[Epiphyseal osteoid osteoma]

Three more cases of osteoid osteoma located in epiphysis are presented. All of them had special features, as a reactive synovitis due to the proximity of the lesion to the joint and the lower movility arch of these joints. The x-ray was essential for the diagnosis and definitive treatment was surgical resection.

Benign osteoblastoma of the mandible

Benign osteoblastoma is a rare osteoblastic tumour with osteoid and bone deposition. A rapidly growing osteoblastoma involving the area of the mandibular first and second molar of a 20-year-old female is described. Investigation of the collagenous components of the tumour by immunofluorescence was suggestive of a normal collagen synthesis by the tumour osteoblasts. The lesion is discussed with particular emphasis on its differential diagnosis and matrix constituents.

[Osteoid osteoma at the end of the phalanx of the big toe]

A 20-year-old man with persistent pain in the left big toe associated with broadening, thickening and discolouration of the toenail had been treated unsuccessfully for 21 months by surgical measures (wedge excision, avulsion of the nail) and local applications (antibiotics, antimycotics, disinfectants). A radiograph of the left big toe showed an area of calcification 0.5 cm in diameter at the base of the terminal phalanx. It was surrounded by a narrow zone of transradiancy and projected upwards above the margin of the bone. Among the diagnostic possibilities were osteomyelitis and osteoid osteoma. Biopsy revealed the latter, and the patient was cured by "en bloc" resection of the tumour. This case shows that abnormalities of nail growth of the kind commonly associated with paronychia may occasionally be due to a neoplastic lesion in the terminal phalanx.

Fibro osseous lesions of cranio facial bones

In a review of all tumours and tumour like lesions of the craniofacial bones between the years 1963 and 1980, 19 cases were diagnosed as fibro osseous lesions. The mean age of occurrence was 23.8 years with a slight male predominance (1.6:1). The clinical and histological aspects of the various lesions, the problems in diagnosis and the impact of diagnosis on clinical behaviour are discussed.

Surgical treatment of osteoid osteoma in an adolescent

The literature is complete in its review of osteoid osteoma and benign bone-forming tumors. When present in a child, the clinical and radiographic picture is not that clear and often is missed diagnosed. Routine radiographs may not offer a complete diagnosis in this young patient and additional studies are indicated. Tomograms and computerized tomographic (CT) scans, as well as bone scans, provide more information in determining the presence of absence of a bone lesion in the child. A case is presented of an 8-year-old female with pain for over 10 months, eventually diagnosed as an osteoid osteoma. A surgical procedure was performed to excise the lesion and replace it with a corticocancellous bone graft. The child has been followed for the past 5 years and has remained asymptomatic.

Neurological manifestations of osteoid osteoma

The clinical and radiological features of 38 children with osteoid osteomas were analysed retrospectively. Twenty nine patients had lesions of the femur (n = 17) or tibia (n = 12). The mean duration from the onset of symptoms to diagnosis was 13.8 months. In seven patients the history of pain and abnormalities on examination suggested a possible neurological disorder. Fourteen of 29 patients (48%) with femoral or tibial osteomas had localised muscle atrophy, and 10 patients (34%) had diminished or absent deep tendon reflexes in the affected limb. Two patients had painless lesions. Six patients had normal plain radiographs. Delay in the diagnosis of osteoid osteoma may be prevented by the knowledge that pain may be referred or radicular, that the concomitant occurrence of muscle atrophy and depressed deep tendon reflexes are relatively common findings, and that the characteristic radiological features may only appear late in the course of the disease.

Treatment of osteoid osteoma by computed tomography guided excision in the pediatric patient

An osteoid osteoma is a benign lesion that can occur in any bone. Controversy exists regarding treatment of this condition. This study demonstrates that the nidus of an osteoid osteoma can be disrupted and removed by use of the CORB biopsy system guided by computed tomography (CT) scan. Of nine patients followed for an average of 42.5 months (range 18-76 months), seven have had complete resolution of their pain after this procedure. The technique failed in two patients, who each required two separate en bloc excisions with bone grafting to resolve each lesion. CT-directed CORB appears to be useful in localization and removal of the nidus of an osteoid osteoma.

