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Updated: Dec 27 2021


  • Snapshot
    • A 12-year-old boy presents to his pediatrician for a bony mass on his left leg. He denies any trauma to the area and it is not associated with pain. Physical examination demonstrates a palpable painless mass close to the knee joint. A radiograph of the knee demonstrates a bony outgrowth with clear, regular margins.
  • Introduction
    • Overview
      • a benign chondrogenic bone tumor (osteocartilaginous exostosis)
        • when there are 2 or more exotoses, it is termed hereditary multiple osteochondromas (HME)
  • Epidemiology
    • Incidence
      • most common benign bone tumor
    • Demographics
      • children and adolescents
      • more common in males
    • Location
      • typically affects
        • long bones in the legs
        • pelvis
        • shoulder blade
    • Pathophysiology
      • occurs in bone that is undergoing endochondral ossiffication and results in an outgrowth of the growth plate
        • the cartilaginous cap serves as the source of growth over the bony spur
    • Genetics
      • mutation
        • EXT1 (on chromosome 8) or EXT2 (on chromosome 11)
  • Presentation
    • Osteochondroma
      • symptoms
        • usually present with painless mass
        • may have mechanical symptoms or symptoms of neurovascular compression
      • physical exam
        • palpable mass
        • may have mechanical symptoms secondary to mass
    • Hereditary multiple exostosis
      • symptoms
        • often presents with limb deformities (short stature, deformed joints, and decreased range of motion)
        • most common sites of deformity include the knee, forearm, and ankle
      • physical exam
        • extremity deformity
        • decreased joint range of motion
  • Imaging
    • Radiograph
      • indication
        • initial imaging study
      • findings
        • sessile (broad base) or pedunculated (narrow stalk) lesions found on the surface of bones
        • cortex of the lesion is continous with the cortex of the bone
        • cavity of the lesion is continous with the medullary cavity of the bone
  • Differential
    • Osteosarcoma
      • differentiating factors
        • painful enlarging mass or fracture
        • Codman triangle or sunburst pattern on radiography of the bone
  • Treatment
    • Lifestyle
      • observation
        • indication
          • asymptomatic cases
    • Surgical
      • excision
        • indication
          • in symptomatic cases
  • Complications
    • Tendon, soft tissue, vascular, and nerve compression
    • Bone deformities
    • Fracture
    • Growth impairment
    • Chondrosarcoma
  • Prognosis
    • Associated with normal life expectancy
    • Rare transformation to chondrosarcoma
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