Bony Tumor

This was shared with us by the current Chief of Surgery here at Tansen Hospital.  He is a Vellore trained Nepali Orthopedic Surgeon, and he and his team are doing a great job here at the hospital.  This is such an amazing story, we wanted to share it.  NOTE:  This is much more medical and has some graphic images so read as you wish – this was not written by non medical Debbie, but we thought some might be interested in something more clinical.

Ashish is an eight year old boy who presented with a large bony tumor in the right scapular region. His parents noticed the swelling in early childhood. He presented late because he was wrongly informed by a  local doctor that he would not be operated on by any doctors till he was 8 years of age. The movement of the right upper limb and neck was limited because of the swelling. The swelling was painless and there was no history to suggest malignant transformation,  such as pain, sudden increase in size, loss of appetite or weight. Neurology was normal in the right upper limb, but the radial pulse was feeble on that side. There were bony swellings in all the four limbs.  His father and his grandfather also suffered from a similar illness. Xrays and CT scans revealed a bony tumor arising from the right scapula, measuring  20cm X 15cm. It was pressing on the right chest wall deforming it.  Diagnosis: Hereditary Multiple exostosis.

Ashish before the surgery. The bony tumor is arising from the right scapula. The tumor looks large externally, it was bigger internally as it compressed and deformed the chest wall.  It is obvious in the Xrays and CTscans

Ashish before the surgery. The bony tumor is arising from the right scapula. The tumor looks large externally, it was bigger internally as it compressed and deformed the chest wall. It is obvious in the Xrays and CTscans

The right chest was deformed due to pressure on it indicating a larger mass internally than what appears externally.

The right chest was deformed due to pressure on it indicating a larger mass internally than what appears externally.

The familial nature of the condition. The father has bony swelling with deformities in the upper limbs.

The familial nature of the condition. The father has bony swelling with deformities in the upper limbs.

X-rays of the chest  demonstrating the Bony tumor arising from the right scapula. Note the chest deformity due to  compression of the the tumor.

X-rays of the chest demonstrating the Bony tumor arising from the right scapula. Note the chest deformity due to
compression of the the tumor.

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Tumor around the knee and ankle involving both the lower limbs.

Tumor around the knee and ankle involving both the lower limbs.

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CT reconstruction demonstrates the bony tumor arising from the right scapula. The clavicle is seen anterior to the tumor.

CT reconstruction demonstrates the bony tumor arising from the right scapula. The clavicle is seen anterior to the tumor.

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Lateral positioning for the surgery.

Lateral positioning for the surgery.

Elliptical skin marking for incision.

Elliptical skin marking for incision.

Extensive dissection around the tumor to enucleate it.

Extensive dissection around the tumor to enucleate it.

Skin closure with two suction drains.

Skin closure with two suction drains.

The tumor weighed 1.72 kgs

The tumor weighed 1.72 kgs

Triumphant removal of the tumor.

Triumphant removal of the tumor.

Ashish recovering from the surgery. The radial pulse was normal and equal to the opposite arm. It would be interesting to follow him up and see if his chest wall reverts to normal shape.

Ashish recovering from the surgery. The radial pulse was normal and equal to the opposite arm. It would be interesting to follow him up and see if his chest wall reverts to normal shape.

Ashish on his 4th post op day.

Ashish on his 4th post op day.

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10 Comments

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10 responses to “Bony Tumor

  1. Peter A Block

    Dear Les,

    Wow! That is amazing. I saw some very large and unusual tumours in my days over seas but never this diagnosis. Thanks for sharing this. And congratulations to the surgeon who removed it.

    God bless.

    Peter Block

  2. Barb Balsmeyer

    Very interesting. Had to look up this Dx. How wonderful that the surgeon could impact this boy’s life in this way. Enjoy reading about health care in Nepal.

  3. Absolutely astounding! I hope that the surgeon will write it up and publish it. Thanks, Les!
    Lots LOVE, Risto

  4. romeo del rosario

    Debbie and Les, All I can say is Alleluia! Wow! Thanks for sharing this. Romy

  5. Elaine Dorrel

    Totally amazing!!! Thanks for sharing yet another miracle from the hospital!

  6. Phyl Asher

    body{font-size:10pt;font-family:arial,sans-serif;background-color:#ffffff;color:black;}p{margin:0px;}I N T E R E S T I N G.   Thanks.     Phyl

  7. Margaret Fain

    So very interesting!!! Hope you can let us know the follow up of this child. What about recurrence or something else coming up again as he gets older? God Bless. Maggie

  8. james pettibone

    Dear Dornans; Thank you for the great e-mail with pictures of the operation to remove the boy’s tumor. Elsie wanted any contributions to go to UMN. Hopefully some of it will benefit Tansen Hospital. I’m doing OK. There sure is a lot of paperwork connected with a person’s passing besides this is right on top of Income tax time. I am keeping busy. Love, Jim

    Date: Tue, 4 Mar 2014 00:32:51 +0000 To: jamespetti@hotmail.com

  9. John Watson

    Well done to the team. Do you have CT now???
    Agree with Risto – this is worth writing up. – esp if you can get any follow up on the boys future development.

  10. Ed and Jean Hollenberg

    What a triumphant outcome. Where was the surgery performed? Who was the surgeon? Thanks for sending that story. I wonder how the boy felt about being relieved of that weight and blight? I’d like to know how the boy feels about the work of the mission? We are still experiencing cold and Winter. It was 8 0 F this a.m. and more cold to come. A cold winter indeed. One foot of snow has covered the ground since before Ckhristmas. We are still working in the prisons and hope to have some good reports in my work here. love Ed and Jean.

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