Author(s): Jitendra Nath Pal1 , Anindya Basu2 , Sunit Hazra3 , Sudipta Ghosh4 , Amiya Kumar Bera5
INTRODUCTION: Bizarre parosteal osteochondral proliferation (BPOP) is a rare variety tumour like bone lesion usually of small bones of hands and feet which has a strong tendency for recurrence. Clinico-radiologically solitary exostosis like lesion in those areas which continue growing after skeletal maturity without any pre-existing lesion one should think of BPOP. CASE REPORT: 46 years male patient presented in 2009 with progressive painless, hard, nontender swelling arising from distal half of the left second metatarsal bone of one year duration. X ray showed multi-horned heterogeneously radio-opaque swelling attached to 2nd metatarsal where one of the horns was pressing over 3rd metatarsal making its divergent appearance. Open biopsy showed lamellar bone with inter-trabecular spindle cells without any evidence of malignancy. Irregular shaped cartilage cells of different size in bluish tint cartilage are found in the bone cartilage interface. Through dorsal incision wide margin resection of the second metatarsal was done and reconstructed with autologus tricortical bone graft from ipsilateral iliac crest. Further histopathological examination demonstrated similar picture and absence of periosteum in addition. Significant cartilaginous cap could not be identified. Features simulate BPOP. It took 6 months - time for incorporation of graft. Movements of foot joints regained except 50% restriction of targeted metatarsophalangeal joint. There is no recurrence in 4 years follow up. CONCLUSION: Exostosis like lesions when arising from unusual site and at unusual age group other rare conditions is to be thought of. As they have tendency for recurrence adequate resection is essential. Though the final diagnosis of BPOP is obtained after histopathological examination, the clinico-radiological findings are also important for treatment planning.