Bizarre parosteal osteochondromatous proliferation explained
| Bizarre parosteal osteochondromatous proliferation |
| Synonyms: | Nora lesion or Nora disease[1] [2] |
| Field: | Orthopedics |
| Symptoms: | Painless lump in finger or toe |
| Risks: | Possibly trauma in a minority |
| Diagnosis: | Medical imaging |
| Differential: | Mainly subungal exostosis |
| Treatment: | Surgical excision. |
| Prognosis: | Up to 50% recur after surgery |
| Frequency: | Rare, <5% of cartilage tumors,[3] M=F |
Bizarre parosteal osteochondromatous proliferation (BPOP), also known as Nora's lesion,[4] is a type of non-cancerous bone tumor belonging to the group of cartilage tumors.[5] [6] [7] It is generally seen in the tubular bones of the hands and feet,[8] where it presents with a rapidly enlarging painless lump in a finger or toe.[1]
It is composed of bone, cartilage and spindle cells.[1] Some people report previous trauma.[1]
Diagnosis is by medical imaging.[1] Treatment is by surgical excision.[1] Up to 50% recur after surgery.[1]
It is rare,[2] and occurs more often in the 20s and 30s.[1] Combined with subungal exostosis, it accounts for less than 5% of cartilage tumors.[3] Males and females are affected equally.[1] The condition was first described by Frederick E. Nora in 1983.[8]
Signs and symptoms
BPOP generally presents with a 1–3 cm painless lump in a finger or more frequently a toe.[1] Growth can be rapid.[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.[8]
Differential diagnosis
BPOP is distinct from subungal exostosis.[1] [8] Conditions that may appear similar to BPOP include: myositis ossficans, ostechondroma, surface osteosarcoma and granulomatous infection.[2]
Treatment
Treatment is by surgical excision.[1]
Outcomes
Up to 50% recur after surgery.[1] [2]
Epidemiology
BPOP is rare.[2] It is most often seen in people in their 20s and 30s.[1] Combined with subungal exostosis, it accounts for less than 5% of cartilage tumors.[3] Males and females are affected equally.[1] [8]
History
Bizarre parosteal osteochondromatous proliferation was first described by Frederick E. Nora in 1983.[8] [9] Generally in the US, it has been thought of as a mouthful and hence it is sometimes referred to as Nora's lesion.[4]
Other animals
In 1998 a report of a similar lesion to BPOP was reported in a wallaby.[10]
Notes and References
- Book: Soft Tissue and Bone Tumours: WHO Classification of Tumours. 2020. WHO Classification of Tumours Editorial Board. International Agency for Research on Cancer. Lyon (France). 5th. 3. 978-92-832-4503-2. Bizarre parosteal osteochondromatous proliferation. 348–350.
- Book: Bocklage . Therese J. . Quinn . Robert . Verschraegen . Claire . Schmit . Berndt . Bone and Soft Tissue Tumors: A Multidisciplinary Review with Case Presentations . 2014 . JP Medical Ltd . London . 978-1-907816-22-2 . 379 . https://books.google.com/books?id=468iAwAAQBAJ&pg=PA379 . en . 16. Cartilaginous tumours of bones and joints.
- Engel . Hannes . Herget . Georg W. . Füllgraf . Hannah . Sutter . Reto . Benndorf . Matthias . Bamberg . Fabian . Jungmann . Pia M. . Chondrogenic Bone Tumors: The Importance of Imaging Characteristics . RöFo: Fortschritte auf dem Gebiete der Röntgenstrahlen und der Nuklearmedizin . March 2021 . 193 . 3 . 262–275 . 10.1055/a-1288-1209 . 33152784 . 1438-9010. free .
- Book: Davies . A. Mark . Sundaram . Murali . James . Steven J. . Imaging of Bone Tumors and Tumor-Like Lesions: Techniques and Applications . 2009 . Springer Science & Business Media . 978-3-540-77982-7 . 684 . en.
- Book: Soft Tissue and Bone Tumours: WHO Classification of Tumours. 2020. WHO Classification of Tumours Editorial Board. International Agency for Research on Cancer. Lyon (France). 5th. 3. 978-92-832-4503-2. Bizarre parosteal osteochondromatous proliferation. 348–350.
- Book: Bocklage . Therese J. . Quinn . Robert . Verschraegen . Claire . Schmit . Berndt . Bone and Soft Tissue Tumors: A Multidisciplinary Review with Case Presentations . 2014 . JP Medical Ltd . London . 978-1-907816-22-2 . 379 . https://books.google.com/books?id=468iAwAAQBAJ&pg=PA379 . en . 16. Cartilaginous tumours of bones and joints.
- Web site: ICD-11 - ICD-11 for Mortality and Morbidity Statistics . icd.who.int . 6 July 2021.
- Mahajan . Sumit . Chandra . Rajesh . Mohan Lal . Yash . "Nora lesion" – Bizarre parosteal osteochondromatous proliferation . Journal of Clinical Orthopaedics and Trauma . December 2012 . 3 . 2 . 119–121 . 10.1016/j.jcot.2012.07.001 . 26403451 . 0976-5662. 3872810 .
- Nora . F. E. . Dahlin . D. C. . Beabout . J. W. . Bizarre parosteal osteochondromatous proliferations of the hands and feet . The American Journal of Surgical Pathology . April 1983 . 7 . 3 . 245–250 . 10.1097/00000478-198304000-00003 . 6837834 . 36384395 . 0147-5185.
- Rungsipipat . A. . Yamaguchi . R. . Naganobu . K. . Iwamoto . K. . Uchida . K. . Tateyama . S. . Kurogi . T. . Katayama . N. . A bone tumour resembling bizarre parosteal osteochondromatous proliferation in a wallaby . Australian Veterinary Journal . 1998 . 76 . 8 . 561–564 . 10.1111/j.1751-0813.1998.tb10218.x . 9741726 . en . 1751-0813.
