Osteochondroma is the most common benign bone tumor, accounting for 20–50% of all benign bone neoplasms and 10–15% of all bone tumors ^[1]. It usually arises from the metaphysis of long bones, whereas flat bones such as the scapula are less frequently involved, representing only 3–5% of all cases ^[2]. Within the scapula, the ventral surface is the predominant site, while the dorsal aspect remains extremely rare, with only a handful of cases reported worldwide ^[3,4].

Patients may present with swelling, pseudo-winging, crepitus, pain, or positional discomfort, though many lesions remain asymptomatic and are detected incidentally ^[5,6]. Imaging, especially CT and MRI, plays a crucial role in flat-bone osteochondromas for delineating cartilage-cap thickness and excluding malignant transformation ^[7]. Surgical excision is typically reserved for cases with pain, deformity, functional limitation, or suspicion of malignant change, while conservative management may suffice in select asymptomatic pediatric cases ^[4,8].

Against this rare clinical background, we present an uncommon dorsal scapular osteochondroma in a young patient, emphasizing its atypical features, diagnostic approach and management considerations in light of existing literature.

CASE PRESENTAION

A 15-year-old female patient presented with a gradually progressive swelling over the left scapular region for the past 6–9 months, associated with persistent dull aching pain and discomfort while lifting objects. The swelling had progressively increased in size, and over the last few weeks, the patient reported difficulty in performing overhead activities.

On clinical examination, there was a firm, non-tender, bony swelling palpable over the scapular blade.

Plain radiography (Figure 1) of the left scapula demonstrated a bony projection arising from the scapular blade. Owing to persistent symptoms, a computed tomography (CT) scan (Figure 2) was performed, which revealed an expansile lesion continuous with the cortex and medullary canal of the scapula. For further characterization, magnetic resonance imaging (MRI) of the left scapula was performed using T1, T2, and STIR sequences (Figure 3). MRI demonstrated a well-defined osseous lesion measuring approximately 3.5 × 2.0 cm with an irregular cartilaginous cap of 8.8 mm thickness, arising from the anterior margin of the inferior scapular blade. The lesion displaced the adjacent latissimus dorsi muscle without neurovascular compression.

Given the patient’s symptomatic presentation and progressive enlargement, surgical excision was planned. The lesion was removed en bloc under general anesthesia. The resected specimen (Figure 4) was submitted for histopathological analysis.

RESULTS

Radiographic Findings: Plain X-ray (Figure 1) showed a bony excrescence arising from the inferior scapular blade, consistent with an exostotic lesion.

CT Findings: CT images (Figures 2) confirmed corticomedullary continuity with the parent bone, characteristic of osteochondroma.

MRI Findings: MRI scans (Figures 3) revealed a lobulated expansile osseous lesion with a cartilage-capped projection measuring 3.5 × 2.0 cm, and a cartilaginous cap thickness of 8.8 mm. The lesion was hyperintense on STIR sequences and displaced the adjacent latissimus dorsi muscle, without evidence of soft tissue invasion or malignant transformation.

Intraoperative Findings: A hard, lobulated mass was excised en bloc (Figures 4). Gross examination demonstrated a cartilage-capped osseous tumor.

Histopathology: Confirmed osteochondroma, showing endochondral ossification beneath the cartilage cap with no atypia.

Postoperative Outcome: Recovery was uneventful. The patient reported significant reduction in pain and regained normal shoulder mobility. Follow-up radiographs (Figure 5) confirmed complete excision with no recurrence at short-term review.

DISCUSSION

Dorsal scapular osteochondroma is a rare entity, representing only 3–6% of scapular osteochondromas, with most cases located on the ventral aspect. The present case of a 15-year-old female is unusual in that she presented with lifting-related pain and associated with a progressively enlarging swelling. Imaging confirmed corticomedullary continuity with a cartilage cap measuring 8.8 mm, larger than most pediatric cases reported in literature but still below the threshold considered suspicious for malignant change in skeletally immature bone. Complete excision achieved prompt relief of symptoms and restoration of function, with no early recurrence.

