Year : 2006 | Volume
: 40 | Issue : 2 | Page : 123--124
Solitary osteochondroma of thoracic spine - A case report
Department of Orthopedics, Jawaharlal Medical College, Belgaum, India
S M Antin
Professor of Orthopedics, Jawaharlal Medical College, KLES Hospital Belgaum – 590 010
|How to cite this article:|
Antin S M. Solitary osteochondroma of thoracic spine - A case report.Indian J Orthop 2006;40:123-124
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Antin S M. Solitary osteochondroma of thoracic spine - A case report. Indian J Orthop [serial online] 2006 [cited 2020 Feb 24 ];40:123-124
Available from: http://www.ijoonline.com/text.asp?2006/40/2/123/34456
Osteochondroma also known as "osteocartilaginous exostosis" is one of the more common benign tumours usually found in appendicular skeleton but rarely in spine. Osteochondroma of spine usually arise from neural arch of cervical and thoracic vertebra and compression of spinal cord is seen more often in hereditary multiple exostosis than in solitary lesion , .
We report a case of solitary osteochondroma arising from the neural arch of T 3 -T 4 vertebra without neurological deficit.
A 25 year young policeman presented with a 2yr history of swelling and pain in the left side of back of the chest. The swelling was associated with a dull aching pain which increased on doing heavy work and relieved by rest. Examination of the spine revealed an elliptical tumor of 8x6 cm size situated lateral to T 3 -T 4 vertebra on left side. The swelling was firm to bony hard in consistency which appeared fixed to the underlying corresponding vertebra and ribs. The characteristic feature of the swelling was that it became more prominent as the patient bent forwards [Figure 1]. Skin over the swelling was normal. The patient had cutaneous hemangioma over anterior wall of the chest. There were no similar swellings in any other parts of the body. The neurological examination and remainder orthopedic examination was normal.
Plain X ray AP view of the thoracic spine showed expansile lesion with irregular calcification within the tumor [Figure 2]. Plain CT of thorax revealed the evidence of expansile lesion seen to arise from the posterior elements of T 3 -T 4 vertebra with the lesion showing mixed density with central dense calcification. The normal marrow was seen between the mass and the normal vertebra and the mass was not extending in the spinal canal [Figure 3]. Contrast CT scan did not show enhanced uptake by the tumor. FNAC of the tumor was done and it was reported as chondroma. Excision biopsy of the tumor was planned.
Under general anaesthesia, patient was put in prone position. A 10 cms long vertical para median incision was made on the tumour. Trapezius was dissected paraspinal muscles were incised along the fibres to expose the tumor. Elliptical capsulated mass was seen with all the borders well defined. En bloc excision of the tumor was carried out. Tumor revealed [Figure 4] a hard mass measuring 8 x 6 x 4 cms along with multiple grey white bony pieces. The mass appears partly encapsulated and cut section shows slightly friable grey white tissue mixed with haemorrhagic areas.
Microscopic picture showed a benign neoplasm consisting of a mixture of osteoid tissue and cartilage. The cartilagenous tissue had normal appearing chondrocytes. The lobules were intermingled with osteoid elements and marrow. At some areas there was endochondral ossification. The whole lesion is encapsulated in a fibrous capsule. The neoplasm was vascular. The histopathological examination was suggestive of osteochondroma. Postoperative course was uneventful and patient got relieved of his symptoms after surgery.
Dahlin and Unni have suggested that osteochondromas account for 36% of all benign bone tumors and that multiple exostosis constitute approximately 12% of all symptomatic lesions  . Between 1.3 to 4.1% of solitary osteochondroma arise in spine  ; approximately 9% of patients who are affected by hereditary multiple exostosis harbours spinal lesions.
Osteochondromas are thought to arise through a process of progressive enchondral ossification of aberrant cartilage of a growth plate as a consequence of congenital defect or trauma. Knowledge of how the spine develops could help us to speculate on another explanation. In adolescence, secondary ossification centers, which lie in the spinous process, transverse process, articular process, and end plate of vertebral body, complete the growth of the vertebral column. These secondary ossification centers appear in children between the ages of 11 and 18 years and develop in to complete ossification in the cervical spine during adolescence: in the thoracic and lumbar spine during the end of second decade of life and in the sacrum during the third decade of life. The cartilage of these secondary ossification centers could be the origin of aberrant islands of cartilaginous tissue that cause osteochondroma to form. It can be speculated that the more rapidly the ossification process of these centers develop, the greater is the probability that aberrant cartilage will form. Therefore, the fact that osteochondroma is more frequently located in the upper segments of the vertebral column could be explained by different durations of the ossification process in these centers  .
Radiculopathy and/or myelopathy are uncommon manifestation of osteochondroma  , when present it is more commonly due to multiple osteochondromas. The neurological deficit is invariably the result of compression caused by an expanding lesion arising from the posterior elements  . Spinal osteochondromas typically appears as a sessile or pedunculate bone like lesion in which the cortex and spongiosa are in continuity with those of the host vertebra  .
Solitary spinal osteochondroma are rare and rarely do they present with myelopathy and or radiculopathy. Most commonly they arise from posterior elements of the cervical and upper thoracic spine could be explained by different durations of the ossification processes that occur in these centers. CT is the diagnostic procedure of choice. Outcome in the majority of surgically treated patients are good and malignant degeneration is a very rare event.
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