervical segments.

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Pathak, Subodh Kumar, Jasneet Singh Chawla, Manjeet Singh, and Jagandeep Singh Virk. "Giant ulcerative benign osteochondroma of shoulder." BMJ Case Reports 14, no. 9 (September 2021): e243202. http://dx.doi.org/10.1136/bcr-2021-243202.

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Osteochondromas in hereditary multiple exostosis have increased risk of malignant transformation as compared with solitary osteochondromas. We present a case of a 54-year-old man who presented to us with complaints of swollen mass of the left shoulder with an ulcerative lesion. Radiograph showed a sessile growth from the proximal humerus and scapula. MRI revealed a sessile osteochondroma measuring about 11×10.1×8.0 cm. The malignant nature of the disease was anticipated due to increased cap thickness and non-healing ulcer, however, biopsy showed a benign lesion without any sarcomatous change. The patient was successfully treated with extra-periosteal excision and was recurrence-free at 24 months follow-up. This case illustrates an extra-articular giant osteochondroma of the proximal humerus, with possible signs of a malignant lesion but diagnosed benign on biopsy. We conclude that a biopsy should always preclude definitive management as this can change the overall mortality and morbidity of the patient.

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Trisolino, Giovanni, Manila Boarini, Marina Mordenti, Andrea Evangelista, Giovanni Gallone, Stefano Stallone, Paola Zarantonello, et al. "Outcomes of Temporary Hemiepiphyseal Stapling for Correcting Genu Valgum in Children with Multiple Osteochondromas: A Single Institution Study." Children 8, no. 4 (April 8, 2021): 287. http://dx.doi.org/10.3390/children8040287.

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Background: Multiple osteochondromas is a rare skeletal disorder characterized by the presence of osteocartilaginous protrusions causing bony deformities, especially around the knee. Guided growth by temporary hemiepiphyseal stapling is the treatment of choice to correct the deformity by modulating the residual physeal growth of the lower limbs. Although this procedure is increasingly practiced, inconclusive evidence exists regarding its effectiveness in children with multiple osteochondromas. The study aims to compare the outcomes of temporary hemiepiphyseal stapling for correcting genu valgum in children with multiple osteochondromas vs. idiopathic cases. Methods: In this retrospective cohort study, we included patients admitted at a single institution from 2008 to 2018. A total of 97 children (77 idiopathic, 20 multiple osteochondromas) were enclosed, accounting for 184 limbs treated by temporary hemiepiphyseal stapling. We investigated if children with multiple osteochondromas had a similar successful rate of correction, rate of complications, and correction velocity compared to children with idiopathic genu valgum. Results: Overall, 151 limbs (82%) achieved complete correction or overcorrection, with idiopathic cases having a significantly higher rate of success compared to pathologic cases (88% vs. 55%; p < 0.001). In addition, multiple osteochondromas children sustained a higher rate of major complications (p = 0.021) and showed significantly lower correction velocity (p = 0.029). Conclusion: Temporary hemiepiphyseal stapling is effective in both idiopathic and multiple osteochondromas children, although the latter often achieved incomplete correction, had a higher risk of complications, and required a longer time of stapling. We suggest to anticipate the timing of intervention; otherwise, children with multiple osteochondromas and severe valgus deformity, approaching skeletal maturity, could undergo combined femoral and tibial stapling.

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Jennes, Ivy, Elena Pedrini, Monia Zuntini, Marina Mordenti, Sahila Balkassmi, Carla G. Asteggiano, Brett Casey, Bert Bakker, Luca Sangiorgi, and Wim Wuyts. "Multiple osteochondromas: mutation update and description of the multiple osteochondromas mutation database (MOdb)." Human Mutation 30, no. 12 (December 2009): 1620–27. http://dx.doi.org/10.1002/humu.21123.

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Ghoti, Santosh, Neetin P. Mahajan, Pranay Kondewar, Kartik Prashant Pande, and Kunal Chaudhari. "A Case Report on Surgical Excision of Intracapsular Osteochondroma of Femur Neck using Mini-Arthrotomy without Hip Dislocation in a Young Female with Hereditary Multiple Exostoses." Journal of Orthopaedic Case Reports 12, no. 6 (2022): 66–69. http://dx.doi.org/10.13107/jocr.2022.v12.i06.2868.

