scholarly journals Nora’s lesion: bizarre parosteal osteochondromatous proliferation in right foot: a case report

2021 ◽  
Vol 7 (5) ◽  
pp. 1043
Author(s):  
Shikhar Yadav ◽  
Divya G. ◽  
Jithin Mohan ◽  
Joice Varghese
Keyword(s):  
Benign Lesion ◽  
Plain Radiograph ◽  
Excision Biopsy ◽  
Bizarre Parosteal Osteochondromatous Proliferation ◽  
Nora’S Lesion ◽  
First Metatarsal ◽  
Benign Pathology ◽  
One Year ◽  
The Right ◽  
Hands And Feet

<p class="abstract"><span lang="EN-US">Nora’s lesion is a benign lesion involving mainly the proximal phalanges, metatarsals or metacarpals in the hands and feet. It may be easily confused with a malignant entity and was first identified and reported by Nora et al. in 1983. We present a case of a 12 years old female with complains of a swelling over the right foot noticed 4 months ago. Plain radiograph revealed heterotrophic calcification over the dorso-lateral aspect of the head of the first metatarsal. MRI scan of the foot was suggestive of a benign pathology with a differential of bizarre parosteal osteochondromatous proliferation (BPOP) or an osteochondroma. The patient was managed with excision biopsy and lesion was excised along with the pseudo-capsule and adjoining periosteum. Cortex appeared normal and wound was washed with hydrogen peroxide and incision closed. Histopathology report was suggestive of Nora’s lesion. One year follow up of the patient showed no recurrence. BPOP proliferation is a benign lesion however differentials need to be kept in mind and treatment with excision of the lesion along with the pseudo-capsule and periosteal tissue beneath the lesion has low rates of recurrence. </span></p>

scholarly journals Bizarre Parosteal Osteochondromatous Proliferation (Nora Lesion) in Upper and Lower Limbs: A Report of Three Cases and Review of Literature

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Maryada Venkateshwar Reddy ◽  
Anjaneyulu Kandukuri ◽  
Vidyasagar Chandankere ◽  
Vinay Mathew Joseph ◽  
Annappareddy Venkata Gurava Reddy
Keyword(s):  
Benign Lesion ◽  
Plain Radiograph ◽  
Lower Limbs ◽  
Radiological Evaluation ◽  
Bizarre Parosteal Osteochondromatous Proliferation ◽  
Diagnostic Dilemma ◽  
Small Bones ◽  
The Right ◽  
High Index Of Suspicion

Introduction: Bizarre parosteal osteochondromatous proliferation (BPOP) is a rare bone pathology affecting small bones of hand and feet. This benign lesion needs to be distinguished from many malignant bone tumors as it poses a diagnostic dilemma due to its clinical, radiological, and histological picture. We report three cases of BPOP affecting the hand and foot. Case 1: A 21-year-old gentleman presented with painful swelling in the long finger of the right hand. A plain radiograph showed a radio dense mass which was later excised and diagnosis confirmed in histopathology. There was no recurrence in 2 years of follow-up. Case 2: A 5-year-old boy presented with painful swelling over the right ankle with no history of antecedent trauma. Following radiological evaluation, the patient was successfully treated with excision. Case 3: A 35-year-old lady presented with a painful swelling on the dorsal aspect of her hand which was gradually increasing in size. After radiological evaluation, the patient was successfully treated with excision and lesion confirmed to be BPOP on histological examination. She was symptom free without recurrence in up to 2 years of follow-up. Conclusion: Nora’s lesion is a rare pathology requiring high index of suspicion. Excision is the recommended mode of treatment. All our cases responded well with excision with immediate pain relief following surgery and no recurrence in up to 2 years of follow-up. Keywords: Nora, bizarre parosteal osteochondromatous proliferation, neoplasm, tumor, benign.

