Chordoma of the lumbar spine-A potential diagnosis not to be forgotten!

Chordoma is a rare, malignant neoplasm thought to develop from the notochord. It most commonly occurs in the base of the cranium or the sacro-coccygeal region but around 15%-20% affect the vertebral body. Extra-lesional resection with or without adjuvant radiotherapy is generally accepted as the mainstay of treatment for this slow-growing tumor. We present a case whereby a patient with an extensive vertebral body lesion causing caudal compression, treated with spinal decompression and posterior stabilization. This case highlights the importance of pre-operative tissue diagnosis, and that, although rare (0.8 per 100,000), chordoma should always be considered.

About a misleading calcified mass of the elbow: Soft tissue osteochondroma: A case report.

INTRODUCTION: Soft tissue osteochondromas are rare lesions, with a misleading radiology, that can present diagnostic dilemma. CASE PRESENTATION: We report the case of 16-year-old girl who presented an anterior swelling in his left elbow, slightly painful on palpation, with no signs of inflammation. Elbow mobility was normal. Standard radiographs showed a globular calcified mass. CT scan revealed a well-defined lobulated soft tissue mass with extensive flaky calcification. Magnetic resonance imaging (MRI) showed lobulated and intermuscular non-enhancing mass. The lesion had a low heterogeneous signal on T1 images, and a high heterogeneous signal on T2 FAT-SAT images, with low signal areas suggesting calcifications. There was no continuity to the adjacent ulna and radius. The patient first underwent image-guided core needle biopsy and histological examination concluded to chondroma. The tumour was then resected by anterior approach and the final histological diagnosis was osteochondroma of soft tissue. DISCUSSION: A diagnosis of extraskeletal osteochondroma should be considered when an ossified mass is localized in the soft tissue particularly on the elbow. Excision is the treatment of choice when the function is reduced and the nature of the tumour remain uncertain. CONCLUSION: Orthopedic surgeons should know about elbow localization of osteochondromas to help in accurate diagnosis and management of the tumour, to avoid overtreatment.

An unusual cause of shoulder pain: osteochondroma of ventral scapula (a case report).

Osteochondromas mainly affect the metaphysis of long bones such as femur, humerus, and tibia. It is unusual in flat bones such as scapula. Osteochondroma of ventral surface of scapula is one of the rare cause of shoulder pain and difficult to diagnose in first place. We report the case of an 18-year old girl, presenting progressive right shoulder pain for two years. Physical examination showed an imbalance of the shoulders, a winging of the right scapula, and a snapping of the shoulder on mobilization. Radiographic evaluation showed a pedunculated bony structure extruding from the scapula. Computed tomography (CT) scanner and magnetic resonance imaging (MRI) revealed a bony exostosis along the medial border on the ventral surface of the right scapula. The patient had an excision of the exostosis. Histologic examination confirmed that the specimen was an osteochondroma with no signs of malignant transformation. The shoulder was immobilized for two weeks. The patient has regained full function of her shoulder, six weeks postoperatively.

Pseudocystic Osteosarcoma: A Potential Diagnostic Pitfall - Case Report.

INTRODUCTION: Pseudocystic osteosarcoma (OS) is an uncommon variant of conventional OS. Clinical and radiological features are presented as benign process with a non-rapid growth rate. Treatment may be adversely affected by the delay in diagnosis or an appropriate invasive procedure. CASE PRESENTATION: We report a rare case of pseudocystic OS of the distal femur in a 6-year-old boy. Imaging findings revealed an osteolytic intra-compartmental tumor, that suggested either simple bone cyst or subacute osteomyelitis. The patient was first operated by lateral approach for curettage but histopathology showed conventional OS. Treatment had been managed by standard current chemotherapy and trans-epiphyseal intercalary resection through lateral approach. Reconstruction was done by a non-vascularized autograft within the induced membrane technique. At 3 years of follow-up, the patient remained disease-free with good anatomical and functional results. CONCLUSION: conventional OS can be presented in rare cases as a benign bone cyst tumor. This type of pseudocystic OS should be included in the differential diagnosis of bone cyst tumors and pseudo-tumors.