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Introduction: Osteochondromas are the most common benign bone tumors. They probably are developmental malformations rather than true neoplasms and are thought to originate within the periosteum as small cartilaginous nodules. The lesions consist of a bony mass produced by progressive endochondral ossification of a growing cartilaginous cap. Osteochondromas usually are found on the metaphysis of a long bone near the physis such as distal femur, proximal tibia, and proximal humerus. Surgical treatment for femur neck osteochondroma is difficult due to the high risk of avascular necrosis following excision. These lesions in femur are in close proximity to important neurovascular bundle and can cause ymptoms related to their compression. Furthermore, the symptoms related to labral tear and hip impingement are common. Recurrence is rare and is caused by failure to remove the entire cartilaginous cap. Case Report: A 25-year-old female presented with the complaints of pain in the right hip and difficulty in walking and running for 1 year. On radiological examination, the right femur neck osteochondroma was diagnosed, it as located along the posteroinferior margin of the femur neck. Surgical removal of the lesion was done in lateral decubitus position using osterolateral approach to hip without dislocation of the femur. Conclusion: Osteochondroma at femur neck can be safely removed without surgical hip dislocation. It’s necessary to remove it completely to avoid recurrence.

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Sakamoto, Akio, and Shuichi Matsuda. "Pes Anserinus Syndrome Caused by Osteochondroma in Paediatrics: A Case Series Study." Open Orthopaedics Journal 11, no. 1 (May 17, 2017): 397–403. http://dx.doi.org/10.2174/1874325001711010397.

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Introduction: Osteochondroma is a common benign bone tumor, protruding from the underlying normal bone. Osteochondromas can cause pain depending on their location and size. The pes anserinus is located at the proximal medial side of the tibia, where the tendinous insertions of the sartorius, gracilis and semitendinosus muscles collectively attach. Pes anserinus syndrome, or anserine bursitis, is a painful condition of the pes anserinus, and is more common in adults typically with overweight females. The occurrence of pes anserinus syndrome is rare in the paediatric population. Results: In the current case series, five patients with pes anserinus syndrome due to proximal tibial osteochondroma are reported. Pain was present in all cases, with snapping in one case. The average age of the patients was 13 ± 1.2 years, ranging from 12 to 15 years. Three patients had a single osteochondroma, and two patients had hereditary multiple exostoses. The sizes of the osteochondromas on plain radiographs varied from 0.5 to 2.5 cm, with an average of 1.46 ± 0.83 cm. All lesions characteristically were located at the medial-posterior edge of the proximal tibia. The symptoms resolved in four cases with surgical resection, and persisted in one non-resected patient. Conclusion: The characteristic location of the osteochondroma causes pes anserinus syndrome, even though the lesion is small. The diagnosis of osteochondroma or pes anserinus syndrome may be overlooked when it occurs in a paediatric population. The symptoms seem to be consistent, and resection of the osteochondroma is necessary for treatment.

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Weinrich, Brooke, and Kim Michael. "Multiple Osteochondromas: An Incidental Finding." Journal of Diagnostic Medical Sonography 24, no. 3 (March 14, 2008): 169–73. http://dx.doi.org/10.1177/8756479308317240.

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SHIH, WEI-JEN, CHRISTINE N. RILEY, PEGGY A. DOMSTAD, and FRANK H. DeLAND. "Scintigraphic Findings of Multiple Osteochondromas." Clinical Nuclear Medicine 11, no. 8 (August 1986): 600–601. http://dx.doi.org/10.1097/00003072-198608000-00023.

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Dey, Biswajit, Mangesh Chikhale, Prita Pradhan, Adarsh Barwad, and Bhawana Ashok Badhe. "Proximal epithelioid sarcomatous dedifferentiation in secondary chondrosarcoma in a known case of multiple osteochondromatosis." Journal of Laboratory Physicians 9, no. 03 (July 2017): 214–16. http://dx.doi.org/10.4103/0974-2727.208253.

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AbstractOsteochondroma is the most common benign bone tumor. Approximately 15% of osteochondromas occur as multiple lesions. Multiple osteochondromatosis has a higher risk of developing chondrosarcomas, which are of low grade with good prognosis. About 10% of all chondrosarcomas may undergo dedifferentiated change, which has a poorer prognosis. Dedifferentiated peripheral chondrosarcoma developing within an osteochondroma is extremely rare. Dedifferentiation usually occurs in the form of osteosarcoma, malignant fibrous histiocytoma, fibrosarcoma, or rhabdomyosarcoma. We report a case of proximal epithelioid sarcomatous dedifferentiation in secondary chondrosarcoma in a 39-year-old male with multiple osteochondromatosis in bilateral arm. To the best of our knowledge, epithelioid sarcomatous dedifferentiation has not been described in the literature.

