Abstract

Introduction: Osteochondroma represents the most common bone tumour and is a developmental lesion rather than a true neoplasm. It constitutes 20%–50% of all benign bone tumours and 10%–15% of all bone tumours. Its radiologic features are often pathognomonic and identically reflect its pathologic appearance. Osteochondromas typically occur at the metaphysis of long bones, especially the distal femur, proximal humerus, proximal tibia and fibula. Most cases are diagnosed within the first three decades of life.

Materials and Methods: We present a case of a 22 yr old male patient with giant osteochondroma of left proximal humerus. It is an unusual presentation for its size and location with no clinical symptoms and a growing mass over the left shoulder extending into axilla. Imaging studies demonstrated large pedunculated and sessile masses arising from the proximal humerus. On surgical exploration, pedunculated and sessile masses were found all around the proximal humerus with cauliflower like growth and hyaline cartilaginous cap. Each mass was carefully separated from the neurovascular structures and resected one by one.

Results: No post-operative neurological deficits were found. Patient was prescribed physiotherapy and was advised monthly follow-up. Patient had complete range of motion at the last follow up visit and was conveniently able to do his daily activities.

Discussion: Osteochondromas may develop from proliferation of cartilage-forming periosteal cells or from a defect in the fibrous tissue surrounding a physis. During skeletal growth the lesions enlarge with the surrounding bone, and they stabilize with skeletal maturity.

In our case, it is very rare to see such huge cauliflower like growth. Also the mass extended into axilla . We were successful in excising the tumour protecting the vital structures in axilla with patient having no postoperative neurological deficits.

Conclusion: It is very rare for Osteochondroma to present at proximal humerus with mass extending gigantically into axilla. Careful dissection and protection of vital structures and good amount of learning curve of surgeon and expertise is demanding in operating such cases to avoid post operative neurovascular deficits

Keywords: Osteochondroma, Proximal Humerus, Axilla