Department of Rheumatology and Radiology, South Infirmary Victoria University Hospital, Cork, Ireland.
Ir J Med Sci. 2012 Sep;181(3):357-60. doi: 10.1007/s11845-009-0435-0. Epub 2009 Oct 8.
We report a rare case of bizarre parosteal osteochondromatous proliferation (BPOP, Nora's lesion) of the right second toe in a 60-year-old man who presented with painful, bluish and bulbous swelling of the right second toe without any break in the skin.
Physical examination, plain radiography and magnetic resonance imaging (MRI) scan of the foot, histology of the excised tissue.
Bizarre parosteal osteochondromatous proliferation.
Radiographs showed a calcified/ossified lesion adjacent to the tuft of the terminal phalanx of the second toe. MRI showed a small low signal nodule on T1- and T2-weighted images in a subungual position adjacent to the terminal phalanx with sclerosis. The second toe was excised and the histology from excised tissue was consistent with "bizarre parosteal osteochondromatous proliferation". There was no malignant change on histology. Local excision of the entire lesion was done and there has been no recurrence to date.
BPOP, although a benign lesion, behaves aggressively with rapid growth and has a high risk of local recurrence after local resection (Nora et al. in Am J Surg Pathol 7(3):245-250, 1983; Meneses et al. in Am J Surg Pathol 17(7):691-697, 1993). Its clinical presentation can be confused with glomus tumour, subungual exostosis and enchondroma. The distinguishing features of BPOP and several relevant different differential diagnoses are discussed in this case report.
我们报告了一例罕见的右第二脚趾奇异骨旁骨软骨瘤性增殖（BPOP，Nora 病变）病例，患者为 60 岁男性，表现为右第二脚趾疼痛、蓝紫色球状肿胀，皮肤无破裂。
足部体格检查、平片和磁共振成像（MRI）扫描、切除组织的组织学检查。
奇异骨旁骨软骨瘤性增殖。
X 线片显示第二脚趾末节趾腹旁有一个钙化/骨化病变。MRI 显示在末节趾骨旁甲下位置有一个小的低信号结节，在 T1 和 T2 加权图像上显示为硬化。切除第二脚趾，切除组织的组织学与“奇异骨旁骨软骨瘤性增殖”一致。组织学未见恶性改变。对整个病变进行了局部切除，迄今无复发。
BPOP 虽然是良性病变，但具有侵袭性，生长迅速，局部切除后复发风险高（Nora 等人，Am J Surg Pathol 7（3）：245-250，1983；Meneses 等人，Am J Surg Pathol 17（7）：691-697，1993）。其临床表现可能与血管球瘤、甲下外生骨疣和软骨瘤混淆。本病例报告讨论了 BPOP 的鉴别特征以及几个相关的不同鉴别诊断。