Nora's Lesion: Bizarre Parosteal Osteochondromatous Proliferation Causing Splay Foot Deformity: A Case Report

2019 ◽  
Vol 109 (6) ◽  
pp. 463-466 ◽  
Author(s):  
Anthony J. Mollica ◽  
Benjamin Getz ◽  
Chinenye Ezike ◽  
Blake Brannick ◽  
Albert J. Mollica
Keyword(s):  
Benign Lesion ◽  
Foot Deformity ◽  
Bizarre Parosteal Osteochondromatous Proliferation ◽  
Nora’S Lesion ◽  
Spindle Cells ◽  
Common Diagnosis ◽  
Hands And Feet ◽  
Splay Foot ◽  
Tubular Bones

Nora's lesion, or bizarre parosteal osteochondromatous proliferation (BPOP), is a rare benign lesion that is made up of varying degrees of cartilage, bone, and spindle cells. Most notably, calcification of the cartilage or “blue bone,” is a feature of the disorder. The condition principally affects long tubular bones of the hands and feet, and is generally seen in patients in their second and third decades of life. We present a case of BPOP occurring in the second interspace with symptoms that would be consistent with a more common diagnosis of predislocation syndrome, or a second interspace neuroma. This case study may help the clinician in considering a more subtle cause of a splay deformity in the second interspace, and walk through the diagnostic and treatment course for BPOP.

scholarly journals Nora’s lesion of the distal ulna: a case report

2021 ◽  
Vol 49 (12) ◽  
pp. 030006052110643
Author(s):  
Cheng Han Lin ◽  
Karl Wu
Keyword(s):  
Benign Lesion ◽  
Excisional Biopsy ◽  
Bizarre Parosteal Osteochondromatous Proliferation ◽  
Distal Ulna ◽  
Nora’S Lesion ◽  
Calcified Lesion ◽  
Bone Cortex ◽  
Painless Mass ◽  
Hands And Feet

Nora’s lesion, also known as bizarre parosteal osteochondromatous proliferation (BPOP), is a very rare benign lesion with few published cases. BPOP is more common in adults during the second to third decades of life, and usually occurs on the hands and feet. Radiologically, it appears as a calcified mass attached to the bone cortex that grows rapidly and that recurs easily following resection. Aggressive features on imaging and confusing histopathological findings usually result in misdiagnosis or mistreatment. Herein, we present a case of a rare bony tumour involving the distal ulna presenting as a painless growing mass. An excisional biopsy with clear margins was performed without disturbing the ulnar nerve and arteries. There was no recurrent mass or calcified lesion 1 year after surgery. Based on its rarity and difficult diagnosis, BPOP should be considered in the differential diagnosis of a painless mass in the distal ulnar region. Careful follow-up after surgery is essential, even without lesion recurrence.

scholarly journals A rare case of unilateral breast filariasis mimicking chronic mastitis

2021 ◽  
Vol 8 (7) ◽  
pp. 2228
Author(s):  
Varsha A. Sharma ◽  
Manmohan M. Kamat ◽  
Jeena K. Sathyan ◽  
Seema Barman ◽  
Shravani Shetye
Keyword(s):  
Benign Lesion ◽  
Rare Condition ◽  
Surgical Excision ◽  
Axillary Lymph Nodes ◽  
Excision Biopsy ◽  
Axillary Lymph ◽  
Presumptive Diagnosis ◽  
Lower Quadrant ◽  
History Of ◽  
The Right

Filariasis of the breast is a very rare condition. In India, largest number (around 600 million) of people live in endemic areas. Despite the huge number, it is quite rare to find microfilaria in routine smears and body fluids and it is even more rare to find it in breasts. A 40 years old female, presented with a history of lump in the right breast approximately 3x3 cm in size in the right lower quadrant. Findings were confirmed by clinical examination which did not reveal any palpable ipsilateral or contralateral axillary lymph nodes. FNAC showed it as a benign lesion. After local excision, histopathology revealed a filarial worm. Filariasis of the breast is a rare disease. The presence of microfilaria in breasts using FNAC has been reported at times but the presence of the filarial worms can only be confirmed on histopathology, hence a core biopsy or an excision biopsy is a must in all the cases. A presumptive diagnosis of filariasis can be made on sonography if the worms are alive and active, the typical presentation on USG is the filarial dance. Surgical excision of the lump followed by DEC therapy is the treatment of choice for filarial lump of the breast.

