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Osteoma of Occipital Bone © 2003 Indian Journal of Surgery www.indianjsurg.comCase Report Effective treatment is crucial for avoiding recurrent Low-grade chondrosarcoma in an extremity can be incidence and depends on excising all tissues with treated with limited surgery. carcinoma. As the tumour is radio-resistant, complete removal is the only treatment of choice. A wide excision REFERENCES for low-grade chondrosarcoma is generally advised. Following open biopsy, local excision or, if required, 1. Bovee JVMG, van der Heul RO, Taminiau AHM, Hogendoorn PCW, reconstruction is advised.5 Chondrosarcoma of the phalanx: A locally aggressive lesion with minimal metastatic potential. Cancer 1999;86:1724-32. 2. Evans HL, Ayala AG, Romsdahl MM, Prognostic factors in chond- In our case, we think that the removal of the tumoral rosarcoma of bone. Cancer 1977;40:818-31. tissue from the normal tissue margin is the treatment 3. Dahlin DC, Beabout JW, Dedifferentiation of low-grade chondro- sarcomas. Cancer 1971;28:461-6. of choice. Our case is a young case that had Grade 1 4. Damron TA, Rock MG, Unni KK, Subcutaneous involvement after chondrosarcoma in his fourth and fifth finger and fifth a metacarpal chondrosarcoma: Case report and review of litera- metatarsal diaphysis. The difference of our case from ture. Clin Orthop 1995;316:189-94. 5. Ogose A, Unni KK, Swee RG, May GK, Rowland CM, Sim FH. the ones reported in literature is that he was young Chondrosarcoma of small bones of the hands and feet. Cancer (18-year-old) and had a lesion involving two different 1997;80:50-9. compartments synchronously as localization. 6. Lewis MM, Marcove RC, Bullough PG. Chondrosarcoma of the foot. Cancer 1975;36:586-9. 7. Dahlin DC, Salvador AH. Chondrosarcomas of bones of the hands CONCLUSION and feet-a study of 30 cases. Cancer 1974;34:755-60. 8. Mankin HJ, Chondrosarcomas of digits. Are they really malig- Chondrosarcoma is a tumour rarely seen in the foot. nant? Cancer 1999;86:1635-7. Osteoma of occipital bone R. Meher, B. Gupta, I. Singh, A. Raj Dept. of ENT and Head and Neck Surgery, Maulana Azad Medical College and associated, L. N. Hospital, New Delhi - 110002, India. ABSTRACT Osteomas are benign, bone-forming tumours located within bones or developing on them. In the head and neck region they are commonly seen in the frontoethmoidal region. Occipital osteomas are very rare tumours. They are often asymptomatic and are incidentally found on radiological investigations. The main clinical symptom is headache of varying intensity and quality, though some patients may complain of dizziness in cases of large tumours. We describe here a case of occipital osteoma in a female, arising from the inner table. It was asymptomatic and osteoma was removed for cosmetic purpose. CT scan is a must to confirm the diagnosis, the involvement of the inner table as well as to look for any intracranial extent of the osteoma. KEY WORDS Osteoma, occipital bone. How to cite this article: Meher R, Gupta B, Singh I, Raj A. Osteoma of occipital bone. Indian J Surg 2004;66:365-7. CASE REPORT it was found to be around 4 cm x 3 cm in size, smooth, bony hard, and non-tender. X-ray skull showed a well- A 35-year-old female reported to the ENT OPD of Lok circumscribed dense bony mass. Her CT scan (Figure Nayak Hospital with a swelling on the right side of her 1) head revealed a bony mass in the right squamous head for more than 7 years. It was gradually increasing part of the occipital bone measuring 4 cm x 3 cm. It in size. There was no history of trauma, headache, originated from the outer table of the skull with no hearing impairment, otorrhoea, dizziness, vomiting, evidence of destruction of the inner table or extension visual trouble, or neurological deficit. On examination of the mass intracranially. Hence, a diagnosis of Address for correspondence: Dr. Ravi Meher, B-2/62, Sector-16, Rohini, Delhi - 110085, India. E-mail: [email protected] Paper Received: August 2003. Paper Accepted: October 2003. Source of Support: Nil. Indian Journal of Surgery 2004 Volume 66 Issue 6 (December) 365 Case Report maxillary sinuses.2 They are rare in the sphenoid sinus and extremely rare on occipital squama. A careful search of the English literature failed to reveal any previously reported case of occipital osteoma. Most often they are localized on sutures. Except for cortical lesions that are seen initially as cosmetic deformities, these tumours are usually unsuspected roentgenographic findings. The main clinical symptom is headache of varying intensity and quality, and in most cases not proportional to the size of the osteoma, which ranges from the size of a pepper bean to the size of a child’s head. In addition to headache, there can be sensitivity to pressure in the region of the frontal sinus or dizziness. Treatment is indicated for symptomatic osteomas. Tumours Figure 1: CT scans showing osteoma of the right occipital involving the middle and inner ear are