Large Osteochondromas During Growth: A Case Series and Literature Review
Abstract
Introduction: Osteochondromas are the most common benign osteochondral tumors. Their size is rarely an indication for surgery, and large osteochondromas are usually reported as isolated cases. However, although rare, the potential for malignant transformation exists. We present a series of large osteochondromas in a pediatric population treated surgically, along with a review of the literature. Materials and Methods: A retrospective, multicenter cohort study was conducted in skeletally immature patients with large osteochondromas who underwent surgical treatment. Tumor volume was assessed using preoperative imaging. Demographic and surgical variables were analyzed. Results: Twenty patients (16 males and 4 females) from eight sites were included; four had multiple osteochondromatosis and the mean age at surgery was 14 years. Nineteen patients had lesions in the extremities, and one had an extraspinal osteochondroma. Four patients were asymptomatic. Magnetic resonance imaging was used to determine tumor volume; the mean volume was 65 cm³ (range: 43.75–904.78 cm³). Surgical treatment included marginal resection in 10 cases, wide resection in 8, and intralesional resection in 2. Mean follow-up was 4 years and 8 months. There were two immediate postoperative complications, two late complications, and one recurrence. Conclusions: Surgical removal of large osteochondromas in the extremities and in extraspinal locations should be considered even in asymptomatic patients due to the risk of malignant transformation. Intralesional resection should be avoided because of the risk of recurrence. Marginal resection is the preferred approach, although selected cases may require wide resection with reconstruction.Downloads
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