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Staal, Heleen M., John Derwall, Adhiambo M. Witlox, and Lodewijk W. van Rhijn. "Time-lapse technic used to uncover the naturel growth of osteochondromas of the wrist in patients with Hereditary Multiple Osteochondromas." International Journal of Diagnostic Imaging 4, no. 2 (June 9, 2017): 57. http://dx.doi.org/10.5430/ijdi.v4n2p57.

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Background: In patients with Hereditary Multiple Osteochondromas (HMO) shortening and deformity of the long bones is a well-known sequel. Several theories could clarify the cause of shortening or deformity.Methods: To reveal the development of the long bones and the influence of the osteochondromas on the growth we used time-lapse technique. Radiographic images, taken for clinical reasons, of 6 HMO affected patients with known osteochondromas on the distal end of the lower arm were selected and adapted to make them suitable for use with a time-lapse technique. The images were placed in chronological order. The ulnar shortening, lunate position and radial inclination were registered, as were the clinical problems. The hypothesis being that slow occurring developmental deformities are easier comprehended and qualitatively studied when the changes are accelerated. Results: None of the patients had radial head dislocation at the elbow. The majority of the wrists had decreased ulnar length and increased radial inclination. The clinical problems were limited. The osteochondromatic growth did not seem related to the wrist growth, but when the inclination of the radius was steep osteochondromas were present in the distal radius and the ulna was shortened. Some osteochondromas disappeared.Conclusions: Time-lapse videos of wrists of patients with HMO showed no relation between growth of wrists and osteochondromas but it did show osteochondromas disappearing. A steep radial inclination seems related to ulnar shortening and might be due to proximity of radial osteochondromas. Patients had marked radiological changes, but relatively few clinical problems.

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Kubota, Hideaki, Akira Okue, Tomoki Ishizaki, Nobuyuki Matsuguchi, Takayasu Shindou, Keishi Tahara, and Yukio Esaki. "Spinal cord compression by an osteochondroma in a patient with multiple osteochondromas." Orthopedics & Traumatology 38, no. 2 (1989): 697–700. http://dx.doi.org/10.5035/nishiseisai.38.697.

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Yanagi, Hidehiro, Katumi Suzuki, Toshitaka Nakamura, Shinichi Mishima, and Akihiko Hijioka. "Thoracic Cord Compression by an Osteochondroma in a Patient with Multiple Osteochondromas." Orthopedics & Traumatology 41, no. 1 (1992): 380–84. http://dx.doi.org/10.5035/nishiseisai.41.380.

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Ng, Colin, Luigi Bibiano, Stephan Grech, and Branko Magazinovic. "Antecubital Fossa Solitary Osteochondroma with Associated Bicipitoradial Bursitis." Case Reports in Orthopedics 2015 (2015): 1–5. http://dx.doi.org/10.1155/2015/560372.

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Antecubital fossa lesions are uncommon conditions that present to the orthopaedic clinic. Furthermore, the radius bone is an uncommonly reported location for an osteochondroma, especially when presenting with a concurrent reactive bicipitoradial bursitis. Osteochondromas are a type of developmental lesion rather than a true neoplasm. They constitute up to 15% of all bone tumours and up to 50% of benign bone tumours. They may occur as solitary or multiple lesions. Multiple lesions are usually associated with a syndrome known as hereditary multiple exostoses (HME). Malignant transformation is known to occur but is rare. Bicipitoradial bursitis is a condition which can occur as primary or secondary (reactive) pathology. In our case, the radius bone osteochondroma caused reactive bicipitoradial bursitis. The differential diagnosis of such antecubital fossa masses is vast but may be narrowed down through a targeted history, stepwise radiological investigations, and histological confirmation. Our aim is to ensure that orthopaedic clinicians keep a wide differential in mind when dealing with antecubital fossa mass lesions.