most bone frequently small and tend to remain stable in size; osteoma was made. Surgical excision was carried out consequently they are usually managed expectantly. for cosmetic purposes using a chisel and mallet. It was Surgery is indicated in cases of deafness, discharge, arising from the outer table with a small stalk. The dizziness and headache.2 Temporal osteoma has osteoma was attached with (to the?) underlying bone been found to produce intracranial complications, with a small stalk. The gross specimen (Figure 2) was justifying surgical removal. In our case the patient smooth, ivory white in appearance, ovoid in shape and did not have any complaints, the swelling was about 4 cm x 3 cm in size. The histopathology report removed for cosmetic reasons. was osteoma composed of compact bone. The patient had an uneventful recovery with no recurrence in the The cause of osteoma has still not been defined. Since 9-month follow-up. the tumour has been found to develop after puberty Haymann believed it to depend on conditions DISCUSSION regulating growth in the cranial bones.3 Friedberg suggested trauma with consequent periostitis as a Osteoma is a slow-growing tumour formed by predisposing factor.4 Most authors feel that it mature bone tissue. Stuart first defined osteoma as originates from the pre-osseous connective tissue.5,6 a benign, circumscribed, slow-growing bony tumour1 The clinical presentation and radiological features of of mastoid. The common site for osteomas is the osteoma are characteristic but differential diagnosis frontoethmoidal region. The incidence of osteomas should include eosinophilic granuloma, giant cell is highest in frontal followed by, ethmoid and tumour, monostotic fibrous dysplasia, a solitary multiple osteoma, and osteoblastic metastasis.7 One should also rule out Gardner’s syndrome in patients presenting with large skull osteomas.8 It includes a clinical triad of familial polyposis coli, osteomas, and soft tissue tumours. CONCLUSION Osteomas are rarely rarely originate from the flat bones of the skull and their management depends upon the symptomology. Small osteomas are harmless and can be left as such; surgery is indicated only in cases of cosmetic problem. Large osteomas causing dizziness, headache and intracranial extension or compression, need excision. Differential diagnosis of other bony tumours should also be kept in mind while dealing with Figure 2: Excised specimen of the osteoma them. 366 Indian Journal of Surgery 2004 Volume 66 Issue 6 (December) © 2003 Indian Journal of Surgery www.indianjsurg.comCase Report REFERENCES 1938;28:20-6. 5. Flaming JP. Osteoma of the mastoid bone. Can J Surg 1966;9:402-4. 1. Stuart EA. Osteoma of the mastoid- report of a case with investi- 6. Ishikawa T, Saito H, Takashaki K. Osteoma of the mastoid. Arch gations of the constitutional background. Arch Otolaryngol Otorhinolaryngol 1977:217:93-7. 1940;31:838. 7. Probost LE, Shanken L, Fox R. Osteoma of the mastoid bone. J 2. Singh I, Agarwal AK, Aggarwal S, Yadav SPS. Giant Osteoma of Otolaryngol 1991;20:228-30. Mastoid Bone. Indian J of Otol 1999;5:97-8. 8. Noterman J, Massager N, Vloeberghs M, Brotchi J. Monstrous 3. Varshney S. Osteoma of temporal bone. Indian J of Otol 2001;7:91-2. skull osteomas in a probable Gardner’s syndrome- case report. 4. Friedberg SA. Osteoma of mastoid process. Arch Otolaryngol Surg Neurol 1998;49:302-4. Stump appendicitis with lipohyperplasia of the ileocecal valve: Report of a case Yasumitsu Hirano, Junzo Shimizu, Seiichi Kinoshita, Yasuhiko Tatsuzawa, Yukimitsu Kawaura Department of Surgery, Saiseikai Kanazawa Hospital, Ni 13-6, Akatsuchi-machi, Kanazawa 920-0353, Japan. ABSTRACT A case report of recurrent appendicitis, 40 years after appendectomy is presented. In the present case, we failed to diagnose stump appendicitis preoperatively due to the existence of the lipohyperplasia of the ileocecal valve which showed features of ileocolic intussusception causing right lower abdominal pain and nausea. Inflammation of the appendiceal stump after appendectomy is a rare complication, but in the assessment of patients with lower quadrant abdominal pain who have previously undergone appendectomies, stump appendicitis should be considered. KEY WORDS Stump appendicitis, Lipohyperplasia, Ileocecal valve. How to cite this article: Hirano Y, Shimizu J, Kinoshita S, Tatsuzawa Y, Kawaura Y. Stump appendicitis with lipohyperplasia of the ileocecal valve: Report of a case. Indian J Surg 2004;66:367-9. INTRODUCTION prior to admission. On physical examination, a soft mass with tenderness located in the lower quadrant of The diagnosis of stump appendicitis in patients who the abdomen was found. Blood examination showed have previously undergone appendectomies is very leukocytosis (white blood cell count 11,600/mm3). The difficult because of the low incidence and other diseases C reactive protein (CRP) level was elevated (4.7 mg/ with a similar clinical presentation.
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