MALIGNANT TRANSFORMATION OF SOLITARY SPINAL

OSTEOCHONDROMA IN TWO MATURE DOGS

ERICM. GREEN, M. ADAMS,DVM, HOWARD

DVM, WILLIAM VMD, PHD
STEINBERG,

Canine osteochondroma is an uncommon bony tumor that arises in skeletally immature animals.
Consequently, clinical signs typically occur in young dogs as a result of impingement of normal struc-
tures by the tumor. Radiographically, osteochondromas are benign in appearance. They are well
circumscribed and cause no bony lysis nor periosteal proliferation. Osteochondromasmay occur in two
forms; solitary or multiple. Although histology and biologic behavior are identical, when in the multiple
form the condition has been termed multiple cartilaginous exostoses. Malignant transformation of
multiple cartilaginous exostoses has been reported in three mature dogs. We report two dogs with
malignant transformation of solitary spinal osteochondromas. Both underwent transformation to os-
teosarcoma. Despite the benign radiographic appearance of osteochondromas and multiple carti-
laginous exostoses, clinical signs should alert the clinician to the possibility of malignant transforma-
tion. Veterinary Radiology & Ultrasound, Vol. 40, No. 6, 1999, p p 634-637.

Key words: canine, spine, osteochondroma, malignant transformation.

Introduction Dog 1

0 STEOCHONDROMAS ARE benign tumors arising in bones

that develop by endochondral ossification. Common
sites include vertebrae, ribs, and long bones. These lesions
consist of cartilage-capped bony nodules typically located at
a metaphysis which arise prior to skeletal maturity. Radio-
graphically, these lesions appear benign, having a cortex
and medullary cavity that blend smoothly with those of the
parent bone, causing no lysis or periosteal new bone for-
mation.’ Synonyms for osteochondroma include cartilagi-
nous exostosis, osteochondromatosis, diaphyseal aclasia or
hereditary exostosis.2 Generally, a solitary lesion is referred
to as an osteochondroma, while multiple cartilaginous ex-
ostoses is the term applied when numerous lesions exist.
Solitary osteochondromas and multiple cartilaginous exos-
toses are histologically identical, although multiple carti-
laginous exostoses have been shown to be hereditary in
dogs”‘ and humans (autosomal dominant trait).5 Addition-
ally, malignant transformation of multiple cartilaginous ex-
ostoses to osteosarcoma or chondrosarcoma has been re-
ported in dogs6g7X8and humans.’ In this paper we present
two mature dogs with solitary spinal osteochondromas that
have undergone malignant transformation to osteosarcoma
resulting in neurologic clinical signs.
Departments of Surgical (Green, Adams) and Pathobiological (Stein-
berg) Sciences, University of Wisconsin-Madison, School of Veterinary
Medicine
Address correspondence and reprint requests to Eric M Green DVM,
University of Wisconsin-Madison, School of Veterinary Medicine, 2015
Linden Dr West, Madison, WI 53706.
Received November 30, 1998; accepted for publication March 19, 1999.
A 6-year-old, female Golden Retriever was referred to the
University of Wisconsin Veterinary Medical Teaching Hos-
pital with a history of progressive paraparesis which had
recently progressed to complete inability to use the hind
limbs. On presentation, the dog was unable to walk. There
was loss of conscious proprioception in both hind limbs and
a panniculus reflex absent caudal to the mid-thoracic region.
No other neurologic abnormalities were noted. The remain-
der of the physical examination was within normal limits.
Based on these findings, an upper motor neuron lesion was
suspected in the region of T3 to L3. Thoracic radiographs
were made to check for metastatic disease (Figs. 1 and 2). A
three centimeter diameter expansile lesion of the dorsal half
of the spinous process of T5 causing deformity of the
spinous process of T6 was seen. No evidence of pulmonary
metastatic disease was noted. The radiographic interpreta-
tion was that of benign neoplasia (osteochondroma or chon-
droma). The owner declined further work-up and elected
euthanasia and necropsy. Grossly there was a solitary 8 x 4
x 2 cm. mottled dark red to pale tan mass centered in the
fifth thoracic vertebral spinous process. The mass was pri-
marily right sided, but extension to the left epaxial muscu-
lature was noted. On cut surface the mass was glistening
white, firm to hard and bony with admixed blood-filled
cystic spaces. The mass extended into the vertebral canal
compressing the spinal cord, which was malacic. There was
no evidence of distant metastasis. Histologically, the tumor
consisted of a poorly delineated hypercellular mass, con-
tinuous with the spinous process, that effaced and replaced

