J Korean Foot Ankle Soc.  2021 Dec;25(4):195-198. 10.14193/jkfas.2021.25.4.195.

Bizarre Parosteal Osteochondromatous Proliferation of the Proximal Phalanx of the Great Toe: A Case Report

• Kim K
• Kim YM
• Han WC
• Han B

• KMID: 2523303
• DOI: http://doi.org/10.14193/jkfas.2021.25.4.195

Abstract

Nora et al. first reported a bizarre parostealosteochondromatous proliferation (BPOP) as a small size bone malformation mainly in the foot and hand in April 1983 that was called Nora’s lesion or Nora’s disease. Nora’s disease is known for its low incidence and is characterized as a benign lesion, without a malignancy or metastasis with different histological, radiological, and clinical features from other common lesions. Several cases of Nora’s disease on the hand, foot, and long bone have been reported in Korea. This paper reports a case of BPOP of the proximal phalanx of the great toe.

Keyword

Proximal phalanx of great toe; Bizarre parostealosteochondromatous proliferation; Nora’s disease

Figure

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  Figure. 1 Preoperative photographs. Dorsal view (A) and plantar view (B) show swelling of proximal phalanx plantar area of patient’s left great toe.

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  Figure. 2 Preoperative simple radiograph. Foot anteroposterior view (A) shows calcification of both sides of great toe (arrow) and foot lateral view (B) shows calcification of plantar side of great toe (arrow).

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  Figure. 3 Magnetic resonance imaging scan. Sagittal T2-weighted fat suppression (fs) image (A) and T1-weighted fs spin echo (se) coronal image (B) show 4 cm×3 cm×2 cm, lobulated marginated, heterogeneous soft tissue mass at left big toe plantar aspect, proximal and distal phalanx level (arrows).

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  Figure. 4 Computed tomography images. Sagittal view (A) and 3-dimensional reconstructed image (B) show 4 cm×3 cm×2 cm calcified mass attached to the periosteum of left big toe proximal phalanx, without continuity of the medulla or the periosteum (arrows).

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  Figure. 5 Clinical photographs during operation. The large calcified mass is located adjacent to the periosteum of proximal phalanx base, but relatively easily dissective (A). After removal of the mass, we saucerized periosteum and adjacent soft tissues to prevent local recurrence (B). The gross appearance of removed mass (C).

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  Figure. 6 Gross specimen photograph shows relatively well margined mass lesion.

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  Figure. 7 Microscopic slide view of H&E stain of excision biopsy is showing exuberant dystrophic calcification (A: x40) and disorganized proliferation of fibrous tissue, cartilage and bone (B: x100). Clinicoradiologically, it correlates to bizarre parosteal osteochondromatous proliferation.

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  Figure. 8 Postoperative 6 months clinical dorsal (A), plantar (B), and medial (C) appearance. Clinically the patient’s symptoms are resolved without any evidence of recurrence.

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  Figure. 9 Postoperative 6 months simple radiograph. Anteroposterior (AP) view (A), oblique view (B), lateral view (C), standing weight bearing AP view (D), and standing weight bearing lateral view (E) show good radiological result and no remnant.

Reference

1. Nora FE, Dahlin DC, Beabout JW. 1983; Bizarre parosteal osteochondromatous proliferations of the hands and feet. Am J Surg Pathol. 7:245–50. doi: 10.1097/00000478-198304000-00003. DOI: 10.1097/00000478-198304000-00003. PMID: 6837834.

2. Meneses MF, Unni KK, Swee RG. 1993; Bizarre parosteal osteochondromatous proliferation of bone (Nora's lesion). Am J Surg Pathol. 17:691–7. doi: 10.1097/00000478-199307000-00006. DOI: 10.1097/00000478-199307000-00006. PMID: 8317609.

3. Abramovici L, Steiner GC. 2002; Bizarre parosteal osteochondromatous proliferation (Nora's lesion): a retrospective study of 12 cases, 2 arising in long bones. Hum Pathol. 33:1205–10. doi: 10.1053/hupa.2002.130103. DOI: 10.1053/hupa.2002.130103. PMID: 12514790.

4. Chung DW, Lee JH, Bae SC. 2002; Bizarre parosteal osteochondromatous proliferation (Nora's lesion) - one case report -. J Korean Soc Surg Hand. 7:101–4.