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Wen, Dennis Y., Thomas A. Bergman, and Stephen J. Haines. "Acute Cervical Myelopathy from Hereditary Multiple Exostoses: Case Report." Neurosurgery 25, no. 3 (September 1, 1989): 472–75. http://dx.doi.org/10.1227/00006123-198909000-00028.

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Abstract A case of hereditary multiple exostoses with acute cervical myelopathy, tetraplegia, and apnea is reported. Neurological complications as a result of osteochondromas in hereditary multiple exostoses are rare. The majority of osteochondromas in the cervical spine arise from the neural arch. Magnetic resonance imaging and computed tomography are invaluable in localizing the origin of the lesion and its relationship to the spinal cord. Decompressive laminectomy usually results in excellent functional recovery. Where significant dorsal spinal cord compression exists without neurological deficit, prophylactic decompression can be recommended.

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Baek, Goo Hyun, Jin Sam Kim, and Moon Sang Chung. "Multiple Subungual Osteochondromas: A Case Report." Journal of the Korean Orthopaedic Association 39, no. 5 (2004): 579. http://dx.doi.org/10.4055/jkoa.2004.39.5.579.

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Talbot, Simon G., Joseph Upton, and Gary F. Rogers. "Muenke Syndrome Associated With Multiple Osteochondromas." Journal of Craniofacial Surgery 23, no. 2 (March 2012): e115-e117. http://dx.doi.org/10.1097/scs.0b013e31824cd9f6.

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Kavipriya, M. "Multiple hereditary osteochondromas - A rare case." Journal of the Anatomical Society of India 66 (August 2017): S113—S114. http://dx.doi.org/10.1016/j.jasi.2017.08.362.

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Fisher, Thomas J., Nicole Williams, Lloyd Morris, and Peter J. Cundy. "Metachondromatosis: more than just multiple osteochondromas." Journal of Children's Orthopaedics 7, no. 6 (December 2013): 455–64. http://dx.doi.org/10.1007/s11832-013-0526-3.

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35

Spasojevic, Milos, Samuel P. Mackenzie, Allan Young, and Benjamin Cass. "Subacromial osteochondroma and rotator cuff tear in a young adult with multiple osteochondromas." JSES Reviews, Reports, and Techniques 2, no. 1 (February 2022): 92–95. http://dx.doi.org/10.1016/j.xrrt.2021.09.008.

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Lee, Dong Hoon, and Dror Paley. "Reconstruction of the Hip in Multiple Hereditary Exostoses." Children 8, no. 6 (June 8, 2021): 490. http://dx.doi.org/10.3390/children8060490.

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The hip joint involvement in multiple hereditary exostoses (MHE) occurs in 30–90%, causing pain and limitation of motion by femoroacetabular impingement, coxa valga, acetabular dysplasia, hip joint subluxation, and osteoarthritis. The purpose of this study was to investigate the clinical and radiographic outcomes of ten hips in seven patients treated by surgical dislocation and corrective osteotomies between 2004 and 2009. Surgical dislocation and excision of the osteochondromas and varus intertrochanteric osteotomies were performed in all cases when the neck–shaft angle was > 150°. Common sites of osteochondromas were medial, posterior, and anterior neck of the femur. Neck–shaft angle of the femur was improved from a mean of 157° to 139°, postoperatively. On an average, the center-edge angle improved from 20° to 30° postoperatively. We believe that Ganz’s safe surgical dislocation technique is the preferred treatment of MHE. This safeguards the circulation of the femoral head and the osteochondromas can be resected under direct vision. It can be combined with additional corrective osteotomies because the hip affected by MHE is frequently associated with dysplastic changes which can result in premature osteoarthritis.

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Milton, Camille K., Kyle P. O’Connor, Adam D. Smitherman, Andrew K. Conner, and Michael D. Martin. "Solitary osteochondroma of the cervical spine presenting with quadriparesis and hand contracture." Surgical Neurology International 11 (March 21, 2020): 51. http://dx.doi.org/10.25259/sni_3_2020.

