{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,3]],"date-time":"2026-05-03T00:48:32Z","timestamp":1777769312199,"version":"3.51.4"},"reference-count":22,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,4,9]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:p>Bizarre parosteal osteochondromatous proliferation (BPOP), or Nora\u2019s lesion, is a rare benign bone tumour that most commonly affects the bones of the hands and feet. It presents diagnostic challenges due to its aggressive imaging features, high recurrence rate and histological overlap with malignant lesions. We report the case of an adolescent girl who presented with a hard, ulcerated swelling over the distal phalanx of the right great toe. Imaging revealed corticomedullary continuity of the lesion with the underlying phalanx, raising suspicion for osteochondroma or subungual exostosis. Surgical excision was performed, and histopathology confirmed BPOP, showing binucleated chondrocytes, endochondral ossification and the characteristic \u2018blue bone\u2019. No recurrence was observed during a 1-year follow-up period. This case highlights the importance of considering BPOP in the differential diagnosis of toe lesions particularly when atypical radiological features are present. Histopathological examination remains the cornerstone for definitive diagnosis.<\/jats:p>","DOI":"10.1136\/bcr-2025-268901","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T16:15:34Z","timestamp":1777479334000},"page":"e268901","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Atypical radiological presentation of bizarre parosteal osteochondromatous proliferation (BPOP) of the great toe"],"prefix":"10.1136","volume":"19","author":[{"given":"Sandeep Kumar","family":"Yadav","sequence":"first","affiliation":[{"name":"Orthopedics, All India Institute of Medical Sciences - Jodhpur, Jodhpur, Rajasthan, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3120-2147","authenticated-orcid":false,"given":"Akshant","family":"Chandel","sequence":"additional","affiliation":[{"name":"Orthopedics, All India Institute of Medical Sciences - Jodhpur, Jodhpur, Rajasthan, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4660-389X","authenticated-orcid":false,"given":"Poonam Abhay","family":"Elhence","sequence":"additional","affiliation":[{"name":"Pathology and Lab Medicine, All India Institute of Medical Sciences - Jodhpur, Jodhpur, Rajasthan, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4748-3049","authenticated-orcid":false,"given":"Rashim","family":"Sharma","sequence":"additional","affiliation":[{"name":"Pathology and Lab Medicine, All India Institute of Medical Sciences - Jodhpur, Jodhpur, Rajasthan, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,4,29]]},"reference":[{"key":"2026042909151732000_19.4.e268901.1","doi-asserted-by":"publisher","DOI":"10.1097\/00000478-198304000-00003"},{"key":"2026042909151732000_19.4.e268901.2","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1016\/j.jor.2018.05.009","article-title":"Bizarre parosteal osteochondromatous proliferation of the femur: A case report","volume":"15","author":"Takahashi","year":"2018","journal-title":"J Orthop"},{"key":"2026042909151732000_19.4.e268901.3","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1016\/j.jbspin.2014.07.008","article-title":"A bizarre parosteal osteochondromatous proliferation (Nora\u2019s lesion) of metatarsus, a histopathological and etiological puzzlement","volume":"81","author":"Doganavsargil","year":"2014","journal-title":"Joint Bone Spine"},{"key":"2026042909151732000_19.4.e268901.4","doi-asserted-by":"publisher","DOI":"10.1097\/00000478-199307000-00006"},{"key":"2026042909151732000_19.4.e268901.5","doi-asserted-by":"crossref","first-page":"88","DOI":"10.13107\/jocr.2024.v14.i02.4228","article-title":"Rare Case of Bizarre Parosteal Osteochondromatous Proliferation of Foot","volume":"14","author":"Sabir","year":"2024","journal-title":"J Orthop Case Rep"},{"key":"2026042909151732000_19.4.e268901.6","doi-asserted-by":"publisher","DOI":"10.1097\/01.pas.0000126642.61690.d6"},{"key":"2026042909151732000_19.4.e268901.7","doi-asserted-by":"publisher","DOI":"10.1046\/j.1440-1827.2001.01271.x"},{"key":"2026042909151732000_19.4.e268901.8","unstructured":"Resnick D , Kyriakos M , Greenway GD . 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