Tumors of the coracoid process: clinical evaluation of twenty-one patients

doi:10.1016/j.jse.2011.11.003

Journal of Shoulder and Elbow Surgery

Volume 21, Issue 11, November 2012, Pages 1508-1515

https://doi.org/10.1016/j.jse.2011.11.003 Get rights and content

Objective

We present the incidence and management of bone tumors of the coracoid process and discuss the related clinical and imaging findings and treatment.

Materials and methods

We present 21 patients (7 males and 14 females; mean age, 39 years) treated for bone tumors of the coracoid process from 1900 to 2010. Mean follow-up was 44 months (range, 12-132 months). Clinical presentation, imaging, surgical treatment, complications, range of shoulder motion, and Musculoskeletal Tumor Society (MSTS) function were evaluated.

Results

Bone tumors were benign in 7 (33%) and malignant in 14 (67%). The most common were chondrosarcomas, osteoblastomas, and chondroblastomas. The most common presentation was pain and palpable mass for a mean duration of 11 months. Limb salvage, with or without megaprosthetic reconstruction, was achieved in 20 patients. One patient required forequarter amputation. One patient with chondroblastoma and 2 with chondrosarcoma had local recurrence. The range of shoulder motion varied according to the type of resection: patients with curettage and limited resections without involvement of the abductor mechanism had better shoulder motion, and patients with scapulectomy and proximal humeral resections had significant limitations of motion. The mean MSTS score was 80% (range, 50%-100%).

Conclusions

Chondrosarcomas, osteoblastomas, and chondroblastomas are the most common bone tumors of the coracoid process. Limited resections are associated with nearly normal range of motion and excellent function; however, limited resections are acceptable in only in a small number of patients. In patients with malignant and recurrent lesions, wide resection is required, which is associated with significant limitations of shoulder function.

Section snippets

Materials and methods

We searched the registry of the Istituto Ortopedico Rizzoli from 1900 to December 2010 for patients admitted and treated for tumors of the scapula. We found 627 patients with benign and malignant tumors; of these, 21 (3%) had tumors involving the coracoid process and were included in this study. There were 7 male and 14 female patients with a mean age of 39 years (range, 6-74 years). All patients with coracoid process tumors were diagnosed after 1978.

No patients were recalled specifically for

Results

Benign bone tumors were diagnosed in 7 patients (33%) and malignant in 14 (67%; Table I). The most common bone tumors were chondrosarcomas (Fig. 1), followed by osteoblastomas and chondroblastomas (Fig. 2, Table II). Malignant bone tumors were more common in patients aged older than 40 years. Patient 8 developed a radiation-induced malignant fibrous histiocytoma 3 years after radiation therapy for breast cancer, and patient 18 developed metastasis at the coracoid process from metastatic breast

Discussion

A variety of malignant and benign tumors may occur at the coracoid process2, 4, 21, 26, 27, 34, 42, 44, 50; misdiagnosis, inappropriate or delayed treatment may potentially have grave consequences.5, 44, 45 We performed this observational retrospective study to evaluate the incidence of bone tumors involving the coracoid process and to discuss the clinical and imaging findings, treatment, and postoperative function in this region. Our results showed that the most common tumors were

Conclusion

A small number of patients with shoulder pain may have a tumor in the coracoid process that is most likely to be chondrosarcoma, especially in patients aged older than 40 years. In patients younger than 40 years, there is a chance that the tumor is osteoblastoma or chondroblastoma. These should be kept in mind when examining patients with shoulder pain and interpreting radiographs of the shoulder. Surgical resection is the main treatment for most bone tumors of the coracoid process. Limited