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Background: Spinal osteochondromas are rare, benign tumors arising from the cartilaginous elements of the spine that may appear as solitary lesions versus multiple lesions in patients with hereditary multiple exostoses. Here, we present a 15-year-old female with a solitary C3-C4 osteochondroma who presented with a progressive quadriparesis and hand contracture successfully managed with a laminectomy/posterior spinal fusion. Case Description: A 15-year-old female presented with a 3-month history of progressive quadriparesis and hand contracture secondary to a magnetic resonance (MR) documented C3-C4 cervical spine osteochondroma. The MR imaging revealed a solitary osseous extramedullary outgrowth arising from the left laminar cortex of the C-3 vertebral body extending to C-4. Due to the marked resultant canal stenosis, the patient underwent a cervical laminectomy of C3- C4 with posterior spinal fusion. Gross total resection was achieved, and the pathology confirmed an osteochondroma. The patient’s myelopathy resolved, and 2 years later, she demonstrated no residual deficits or tumor recurrence. Conclusion: Here, we report the successful management of a 15-year-old female with a C3-C4 osteochondroma and progressive quadriparesis through cervical laminectomy/fusion.

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Veraldi, Noemi, Alessandro Parra, Elena Urso, Cesare Cosentino, Manuela Locatelli, Serena Corsini, Elena Pedrini, Annamaria Naggi, Antonella Bisio, and Luca Sangiorgi. "Structural Features of Heparan Sulfate from Multiple Osteochondromas and Chondrosarcomas." Molecules 23, no. 12 (December 11, 2018): 3277. http://dx.doi.org/10.3390/molecules23123277.

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Multiple osteochondromas (MO) is a hereditary disorder associated with benign cartilaginous tumors, known to be characterized by absence or highly reduced amount of heparan sulfate (HS) in the extracellular matrix of growth plate cartilage, which alters proper signaling networks leading to improper bone growth. Although recent studies demonstrated accumulation of HS in the cytoplasm of MO chondrocytes, nothing is known on the structural alterations which prevent HS from undergoing its physiologic pathway. In this work, osteochondroma (OC), peripheral chondrosarcoma, and healthy cartilaginous human samples were processed following a procedure previously set up to structurally characterize and compare HS from pathologic and physiologic conditions, and to examine the phenotypic differences that arise in the presence of either exostosin 1 or 2 (EXT1 or EXT2) mutations. Our data suggest that HS chains from OCs are prevalently below 10 kDa and slightly more sulfated than healthy ones, whereas HS chains from peripheral chondrosarcomas (PCSs) are mostly higher than 10 kDa and remarkably more sulfated than all the other samples. Although deeper investigation is still necessary, the approach here applied pointed out, for the first time, structural differences among OC, PCS, and healthy HS chains extracted from human cartilaginous excisions, and could help in understanding how the structural features of HS are modulated in the presence of pathological situations also involving different tissues.

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Mariúba, Jamil Victor de Oliveira, Marcone Lima Sobreira, Winston Bonetti Yoshida, Eduardo Savio de Oliveira Mariúba, Hamilton de Almeida Rollo, Regina Moura, Matheus Bertanha, et al. "Case Report: Tibial and fibular osteochondroma as an unusual cause of popliteal artery entrapment syndrome." F1000Research 7 (February 16, 2018): 198. http://dx.doi.org/10.12688/f1000research.13648.1.

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Background: Osteochondroma, or osteocartilaginous exostosis, is the most common benign neoplasm of bone, and accounts for 20-50% of all benign tumors. Vascular complications associated with osteochondromas are rare, and include pseudoaneurysm formation, vessel occlusion and vessel displacement. To date, only two cases of popliteal artery entrapment syndrome (PAES) caused by an isolated fibular osteochondroma have been reported. Case Report: This report describes a unique case of PAES. A 33-year-old woman had a history of multiple osteochondroma, including of the proximal tibia and fibula on the left, diagnosed at age two years and monitored clinically by an orthopedist. The patient presented at our facility with a one-year history of a progressive intermittent claudication, left-sided toe pain and pallor in cold weather. After a complete evaluation, we diagnosed an arterial occlusion of the left popliteal artery. We tried several attempts of revascularization, by different forms, without success. The case went to amputation surgery. Conclusion: We consider this an important case because, although the association of osteochondroma and PAES is rare, physicians should consider it early to avoid acute vascular complications. Moreover, to date, we believe this is the first description of a PAES related with multiple osteochondroma.

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Temple, H. Thomas. "Central Chondrosarcoma in Patients with Multiple Osteochondromas." Journal of Bone and Joint Surgery 97, no. 1 (January 2015): e5. http://dx.doi.org/10.2106/jbjs.n.00960.

