International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - Vol 07 Issue 03, February, 2015

Pages: 29-31

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OSTEOMA CUTIS -A CASE REPORT

Author: C. Nirmala, Lakshmi S., Dayananda S. Biligi, A. R. Raghupathi

Category: Healthcare

Abstract:Case report: We present an interesting case of Osteoma Cutis in a 70 year old women with a large plaque lesion on the scalp and multiple nodules with discharging sinuses in the fingers of both the hands since 30 years.
Discussion:
Osteoma Cutis is a rare slow growing, benign ossifying disorder characterized by deposition of bony nodules in the dermis and occurs more frequently in women. There are two types of Osteoma cutis ,Primary and Secondary. Primary Osteoma Cutis is characterized by denovo bone formation in the skin. Secondary Osteoma Cutis is more common, seen in 85% of cases, as a sequel of various disorders. Conclusion: The final diagnosis of Osteoma Cutis cases are based on clinical features, clinical evaluation, phosphorous- calcium metabolism, skin biopsy and radiological imaging.

Keywords: Osteoma cutis, Benign ossifying disorder

Full Text:

INTRODUCTION

Osteoma Cutis is a rare benign ossifying disorder characterized by deposition of bony nodules in the dermis and occurs more frequently in women. In Osteoma Cutis, mesenchymal stem cells differentiate into bone outside the normal skeletal system(4).There are two types of Osteoma Cutis Primary and Secondary. Primary Osteoma Cutis is less common and occurs in 15% of patients and Secondary Osteoma Cutis is common and occurs in 85% of patients(1).

CASE REPORT

A 70 year old female presented with slow growing plaque like lesions over the scalp and multiple nodules over the hands of 30 years duration. The scalp lesion is seen extending into the frontal region of the face. On examination Scalp lesion measured 12 x 10 cms, solitary with irregular margins (Figure 1). The skin over the surface was eroded, underlying tissue appeared pinkish in colour. On palpation the lesion was bony hard in consistency and fixed to the underling skull bone. Margins showed multiple discharging sinuses and discharging chalky white material. Multiple tiny hard nodules measuring 0.5 – 1cm with discharging sinuses were also seen in fingers of both the hands (Figure 2). Skin biopsy from both the scalp and hand lesions was taken and subjected to histopathological examination. Microscopy on routine Haemotoxylin and Eosin staining showed presence of islands of well formed calcified lamellar bone tissue in the dermis with presence of few osteocytes (Figure 3 & Figure 4). The over lying epidermis appears unremarkable. No other underlying cutaneous pathology was observed. Various investigation of complete blood counts, Serum calcium, phosphorous, electrolytes, Liver and Renal function tests were normal. There was no history of trauma or previous cutaneous lesions. Based on the medical history, clinical and histopathological findings, diagnosis of Primary Osteoma Cutis was confirmed.

DISCUSSION

Osteoma Cutis is characterized by formation of morphologically normal bone within the dermis or in the subcutaneous tissue. In Osteoma Cutis, mesenchymal stem cells differentiate into bone outside the normal skeletal system(4). There are two types of Osteoma Cutis Primary and Secondary. Primary Osteoma Cutis is less common and seen in 15% of patients and secondary Osteoma Cutis is commoner and seen in 85% (1). Histological evaluation of the lesions on skin biopsy show lamellar bone completely calcified and inhabited by osteocytes in the deepest layer of the skin (reticular layer), the area around the nodules are less calcified and presents metaplastic areaof fibroblast to osteoblast which is confirmed on electron microscopy(1). Primary Osteoma Cutis is characterized by denovo bone formation in the skin without a known associated or pre-existing cutaneous disorder . Primary Osteoma Cutis has four different clinical variants – solitary, widespread, plaque like and multiple miliary osteomas of the face(3). Four main syndromes associated with Primary Osteoma Cutis are Albrights hereditary Osteodystrophy, Fibrodysplasia of Progressive Ossification, Osseous Progressive Heteroplasia and Plate like Osteoma Cutis(5). Albright’s Hereditary Osteodystrophy includes features of Pseudohypoparathyroidism , pseudo pseudohypoparathyroidism. Clinical features includes obesity, short stature, brachydactyly, round Facies(4). In the Genetic level, there is heterozygous inactivating germ line mutation of the GNAS gene causing abnormal expression or function of the α-subunit of the stimulatory G-protein adenyl cyclase. This results in reduced inhibitory control of cellular induction to osteoblast differentiation in ectopic sites(4) resulting in heterotrophic ossification originating in fat cells(6). Progressive osseous heteroplasia is characterized by dermal ossification of cutaneous, subcutaneous and deep connective tissues(6). Fibrodysplasia of Progressive Ossification is unique in the mechanism of bone formation is endochondral. The other three entities show more clinical overlap as they all involve intramembranous ossification that begins in dermis(4). Secondary Osteoma Cutis occurs as a sequel to multiple disorders including nevi, scleroderma, pilomatricoma, dermatomyositis, basal cells carcinoma, scars, cutaneous inflammation, trauma, calcification, fibrous proliferation and venous stasis, syringoma ,epidermoid cyst(1). In some cases transepidermal elimination of fragments of bone within the channels lined by epidermis and leading to the surface is seen. The patient in the present study presented with lesion in scalp and fingers of both hands. The most affected areas reported are the scalp, face, chest, breast, extremities and buttocks(7). Lesions do not cause pain or any other symptoms .They arise as single or multiple papules, nodules, plaques or miliary lesions. In a review of literature seven cases of non-congenital forms that had no abnormalities in calcium or phosphate metabolism were detected and no inflammatory conditions preceded the disease(8). Pathogenesis of Osteoma Cutis is still obscure. Some feel Primary Osteoma Cutis may be nevoid and may develop from embryonal nest. Where as in metaplastic osteomas, trauma and inflammation lead to damage of the tissue in course of time, some of the foci damage may become calcified, eventually ossified to masses of bone. Treatment: These patients are treated with topical application of Retinoic acid and surgical excision. Surgical excision was a simple treatment with a quick recovery, minimal scarring and no local recurrence(1).

