Bizarre Parosteal Osteochondromatous Proliferation (Nora Lesion) in Pediatric Phalanges

Álvarez, Sergio Martínez; Cuadrillero, Daniel L. Azorín; Little, Kevin J.

doi:10.1016/j.jhsa.2020.05.002

Cited by 7 publications

(12 citation statements)

References 17 publications

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“…BPOP, or Nora’s lesion, is a rare, benign reactive lesion arising from the periosteum through cartilaginous metaplasia [ 3 ]. This lesion commonly affects small tubular bones, such as the proximal and middle phalanxes, and metacarpal and metatarsal bones; the hand is affected four times more frequently than the foot [ 2 , 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…Other bones of the upper limb demonstrate a lower occurrence, including the radius (10 cases), ulna (17 cases), humerus (four cases), and clavicle (one case) [ 1 ]. The second most common location for BPOP was observed in the bones of the foot (66 cases), while other sites of the human skeleton that have been described in various case reports or case series were the spine (one case), femur (11 cases), patella (one case), tibia (eight cases), fibula (four cases), mandible (four cases), maxilla (one case), zygoma (one case), nose (one case), and an unspecified location in the skull (one case) [ 1 , 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…Patients at the time of diagnosis tend to be between the third and fourth decade of life, with a mean age of 34.3 years, although diagnosis at younger ages is not infrequent [ 3 ]. An equal distribution of the disease by sex has been observed (49.8% females vs. 50.2% males) [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Bizarre Parosteal Osteochondromatous Proliferation of the Hand: A Report of an Atypical Case and Current Concepts

Kastanis,

Pantouvaki,

Siligardou

et al. 2024

Cureus

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Bizarre parosteal osteochondromatous proliferation (BPOP), or Nora’s lesion, is an unusual, benign, bony lesion often found in the tubular small bones of the hand and foot. In general, two characteristic radiological signs are used to diagnose the lesion, namely, (1) the absence of corticomedullar continuity and (2) BPOP developed from the parosteal surface of bones with an intact underlying cortex. Here, we present an atypical case of Nora’s lesion of the proximal phalanx of the index finger, in which BPOP was diagnosed only histologically, with preoperative imaging examinations (X-ray and MRI) suggesting another lesion (enchondroma). Therefore, imaging (X-ray and MRI) alone may be inadequate to achieve the correct diagnosis of the lesion because many cartilaginous neoplasms may surround a broad range of lesions that mimic BPOP. Only histopathological evidence can confirm the correct diagnosis of the lesion.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Bizarre Parosteal Osteochondromatous Proliferation of the Hand: A Report of an Atypical Case and Current Concepts

Kastanis,

Pantouvaki,

Siligardou

et al. 2024

Cureus

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“…Histologically, it can be distinguished from the OO by consisting of cartilage, bone, and fibrous tissue. It has a high rate of recurrences in the case of incomplete resection [ 30 , 31 ]. Especially in OO in close proximity to the wrist, tendinitis, as initially suspected in case 2, is a common misdiagnosis.…”

Section: Discussionmentioning

confidence: 99%

The Diagnostic Challenge of Osteoid Osteoma in the Bones of the Hand—A Case Series

et al. 2023

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Osteoid osteoma (OO) is a benign bone tumor that rarely occurs in the bones of the hand. Due to the comparatively non-specific symptoms when occurring in the hand, OO is often misdiagnosed at first presentation, posing a diagnostic challenge. In the present case study, six cases of phalangeal and carpal OO, treated surgically at our department between 2006 and 2020, were retrospectively reviewed. We compared all cases regarding demographic data, clinical presentation, imaging findings, time to diagnosis, surgical treatment, and clinical outcome in follow-up examinations. When OO occurs in the bones of the hand, it can lead to swelling and deformities, such as enlargement of the affected bone and nail hypertrophy. Initial misdiagnoses such as primary bone tumors other than OO, tendinitis, osteomyelitis, or arthritis are common. Most of the presented cases showed a prolonged time until diagnosis, whereby the primarily performed imaging modality was often not sensitive. CT proved to be the most sensitive sectional imaging modality for diagnosing OO. With adequate surgical treatment, complications and recurrence are rare.

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“…In particular, the bones of the hand were the most frequently affected, accounting alone for a total of 191 cases (59.3%). Metacarpal bones were involved in 38 cases (11.8%) [ 1 , 3 - 17 ], proximal phalanx in 41 (12.7%) [ 1 , 3 , 7 - 10 , 18 - 24 ], middle phalanx in 44 (13.6%) [ 1 , 3 , 6 - 10 , 13 , 19, 20 , 25 - 29 ] and distal phalanx in 19 (5.9%) [ 1 , 3 , 7 - 10 , 19 , 30 , 31 ]. The exact localization of the disease inside the hand was unknown in the other 49 patients.…”

Section: Epidemiologymentioning

confidence: 99%

Bizarre Parosteal Osteochondromatous Proliferation (Nora Lesion): A Narrative Review

Ipponi

Ferrari

Ruinato

et al. 2022

AML

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Background: Bizarre parosteal osteochondromatous proliferation (BPOP), or Nora lesion, is a rare proliferative disease arising from the parosteal region of bones. Although BPOP’s pathogenesis is still not certain, modern literature suggests it to be a tumor-like lesion or even a benign neoplasm. Due to the extremely low incidence, to this date studies on the topic are limited to case reports and a few case series. This narrative review aims to resume literature on BPOP and provide an overview of its natural history, morphologic characteristics and prognostic horizon.Materials and methods: A systematic research of the literature was done to identify studies reporting on patients who suffered from BPOP between 1983 and 2021. We collected data regarding aetiologic and pathogenetic theories, patients’ personal data and anamnesis, lesions’ location, clinical presentation, imaging features, pathological appearance, treatment and prognosis.Results: We identified 322 cases of BPOP with a mean age of 34.3 years at the moment of diagnosis. There was no gender difference. The most involved site was the hand, followed by the foot. A history of trauma was reported for 14.7% of the cases. 38.7% of the patients had pain. Literature defined typical radiographic and microscopic patterns that characterize Nora lesions. While imaging is fundamental to orientate towards BPOP, histological evaluation is mandatory to get the definitive diagnosis. To this date, only reliable therapeutic option is represented by surgical resection. BPOP is burdened by a risk of recurrence that accounts to 37.4%.Conclusion: BPOP is a rare benign disease that should be considered during the differential diagnosis of parosteal lesions, especially in the acral regions. Careful diagnostic evaluations are necessary to get the correct diagnosis and wide margins of resection are recommended to minimize the relatively high risk of local recurrence.

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Bizarre Parosteal Osteochondromatous Proliferation (Nora Lesion) in Pediatric Phalanges

Cited by 7 publications

References 17 publications

Bizarre Parosteal Osteochondromatous Proliferation of the Hand: A Report of an Atypical Case and Current Concepts

Bizarre Parosteal Osteochondromatous Proliferation of the Hand: A Report of an Atypical Case and Current Concepts

The Diagnostic Challenge of Osteoid Osteoma in the Bones of the Hand—A Case Series

Bizarre Parosteal Osteochondromatous Proliferation (Nora Lesion): A Narrative Review

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