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小児指骨傍骨軟骨増殖症（ノラ病変）の奇妙な一例
Bizarre Parosteal Osteochondromatous Proliferation (Nora Lesion) in Pediatric Phalanges.
PMID: 32611484 DOI: 10.1016/j.jhsa.2020.05.002.
抄録
奇妙な骨傍骨軟骨増殖症、またはノラ腫瘍は、手および足の管状骨に影響を及ぼすまれな病変である。通常、これらの病変は、これらの骨の皮質表面および骨膜に発生し、組織学的には、骨化した領域および紡錘体細胞の間質に囲まれた骨茎を覆う多細胞性軟骨性キャップからなる。鑑別診断には、軟骨肉腫、骨傍骨肉腫、骨軟骨腫、タレット外骨症、および流動性反応性骨膜炎などの骨膜に関与する疾患が含まれる。唯一の有効な治療法は広汎な外科的切除術であるが，局所再発率が非常に高く，再手術を必要とすることもある．本研究では，小児の手指に発生したNora病変を3例報告した．これらの症例は症状やX線所見から診断が困難であった。これらの症例の診断は放射線画像上の特徴的な所見に基づいて行われ，切除後の組織学的検査で確認された．
Bizarre parosteal osteochondromatous proliferation, or Nora tumor, is an uncommon lesion affecting the tubular bones of the hands and feet. Normally arising from the cortical surface and periosteum of these bones, these lesions histologically consist of a hypercellular cartilaginous cap covering a bony stalk that is surrounded by ossified areas and spindle cell stroma. The differential diagnosis includes conditions involving the periosteum such as chondrosarcoma, parosteal osteosarcoma, osteochondroma, turret exostosis, and florid reactive periostitis. The only effective treatment is wide surgical excision; nevertheless, local recurrence rates are extremely high and may necessitate revision surgery. In the present study, we report 3 cases of Nora lesion located in the hand in pediatric patients. The diagnosis in these cases was challenging owing to their presenting symptoms and radiographic findings. The diagnosis was made based on characteristic findings noted on the radiographic images and was confirmed by histological examination following excision.
Copyright © 2020 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.