Vol 2 | Issue 2 | Sep – Dec 2016 | page:16-18 | Kanakeya Bachha Reddy, Rajesh Kumar Kanojia, Atul Sareen, Vikas Keshri
Authors : Kanakeya Bachha Reddy [1*], Rajesh Kumar Kanojia [2], Atul Sareen [3], Vikas Keshri [4]
[1] Department of Orthopedics, Ashwini Hospital, Cuttack, Odisha-753015
[2] Department of Orthopedics, Lady Hardinge Medical College & Associated Hospitals, New Delhi -110001
[3] Deen Dayal Upadhyay Hospital, New Delhi – 110064
[4] Dept of Orthopedics, Vardhman Mahavir Medical College and Safdarjung Hospital.
Address of Correspondence
Dr. Kanakeya Bachha Reddy
Department of Orthopedics,
Ashwini Hospital, Cuttack,
Odisha-753015
Email:- kanakeyareddy@gmail.com
Abstract
Introduction: Osteochondroma is the most common benign bone tumor, it usually arise from the long bones. However, involvement of other small bones and flat bones are very rare. Rib tumors are very rare in pediatric age group and most of them are malignant. So it is very important and crucial to diagnose Osteochondroma of rib in a child.
Case Presentation: A ten year-old boy presented with a hard painful swelling around left 6th rib. Radiographs of chest revealed nothing conclusive. We suspected some tumor and planned for CT scan. CT scan showed a well defined expansile lytic lesion with soft tissue component, most likely Ewing’s sarcoma. FNAC was performed and was reported as Chondroblatoma. Excsional biopsy was done and histopathology confirmed the lesion to be Osteochondroma.
Conclusion: rib tumors are usually malignant in paediatric age group. To diagnose a Osteochondroma of rib in this patient is very crucial because of CT scan was suggestive of Ewing’s sarcoma, FNAC was suggestive of Chondroblastoma and excisional biopsy was suggestive of osteochonroma. So there is a great diagnostic dilemma to diagnose Osteochonroma of rib in paediatric age group.
Keywords: Osteochonroma, rib, malignant.
Introduction
A ten year-old boy presented with a hard painful swelling of approximately (5mm×6 mm) on left chest wall at around costo-chondraljunction of left 6th rib (fig-1). CT scan showed a well defined expansile lytic lesion with soft tissue component measuring 26×15mm involving anterior end of left 6th rib suggestive of neoplastic origin, most likely Ewings sarcoma. The growth was seen extending inside chest wall, abutting pleura with exophytic component (fig-2). FNAC was performed and was reported as Chondroblatoma. Due to financial constrains of the patient, MRI could not be done and thus excisional biopsy was planned. Excsional biopsy was done with resection of part of the left 6th rib along with chondral cartilage, leaving the overlying pleura intact and the material was sent for histopathological examination (fig-3). Histopathology (fig-4) confirmed the lesion to be Osteochondroma. Postoperatively patient was asymptomatic till last follow up at 7 months after surgery.
Case report
Rib lesions are rare entities in paediatric population and most of them are malignant. According to various studies, most rib neoplasms (52%-90%) are malignant [4, 5]. Out of various benign lesions, rib Osteochondroma is a very rare entity [4]. Costal Osteochondroma is associated with complications like, restriction of chest wall movement, pain, cosmetic abnormalities and bursitis [4]. Costal osteochondromas tend to grow into the chest cavity and are rarely exophytic. A case of exophytic costal osteochondroma has been reported in a child [4]. But in our case, the osteochondroma had both exophytic and a component of growth towards pleura. To the best of our knowledge, this type of lesion in rib has not been reported in literature. We have treated this condition by extrapleural enblock excision of tumor with part of rib and chondral cartilage. Clinically patient was presented with pain full swelling. As per literature it was thought to be a malignant lesion. But CT scan was suggested malignant tumor, most likely Ewings sarcoma. FNAC was in favour of as benign lesion, Chondroblastoma. So we had planned for excisional biopsy and confirmed as Osteochondroma. Rib Osteochonroma in child is of great diagnostic dilemma. Therefore, it requires proper diagnosis and treatment.
Discussion
Rib lesions are rare entities in paediatric population and most of them are malignant. According to various studies, most rib neoplasms (52%-90%) are malignant [4, 5]. Out of various benign lesions, rib Osteochondroma is a very rare entity [4]. Costal Osteochondroma is associated with complications like, restriction of chest wall movement, pain, cosmetic abnormalities and bursitis [4]. Costal osteochondromas tend to grow into the chest cavity and are rarely exophytic. A case of exophytic costal osteochondroma has been reported in a child [4]. But in our case, the osteochondroma had both exophytic and a component of growth towards pleura. To the best of our knowledge, this type of lesion in rib has not been reported in literature. We have treated this condition by extrapleural enblock excision of tumor with part of rib and chondral cartilage.
Conclusion
Rib tumors are rare entities in the pediatric population. However, a significant number of rib lesions are malignant. Therefore, proper diagnosis and expeditious treatment are essential.
Clinical Message
Most of the rib lesions are malignant. Though rare, Osteochodroma of rib do occur in children.
References
1. HuvosA.Bone Tumors: Diagnosis, Treatment, and Prognosis, 2nd ed. Philadelphia: Saunders, 1991.
2. Canale & Beaty: Campbell’s Operative Orthopaedics, 11th ed. Vol-I page no-860
3. Calafiore G, Calafiore G, Bertone C, Urgelli S, Rivera F, Maniscalco P Osteochondroma. Report of a case with atypical localization and symptomatology. Acta Biomed Ateneo Parmense 2001;72(5-6):91-6.
4. Marino-Nieto J, Lugo-Vicente H Rib osteochondroma in a child: case report and review of literature. Bol Asoc Med P R. 2011 Jan-Mar; 103(1):47-50.
5. Kim S, Lee S, Arsenault DA, Strijbosch RA, Shamberger RC, Puder M. Pediatric rib lesions: a 13-year experience. J Pediatr Surg. 2008 Oct; 43(10):1781-5.
| How to Cite this Article: Reddy KB, Kanojia RK, Sareen A, Keshri V. International Journal of Surgical Cases 2016 Sep – Dec; 2(2): 16-18. |
