Scientific Article

Skeletal Radiology

, Volume 36, Issue 9, pp 829-834

Cortico-medullary continuity in bizarre parosteal osteochondromatous proliferation mimicking osteochondroma on imaging

  • Leon D. RybakAffiliated withDepartment of Radiology, NYU Hospital for Joint Diseases Email author 
  • , Luigia AbramoviciAffiliated withDepartment of Pathology and Laboratory Medicine, NYU Hospital for Joint Diseases
  • , Samuel KenanAffiliated withOncology Service, Department of Orthopedics, NYU Hospital for Joint Diseases
  • , Martin A. PosnerAffiliated withHand Service, Department of Orthopedics, NYU Hospital for Joint Diseases
  • , Fiona BonarAffiliated withDouglass Hanly Moir Pathology
  • , German C. SteinerAffiliated withDepartment of Pathology and Laboratory Medicine, NYU Hospital for Joint Diseases

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Abstract

Bizarre parosteal osteochondromatous proliferation (BPOP), or Nora’s lesion, is an unusual surface-based lesion of bone found most commonly in the hands and feet. In the original description of the lesion and in all publications that followed, one of the key imaging characteristics used to define this entity was the lack of cortico-medullary continuity with the underlying bone. The authors present 4 unique cases of pathologically proven BPOP in which cortico-medullary continuity with the underlying bone was demonstrated on imaging. It is believed that florid reactive periostitis, BPOP and turret osteochondroma may reflect points along the same continuum with trauma the likely inciting event. The authors suggest that, given this continuum, it may be possible to have BPOP lesions demonstrating overlapping imaging features with osteochondroma. If this is the case, strict adherence to the standard imaging criterion of lack of continuity between the lesion and the underlying bone may lead to misdiagnosis of these unusual cases of BPOP as osteochondromas.

Keywords

Bizarre parosteal osteochondromatous proliferation Turret exostosis Florid reactive periostitis CT MRI