Osteoid osteoma of the talus

The talus is a rare site of predilection for osteoid osteoma. This tumor, in its juxta-articular position, presents particular clinical and pathological features. Three cases of subperiosteal osteoid osteoma are discussed in patients aged 15, 17 and 25 years. In diagnosis, a basic role is played by awareness of the disease, which must lead to the use of bone scan, indicating the site of the pathological lesion, which may be difficult to determine because of subtle radiographic modifications, and particularly because of long-term changes in the symptoms. Radiographic examination (standard x-rays, enlarged x-rays), often characterises and reinforces what is diagnostically suspected. CAT clearly shows the features and type of osteoid osteoma in relation to the adjacent structures. Sequential angioscintigraphy, based on the captation curve of the radionuclide, may suggest the nature of the lesion, subsequently confirmed by the macroscopic picture and histological examination.

Osteoid osteoma of the femoral neck in the young athlete

The purpose of this paper is to present a progressive diagnostic and management program for osteoid osteoma of the femoral neck in the young athlete. Five young athletes with hip pain secondary to osteoid osteoma are presented. The average age of the patients was 15 years old, with an average followup of 4 years. Radioisotope bone scans, computed axial tomograms, and linear tomograms were valuable diagnostic aids. All five athletes were treated with a limited excisional biopsy via an anterior approach to the femoral neck. Associated treatment modalities, such as bone grafting, internal fixation, and cast immobilization, were not necessary. There were no major complications. The five young athletes returned to sports at an average of 4 months postoperatively. Osteoid osteoma of the femoral neck should be included in the differential diagnosis of hip pain in young athletes. A limited excisional biopsy provided a rapid return to sports for the young athlete without the potential morbidity associated with internal fixation, bone grafting, and cast immobilization.

Recurrent osteoid osteoma. Case report with a ten-year asymptomatic interval

Osteoid osteoma has been accepted as a distinct clinical and pathologic entity for more than 50 years. Surgical curettage will often cure the lesion, although en bloc excision is now the preferred treatment. The development of local recurrence after surgery, although rare, has been well documented after both curettage and en bloc excision. Symptomatic recurrence of an osteoid osteoma was seen ten years after surgical curettage. Its occurrence at the same site as the original lesion is consistent with the concept that it had originated from residual tissue and is in keeping with the concept of osteoid osteoma as a benign tumor.

Osteoid osteoma of the elbow. A review of six cases

Six cases of osteoid osteoma of the elbow were reviewed to determine the spectrum of clinical, pathologic and radiologic findings. Since osteoid osteoma of the elbow may masquerade as a nonspecific synovitis, the diagnosis is challenging and frequently delayed. The histology is, however, indistinguishable from that of osteoid osteoma occurring in typical locations. The radiologic features of osteoid osteoma of the elbow include the following triad: (a) osteosclerosis, usually a dominant feature at initial imaging and typically enveloping the nidus; (b) joint effusion; and (c) periosteal reaction that can involve both the bone in which the osteoid osteoma arises and adjacent bones. Awareness of these features will facilitate correct diagnosis, thereby facilitating timely and appropriate treatment.

Interleukin-1 alpha and phorbol ester inhibit collagen synthesis in osteoblastic MC3T3-E1 cells by a transcriptional mechanism

The effects of recombinant human interleukin-1 alpha (IL-1) on procollagen gene expression were examined in the clonal mouse osteoblastic cell line MC3T3-E1. Cells were grown in Dulbecco's Modified Eagle's Medium containing 10% fetal calf serum and 50 micrograms/ml ascorbic acid. Collagen synthesis was assessed as [3H]proline incorporation into collagenase-digestible protein (CDP). Procollagen mRNA levels were determined by Northern blot analysis using a 32P-labeled alpha 1(I) cDNA. Transcription rates were determined by nuclear run-off assay. IL-1 at 1-1000 pg/ml caused a concentration-dependent inhibition of CDP, which was maximally reduced by 75-80%, and a parallel reduction of procollagen alpha 1(I) mRNA levels. The effects of IL-1 were mimicked by the tumor promoter phorbol 12-myristate 13-acetate (PMA) at 1-100 nM, which inhibited CDP and reduced procollagen alpha 1(I) mRNA levels to a similar extent. The effects of IL-1 and PMA were independent of prostaglandin production, since indomethacin did not alter the inhibitory effect of either agent on CDP. Neither IL-1 (up to 10 ng/ml) nor PMA (100 nM) affected adenylate cyclase activity, while forskolin (10 microM), PTH (10 nM) and prostaglandin E2 (1 microM) stimulated adenylate cyclase activity 3- to 5-fold. However, forskolin (10 microM) and (Bu)2cAMP (100 microM) failed to alter CDP or procollagen alpha 1(I) mRNA levels. IL-1 (1 ng/ml) and PMA (100 nM) reduced transcription of the alpha 1(I) procollagen gene by 70% and 80%, respectively, while alpha 2(I) transcription was decreased by 59% and 53%. Neither IL-1 nor PMA affected transcription of the beta-actin or beta-tubulin genes.(ABSTRACT TRUNCATED AT 250 WORDS)

