Both Trevor and Ollier disease limited to one upper extremity

Hemimelic epiphyseal dysplasia: a case report

Hemimelic epiphyseal dysplasia HED also known as Trevor's disease is a rare pathology, characterized by a developmental disorder of an internal or external half of one or more epiphyses of a limb, mainly the lower limb, and/or of the short tarsal bones in children and young adolescents, with a male predominance. Its etiology remains unclear. Its clinical symptomatology is variable, ranging from asymptomatic involvement to orthopedic complications such as limb length inequality. As the clinic is non-specific, radiological assessment is the essential diagnostic tool for Trevor's disease, including standard radiography, MRI, CT, and possibly biopsy in some cases. The radio clinical signs make it possible to establish the diagnosis, even if it remains difficult because of the rarity of the disease and the presence of multiple differential diagnoses which are often better known such as osteochondroma and exostosis. After diagnostic confirmation, the therapeutic decision remains debated, ranging from simple observation to surgical excision. The prognosis of HED remains good, given the absence of the risk of malignant transformation. Post-therapeutic complications are dominated by recurrence or the appearance of secondary osteoarthritis. Objective: This clinical case challenges us to keep in mind the hemimelic epiphyseal dysplasia (HED) in front of a mass that originates at the level of the internal or external half of one or more epiphyses in children.

Epiphyseal osteochondromas of the upper limb: a report of 7 cases

BACKGROUND

Originally described as osteochondromatous lesions arising from the tarsal bones, osteochondromas arising from the epiphysis or carpal/tarsal bones are less common than those arising from the metaphysis. Histologically, all osteochondromas are indistinguishable regardless of the location from which they arise. Few case reports and case series exist describing these lesions in the upper limb.

METHODS

We review 7 cases of osteochondromas arising from epiphyses and ossicles in the upper limb treated at 3 institutions. Patients were followed for an average of 5.7 years. The average patient age at the presentation was 7.8 years.

RESULTS

We identified 25 lesions: 5 distal radial epiphyseal, 3 distal radial metaphyseal, 4 scaphoid, 4 lunate, 4 trapezial, 2 accessory ossicles adjacent to the trapezium, 2 trapezoid, and 1 metacarpal lesion. Three patients presented with pain, 5 with decreased motion, and 3 with angular deformity. In 1 case, the lesion presented as an incidental finding. Four patients underwent a total of 7 procedures: 2 open biopsies, 2 distal radial epiphyseal lesion excisions, 2 revisions, and 1 excision of all lesions with a scaphoid osteotomy.

CONCLUSIONS

Intra-articular and transosseous lesions are more likely to result in angular deformities and loss of motion at the joints, whereas juxtaphyseal and transphyseal lesions are more likely to result in growth disturbances and angular deformities at the physis.

LEVEL OF EVIDENCE

Case series, level IV.

Treatment of dysplasia epiphysealis hemimelica: a systematic review of published reports and a report of seven patients

Dysplasia epiphysealis hemimelica is a rare entity. It is characterized by cartilage overgrowth in the epiphyses and is considered to be an epiphyseal osteochondroma. It usually presents during childhood and can cause pain and functional limitations. The aim of the present study was to describe the entity through our cases and published data and to present the results of our suggested treatment. A systematic search was performed to retrieve and describe all studies on dysplasia epiphysealis hemimelica. Studies were included if sufficient information on the patient characteristics, lesion location, treatment, and outcomes were described. In addition, we report on 7 of our patients. In our review, 48 studies were found, of which 42 could be included. Owing to the large heterogeneity in the studies, no pooling of data was performed. The studies included 138 patients with 255 lesions. Approximately 27% were female patients. The age at presentation ranged from 3 months to 66 years; however, in most, the entity was discovered before 8 years of age. No apparent guidelines were presented concerning the treatment strategy; however, most investigators performed resection because of pain or limitations in the range of motion. Most lesions were located in the ankle or foot (139 of 255). In our own cases, 5 of 7 patients experienced pain, limited range of motion, or activity restriction. The mean follow-up period was 4 years. Dysplasia epiphysealis hemimelica is a rare entity, occurring predominantly in the lower extremity of in young male patients. Its aggressive growth warrants aggressive treatment in the case of pain or functional or range of motion limitations.

Trevor's disease (dysplasia epiphysealis hemimelica) located at the hand: case report and review of the literature

Trevor's disease, also known as dysplasia epiphysealis hemimelica (DEH), is a rare developmental bone dysplasia, characterized by benign osteocartilaginous overgrowth. The lesion arises from an epiphysis. Its localization may be different, and it mostly occurs unilateral. In this report, we present a 40 years old woman suffering from Trevor's disease with unusual localization at the hand. Because of significant symptoms surgical excision was chosen.

Dysplasia epiphysealis hemimelica of the distal ulna: a case report and review of the literature

Dysplasia epiphysealis hemimelica (DEH) or Trevor's Disease is a very rare disease with an estimated incidence of one in 1.000.000. The majority of cases reported affect the lower limb and only 25 case reports of 33 cases with affection of the upper limb have been published. Here we present a case of DEH affecting the distal ulnar epiphysis and the lunate in an eleven-year-old girl, a DEH location described extremely rarely before. We firstly do not only present clinical and radiological findings (plane radiographs, CT, MRI), but also the surgical approach and the histopathological results of DEH in this uncommon location. Although extremely rare, DEH should be considered also in non-typical locations.

Trevor disease of the spine

✓ The authors report the case of a 15-year-old boy who presented with left shoulder pain and paresthesia of the left hand. Imaging studies revealed an osseous lesion compressing the C-8 nerve root. The patient underwent tumor resection followed by instrumentation-augmented fusion. Histological findings were consistent with osteochondroma. The tumor most likely originated from the articular cartilage between the first rib and T-1 or between C-7 and T-1. The correct diagnosis, therefore, was dysplasia epiphysialis hemimelica (DEH), also known as Trevor disease. To the authors' knowledge, this is the first report of DEH involving the spine.

Achondroplasia and enchondromatosis in a female child

We present a girl with achondroplasia and enchondromatosis. Coexistence of these two disorders has, to the best of our knowledge, not been reported previously.