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.
The third child was a 12-year-old male presenting to the outpatient department with complaints of swelling located in the medial aspect of right knee for the last three months. The swelling was insidious in onset without any history of trauma or fever. It was of the size of a lemon, as described by the patient’s guardian. There was associated vague pain in the same area, without any aggravating factor. There was no history of rapid increase in the size of swelling or the intensity of pain. Similar to the other two cases, there was no other swelling or pain elsewhere in the body. On examination, it was found that there was a bony hard, spherical, nodular, tender swelling on the medial aspect of right proximal tibia measuring 3 x 3 cm in size. The overlying skin was normal. Range of motion of knee joint was comparable to the other side. Plain radiograph of the right knee showed the presence of a bony outgrowth from the medial aspect of right proximal tibial metaphysis suggestive of an osteochondroma (Figure ). There was no evidence of malignant transformation on the plain radiograph. The patient was advised rest from exertional activities along with analgesic medications for three weeks causing reduction in pain. However, soon the pain started again gradually over a few days, for which the patient was injected with injection hydrocortisone and 2% xylocaine at the most tender point in the pes anserinus area. After this intervention, the patient became pain-free. The patient was regularly followed-up to check malignant transformation of the swelling. At the last follow-up of one-and-a-half years, there was no increase in the size of swelling or recurrence of pain.