J Korean Bone Joint Tumor Soc.  2013 Dec;19(2):92-96. 10.5292/jkbjts.2013.19.2.92.

Heterotopic Ossification Mimics Neurogenic Tumor: A Case Report

• Yang HK
• Jung ST
• Jo AR
• Moon JY

• KMID: 1961765
• DOI: http://doi.org/10.5292/jkbjts.2013.19.2.92

Abstract

Heterotopic ossification is an abnormal bone formation after surgery or without any reason. Large joint, such as hip and knee joint, is a known most common site. Operation itself and postoperative early range of motion exercise are risk factors. We present a case of heterotopic ossification mimics neurogenic tumor after high tibial osteotomy.

Keyword

heterotopic ossification; neurogenic tumor

MeSH Terms

Hip
Joints
Knee Joint
Ossification, Heterotopic*
Osteogenesis
Osteotomy
Range of Motion, Articular
Risk Factors

Figure

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  Figure 1. Plain radiograph of the right knee showing 2×2 cm sized calcified mass in the posterior knee joint (arrow).

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  Figure 2. Ultrasonography on right knee. Inhomogeneous mass connected on tibial nerve.

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  Figure 3. Preoperative magnetic resonance image shows 3×2.5×2 cm sized tumor arising from tibial nerve in popliteal region. (A) Axial T1weighed MR image shows inhomogeneous low signal intensity. (B) Axial T2 weighted MR image shows heterogeneous high signal intensity. (C) Axial gadolinum enhanced MR image shows heterogeneous enhanced mass.

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  Figure 4. Magnetic resonance image before the high tibial osteotomy on right knee. There is no mass formation in right knee popliteal area. (A) T1 weight MR image, (B) T2 weighted MR image.

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  Figure 5. Intraoperative photograph shows tumor that divided into several pieces.

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  Figure 6. Hematoxylin and eosin stain of the heterotopic ossification of the right knee popliteus demonstrating osseous tissue and bone marrow formation. (A) H & E ×100, (B) H & E ×400.

Reference

References

1. Harwin SF, Stein AJ, Stern RE, Kulick RG. Heterotopic ossification following primary total knee arthroplasty. J Arthroplasty. 1993; 8:113–6.

2. Cook J, Scott RD. Bony ankylosis following total knee arthroplasty: a case report. J Arthroplasty. 2005; 20:122–4.

3. Furia JP, Pellegrini VD Jr. Heterotopic ossification following primary total knee arthroplasty. J Arthroplasty. 1995; 10:413–9.

4. Hasegawa M, Ohashi T, Uchida A. Heterotopic ossification around distal femur after total knee arthroplasty. Arch Orthop Trauma Surg. 2002; 122:274–8.

5. Figgie HE 3rd, Goldberg VM, Heiple KG, Moller HS 3rd, Figgie MP. The incidence and significance of heterotopic ossification following total knee arthroplasty. Adv Orthop Surg. 1986; 10:12–7.

6. Mollan RA. Serum alkaline phosphatase in heterotopic para-articular ossification after total hip replacement. J Bone Joint Surg Br. 1979; 61B:432–4.

7. Isobe K, Shimizu T, Akahane T, Kato H. Imaging of ancient schwannoma. AJR Am J Roentgenol. 2004; 183:331–6.

8. Pape HC, Marsh S, Morley JR, Krettek C, Giannoudis PV. Current concepts in the development of heterotopic ossification. J Bone Joint Surg Br. 2004; 86:783–7.