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Presented by Edward McCarthy, M.D. and prepared by Jeffrey Seibel, M.D. Ph.D.
Case 6: A 30 year-old woman had pain in her hand for six weeks.
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Week 48: Case 6
A 30 year-old woman had pain in her hand for six weeks. A radiograph demonstrated a bony nodule on the ulnar aspect of her distal fifth metacarpal./images/JS0709case6a.jpg
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/images/JS0709case6d.jpgCorrect
Answer: Bizarre parosteal osteochondromatous proliferation (BPOP)
Histology: There is an admixture of cartilage, loose fibrous tissue and bone formation in a haphazard arrangement. Although there is abundant cartilage and osteoid production, there is no cellular pleomorphism.
Discussion: BPOP is a reactive process, also known as Nora’s Lesion. It is a manifestation of heterotopic bone formation in the hand. Radiographically, the lesion is on the surface and is fairly well demarcated. Osteochondromas are almost unheard of in the hand. These are developmental lesions which affect the metaphases of long bones. The radiographic pattern in this patient does not show a stalk typical of an osteochondroma anywhere. Osteosarcomas are extremely uncommon in the hand. Although there is abundant osteoid and cartilage in the lesion, there is no cellular pleiomorphism.
Incorrect
Answer: Bizarre parosteal osteochondromatous proliferation (BPOP)
Histology: There is an admixture of cartilage, loose fibrous tissue and bone formation in a haphazard arrangement. Although there is abundant cartilage and osteoid production, there is no cellular pleomorphism.
Discussion: BPOP is a reactive process, also known as Nora’s Lesion. It is a manifestation of heterotopic bone formation in the hand. Radiographically, the lesion is on the surface and is fairly well demarcated. Osteochondromas are almost unheard of in the hand. These are developmental lesions which affect the metaphases of long bones. The radiographic pattern in this patient does not show a stalk typical of an osteochondroma anywhere. Osteosarcomas are extremely uncommon in the hand. Although there is abundant osteoid and cartilage in the lesion, there is no cellular pleiomorphism.
