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Imaging of Osteochondroma: Variants and Complications with Radiologic-Pathologic Correlation¹

¹ From the Departments of Radiologic Pathology (M.D.M., J.J.C.) and Orthopedic Pathology (F.H.G.), Armed Forces Institute of Pathology, 6825 16th St NW, Bldg 54, Rm M-133A, Washington, DC 20306; the Departments of Radiology and Nuclear Medicine, Uniformed Services University of Health Sciences, Bethesda, Md (M.D.M.); the Department of Radiology, University of Maryland School of Medicine, Baltimore (M.D.M.); the Department of Radiology, National Naval Medical Center, Bethesda, Md (D.J.F.); and the Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.J.K.). Received April 12, 2000; revision requested April 27 and received May 19; accepted May 19. Address correspondence to M.D.M. (e-mail: murphey@afip.osd.mil).

Osteochondroma represents the most common bone tumor and is a developmental lesion rather than a true neoplasm. It constitutes 20%–50% of all benign bone tumors and 10%–15% of all bone tumors. Its radiologic features are often pathognomonic and identically reflect its pathologic appearance. Osteochondromas are composed of cortical and medullary bone with an overlying hyaline cartilage cap and must demonstrate continuity with the underlying parent bone cortex and medullary canal. Osteochondromas may be solitary or multiple, the latter being associated with the autosomal dominant syndrome, hereditary multiple exostoses (HME). Complications associated with osteochondromas are more frequent with HME and include deformity (cosmetic and osseous), fracture, vascular compromise, neurologic sequelae, overlying bursa formation, and malignant transformation. Malignant transformation is seen in 1% of solitary osteochondromas and in 3%–5% of patients with HME. Continued lesion growth and a hyaline cartilage cap greater than 1.5 cm in thickness, after skeletal maturity, suggest malignant transformation. Variants of osteochondroma include subungual exostosis, dysplasia epiphysealis hemimelica, turret and traction exostoses, bizarre parosteal osteochondromatous proliferation, and florid reactive periostitis. Recognition of the radiologic spectrum of appearances of osteochondroma and its variants usually allows prospective diagnosis and differentiation of the numerous potential complications, thus helping guide therapy and improving patient management.

Index Terms: Osteochondroma, 40.3113, 40.1542 • Osteochondromatosis, 40.365, 40.782 • Bone neoplasms, 40.3113, 40.1542

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