634
VOL. 40. No. 6 MALIGNANT
TRANSFORMATION
OF SOLITARY SPINAL OSTEOCHONDROMA
FIG. 1. Radiograph of the thoracic spine of dog 1. Note the benign
appearing lesion involving the T5 spinous process.
normal bony structures and infiltrated into adjacent tissue.
The central portion occupied the site of the spinous process
of T5 and primarily consisted of a peripheral margin of
moderately well differentiated hyaline cartilaginous tissue
with abundant chondroid extracellular matrix with intrala-
cunar single or multiple neoplastic chondrocytes surround-
ing central differentiating neoplastic osseous tissue forming
cancellous bone with interspersed serum and blood-filled
cystic spaces and admixed adipose and collagenous connec-
tive tissue. This was consistent with an osteochondroma.
Peripheral to and arising from this osteochondroma, were
infiltrating, invasive, more cellular areas (Fig. 3). These
regions consisted of more densely packed sheets of pleo-
morphic stellate to spindle shaped neoplastic mesenchymal
cells with small numbers of mitotic figures associated with
deposition of extracellular chondroid and osteoid matrix and
neoplastic bone which frequently entrapped neoplastic os-
teocytes (Fig. 4). The diagnosis of osteosarcoma arising
FIG. 2. Post-mortem radiograph of the thoracic spine in Dog 1. Note the
sharply-marginated lesion smoothly continuous with the spinous process of
T5. There is well-defined remodelling of the spinous process of T6.
635
FIG. 3. Dog 1. Malignant cell population of osteosarcoma (arrow) at the
periphery of the well differentiated osteochondroma. Bar = 210 pm.
from malignant transformation of an osteochondroma was
made.
Dog 2
A 5-year-old, female Samoyed mix was referred to the
University of Wisconsin VMTH for evaluation of acute bi-
lateral forelimb paralysis. There was bilateral forelimb pa-
ralysis with significant muscular atrophy and loss of with-
drawal reflex and deep pain sensation. Hindlimbs exhibited
hyperreflexive patellar reflexes. The panniculus reflex was
absent and Horner’s syndrome was present bilaterally. Pain
was elicited upon abduction of the forelimbs and manipu-
lation of the neck. No other neurologic or physical abnor-
malities were noted. Based on these findings, a compressive
lesion in the region of the brachial plexus was suspected.
The owner declined further work-up and elected euthanasia
and necropsy. Grossly there was a solitary 1.5 cm. diameter,
well-circumscribed, firm to hard off-white mass extending
caudally from the right side of the sixth cervical vertebral
neural arch (Fig. 5). Ventral to the mass there was hemor-
FIG.4. Dog 1. Extracellular osteoid deposition (arrow) associated with
the malignant population of osteocytes. Bar = 35 pm.
636 GREENET
FIG.5. Post-mortem radiograph of the cervical spine in Dog 2. Note the
well-circumscribed lesion arising from the neural arch of C6.
rhage within the vertebral canal, and the spinal cord was
malacic. There was no evidence of distant metastasis. His-
tologically, the mass was continuous with the neural arch
and consisted of central coalescing nodules of hypocellular
cartilaginous tissue populated by well differentiated, mildly
pleomorphic neoplastic chondrocytes with occasional focal
central areas of osseous differentiation forming cancellous
bone. Along the periphery of the mass, there were densely
cellular areas comprised of markedly pleomorphic spindle
to polygonal neoplastic mesenchymal cells with moderate
numbers of mitotic figures associated with extracellular os-
teoid deposition frequently surrounding these neoplastic os-
teocytes. The diagnosis of osteochondroma with malignant
transformation to osteosarcoma was made.
Discussion
Solitary spinal osteochondromas are uncommon in ani-
mals. Five have been reported in skeletally immature
and a cat,I4 all of which were exhibiting neuro-
logic signs associated with the osteochondroma. In four of
these patients, the osteochondroma was located in the tho-
racic spine (3 dogs and the cat), while in the fifth patient it
was located in the cervical spine (one dog). Clinical neuro-
logic signs related to compression by the osteochondroma
were found in 64% of humans with spinal osteochon-
droma. l5
Numerous animals with multiple cartilaginous exostoses
have been Only one of these reports in-
cluded clinical signs from spinal compression.12 In a search
of 32,799 individual patients from 1/1/87 through 10/30/96
at the University of Wisconsin-Madison VMTH, only 2
patients with solitary spinal osteochondromas (0.006%) and
2 with multiple cartilaginous exostoses (0.006%) were
found.
These conditions should not be confused with synovial
osteochondromatosis (also referred to as synovial chon-
AL. 1999
drometaplasia), where chondral or osteochondral nodules
