Bizarre parosteal osteochondromatous proliferation

Bizarre parosteal osteochondromatous proliferation
Other names: Nora lesion or Nora disease (not recommended)[1][2]
Bizarre parosteal osteochondromatous proliferation, middle finger
SpecialtyOrthopedics
SymptomsPainless lump in finger or toe[1]
Risk factorsPossibly trauma in a minority[1]
Diagnostic methodMedical imaging[1]
Differential diagnosisMainly subungal exostosis[1]
TreatmentSurgical excision.[1]
PrognosisUp to 50% recur after surgery[1]
Frequency<5% of cartilage tumors,[3] Males=Females[1]

Bizarre parosteal osteochondromatous proliferation (BPOP) is a type of non-cancerous bone tumor belonging to the group of cartilaginous tumors.[1][4] It is generally seen in the tubular bones of the hands and feet,[5] where it presents with a rapidly growing 1-3cm painless lump, usually in a finger or toe.[1][2]

BPOP is composed of bone, cartilage and spindle cells.[1] A small number of people have reported previous trauma.[1]

Diagnosis is by medical imaging.[1] Treatment is by surgical excision.[1] Up to 50% recur after surgery.[1]

It occurs more often in the 20s and 30s,[1] and combined with subungal exostosis, accounts for less than 5% of cartilage tumors.[3] Males and females are affected equally.[1] The condition was first described in 1983 by Frederick E. Nora.[5][6]

Signs and symptoms

BPOP generally presents with a rapidly growing 1-3cm painless lump in a finger or toe.[1][2]

Mechanism

It is composed of bone, cartilage and spindle cells.[1] A small number of people have reported previous trauma.[1]

Diagnosis

Medical imaging usually shows a well-defined wide-based bony growth on the surface of bone.[5] It can be pedunculated and irregular, giving it a "bizarre" appearance, and is not connected to underlying bone.[2]

  • X-ray left foot: Bizarre parosteal osteochondromatous proliferation in 2nd toe
    X-ray left foot: Bizarre parosteal osteochondromatous proliferation in 2nd toe
  • MRI mid-upper arm
    MRI mid-upper arm
  • MRI mid-arm axial view
    MRI mid-arm axial view
  • X-ray hand, BPOP 2nd metacarpal
    X-ray hand, BPOP 2nd metacarpal
  • X-ray hand, BPOP 2nd metacarpal (side view)
    X-ray hand, BPOP 2nd metacarpal (side view)

Histopathology

  • Bone Bizzare Parosteal Osteochondromatous Proliferation
    Bone Bizzare Parosteal Osteochondromatous Proliferation
  • Bone Bizzare Parosteal Osteochondromatous Proliferation
    Bone Bizzare Parosteal Osteochondromatous Proliferation
  • Bone Bizzare Parosteal Osteochondromatous Proliferation
    Bone Bizzare Parosteal Osteochondromatous Proliferation

Differential diagnosis

BPOP is distinct from subungal exostosis.[1][5] Granulomatous infection may also appear similar.[2] Other differential diagnoses include:

Treatment

Treatment is by surgical excision.[1]

Outcomes

Bizarre parosteal osteochondromatous proliferations are non-cancerous with no risk of spread.[5] They may invade local tissue and recurrence after surgery can occur in up to 50%.[1][5]

Epidemiology

They are most often seen in people in their 20s and 30s.[1] Combined with subungal exostosis, account for less than 5% of cartilage tumors.[3] Males and females are affected equally.[1][5]

History

Bizarre parosteal osteochondromatous proliferation was first described by Frederick E. Nora in 1983.[5][6] Generally in the US, it has been thought of as a mouthful and hence it is sometimes referred to as Nora's lesion.[7]

Other animals

In 1998 a report of a similar lesion to BPOP was reported in a wallaby.[8]

References

  1. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 WHO Classification of Tumours Editorial Board, ed. (2020). "Bizarre parosteal osteochondromatous proliferation". Soft Tissue and Bone Tumours: WHO Classification of Tumours. Vol. 3 (5th ed.). Lyon (France): International Agency for Research on Cancer. pp. 348–350. ISBN 978-92-832-4503-2. Archived from the original on 2021-06-13. Retrieved 2021-07-04.
  2. 1 2 3 4 5 6 Bocklage, Therese J.; Quinn, Robert; Verschraegen, Claire; Schmit, Berndt (2014). "16. Cartilaginous tumours of bones and joints". Bone and Soft Tissue Tumors: A Multidisciplinary Review with Case Presentations. London: JP Medical Ltd. p. 379. ISBN 978-1-907816-22-2. Archived from the original on 2023-01-11. Retrieved 2021-07-05.
  3. 1 2 3 Engel, Hannes; Herget, Georg W.; Füllgraf, Hannah; Sutter, Reto; Benndorf, Matthias; Bamberg, Fabian; Jungmann, Pia M. (March 2021). "Chondrogenic Bone Tumors: The Importance of Imaging Characteristics". RoFo: Fortschritte Auf Dem Gebiete Der Rontgenstrahlen Und Der Nuklearmedizin. 193 (3): 262–275. doi:10.1055/a-1288-1209. ISSN 1438-9010. PMID 33152784. Archived from the original on 2021-07-09. Retrieved 2021-07-05.
  4. ↑ "ICD-11 - ICD-11 for Mortality and Morbidity Statistics". icd.who.int. Archived from the original on 1 August 2018. Retrieved 6 July 2021.
  5. 1 2 3 4 5 6 7 8 9 10 11 12 13 Mahajan, Sumit; Chandra, Rajesh; Mohan Lal, Yash (December 2012). ""Nora lesion" – Bizarre parosteal osteochondromatous proliferation". Journal of Clinical Orthopaedics and Trauma. 3 (2): 119–121. doi:10.1016/j.jcot.2012.07.001. ISSN 0976-5662. PMID 26403451. Archived from the original on 2020-12-11. Retrieved 2021-07-04.
  6. 1 2 Nora, F. E.; Dahlin, D. C.; Beabout, J. W. (April 1983). "Bizarre parosteal osteochondromatous proliferations of the hands and feet". The American Journal of Surgical Pathology. 7 (3): 245–250. doi:10.1097/00000478-198304000-00003. ISSN 0147-5185. PMID 6837834. Archived from the original on 2021-07-09. Retrieved 2021-07-04.
  7. ↑ Davies, A. Mark; Sundaram, Murali; James, Steven J. (2009). Imaging of Bone Tumors and Tumor-Like Lesions: Techniques and Applications. Springer Science & Business Media. p. 684. ISBN 978-3-540-77982-7. Archived from the original on 2021-08-28. Retrieved 2021-08-18.
  8. ↑ Rungsipipat, A.; Yamaguchi, R.; Naganobu, K.; Iwamoto, K.; Uchida, K.; Tateyama, S.; Kurogi, T.; Katayama, N. (1998). "A bone tumour resembling bizarre parosteal osteochondromatous proliferation in a wallaby". Australian Veterinary Journal. 76 (8): 561–564. doi:10.1111/j.1751-0813.1998.tb10218.x. ISSN 1751-0813. PMID 9741726. Archived from the original on 2021-08-18. Retrieved 2021-07-05.
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