Osteochondroma of the hip with adjacent bursal chondromatosis

Abstract

It is well established that irregular bursae can form adjacent to an osteochondroma (bursa exostotica) as a result of mechanical irritation and that these bursae can be complicated by inflammation, hemorrhage, or infection. Bursal chondromatosis is a rare complication, with only seven published cases in the literature according to our searches. We present the case of a 53-year-old female who presented with slowly progressive left hip/thigh pain and was found to have an osteochondroma arising from the lesser trochanter with numerous ossified bodies in the adjacent soft tissues. MRI demonstrated osteochondral bodies in a fluid-filled bursa adjacent to the osteochondroma, with several of the bodies noted to be fairly displaced from the osteochondroma cartilaginous cap. At surgery, the osteochondroma was removed and numerous bodies of varying sizes were excised, some of which were noted to be adherent to the bursal lining and others that were separated/distant from the cartilage cap. The question arises as to whether this process represents bursal chondromatosis resulting from benign neoplasia of cells lining the abnormal bursa, "cartilage shedding" from the osteochondromatous cap, or both. The purpose in presenting this case is to introduce a rare complication of an osteochondroma, demonstrate that soft tissue calcification and osteochondral densities displaced from an underlying osteochondroma are not always the result of sarcomatous degeneration, and provide support for the theory that cells lining a bursa in a nonphysiologic location can undergo benign neoplasia with subsequent formation of osteochondral bodies.

Bursal synovial chondromatosis overlying a solitary osteochondroma of the distal femur: a case report

“…There are only seven case reports of concurrent synovial chondromatosis and an underlying osteochondroma. [8][9][10][11][12][13][14] Bursa formation over the osteochondroma is secondary to mechanical irritation of the osteochondroma and the overlying tendons. Whether the bursal chondromatosis represents a secondary pathology due to the underlying osteochondroma or a true primary benign neoplastic process, is still unclear.…”

“…6,7 There have been few case reports of concomitant existence of osteochondromas and synovial chondromatosis. [8][9][10][11][12][13][14] We report one such case in an 11-year-old female patient and speculate on the common underlying pathogenetic mechanisms which might be involved.…”

Endoscopic Resection of the Lateral Ankle Bursa With Synovial Chondromatosis

“…19 Any adjacent osteochondroma should be assessed to eliminate the possibility of an adventitious bursa. 11,15,20 It has been proposed that "cartilage shedding" from the osteochondromatous cap into the bursa can be a cause of secondary synovial chondrometaplasia. 11,15,20 Alternatively, the osteochondroma may cause irritation of the bursa, inciting cartilaginous proliferation and eventual osteochondral body formation.…”

“…11,15,20 It has been proposed that "cartilage shedding" from the osteochondromatous cap into the bursa can be a cause of secondary synovial chondrometaplasia. 11,15,20 Alternatively, the osteochondroma may cause irritation of the bursa, inciting cartilaginous proliferation and eventual osteochondral body formation. 20 If lesions are present, treatment of the accompanying lesions should be included in the preoperative surgical plan.…”

“…11,15,20 Alternatively, the osteochondroma may cause irritation of the bursa, inciting cartilaginous proliferation and eventual osteochondral body formation. 20 If lesions are present, treatment of the accompanying lesions should be included in the preoperative surgical plan.…”