Bizarre parosteal osteochondromatous proliferation of the femur: A case report

Takahashi, Ryosuke; Matsuo, Toshihiro; Kawanami, Katsuhisa; Takata, Takuya; Takahashi, Emiko; Deie, Masataka

doi:10.1016/j.jor.2018.05.009

Cited by 4 publications

(4 citation statements)

References 17 publications

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“…Parosteal osteosarcoma can also show characteristics of medullary involvement and cortical erosion. 19 , 20 In addition, severe cell atypia, not observed in BPOP, can be seen in parosteal osteosarcoma.…”

Section: Discussionmentioning

confidence: 99%

“…Radiographically, periosteal chondrosarcoma typically presents as a lobular juxtacortical lesion with ring-like or popcorn calcification. 20 In addition, it often exhibits intramedullary extension, cortical erosion, aggressive periosteal reaction, and invasion of surrounding soft tissues. Histologically, periosteal chondrosarcoma shows well-differentiated hyaline cartilage with a lobular structure.…”

Section: Discussionmentioning

confidence: 99%

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Bizarre parosteal osteochondromatous proliferation (Nora lesion) involving the spine: a case report and systematic review

Chen,

Wei,

Liu

et al. 2024

J Int Med Res

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Bizarre parosteal osteochondromatous proliferation (BPOP), also termed Nora lesion, is a rare, benign tumor most often located in the hands and feet. We herein present the second reported case of BPOP affecting the spine, an uncommon location. One year after surgical excision, the patient was pain-free and showed no evidence of recurrence. We reviewed a total of 323 cases of BPOP among 101 articles, providing the first systematic update on the latest knowledge of BPOP. The age of patients with BPOP ranges from 3 months to 87 years, peaking in the second and third decades of life. The hands are the most common location of BPOP (58.39%), followed by the feet (20.81%). Imaging features play a key role in the diagnosis of BPOP, but histopathologic diagnosis remains the gold standard. Differential diagnosis of BPOP should be based on the epidemiologic and clinical features as well as clinical examination findings. Surgical resection is the most extensively used treatment for BPOP. Recurrence is common (37.44%) and can be treated with re-excision. This article can deepen our understanding of BPOP and will be helpful for the diagnosis and treatment of BPOP in clinical practice.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Bizarre parosteal osteochondromatous proliferation (Nora lesion) involving the spine: a case report and systematic review

Chen,

Wei,

Liu

et al. 2024

J Int Med Res

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“…A diffusely calcified mass adjacent to the medial cortex of the distal femur in a different patient showed an absent medullary connection and the lesion was excised to reveal the BPOP on histopathology. [34] One case presenting as a growing lesion at the lower pole patella after the skeletal maturity with progressive swelling in a 21-year-old male was reported. [35] The swelling seemed fixed to the patella and moving along with it and the mass incorporated the patellar tendon entirely except for a narrow cleavage.…”

Section: Lower Extremitymentioning

confidence: 99%

Bizarre parosteal osteochondromatous proliferation or Nora’s lesion affecting the extremities: A concise update

Dharmshaktu

Agarwal

et al. 2022

JMSR

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The bizarre parosteal osteochondromatous proliferation or Nora’s lesion is an unusual clinical entity that presents with localized swelling and pain. The characteristic radiological appearance includes a cluster of variably calcified lesions adjacent to a particular bone. However, it does not necessarily have direct continuity with its medullary region. The etiopathogenesis of this disorder is not yet fully understood. Various other lesions require careful exclusion and the use of advanced imaging modalities to supplement the diagnosis. The final diagnosis of the lesion, however, is based on the histopathological basis. However, these lesions are reported as sporadic reports or small series in the literature and are also discovered in areas other than the common locations in hands and feet. The recent research aims to throw more advanced knowledge into their causation, including genetic etiology. The symptomatic lesions may require excision for clinical relief, but recurrence is not uncommon. The future research, and preferably multi-center collaboration, is required for more insight into their comprehensive nature and clinical spectrum. A brief and crisp update of the articles published in the past 10 years describing bizarre parosteal oseochondromatous proliferation in the extremities is presented here for educational purposes for orthopedists and generalists alike.

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“…87 patients (27.0%) developed Nora lesions in their lower limbs. Neoformation involved femur [ 3 , 16 , 33 , 37 , 47 , 48 ], tibia [ 3 , 9 , 18 , 33 , 49 , 50 ] and fibula [ 18 , 33 , 51 ] in 11 (3.4%), 8 (2.5%) and 4 cases (1.2%), respectively. One additional case was discovered nearby the patella [ 52 ].…”

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 of the femur: A case report

Cited by 4 publications

References 17 publications

Bizarre parosteal osteochondromatous proliferation (Nora lesion) involving the spine: a case report and systematic review

Bizarre parosteal osteochondromatous proliferation (Nora lesion) involving the spine: a case report and systematic review

Bizarre parosteal osteochondromatous proliferation or Nora’s lesion affecting the extremities: A concise update

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

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