Bizarre Parosteal Osteochondromatous Proliferation (Nora's Lesion) in the Medial Sesamoid of the First Toe

2020 ◽  
Vol 110 (6) ◽  
Author(s):  
Onur Tetik ◽  
Lercan Aslan ◽  
Kadir Buyukdogan ◽  
Mehmet Chodza ◽  
Onder Kilicoglu
Keyword(s):  
Young Adults ◽  
Bizarre Parosteal Osteochondromatous Proliferation ◽  
En Bloc ◽  
Nora’S Lesion ◽  
Bony Lesion ◽  
En Bloc Excision ◽  
Small Bones ◽  
Bloc Excision ◽  
Hands And Feet

Bizarre parosteal osteochondromatous proliferation, or Nora's lesion, is a unique bony lesion that generally originates from the small bones of the hands and feet in young adults. We report a case of a bizarre parosteal osteochondromatous proliferation originating from the medial sesamoid of the first toe that was managed surgically by en bloc excision. At 5-year follow-up, there was no evidence of recurrence.

scholarly journals A Pelvic Pseudotumor in a Nonhemophilic Patient: An Unusual Presentation

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Mohamad Gouse ◽  
Abel Livingston ◽  
Dan Barnabas ◽  
Vinoo Mathew Cherian
Keyword(s):  
Complete Blood Count ◽  
Rare Complication ◽  
Iliac Fossa ◽  
Plain Radiograph ◽  
Factor Ix ◽  
Lytic Lesion ◽  
Excision Biopsy ◽  
History Of ◽  
Factor Ix Deficiency ◽  
The Right

Hemophilic pseudotumor is a rare complication of hemophilia, occurring in 1 to 2 percent of individuals with severe factor VIII or factor IX deficiency. A 35-year-old male presented with a swelling in the right lower abdomen for 3 months. There was no history of trauma. Examination revealed a swelling over the right iliac fossa. Right hip showed 30° flexion deformity. Blood investigations like complete blood count, APTT, PT, bleeding and clotting time, and fibrinogen were all normal. Plain radiograph and MRI showed a lytic lesion in the right iliac wing. Excision biopsy of the swelling showed organized hematoma with a fibrous capsule suggestive of a pseudotumor. Further haematological workup like factors VIII and IX was normal. At 2 years follow-up, there was no recurrence. We report this case of pseudotumour in patient without any bleeding disorder. Such case has not been reported in literature to the best of our knowledge.

DIGITAL FIBROMYXOMA: A CASE REPORT

2021 ◽  
pp. 2172001
Author(s):  
Mahmood Ajawi ◽  
Irfan Abdulkareem ◽  
Abdullah H. Darwish ◽  
Iftikhar A. Mukhtar ◽  
Noora Iftikhar
Keyword(s):  
Case Report ◽  
Tissue Sample ◽  
Ring Finger ◽  
High Rate ◽  
Excision Biopsy ◽  
Histopathological Analysis ◽  
Complete Excision ◽  
The Right ◽  
Hands And Feet

Digital fibromyxoma is a rare soft tissue tumor with a propensity to grow in the digits of the hands and feet. While mostly asymptomatic, the tumors can grow and cause discomfort and eventually pain. It is a benign tumor, with treatment revolving around complete excision to prevent recurrence. In this case report, we discuss the case of a 11-year old boy presented with a swelling in the right ring finger that had been increasing in size for over a year. Despite the lack of pain or limitation of movement in the finger, the swelling caused concern to the patient and family due to cosmetic appearance. An excision biopsy with histopathological analysis of the tissue sample suggested the diagnosis of digital fibromyxoma. The high rate of recurrence is due to incomplete excision, and therefore regular follow up is recommended to monitor for recurrence.

scholarly journals P043 Fascinating phosphate: seek and you will find

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Jyoti Bakshi ◽  
Clare Batten
Keyword(s):  
Back Pain ◽  
Degenerative Change ◽  
Nasal Bone ◽  
Rare Condition ◽  
Whole Body ◽  
Excision Biopsy ◽  
Small Lesion ◽  
History Of ◽  
The Right ◽  
Fgf 23