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Myers, Kyle, and Kathryn Dahir. "RF30 | PSAT134 Autosomal Dominant Hereditary Multiple Osteochondromas Misdiagnosed As Paget's Disease of Bone." Journal of the Endocrine Society 6, Supplement_1 (November 1, 2022): A229—A230. http://dx.doi.org/10.1210/jendso/bvac150.471.

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Abstract Background Autosomal dominant hereditary multiple osteochondromas is a rare genetic disorder with variable clinical manifestations. We present the case of a patient misdiagnosed with Paget's disease of bone found to have hereditary multiple osteochondromas. Clinical Case We present a 55-year-old male with history of chronic back and hip pain who presented to endocrinology clinic for evaluation of Paget's disease of bone. He was diagnosed with Paget's disease at age 16 after a bike accident resulting in knee pain where a "knot" was removed from his knee. He reported multiple "knots" in bones throughout adulthood but never sought treatment. He had history of elevated alkaline phosphatase on prior chemistries. He developed debilitating back, hip, and thigh pain resulting in immobility and suffered vertebral osteomyelitis from MRSA requiring laminectomy at age 52. On physical exam, massive maxillary and mandibular tori were noted along with bilateral cataracts and decreased muscle strength in upper and lower extremities. He underwent evaluation by oral surgery for extensive tooth decay and was recommended for extraction of teeth #12, 14, 15, and 17 with restorative needs for teeth #2, 4, 5, 13, 28, 30, 32. Labs notable for serum calcium 10.1 (ref: 8.4-10.5 mg/dl), phosphorus 4.2 (ref: 2.3-4.7 mg/dl), magnesium 1.8 (ref: 1.6-2.6mg/dl), PTH 34 (ref: 16-77 pg/ml), 25-OH Vit D 28 (ref: 25-80 ng/ml), 1,25 dihydroxyvitamin D 45.9 (ref: 19.9-79.3pg/ml), alkaline phosphatase 199 (ref: 40-150 unit/L), bone-specific alkaline phosphatase 52.5 (ref: 6.5 - 20.1 mcg/L). 24-hr urine calcium 0.06 g/24hr (ref: 0.04-0.35) from an 850ml urine volume. Procollagen type 1 n-terminal propeptide 179 (ref 22-105 UG/L). Prior MRI right hip showed "abnormal appearance of pelvic bony ring and proximal femurs with heterogenous marrow signal and cortical thickening suspicious for Paget's disease", as well as a 1.2cm circumscribed cystic focus within proximal right femoral diaphysis. Prior bone scan demonstrated diffusely uptake in pelvis, uptake in proximal right femur, focally intense uptake in L5 vertebrae. Plain film imaging demonstrated severe diffuse degenerative changes in cervical, thoracic and lumbar vertebrae and sessile osteochondromas arising from both scapulae, mild thoracic levoscoliosis. Genetic testing demonstrated loss-of-function mutation in the EXT-1 gene, diagnostic of hereditary multiple osteochondromas. Currently, there are no FDA-approved treatments for osteochondromas though studies involving biologic therapy are ongoing. This patient was referred to orthopedic oncology and OMFS for dental extraction and decision for conservative treatment with observation. Conclusion This case demonstrates how the rare entity of hereditary multiple osteochondromas can have variable clinical presentations leading to its misdiagnosis and highlights the need for ongoing research into non-surgical treatment options. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m., Monday, June 13, 2022 12:36 p.m. - 12:41 p.m.

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EL-Sobky, Tamer A., Shady Samir, Ahmed Naeem Atiyya, Shady Mahmoud, Ahmad S. Aly, and Ramy Soliman. "Current paediatric orthopaedic practice in hereditary multiple osteochondromas of the forearm: a systematic review." SICOT-J 4 (2018): 10. http://dx.doi.org/10.1051/sicotj/2018002.

