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Received Nov 21, 2017; Revised Jan 8, 2018; Accepted Jan 15, 2018
This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
1. Introduction
Osteochondromas account for 35 to 46% of benign bone tumors [1]. This tumor is characterized as a cartilage-capped osseous stalk with a bone marrow cavity in continuity to the underlying bone. This lesion usually develops from the growth plate of long bones in the first two decades of life, when the cartilage solidifies into the bone. Solitary osteochondromas are by far the most common presentation, and numerous lesions in the same patient are observed in the multiple hereditary osteochondromatosis.
Osteochondroma is generally asymptomatic and discovered during diagnostic radiological exams ordered for other purposes (i.e., search for fractures after a trauma). Two different morphological types are described: sessile, with an increased risk for malignant transformation, and pedunculated. The risk for malignant transformation into chondrosarcoma is thought to be less than 1%. Osteosarcoma transformation is very uncommon.
Depending on its location, an osteochondroma can sometimes cause neurovascular compression, cosmetic issue, and/or pain. This often leads to surgical removal with histopathologic analysis to confirm the diagnosis. Symptom disappearance with fully recovered function is generally expected [1–5].
Uncommonly, an osteochondroma can develop from flat bones. We present the case of a 25-year-old patient with a right scapula osteochondroma causing an accessory nerve (XI) compression. The mass was surgically removed through a posterior incision, and the diagnosis was confirmed. The patient fully recovered at the latest 3-year follow-up visit.
2. Case Report
A 25-year-old male presented at our clinics for a right shoulder pain related to a dorsal scapular mass first observed 4 months earlier. The main symptom was a shoulder discomfort when lying on his back, sometimes compromising the sleep. The patient also complained of some weakness when using his right arm under the shoulder level. The medical history consisted in a unique kidney and past treatments for a nodular sclerosis-subtype Hodgkin lymphoma (chemotherapy and radiotherapy, last treatment twelve years ago and no recurrence).
The physical examination revealed a nonmobile 3 cm T × 3 cm AP × 2 cm CC hard mass on the posterior superomedial angle of the right scapula,...