[Osteoid osteoma and osteoblastoma]

A follow-up study, based on clinical, radiological and pathological information was performed of 20 patients who had suffered from an osteoid osteoma and of three patients who had been treated for an osteoblastoma in the period 1978-1988. 50% of the patients mentioned both pain at night and a good reaction to salicylates. In 87% of the cases a correct diagnosis was made with the aid of conventional radiography, tomography and bone scanning. Primary treatment consisted of intracapsular (mostly piecemeal) excision in all cases. A local recurrence was observed in one patient with osteoid osteoma and in two with osteoblastoma. At the time of this follow-up study none of the 23 patients had complaints. Histopathological examination did not reveal any difference between the two types of bone tumour.

Osteoid osteoma: report of a case

An osteoid osteoma on the foot diagnosed by clinical, pathologic, and radiographic evaluation was described. The lesion is found predominantly in the long bones of the foot. A differential diagnosis of osteoma, osteoblastoma, and osteogenic sarcoma must be ruled out in order for proper management of the patient. The case of a solitary, bony lesion located at the base of the proximal phalanx of the fifth toe in a 38-year-old, white female was presented. No evidence of malignancy was found. The lesion was a hard, painful, palpable mass, located in the fourth left web space, and was excised completely. The skin defect was closed in order for proper syndactilization of the adjoining fourth and fifth digits. Two years post-operatively, the patient was asymptomatic with no evidence of reoccurrence.

"Aggressive" osteoblastoma of the maxilla

A case of osteoblastoma in the maxilla of a 6-year-old boy is reported. The tumor was clinically characterized by locally aggressive behavior but histologically consisted of a relatively well-circumscribed mass of bone-producing epithelioid osteoblasts and occasional multinucleated osteoclasts characteristic of osteoblastoma. Radiographically the tumor appeared to penetrate the cortical plate. Because of the size of the lesion, its histologic features, and the clinical and radiographic impression of its being poorly confined, the diagnosis of "aggressive" osteoblastoma was rendered. The problem of differentiating between benign and aggressive forms of osteoblastoma is discussed.

Osteoid osteoma and osteoblastoma

In conclusion, while similar histologically, osteoid osteoma and osteoblastoma have the potential of being significantly different clinically. Osteoid osteoma tends to be a problem of pain and not of great oncologic significance. Osteoblastoma, on the other hand, has the potential for local bone destruction and aggressiveness as well as the rare occurrence of metastases. For this reason, the latter tumor needs to be respected from an oncologic standpoint and appropriate surgical excision performed.

Osteoid osteoma of the elbow. A study of twelve cases

The authors report 12 cases of osteoid osteoma of the elbow. They emphasize the peculiarity of the clinical, radiographic and histological pictures and discuss the criteria for differential diagnosis with other tumours, pseudotumours and inflammatory lesions of bone. The results obtained are discussed in the light of data emerging from a review of the literature on the subject.

Osteoid osteoma of the vertebral body. A case report

The authors describe a case of osteoid osteoma localised in the body of a lumbar vertebra. This rare localisation--the tenth case described in the literature--and its associated drug-dependency and serum positivity for HTL3 justify its addition to the literature. In addition to an accurate history, the diagnosis requires scintigraphy with Tc 99 and CT scan. The latter is needed so that a correct surgical approach may be planned.

A double nidus osteoid osteoma in a finger

The diagnosis of an osteoid osteoma in the proximal phalanx of the right index finger was suggested by the patient's history and the initial radiographs. The diagnosis was histologically confirmed postoperatively. One year later, however, persistent symptoms and typical radiographic findings, again suggested the presence of an osteoid osteoma. Subsequent en bloc resection of the second nidus, which was again histologically confirmed as an osteoid osteoma, was followed by complete resolution of the symptoms. The definitive diagnosis of a double-nidus osteoid osteoma was suggested after careful analysis of the initial radiographs demonstrated the existence of two distinct intracortical nidi.