Comparison with the literature highlights both similarities and unique aspects of present case. Munde et al. (2025) reported a 10-year-old boy with a dorsal scapular lesion of 23 × 20 mm and a cap of 3 mm, presenting with cosmetic concerns and supine discomfort; muscle-sparing excision achieved excellent results ^[9]. Das et al. (2023) described another 10-year-old boy with a 4.8 × 4.1 × 3.4 cm lesion and a 4.6 mm cap, where en-bloc excision led to complete recovery and normalization of QuickDASH scores ^[2]. Bektas and Ozmanevra (2019) detailed a 15-year-old female with a painful dorsal scapular mass measuring 6 × 4 cm, with symptoms including inability to sleep supine and cosmetic disfigurement; excision resulted in complete relief and no recurrence ^[6]. Chu and Sabpresentdy (2023) provided a different management perspective, reporting an 8-year-old boy with a 2.3 × 1.3 cm dorsal scapular lesion associated with scoliosis and winging but minimal pain; conservative chiropractic management improved symptoms despite radiographic enlargement of the mass ^[4].

A comparative summary of these cases is provided in Table 1, demonstrating the heterogeneity of presentation, management strategies, and outcomes:

From this comparative analysis, several conclusions can be drawn. First, dorsal scapular osteochondromas tend to occur in children and adolescents, frequently causing pain or discomfort in the supine position, mechanical irritation, or cosmetic concern. Second, cartilage cap thickness in pediatric lesions is usually <5 mm; present case contributes by documenting a cap of 8.8 mm, higher than reported averages but benign in context. Third, while conservative management may be justified in minimally symptomatic cases, surgical excision remains the definitive treatment for symptomatic patients and consistently yields excellent outcomes. Finally, incorporating patient-reported outcomes, as demonstrated by Das et al. (2023), offers a valuable framework for assessing the true clinical impact of intervention ^[2].

Present case thus reinforces the importance of individualized management, with early surgical intervention when symptoms are functionally limiting, and expands the literature by documenting a trauma-associated symptomatic dorsal scapular osteochondroma with a comparatively thick cartilage cap in an adolescent female.

CONCLUSION

Dorsal scapular osteochondroma remains an exceptionally rare presentation of a common benign tumor. Present case underscores that even trauma can unmask symptoms in otherwise indolent lesions and highlights the significance of careful imaging evaluation, particularly of cartilage cap thickness, in guiding management. Complete surgical excision in symptomatic patients provides excellent functional recovery with minimal risk of recurrence, while comparative evidence confirms that individualized treatment ranging from observation to excision should be tailored to patient age, symptom burden and risk of malignant transformation.

REFERENCES

1. Alabdullrahman LW, Byerly DW. StatPearls. Treasure Island, FL: StatPearls Publishing. 2023.
2. Das R, Arya S, Krishna A, Ghosh S, Mukartihal R, Keezhadath S. Osteochondroma of Dorsal Scapula: A Case Report and Review of Literature. J Orthop Case Rep. 2023 Jul;13(7):104-109. doi: 10.13107/jocr.2023.v13.i07.3772. PMID: 37521381; PMCID: PMC10379260.
3. Altwaijri NA, Fakeeha J, Alshugair I. Osteochondroma of the scapula:A case report and literature review. Cureus. 2022;14:e30558. doi: 10.7759/cureus.30558. 
4. Chu EC, Sabourdy E. Dorsal scapular osteochondroma in the chiropractic clinic: a case report and literature review. Cureus. 2023;15(7). DOI 10.7759/cureus.42007.
5. Mohsen MS, Moosa NK, Kumar P. Osteochondroma of the scapula associated with winging and large bursa formation. Med Princ Pract 2006;15:387-90. https://doi.org/10.1159/000094275.
6. Bektas YE, Ozmanevra R. An unusual location of osteochondroma: Dorsal scapula. Cureus 2019;11:e6464. DOI: 10.7759/cureus.6464.
7. Tomo H, Ito Y, Aono M, Takaoka K. Chest wall deformity associated with osteochondroma of the scapula:A case report and review of the literature. J Shoulder Elbow Surg. 2005;14:103–6. doi: 10.1016/j.jse.2004.03.007. 
8. Wirganowicz PZ, Watts HG. Surgical risk for elective excision of benign exostoses. J Pediatr Orthop. 1997;17:455–9. 
9. Munde R, Ravariya R, Konde S, Madhavi A. Rare Presentation of Dorsal Scapular Osteochondroma in a Young Patient: A Case Report. An Observational Study. MIMER Med J 2025;9(1):29-34. doi.10.15713/ins.mmj.112.