A Nora's lesion, a rare and typically non-cancerous growth originating from the parosteal osteochondromatous tissue, primarily manifests in the hands and feet. Despite its benign nature, diagnosing Nora's lesions is complex due to their tendency to exhibit aggressive features in imaging scans and the ambiguity encountered in histological examinations. This rarity is evidenced by the limited number of reported cases in medical literature since its initial discovery. Detailing a distinctive instance, we document a specific case of a Nora's lesion situated on the dorsum of the left hand, specifically above the shafts of the fourth and fifth metacarpal bones. Through a meticulous histopathological analysis, the diagnosis was confirmed, aligning precisely with imaging features. To address the lesion conclusively, a comprehensive surgical excision of the mass was performed. This particular case not only adds to the scant body of documented instances but also underscores the significance of accurate diagnosis and management. Understanding and documenting such cases are crucial in refining diagnostic approaches and optimizing treatment strategies for Nora's lesions, emphasizing the ongoing need for further research in this domain.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10784761PMC
http://dx.doi.org/10.7759/cureus.50439DOI Listing

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Background: Bizarre parosteal osteochondromatous proliferation (BPOP) is a rare benign bone tumor, it is also called "Nora's lesion". The lesion is characterized by heterotopic ossification of the normal bone cortex or parosteal bone. The etiology of BPOP is unclear and may be related to trauma.

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Bizarre parosteal osteochondromatous proliferations, also known as Nora's lesions, are rare benign tumors with a high recurrence rate. They are often difficult to identify because of their similar appearance to other tumors. We describe a 25-year-old healthy female patient with bizarre parosteal osteochondromatous proliferations in an uncommon location on the pelvic ilium, presenting with unique clinical findings of abdominal pain and femoral paresthesia and showing atypical radiographic findings.

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A 45-year-old woman complained of left wrist pain and swelling for two years accompanied by limited dorsiflexion. Plain X-rays revealed an abnormal bony mass in the carpal bones, further evaluated using computed tomography and magnetic resonance imaging. Upon confirmation of the benign nature surgical excisional biopsy of the lesion, the histopathology confirmed the diagnosis of Bizarre parosteal osteochondromatous proliferation (BPOP).

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Bizarre parosteal osteochondromatous proliferation (BPOP), or Nora's lesion, is an unusual, benign, bony lesion often found in the tubular small bones of the hand and foot. In general, two characteristic radiological signs are used to diagnose the lesion, namely, (1) the absence of corticomedullar continuity and (2) BPOP developed from the parosteal surface of bones with an intact underlying cortex. Here, we present an atypical case of Nora's lesion of the proximal phalanx of the index finger, in which BPOP was diagnosed only histologically, with preoperative imaging examinations (X-ray and MRI) suggesting another lesion (enchondroma).

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Rare Case of Bizarre Parosteal Osteochondromatous Proliferation of Foot.

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February 2024

Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India.

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