Disclaimer

The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

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Tumors of the scapula: A retrospective analysis identifying predictors of malignancy
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Citation Excerpt :
Brtková et al. found chondrosarcoma was most prevalent at the inferior angle, acromion, and coracoid process [4]. Other studies looking specifically at the coracoid process have found chondrosarcoma to be the most prevalent tumor at this site [14,17]. It is unclear if there is a predilection for chondrosarcoma in the coracoid process, or if chondrosarcoma is simply the most frequently occurring malignancy of the scapula and the coracoid process is an unusual location.
Osseous tumors of the shoulder girdle occur most frequently in the proximal humerus, scapula and clavicle. Prior studies have determined that tumors occurring in the scapula have a higher risk of malignancy, but few have looked exclusively at tumors of this site to describe incidence, clinical features and potential predictors of malignancy. As imaging technologies for diagnosis have improved, it is important to re-evaluate if patterns of incidence have changed and if new imaging findings could potentially be predictors of malignancy.
This retrospective analysis identified 173 patients from a pediatric and an adult hospital between 1990 and 2015. All patients with tumors of the scapula either of bony origin or with bony invasion were included. Diagnosis, tumor location, and patient demographics were collected. Bivariate and logistic regression analyses were performed to identify potential predictors of malignancy.
Chondrosarcoma and osteochondroma were the most common malignant and benign tumors, respectively. Benign tumors were more prevalent in the pediatric population. Tumors occurred most frequently in the body of the scapula.
Risk for malignancy increased with age (OR 1.09, 95% CI 1.05–1.12), tumors invading multiple sites (OR 10.85, 95% CI 2.37–49.72) and tumors that were lucent (OR 7.02, 95% CI 1.14–43.21) or had a mixed radiographic appearance (OR 11.47, 95% CI 1.36–99.65).
Including neoplasia in the differential diagnosis for shoulder complaints is important because the scapula is a site of increased risk of malignancy. Patterns of incidence and prevalence have not changed in the last years with the use of more advance techniques of imaging studies. Older age, lucent or mixed imaging, and tumors that span multiple sites of the scapula were found to be predictors of malignancy. Additional cross-sectional anatomy studies may be warranted for further evaluation in patients presenting with these characteristics given the higher concern for malignant disease.
Level IV, Prognostic Study.
Osteoid osteoma of the base of the coracoid process – A case report
2020, International Journal of Surgery Case Reports
Osteoid osteomas (OO) are small, well-defined, benign bone tumors of the young that are commonly found in long bones. In rare circumstances, when present elsewhere, they can mimic the symptoms of other pathologies pertaining to that area.
We present such case in which an "OO" of the coracoid process led to a 2-year delay in diagnosis and management of a young male due to the presenting symptoms resembling those of other shoulder pathologies. Ultimately, the use of advanced imaging modalities proved to be useful in detecting the "OO", which was consequently arthroscopically excised.
Appropriate imaging modalities such as CT or MRI often visualize the characteristic nidus more clearly as opposed to an X-ray and should therefore be used early when conservative management of shoulder pain has not been proven to be useful.
A long history of shoulder pain that is not responsive to conservative management in young patients should raise the suspicion of an "OO", and physicians should be encouraged to use early advanced imaging modalities in order to confirm it.
Histological, epidemiological and anatomical analysis of 193 bone tumours of the scapula
2019, Journal of Bone Oncology
Citation Excerpt :
Baena-Ocampo et al. [2] reported that 71.6% of the bone tumours were benign/intermediate, while 28.4% were malignant in their series of 566 patients. Previous studies focusing on bone tumours of the scapula found a high incidence of malignancy as well with a percentage of 54–67% [1,3,13]. It should be considered that benign bone tumours of the scapula may be underrepresented in these studies as well as in our series, because lesions of the scapula which were not operated are missing.
This study aimed to determine the frequency and distribution of bone tumours of the scapula as well as the histological and anatomical characteristics of these rare lesions in a large case series.
The records of all lesions of the scapula collected from 1975 to 2018 in our bone tumour registry and institute of pathology were evaluated. During these 43 years, 223 cases were identified. Analysis included assessment of age, gender, side, imaging findings, tumour location, and histological evaluation with the assignment of each lesion to one of the bone tumours according to the World Health Organization (WHO) classification of bone tumours.
Bone tumours of the scapula were found in 193 cases. Mean patient age was 38.4 years (2.6–82.4). Most of the lesions were of cartilage origin (47%). 59 bone tumours were benign (30.6%), 29 were intermediate (15.0%), and 105 were malignant (54.4%). The most commonly found bone tumour was Osteochondroma (23.3%), followed by Chondrosarcoma (17.6%), Bone metastases (16.6%), Ewing sarcoma (8.8%), and Osteosarcoma (7.8%). The percentage of malignant bone tumours increased with increasing age. In patients >50 years of age, 91% had a malignant lesion of the scapula.
Evaluation of 193 bone tumours of the scapula revealed a high incidence of malignancy in this series, while increased patient age was identified as a potential risk factor for the development of a malignant lesion of the scapula. These findings highlight the importance of early diagnosis and treatment of suspicious lesions of the scapula to improve patient outcome.
Anatomical distribution, the incidence of malignancy and diagnostic workup in the pathological lesions of the clavicle: a review of 410 cases
2023, Archives of Orthopaedic and Trauma Surgery
Subcoracoid Impingement and Endoscopic Coracoplasty
2023, Arthroscopy and Endoscopy of the Shoulder: Principle and Practice
Clinical and Imaging Features of Tumors in the Scapula
2022, Current Medical Imaging

View all citing articles on Scopus

: This study was approved by the Institutional Review Board of the Istituto Ortopedico Rizzoli, Bologna, Italia.

View full text

ShoulderTumors of the coracoid process: clinical evaluation of twenty-one patients

Objective

Materials and methods

Results

Conclusions

Section snippets

Materials and methods

Results

Discussion

Conclusion

Disclaimer

Hum Pathol

J Shoulder Elbow Surg

Hum Pathol

Giant cell tumor of the scapula: a review of 13 cases

Skeletal Radiol

Osteoid osteoma in the base of the coracoid process of the scapula. Excision by anterior approach: a case report

Bull Hosp Jt Dis

Radiation-induced sarcoma of bone

Cancer

Metastatic breast carcinoma of the coracoid process: two case reports

J Orthop Surg Res

Neoplasms of the scapula

AJR Am J Roentgenol

Tumours and tumour-like lesions of scapula

Acta Medica (Hradec Kralove)

Sarcoma arising in irradiated bone: report of eleven cases. 1948

Cancer

Bone and soft tissue tumours

Dedifferentiated chondrosarcoma

J Bone Joint Surg Am

Dedifferentiated chondrosarcoma of bone

Orthopedics

Primary chest wall tumour appearing as frozen shoulder. Review and case presentations

J Rheumatol

A system for the classification of skeletal resections

Chir Organi Mov

A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system

Clin Orthop Relat Res

Tumorous space occupying lesions of the scapula. An analysis of preoperative assessment of invasion

Radiologe

Risk factors for survival and local control in chondrosarcoma of bone

J Bone Joint Surg Br

Primary malignant bone tumors of the shoulder girdle: surgical technique of resection and reconstruction

Am Surg

Dedifferentiated chondrosarcoma: a report of the clinicopathological features and treatment of seventy-eight cases

J Bone Joint Surg Am

Osteochondroma of the scapula

Mo Med

Function after subtotal scapulectomy for neoplasm of bone and soft tissue

J Bone Joint Surg Br

Oblique angled view for coracoid fractures

Skeletal Radiol

Osteoid osteoma of the coracoid process

J South Orthop Assoc

Oncologic and functional outcome of scapular chondrosarcoma

Ann Surg Oncol

Shoulder
Tumors of the coracoid process: clinical evaluation of twenty-one patients