CASE REFLECTION

OF
OSTEOCHONDROMA
PEMBIMBING : DR. YANA SUPRIYATNA , PHD, SP. R AD (K)
BENNY YOHANIS GAE
STASE RADIOLOGI RSUP SARDJITO
IDENTITAS
Nama : Tn. BS
Usia : 18 th
Alamat : Imogiri, Bantul
Pekerjaan : Mahasiswa
No RM : 01.46.4X.XX
Tanggal masuk : 25/4/2018
ANAMNESIS
Keluhan Utama : Benjolan di lutut kanan yang mulai dirasakan ±
1,5 TSMRS, teraba keras, tidak bergerak, nyeri (-), penurunan BB
(-), batuk (-). HMRS keluhan menetap.
RPD : keluhan yang sama (-), tumor (-), riw. trauma (-)
RPK : keluhan yang sama (-), tumor (-).
Pemeriksaan fisik dalam batas normal. Status lokalis genu dextra :
◦ Look : Lump (+) di posterior knee Dextra Ø 5 cm
◦ Feel : Terfiksir, NT (+), NVD (-)
◦ Move : Limited due to pain
Pemeriksaan laboratorium dalam batas normal
Tampak foto genu dextra, proyeksi AP dan
lateral, kondisi cukup, hasil :

Tampak soft tissue swelling di aspek posterior

articulatio genu D & os femur D
Trabekulasi tulang baik
Tampak eksostosis di margo posterior os femur
D pars tertia distal bentuk pedunculated,
dengan arah menjauhi sendi, cartilago cap (+),
densitas sama dengan os femur
Tak tampak diskontinuitas pada sistema tulang
yang tervisualisasi
Tampak facies articularis licin
Tak tampak osteofit maupun subchondral
sclerotic
 Kesan :
Osteochondroma margo posterior os
femur dextra pars tertia distal tipe
pedunculated

Tampak eminantia intercondilar

bilateral tak meruncing
Tak tampak penyempitan maupun
pelebaran joint space

PRO EKSISI
DISCUSSION
 Introduction
Osteochondroma is a bony exostosis
projecting from the external surface of
a bone.
Tend to stop growing when normal
growth finished
Occas. pelvis, scapula, ribs -> mostly
sessile
Short tubular bones -> rare
INCIDENCE
45 % of benign bony tumours

12 % of all bony tumours

Become evident < 20 yrs

Solitary or multiple

Any enchondral ossification bone

D FRANTZEN OSTEOCHONDROMA
 Solitary Osteochondroma
Osteochondromatous exostosis ; osteocartilaginous exostosis
10% of all bone tumors ; 85% of individual with osteochondroma
M:F = 3:1
Common during childhood or adolescence
Appendicular skeleton, mostly long bones of lower limbs
Knee (40%), prox. portion of femur and humerus
Metaphysis, diaphysis (rare)
Multiple Osteochondromas

Hereditary Multiple Exostosis; Multiple cartilaginous

exostosis; hereditary osteochondromatosis
15% of patient with exostosis
Tends to be large and sessile
Predilection site, age, and sex similar to solitary
 Pathogenesis-Etiology
Herniation of peripheral portion of the physis -> causes idiopathic,
trauma
Mutation on EXT1 & EXT2 gene
 Clinical Manifestation
Around the knee
Mostly asymptomatic
Mass ; pain optional
◦ Mechanical mass effect
◦ Fracture of the stalk
Continue to grow until skeletal maturity
Slowly increasing bulging with hard
consistency
 TYPES
TYPE SESSILE PEDUNCULATED

Incidence Uncommon Common

Location Proximal humerus Knee , hip and ankle

and scapula

Appearance Flat plateau like stalk Elongated bony stalk

producing a broad based merging with the host
protuberance bone .The hyaline cap is
lobulated giving its
appearance
 Grows out from the
medullary canal
 Cortex of the bone
becomes cortex of the
lesion
 Never sits on an intact
cortex
 Increase of Malignant if
cartilage cap is thicker
than 2.5 cm in aduts
 X-Ray Appearance
Well-defined exostosis emerging
from metaphysis, base co-extensive
with parent bone
In metaphyseal region projecting
away from epiphysis
Looks smaller than it feels -> cartilage
is invisible
Cartilage degeneration and
calcification -> bony exostosis
surrounded by clouds of calcified
material -> cauliflower appearance
 Sessile Type
Broad base
↑ risk of malignant
degeneration
 Pedunculated Type
Narrow stalk
 Complications

Malignant transformation mostly occurred for HME (6%) rather

than solitary (1%)
Features suggestive :
◦ Enlargement of the cartilage cap in successive examinations
◦ A bulky cartilage cap (more than 1 cm in thickness)
◦ Irregularly scattered flecks of calcification with the cartilage cap
◦ Spread into the surrounding soft tissues
 Management

Asymptomatic lesions require no treatment

For symptomatic lesions -> excision
◦ Neurovascular compression
◦ Limitation of joint movement
◦ Fracture of the base
 Referensi
De Souza, AMG & Bispo Junior, RZ. Osteochodroma : ignore or investigate?. Rev Bras Ortop. 2014;49:555-
564.
Kumar, V, et al. Robbins basic pathology. 2013. 9th ed. Elsevier, Philadelphia.
Solomon, L, et al. Apley’s system orthopedic and fracture. 2010. 9th ed. Taylor & Francis, USA.
Radiopedia.org
Orthobullets.com