Abstract Background/Aims  A 62-year-old accountant was referred to the metabolic bone clinic with a 2 year history of thoracic back pain and a persistently raised ALP. There were no associated red flags for her back pain. She had a history of a gluteal lump, thought to be benign, for which she had declined excision. She has hypertension and had a previous navicular fracture. Medications included bendroflumethiazide and Adcal D3. She had restriction in neck movements and was tender to percussion in the thoracic spine. There was no proximal weakness or focal neurology. Systems and joint exam were unremarkable. Methods  The case is discussed below. Results  Salient abnormal results on presentation were a raised ALP of 207 and corrected calcium of 2.34. PTH was elevated at 8.2 (NR:1.6-6.9), Vitamin D 79 and a low phosphate of 0.34 (NR:0.8-1.50). Alkaline phosphatase isoenzymes showed the raised level came from bone. Protein and urine electrophoresis were normal. A bone density scan was normal, and a recent thoracic MRI showed only degenerative change. An isotope bone scan was requested and was reported to show increased activity in the nasal bone, maxilla and both orbits, raising the possibility of Paget’s disease. However, when reviewed in the Radiology meeting with a skull x-ray, the appearances were not felt to be in keeping with Paget’s. Despite physiotherapy, hydrotherapy, acupuncture and neuropathic medication the patient’s back pain continued. Her phosphate remained low and her calculated tubular reabsorption of phosphate from a 24h urine collection (TmP/GFR) was low at 0.42mmol/l (NR 0.80-1.35). She was started on phosphate replacement and calcitriol, and Adcal D3 was continued. The Fibroblast Growth Factor (FGF) 23 levels were sent and came back significantly elevated at 1380 (NR &lt; 100). A 68Ga DOTA-TATE scan (whole body PET/CT scan), confirmed the right gluteal lump as the source of the FGF 23. The patient went on to have an excision biopsy and histology confirmed a mesenchymal tumour of the right buttock. Her phosphate replacement was gradually weaned, but on reducing the dose phosphate levels dropped and her symptoms returned. The repeat TmP/GFR was again low at 0.61, and FGF 23 levels were still raised at 204. A repeat 68Ga DOTA-TATE scan, 4 years after the first one, showed recurrence of the right gluteal lesion and a possible small lesion in the left gluteal muscle. She has been sent for further excision. Conclusion  Tumour induced osteomalacia (TIO) is a rare condition and should be considered in cases of hypophosphataemia. Classical symptoms are proximal weakness and muscle and bone pain. They are typically associated with small benign tumours (most commonly mesenchymal tumours) which may be difficult to find. Excision is curative but if small amounts of tumour remain, relapses may occur. Disclosure  J. Bakshi: None. C. Batten: None.

Normative Distribution of First Metatarsal Axial Rotation

2021 ◽  
pp. 107110072110010
Author(s):  
Jesse Steadman ◽  
Neil Bakshi ◽  
Christopher Arena ◽  
Richard Leake ◽  
Alexej Barg ◽  
...  
Keyword(s):  
Plain Radiograph ◽  
Axial Rotation ◽  
Valgus Deformity ◽  
Intraobserver Reliability ◽  
Foot Deformities ◽  
Level Of Evidence ◽  
Mean Values ◽  
First Metatarsal ◽  
Hallux Valgus Deformity ◽  
First Ray

Background: First metatarsal (M1) axial rotation is recognized as a clinically relevant component of hallux valgus deformity. Methods to realign the M1 in 3 dimensions have been developed. One goal of these operations is to restore normal rotation of the first ray. The aim of this study is to provide estimates for the normal distribution of M1 rotation in patients without relevant anatomic pathology. Methods: Using stringent clinical and radiographic criteria, we evaluated a set of plain radiograph and weightbearing computed tomography (WBCT) images of 62 feet from a consecutive patient database. Subjects included had normal foot alignment without bunion symptoms. M1 rotation of each foot was measured using 2 unique methods (Saltzman et al and Kim et al methods). Measurement of rotation was performed by 2 observers from coronal WBCT images. Mean values and confidence intervals (CIs) of M1 rotation were calculated for each method. Inter- and intraobserver reliability values were also reported. Results: Mean M1 rotation values of 2.1 degrees (95% CI: 0.9-3.4) and 6.1 degrees (95% CI: 4.4-7.8) were identified using the Saltzman et al and Kim et al methods, respectively. Inter- and intraobserver reliability values were interpreted as excellent for both methods. Conclusion: In this study, we describe the natural distribution of the M1 axial rotation in subjects without bunion or other identifiable bony foot deformities. This information should provide a normative reference for surgeons correcting rotational issues of the first metatarsal. Level of Evidence: Level III.

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