Osteochondroma of hyoid

García-Callejo, Francisco Javier; Guastella-Almeida, Pablo Tiziano; Cardona-Henao, John Deiver; Juantegui-Azpilicueta, Miguel
doi:10.1016/j.otoeng.2021.10.002
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Cervicotomy and identification of the lesion &#40;A&#41; with exeresis of the piece en bloc with the body of the hyoid &#40;B&#41; and microscopic view of the well-delimited lesion with cartilaginous rods constituting the periphery with mature chondrocytes without atypia&#44; arranged in whorls presenting endochondral ossification of trabecular arrangement in the centre&#44; its spaces being occupied by representative elements of the three haematopoietic series&#44; without signs of histological malignancy &#40;C&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Clinical case</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 33-year-old woman of Central American origin with no associated underlying disease consulting due to a cervical mass in the midline&#44; prehyoid&#44; of hard consistency&#44; painless and adherent in depth&#44; but not on the surface &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#44; rising on swallowing&#46; The mass did not cause dyspnoea or dysphagia and she reported having had it since at least the age of 10 years&#44; with gradual&#44; slow growth&#46; She had not consulted earlier for sociocultural reasons&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Nasofibroscopy did not detect any anomalies in the upper aerodigestive tract&#46; The CT imaging study reported a solid tumour with well-defined lobulated contours not infiltrative&#44; of 51&#8239;&#215;&#8239;22&#8239;&#215;&#8239;21&#8239;mm &#40;axial&#44; anteroposterior&#44; and craniocaudal diameters&#41;&#44; with homogeneous density and multiple gross calcifications inside&#44; without a fatty cleavage plane with the hyoid bone &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">It was decided to excise it using a median horizontal cervicotomy&#44; detecting an expansive&#44; hard&#44; pearly and papilliform mass under the platysma&#46; It was overlapping the prelaryngeal muscular plane along the midline and depended on the inferior face of the hyoid body&#44; and both were removed en bloc &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#44; without intra or postoperative complications&#46; The histopathological report of the piece was large nodules of mature cartilage without atypia and with central ossification of endochondral nature arranged in trabeculae &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#44; all of which consistent with osteochondroma of the hyoid bone&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">One year after the operation&#44; the cervical and pharyngolaryngeal examination was normal&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">Osteochondromas or cartilaginous exostoses are the most common bone tumours&#44; accounting for approximately 35&#37;&#8211;50&#37; of all benign bone neoplasms and 8&#37;&#8211;15&#37; of all primary tumours&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In 85&#37; of cases they are single lesions&#44; predominantly in the metaphyseal zone of the long bones&#44; although they have been described in any segment of the skeleton developing due to endochondral ossification&#44; especially in children and young adults&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3</span></a> The systemic form encompasses 15&#37; of cases&#44; and is a multiple osteochondromatosis &#40;MO&#41; with exostosis of symmetrical distribution throughout almost the entire skeleton and an average age of presentation of 3 years&#44; congenital and of autosomal dominant inheritance associated with mutations in the EXT 1 and EXT 2 genes involved in the biosynthesis of heparan sulphate proteoglycans&#44; involved in epiphyseal growth&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Osteochondromas of the head and neck are extremely rare&#44; since most maxillofacial bones develop by intramembranous ossification&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In this area&#44; the most common location is the mandible&#44; where they represent &#46;6&#37; of all osteochondromas&#44; very typically in the condylar segment&#44;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> embryonic derivative of the first branchial arch or Meckel&#8217;s cartilage&#46; Our case would have originated in the third arch&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">To date&#44; only 3 cases of hyoid osteochondroma have been reported&#46; Torous et al&#46; reported in 2015 the case of a 31-year-old woman with a left cervical mass of 16&#8239;mm maximum diameter&#44; without symptoms&#44; slow-growing over 2 years&#46; Excision of the tumour confirmed its dependence on the lesser horn&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Raggio et al&#46; reported in 2018 a 17-year-old male and MO with several previous exereses of other similar lesions in extremities&#44; with a cervical midline mass of 15&#8239;mm maximum diameter and one month since onset&#44; causing pain and dysphagia&#46; It was removed along with a segment of the body of the hyoid&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> In 2020 Shameen et al&#46; presented a 62-year-old male with a right cervical tumour of about 5 years&#8217; evolution and 53&#8239;mm maximum diameter&#44; asymptomatic&#44; but with obliteration of the homolateral vallecula on fibroscopy&#46; Cervicotomy revealed its origin in the greater horn of the hyoid bone&#44; and the bone was removed in its entirety&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">As they are typically asymptomatic&#44; the exact prevalence of osteochondroma is unknown&#44; and some authors do not consider them to be an authentic lesion&#44; although it is possible that 3&#37; of the population may have them&#44; and up to 4&#37; of patients with osteochondroma may present some complication&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;10</span></a> When they grow subcutaneously&#44; they are characteristically hard and painless&#46; Symptoms are caused by of their intraosseous expansion due to fracture or mechanical irritation in other bones&#44; compression of nerves&#44; vessels or soft tissues&#44; or due to malignant transformation&#44; which occurs in 1&#37; of cases&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;10</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The WHO defines osteochondroma as an osteocartilaginous exostosis with continuity of cortical and medullary bone covered by a layer of hyaline cartilage&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> They are thought to be lesions resulting from the separation of a fragment of epiphyseal growth plate&#44; herniating through the normal bone surrounding the growth plate with intense chondrogenic potential&#44; possibly increased by repeated microtrauma and even radiotherapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;5&#44;10</span></a> This is why CT is an excellent diagnostic tool as it easily detects the lesion&#8217;s corticomedullary continuity from the bone from which it originates&#8212;even in scenarios of complex anatomy&#8212;or coarse dot-and-comma calcifications on tumour areas of hyaline cartilage&#44; highly specific radiological features of the tumour&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;10</span></a> MRI offers optimal complementary measurement of cartilage layer thickness&#44; an important criterion for chondrosarcoma differentiation&#46; Needle aspiration tests are often insensitive due to the hardness and inaccessibility of the lesions&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The only effective treatment is surgical excision including all the perichondrium surrounding the base of the tumour&#44; otherwise it may recur&#46; This occurs in 2&#37; of osteochondromas&#44;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;6</span></a> more frequently in childhood due to the potential for growth&#46; Recurrence consists of a new osteochondroma or a low-grade chondrosarcoma&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The case presented is very unusual because of its location and size&#44; due to the patient&#8217;s reluctance to seek advice&#44; but its continued growth after bone maturity required its removal to prevent upper airway problems&#46; The striking hard consistency of the tumour and the imaging tests are diagnostic&#44; but only by complete excision of the lesion with a large segment of the original bone can it be confirmed and cured&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflict of interests</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
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