are formed in the synovial tissue of joints, tendon sheaths or
bursae. l 6 This condition can be found in one or more joints
and has not been associated with malignant transformation.
Malignant transformation of multiple cartilaginous exos-
toses to osteosarcoma* and c h o n d r o ~ a r c o m a has
~ ~ ~been
~’~
described in six dogs. Four of these had evidence of me-
t a s t a ~ e s . ~No
’ ~ ”report
~ of malignant transformation of soli-
tary spinal osteochondroma in animals could be found.
Banks et. al. described a nine year old dog that had mul-
tiple expansile bony lesions of several ribs, long bones and
vertebrae identified on radiographs which grossly were de-
scribed as expansions of cancellous bone covered with hya-
line cartilage. One of these lesions consisted of cancellous
bone with a hyaline cartilage cap interspersed with neoplas-
tic tissue characteristic of chondrosarcoma. This lesion was
not identified as being radiographically different from the
other exostoses. No distant metastases were found.
Owen et. al. described an eight year old dog initially
presented for evaluation of an intermittent left forelimb
lameness and a mass over the left scapula. Radiographs
made at that time demonstrated expansile bony lesions of
the left scapula, several ribs and multiple vertebrae. Seven
weeks later, the mass on the left scapula was larger, al-
though radiographically it appeared unchanged. Malignant
transformation was suspected. A further seven weeks later,
the mass had grown considerably and radiographs demon-
strated extensive lysis of the left scapula and the previously
noted expansile bony lesion. Histologically, the left scapular
mass was identified as an exostosis that had transformed
into osteosarcoma. Pulmonary metastases were identified.
The dog described by Doige et. al. presented at 16
months of age for vaccination and several firm masses were
noted that were described radiographically as well-
circumscribed expansile lesions typical of multiple carti-
laginous exostoses. A single lesion arising from the first and
second lumbar vertebrae was larger, more mineralized, and
more irregular that the other exostoses. At three years of
age, radiographs demonstrated the presence of additional
lesions typical of multiple cartilaginous exostoses. Several
of the previously identified lesions, including the Ll-L2
lesion, were larger and more densely mineralized. Radio-
graphs made at final presentation 4 years later demonstrated
dramatic growth of the L1-L2 lesion. It contained a large
area of amorphous mineralization without a discrete bony
“shell.” Histologically, this mass was described as a chon-
drosarcoma arising from an exostosis. Multiple pulmonary
metastases were present.
It has been reported that osteochondromas cease growing
at skeletal maturity and the mature lesion may possess little
or no cartilage on its apical surface.” It is of interest that the
two dogs in this report and the three dogs in previous reports
(all mature animals) had osteochondromas or multiple car-
tilaginous exostoses with cartilaginous caps present on their
VOL. 40, No. 6 MALIGNANT
TRANSFORMATION
OF SOLITARY
SPINAL
OSTEOCHONDROMA
apical margins. The dog described by Doige et. al. experi-
enced the development of new lesions and the growth of
existing lesions after 16 months of age. This information
suggests that histologic maturation of the apical cartilage
cap is an inconsistent finding in mature dogs with osteo-
chondroma and that tumor growth may not cease at maturity
in some lesions. These findings contradict historical de-
scriptions of osteochondromdmultiple cartilaginous exos-
tosis maturation.I8 Further investigation into growth pat-
terns of osteochondromas and multiple cartilaginous exos-
toses would appear warranted.
Osteochondromas are said to represent nearly 8% of be-
nign cartilaginous neoplasms of the human spine, still an
. ~ ~a review of reported cases of
uncommon o c c ~ r r e n c e In
spinal osteochondroma in humans, 48 of 77 were solitary
and 25 were associated with multiple cartilaginous exos-
toses (two were un~pecified).’~ Chondrosarcomatous trans-
formation is reported in 1% to 5% of solitary osteochon-
dromas and 10% to 25% of patients with multiple cartilagi-
nous exostoses in human^.^ It has been suggested that
malignancy of these lesions can be determined by the thick-
ness of the cartilaginous cap as seen on magnetic resonance
(MR) A thickness greater than 2 to 3 cm war-
rants consideration of malignancy. Others have developed
criteria for distinguishing osteochondroma from chondrosa-
rcoma on computed tomographic images.” Osteochondro-
mas have a cortex and medullary cavity continuous with
that of the parent bone, have an organized pattern of min-
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