Subungual Bizarre Parosteal Osteochondromatous Proliferation: A Unique Case Report
Abstract
Introduction: Bizarre parosteal osteochondromatous proliferation (BPOP), also known as Nora’s lesion, is a rare benign condition that predominantly affects the short bones of the hands and feet. Its subungual presentation is exceedingly rare. Differentiating it from malignant tumors is essential. We present the case of a 32-year-old man with a painful, progressively enlarging mass in the nail bed of the right second toe. Radiographs and computed tomography revealed a well-defined juxtacortical lesion without continuity with the medullary canal. Complete excision of the tumor, including the periosteum and superficial cortex, was performed, followed by nail-bed reconstruction. Histopathological examination confirmed the diagnosis of Nora’s lesion. No recurrence was detected during follow-up, and full functional recovery was achieved. Conclusions: Recognition of this entity is essential to avoid diagnostic errors and unnecessarily aggressive surgery. Wide resection encompassing the affected cortical bone and periosteum is the treatment of choice to reduce the risk of recurrence.Downloads
References
Nora FE, Dahlin DC, Beabout JW. Bizarre parosteal osteochondromatous proliferations of the hands and feet. Am J Surg Pathol 1983;7(3):245-50. https://doi.org/ 10.1097/00000478-198304000-00003
García Espinosa J, Martínez Martínez A, Muñoz PT, Ruiz Santiago F. Proliferación osteocondromatosa parostal bizarra (Enfermedad de Nora) como simulador de entidades malignas. SERAM 2019. Disponible en: https://www.piper.espacio-seram.com/index.php/seram/article/download/502/325
Zambrano E, Nosé V, Perez-Atayde AR, Gebhardt M, Hresko MT, Paul Kleinman P, et al. Distinct chromosomal rearrangements in subungual (Dupuytren) exostosis and bizarre parosteal osteochondromatous proliferation (Nora lesion). Am J Surg Pathol 2004;28(8):1033-9. https://doi.org/10.1097/00000478-200408000-00006
Gitto S, Serpi F, Messina C, Albano D, Di Bernardo A, Armiraglio E, et al. Bizarre parosteal osteochondromatous proliferation: an educational review. Insights Imaging 2023;14:109. https://doi.org/10.1186/s13244-023-01455-0
Berber O, Dawson-Bowling S, Jalgaonkar A, Pollock RC, Skinner JA, Aston WJS, et al. Bizarre parosteal osteochondromatous proliferation of bone: clinical management of a series of 22 cases. J Bone Joint Surg Br 2011;93(8):1118-21. https://doi.org/10.1302/0301-620X.93B8.26349
Dharmshaktu GS, Dharmshaktu IS, Agarwal N, Pangtey T. Bizarre parosteal osteochondromatous proliferation or Nora’s lesion affecting the extremities: a concise update. J Musculoskelet Surg Res 2022;6(3):200-6. https://doi.org/10.25259/JMSR_66_2022
Wang T, Ouyang Z, Chen Z, Yang Y, Huang X, Cheng Xiang, et al. Bizarre parosteal osteochondromatous proliferation in the distal ulna where the lesion is continuous with the medullary cavity: a case report. BMC Musculoskelet Disord 2024;25(1):588. https://doi.org/10.1186/s12891-024-07715-4
Rybak LD, Abramovici L, Kenan S, Posner MA, Bonar F, Steiner GC. Cortico-medullary continuity in bizarre parosteal osteochondromatous proliferation mimicking osteochondroma on imaging. Skeletal Radiol 2007;36(9):829-34. https://doi.org/10.1007/s00256-007-0305-4
Torreggiani WC, Munk PL, Al-Ismail K, Nicolaou S, Lee MJ, Masri BA. MR imaging features of bizarre parosteal osteochondromatous proliferation of bone (Nora’s lesion). Eur J Radiol 2001;40(3):224-31. https://doi.org/10.1016/S0720-048X(01)00356-0
Michelsen H, Abramovici L, Steiner G, Posner MA. Bizarre parosteal osteochondromatous proliferation (Nora’s lesion) in the hand. J Hand Surg Am 2004;29(3):520-5. https://doi.org/10.1016/j.jhsa.2004.01.009
Espinosa A, Barbosa G. Enfermedad de Nora. Proliferación osteocondromatosa parostal atípica. Rev Colomb
Cancerol 2011;15(3):155-60. https://doi.org/10.1016/S0123-9015(11)70064-6
Manuscript acceptance by the Journal implies the simultaneous non-submission to any other journal or publishing house. The RAAOT is under the Licencia Creative Commnos Atribución-NoComercial-Compartir Obras Derivadas Igual 4.0 Internacional (CC-BY-NC.SA 4.0) (http://creativecommons.org/licences/by-nc-sa/4.0/deed.es). Articles can be shared, copied, distributed, modified, altered, transformed into a derivative work, executed and publicly communicated, provided a) the authors and the original publication (Journal, Publisher and URL) are mentioned, b) they are not used for commercial purposes, c) the same terms of the license are maintained.
In the event that the manuscript is approved for its next publication, the authors retain the copyright and will assign to the journal the rights of publication, edition, reproduction, distribution, exhibition and communication at a national and international level in the different databases. data, repositories and portals.
It is hereby stated that the mentioned manuscript has not been published and that it is not being printed in any other national or foreign journal.
The authors hereby accept the necessary modifications, suggested by the reviewers, in order to adapt the manuscript to the style and publication rules of this Journal.