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Introduction: This systematic review aims to answer three research questions concerning the management of hereditary multiple osteochondromas of forearm in children: What is the best available evidence for the currently employed surgical procedures? What patient characteristics are associated with better prognosis? What disease characteristics are associated with better prognosis? Methods: We searched the literature using three major databases with no publication date restrictions. To enhance search sensitivity and maintain precision we used keywords/subject terms correlating with patient population, problem and interventions. We used strict inclusion/exclusion criteria to improve validity evidence. Results: The search process yielded 34 eligible studies with a total of 282 patients (315 forearms). We comprehensively analysed study and patient demographics and interventions and outcomes. Eleven studies (32%) had a long-term follow-up and 31 studies (91%) were retrospective. Of the total number of forearms, ulnar lengthening +/− associated procedures was used in 210 forearms (66.7%), isolated osteochondroma excision in 65 forearms (20.6%) and isolated distal radius hemiepiphysiodesis in 15 forearms (4.7%) among others. Discussion: Ulnar lengthening can restore radiologic anatomy, improve appearance and to a lesser extent objective clinical parameters like joint range of motion on the short/intermediate term. Isolated osteochondroma excision can relief pain and satisfy cosmetic concerns occasionally. There is poor evidence to suggest that surgery improves quality of life or function. Predictors of surgical success in regard to patient and disease characteristics remain elusive. Natural history and prospective randomized control studies where the control group receives no treatment should be rethought. They have the potential for bias control and identification of the ideal surgical candidate. The complex interplay between the confounding variables has undermined the capability of most studies to provide well-grounded evidence to support and generalize their conclusions. Valid quality of life scales should supplement objective outcome measures.

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GORE, DONALD R. "Intra???articular Osteochondromas of the Hip Joint in a Child with Multiple Osteochondromas Case Report." Clinical Orthopaedics and Related Research &NA;, no. 199 (October 1985): 173???178. http://dx.doi.org/10.1097/00003086-198510000-00023.

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Masada, K., Y. Tsuyuguchi, H. Kawai, H. Kawabata, K. Noguchi, and K. Ono. "Operations for forearm deformity caused by multiple osteochondromas." Journal of Bone and Joint Surgery. British volume 71-B, no. 1 (January 1989): 24–29. http://dx.doi.org/10.1302/0301-620x.71b1.2914999.

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de Mooij, Tristan, Wim Wuyts, and John Ham. "Phenotypic Differences in Multiple Osteochondromas in Monozygotic Twins." JBJS Case Connector 2, no. 4 (October 24, 2012): e60. http://dx.doi.org/10.2106/jbjs.cc.k.00134.

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Masada, Kazuhiro, Haruo Kojimoto, Natsuo Yasui, and Keiro Ono. "Progressive Lengthening of Forearm Bones in Multiple Osteochondromas." Journal of Pediatric Orthopaedics B 2, no. 1 (1993): 66–69. http://dx.doi.org/10.1097/01202412-199302010-00012.

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Takagi, M., Yoshiro Kiyoshige, Akira Ishikawa, and Toshihiko Ogino. "Multiple occurrence of osteochondromas in dysplasia epiphysealis hemimelica." Archives of Orthopaedic and Trauma Surgery 120, no. 5-6 (April 25, 2000): 358–60. http://dx.doi.org/10.1007/s004020050484.

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Piombo, Virginia, Katja Jochmann, Daniel Hoffmann, Manuela Wuelling, and Andrea Vortkamp. "Signaling systems affecting the severity of multiple osteochondromas." Bone 111 (June 2018): 71–81. http://dx.doi.org/10.1016/j.bone.2018.03.010.

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Schmale, Gregory A., Douglas S. Hawkins, Joe Rutledge, and Ernest U. Conrad. "Malignant Progression in Two Children with Multiple Osteochondromas." Sarcoma 2010 (2010): 1–7. http://dx.doi.org/10.1155/2010/417105.

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Multiple Osteochondromas (MO) is a disease of benign bony growths with a low incidence of malignant transformation. Secondary chondrosarcoma in children is rare even in children with MO. Making a diagnosis of malignancy in low-grade cartilage tumors is challenging and requires consideration of clinical, radiographic, and histopathological factors. We report two cases of skeletally immature patients with MO who presented with rapidly enlarging and radiographically aggressive lesions consistent with malignant transformation. Both underwent allograft reconstruction of the involved site with no signs of recurrence or metastatic disease at a minimum of four-year follow-up.

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Porter, D. E., and A. H. R. W. Simpson. "The neoplastic pathogenesis of solitary and multiple osteochondromas." Journal of Pathology 188, no. 2 (June 1999): 119–25. http://dx.doi.org/10.1002/(sici)1096-9896(199906)188:2<119::aid-path321>3.0.co;2-n.

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Journal articles on the topic 'Multiple Osteochondromas'

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