technetium-tc-99m-medronate and Chondromatosis--Synovial

It is well established that irregular bursae can form adjacent to an osteochondroma (bursa exostotica) as a result of mechanical irritation and that these bursae can be complicated by inflammation, hemorrhage, or infection. Bursal chondromatosis is a rare complication, with only seven published cases in the literature according to our searches. We present the case of a 53-year-old female who presented with slowly progressive left hip/thigh pain and was found to have an osteochondroma arising from the lesser trochanter with numerous ossified bodies in the adjacent soft tissues. MRI demonstrated osteochondral bodies in a fluid-filled bursa adjacent to the osteochondroma, with several of the bodies noted to be fairly displaced from the osteochondroma cartilaginous cap. At surgery, the osteochondroma was removed and numerous bodies of varying sizes were excised, some of which were noted to be adherent to the bursal lining and others that were separated/distant from the cartilage cap. The question arises as to whether this process represents bursal chondromatosis resulting from benign neoplasia of cells lining the abnormal bursa, "cartilage shedding" from the osteochondromatous cap, or both. The purpose in presenting this case is to introduce a rare complication of an osteochondroma, demonstrate that soft tissue calcification and osteochondral densities displaced from an underlying osteochondroma are not always the result of sarcomatous degeneration, and provide support for the theory that cells lining a bursa in a nonphysiologic location can undergo benign neoplasia with subsequent formation of osteochondral bodies.

Topics: Bone Neoplasms; Bursa, Synovial; Chondromatosis, Synovial; Contrast Media; Female; Hip Joint; Humans; Image Enhancement; Magnetic Resonance Imaging; Middle Aged; Osteochondroma; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Whole Body Imaging

A case is presented of synovial chondromatosis within a bursal sac overlying an osteochondroma in a patient with osteochondromatosis. This condition presented with a symptomatic soft tissue mass containing calcified bodies. It can be mistaken clinically and radiographically for malignant degeneration of an osteochondroma with development of chondrosarcoma. Magnetic resonance findings have not previously been described in this entity and proved helpful in the preoperative diagnosis. Magnetic resonance imaging was also helpful in defining the extent of the lesion. Ultrasound and other imaging modalities are also discussed, including the pathologic basis for the radiographic findings.

Topics: Adult; Bone Neoplasms; Bursa, Synovial; Chondromatosis, Synovial; Diagnosis, Differential; Female; Humans; Magnetic Resonance Imaging; Osteochondromatosis; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Topics: Adult; Bone and Bones; Chondromatosis, Synovial; Humans; Magnetic Resonance Imaging; Male; Radionuclide Imaging; Technetium Tc 99m Medronate; Tomography, X-Ray Computed