MR imaging features of bizarre parosteal osteochondromatous proliferation of bone (Nora's lesion)

Torreggiani, William C.; Munk, Peter L.; Al‐Ismail, Khalid; O’Connell, John X.; Nicolaou, Savvas; Lee, Mark J.; Masri, Bassam A.

doi:10.1016/s0720-048x(01)00362-x

Cited by 80 publications

(55 citation statements)

References 14 publications

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“…In agreement with Dhondt et al [4] and Torreggiani et al [23], we believe radiology alone is sufficient to diagnose BPOP in typical cases (typical radiographic appearance and typical clinical findings). There are however radiographic reports in the literature of corticomedullary continuity [18], cortical destruction [10], and intramedullary inflammation [17] in histologically confirmed BPOP.…”

Section: Resultssupporting

confidence: 92%

“…Subsequent reports however have identified lesions in the long bones, skull, pelvis, clavicle, maxilla, and the tibial sesamoid [1,3,9,13,19,21,24]. Lesions of the tubular bones of the hands and feet remain the most common, with the hand being affected four times more commonly than the foot [23]. BPOP has no gender predilection [16] and can occur at any age; however, most patients are 20 to 30 years old [8].…”

mentioning

confidence: 99%

“…The natural architecture of the bone should be preserved and there should be no cortical flaring [16]. The soft tissues also should appear normal [8,23] (Fig. 2).…”

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confidence: 99%

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Bizarre Parosteal Osteochondromatous Proliferation: A Locally Aggressive Benign Tumor

Joseph

Ritchie

MacDuff

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Bizarre parosteal osteochondromatous proliferation (BPOP) is a benign lesion of bone, and numerous questions remain unresolved regarding its etiology, diagnosis, and treatment. Questions/purposes We present the Scottish Bone Tumour Registry experience of this rare lesion. Patients and MethodsWe performed a retrospective analysis of the Scottish Bone Tumour Registry records. Histologic specimens were reexamined by a musculoskeletal pathologist. Radiographs were reevaluated by a musculoskeletal radiologist.Results From 1983 to 2009, 13 cases (13 patients; six male, seven female) were identified. Their ages ranged from 13 to 65 years. All patients presented with localized swelling. Pain was present in five. Antecedent trauma was present in two. Nine lesions affected the hand, three the foot, and one the tibial tuberosity. Twelve lesions were excised and one was curetted. There were seven recurrences of which six were excised. One lesion recurred a second time and was excised. There were no metastases. Radiographs showed densely mineralized lesions contiguous with an uninvolved cortex. Cortical breakthrough was present in one case and scalloping in another. Histologic analysis characteristically showed hypercellular cartilage with pleomorphism and calcification/ossification without atypia, bone undergoing maturation, and a spindle cell stroma. Conclusions BPOP is a rare benign lesion that probably is neoplastic, with no gender predilection, and affecting patients over a wide age range. Previously trauma was considered an etiologic factor, but this no longer seems to be the case. The rate of recurrence was 50%, which may indicate a more extensive resection is required for this locally aggressive lesion. No metastases were reported.

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Section: Resultssupporting

confidence: 92%

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confidence: 99%

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Bizarre Parosteal Osteochondromatous Proliferation: A Locally Aggressive Benign Tumor

Joseph

Ritchie

MacDuff

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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“…Underlying bony architecture and surrounding soft tissues are preserved. MRI may demonstrate a cartilage cap and overlying pseudocapsule, although the latter is better appreciated histologically [4]. When present, this cartilage cap is less well formed than that of an osteochondroma.…”

Section: Discussionmentioning

confidence: 99%

“…The underlying native cortex, medullary bone, and adjacent soft tissues are normal in signal intensity. Radionuclide bone scans typically show increased uptake of Tc-99 m MDP [4].…”

Section: Discussionmentioning

confidence: 99%

Painless hand mass

et al. 2016

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AnswerBizarre parosteal osteochondromatous proliferation (Nora lesion) of the metacarpal. DiscussionRadiograph (Fig. 1) and CT ( Fig. 2) images show a wellcorticated osseous lesion originating from the dorsomedial surface of the second metacarpal neck. There is a slight irregularity of the underlying cortex, but no periosteal reaction or bone destruction. Although no visible cleavage plane separates the lesion from the second metacarpal, the medullary space of the lesion is noncontiguous with that of the underlying bone, and it lacks characteristic orientation away from the joint space as is seen with an osteochondroma. Clinically, a firm, immobile, nontender mass was palpated in the second intermetacarpal space. The overlying skin was normal in appearance. Because the patient had a limited range of motion at the second and third carpometacarpal joints, surgical excision was performed. Histopathology demonstrates fragments of bone and cartilage with areas of endochondral ossification and surrounding bland fibroblastic proliferation. The interface between forming bone and cartilage has a characteristic purple-blue staining quality (Fig. 3).First described by Nora et al. in 1983 (described in A b r a m ov i c i a nd S t e i ne r [1 ] ), b i za rr e pa ro st e al osteochondromatous proliferation (BPOP), also referred to as a BNora lesion,^is a rare, benign, locally aggressive osteochondromatous exostosis composed of bone and cartilage in a fibrous myxoid cell stroma without cellular atypia. Histologically, BPOP is characterized by the presence of a hypercellular fibrocartilaginous cap containing large, bizarre binucleate chondrocytes, with admixed areas of endochondral ossification maturing to trabecular bone. Bony trabeculae are histologically immature, with high osteoblastic activity and irregular calcification.Bizarre parosteal osteochondromatous proliferation most commonly arise from the periosteum of the metacarpals and metatarsals, with the hand affected four times more commonly Fig. 1 Anteroposterior radiograph of the right second to fourth metacarpals and proximal phalanges The case presentation can be found at

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