A 20-year-old man presented with complaints of right upper leg pain that extended over six months, with no relief after taking analgesics. He had a history of multiple asymptomatic swellings in both upper and lower limbs including the forearm, thighs, and the medial aspect of both upper legs since childhood. However, he did not report a rapid increase in any of the swellings. The patient’s father had a similar history of multiple bony swellings since childhood. Examination revealed an immobile, non-tender, 4cm x 2cm swelling fixed to the underlying bone, over the right medial proximal tibia. Also, there was diffuse tenderness along the course of pes anserinus tendons. Plain X-ray demonstrated a pedunculated bony swelling over medial proximal tibia with a tiny stalk without any associated matrix changes/periosteal reaction, pointing away from the knee joint, suggestive of a diagnosis of osteochondroma (Figure ).\nBased on the skeletal survey, a presumptive diagnosis of diaphyseal aclasis with pes anserinus syndrome was made, and excision of the painful right proximal tibial swelling was planned. The swelling was excised through a direct medial approach, which revealed swelling of the pes anserinus tendons that were stretched over the bony swelling. The bony swelling was excised extraperiostealy en masse, and the adjoining part of the tibial cortex was nibbled out (Figure ).\nThe histopathology report revealed a bony mass with marrow elements in the stalk along with an overlying hyaline cartilage cap without any cellular atypia, confirming the diagnosis of benign osteochondroma. By the end of the year at the last follow-up, the patient was pain-free i.e., measuring zero on the visual analog scale (VAS) with no evidence of recurrence. Consent was obtained from the patient for the publication of this manuscript.
A 13-year-old girl presented with pain and swelling on the medial aspect of the proximal leg, which she had noticed for several years. Her height and body weight were 161 cm and 64 kg, respectively. She had no past medical history related to the lesion. There was no history of trauma or injury. On physical examination, the non-mobile hard lesion was palpable with slight tenderness on the medial side of the proximal tibia. Plain radiographs showed a lesion protruding from the bone with continuity to the underlying bone (Fig. ). The size of the lesion was 2.0 cm on a plain radiograph. MRI depicted a protuberant bone lesion with continuity to normal bone. However, an overlying cartilaginous cap or surrounding inflammation was not apparent (Figs. ). Surgically, the lesions were approached posterior to the conjoint tendon, and resected using a curved chisel (Fig. ). The lesion was composed of lamellar bone trabeculae with fatty marrow and a covering cartilaginous component, compatible with osteochondroma. There was no evidence of malignancy. Six months after surgery, the preoperative symptoms had disappeared.