CONCLUSION

The final diagnosis of these cases are based on clinical features,clinical evaluation,phosphorous –calcium metabolism,skin biopsy and radiological imaging.

ACKNOWLEDGEMENT

Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.

Source of Funding: Nil

Conflict of Interest: None

References:

1. NA Montecionos Ayariri, FX Nahas, MV Jardini Barbosa, AB Farah, J de Arimatéia Mendes, LM Ferreira. Isolated primary osteoma cutis of the head: Case report. Can J Plast Surg 2006;14(1): 33-36.

2. Osteoma cutis. Indian J Dermatol Venereol Leprol 1996;62:178-9.

3. Sethuraman G, Malhotra AK, Khaitan BK, Kumar R, Sharma VK, Kabra M, et al. Osteoma cutis in pseudohypoparathyroidism. Clin Exp Dermatol 2006;31:225-7.

4. Acquired platelike osteo ma cutis Neelam Vashi MD, Julie Chu MD, Rishi Patel MD, Dermatology online Journal 17 (10):1, 2011.

5. Bowman PH, Lesher JL Jr. Primary multiple military osteoma cutis and exogenous ochronosis Cutis 2001; 68:103.

6. Unilateral progressive osseous heteroplasia Eur J Dermatol 2009; 19 (3): 214-5

7. Boschert MT, Puckett CL. Osteoma cutis of the hand. Plast Reconstr Surg 2000; 105:1017-8.

8. Haro R, et al. Plaque-like osteoma cutis with transepidermal elimination. J Cutan Pathol 2009;36:591.

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One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to editor@ijcrr.com for more details.

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A Study by Monica K. entitled "Risk Predictors for Lymphoma Development in Sjogren Syndrome - A Systematic Review" is awarded Best Article for Vol 14 issue 13
A Study by Mokhtar M Sh et al. entitled "Prevalence of Hospital Mortality of Critically Ill Elderly Patients" is awarded Best Article for Vol 14 issue 12
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A Study by Vinita S & Ayushi S entitled "Role of Colour Doppler and Transvaginal Sonography for diagnosis of endometrial pathology in women presenting with Abnormal Uterine Bleeding" is awarded Best Article for Vol 14 issue 08
A Study by Prabhu A et al. entitled "Awareness of Common Eye Conditions among the ASHA (Accredited Social Health Activist) Workers in the Rural Communities of Udupi District- A Pilot Study" is awarded Best Article for Vol 14 issue 07
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A Study by Kholis Ernawati et al. entitled "The Utilization of Mobile-Based Information Technology in the Management of Dengue Fever in the Community Year 2019-2020: Systematic Review" is awarded Best Article for Vol 13 issue 18
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A Study by Sarmila G. B. et al. entitled "Study to Compare the Efficacy of Orally Administered Melatonin and Clonidine for Attenuation of Hemodynamic Response During Laryngoscopy and Endotracheal Intubation in Gastrointestinal Surgeries" is awarded Best Article for Vol 13 issue 07
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A Study by Gainneos PD et al. entitled "A Comparative Evaluation of the Levels of Salivary IgA in HIV Affected Children and the Children of the General Population within the Age Group of 9 – 12 Years – A Cross-Sectional Study" is awarded Best Article of Vol 13 issue 05 Special issue on Recent Advances in Dentistry for better Oral Health
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A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
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A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
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A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
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A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
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A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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