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Dupuytren's (subungual) exostosis
A Miller-Breslow1, H D Dorfman
1Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, New York 10467-2490.
The American Journal of Surgical Pathology
|May 1, 1988
Summary
Subungual exostosis, a benign bone growth, is often mistaken for cancer due to varied histology. Early diagnosis and complete surgical removal are key to preventing recurrence of this toe condition.
Area of Science:
- Orthopedic Surgery
- Skeletal Pathology
Background:
- Subungual exostosis (Dupuytren's exostosis) presents diverse histologic patterns, leading to potential misdiagnosis.
- It is crucial to differentiate this benign lesion from malignant bone tumors like chondrosarcoma.
Observation:
- This study reviews 15 cases of subungual exostosis and relevant literature.
- The lesion originates as reactive fibrous tissue and metaplastic cartilage, progressing through enchondral ossification.
- Most cases (80%) affect the dorsal-medial aspect of the great toe in postadolescents and young adults, often linked to trauma or infection.
Findings:
- Radiologic findings are consistent and can be diagnostic for subungual exostosis.
- Despite initial suspicion of chondrosarcoma in over half the cases, careful clinical evaluation distinguishes it as benign.
- The lesion, though potentially exuberant in growth, is self-limiting.
Implications:
- Subungual exostosis is an acquired, benign condition.
- Complete local excision is curative for subungual exostosis.
- Recurrence rates are high (53%) following incomplete excision or if the lesion is immature.