Cytological diagnosis of osteoblastoma of cervical spine: a case report with review of literature

Chronic neck pain in a child: a case of osteoblastoma of the C5 cervical vertebra

Osteoblastoma is a primary bone-forming tumour that usually occurs in the second decade with an affinity to the posterior elements when found in the spine. Its occurrence in the early first decade is uncommon and often causes a diagnostic dilemma. It usually has a late presentation and the symptoms may be non-specific which may lead the clinician to overlook this particular entity. We present a case of osteoblastoma of the posterior elements of the C5 vertebra in a pre-adolescent child who was diagnosed and successfully managed with surgical resection in a timely fashion that led to favourable recovery postoperatively.

Multimodal Imaging Evaluation and Clinical Progress of Spinal Osteoblastoma: A Comprehensive Review

Spinal osteoblastoma is rare clinically, with insidious onset, atypical symptoms, and various imaging manifestations, which can easily lead to misdiagnosis and delayed diagnosis. It can cause severe neurological dysfunction in patients with intermediate to advanced stages and may easily recur after surgery. Imaging examinations such as radiography, computed tomography, magnetic resonance imaging, and positron emission tomography have different value for the diagnosis of spinal osteoblastoma, but they lack specificity. The preferred treatment is surgical resection, which is technically difficult, and in some cases, osteoblastoma cannot be completely removed. New clinical approaches such as radiofrequency ablation, radiotherapy, targeted chemotherapy, and other comprehensive treatments have emerged and are progressing rapidly, but no unified norms have yet been developed. This manuscript provides a systematic review of the literature and provides an extensive and comprehensive review of this rare tumor in terms of multimodality imaging manifestations and clinical progress.

Nanozymes: A New Disease Imaging Strategy

Nanozymes are nanomaterials with intrinsic enzyme-like properties. They can specifically catalyze substrates of natural enzymes under physiological condition with similar catalytic mechanism and kinetics. Compared to natural enzymes, nanozymes exhibit the unique advantages including high catalytic activity, low cost, high stability, easy mass production, and tunable activity. In addition, as a new type of artificial enzymes, nanozymes not only have the enzyme-like catalytic activity, but also exhibit the unique physicochemical properties of nanomaterials, such as photothermal properties, superparamagnetism, and fluorescence, etc. By combining the unique physicochemical properties and enzyme-like catalytic activities, nanozymes have been widely developed for in vitro detection and in vivo disease monitoring and treatment. Here we mainly summarized the applications of nanozymes for disease imaging and detection to explore their potential application in disease diagnosis and precision medicine.

Diagnostic and Management Options of Osteoblastoma in the Spine

Background

Osteoblastoma is a rare, benign, osteolytic neoplasm commonly found in the spine in early adulthood. Here, we review the clinical characteristics, radiographic findings, and surgical management of patients with spinal osteoblastoma.

Material/Methods

Thirteen patients with osteoblastoma who underwent surgery at our institute from June 2008 to November 2017 were enrolled in this study. The American Spinal Injury Association (ASIA) impairment scale was used to assess neurological function. All patients were treated with either total excision or intralesional piecemeal excision without postoperative radiotherapy. Clinical efficacy was evaluated by visual analog scale (VAS) scores, the Oswestry Disability Index (ODI) of nerve function, physical and radiographic examinations, bone fusion, and neurologic status.

Results

The follow-up lasted 23–82 months (average, 43.8 months). The average surgical time was 178.1 minutes (range, 100–230 minutes), with an average intraoperative blood loss of 574 mL (range, 230–1100 mL). Postoperatively, VAS scores decreased from 6.2±1.7 to 0.5±0.7 (P<0.001). The preoperative and final ODI scores were 51.1±7.7 and 22.6±4.9, respectively, reflecting a significant decrease (P<0.001). According to the ASIA classification, 3 patients had grade C, 3 patients had grade D, and 7 patients had grade E disease. Three months postoperatively, 1 patient had grade D and 10 patients had grade E disease; ultimately, all cases were grade E disease. Only 1 patient experienced local recurrence and underwent en bloc marginal resection with postoperative radiotherapy. All patients remained neurologically stable without any major complications.

Conclusions

Accurate intraoperative localization with complete resection is the key to preventing recurrence. Aggressive surgical resection can achieve satisfactory clinical and radiographic outcomes.

Cytological diagnosis of osteoblastoma of the talus: Case report with unusual presentation and diagnostic pitfalls

Osteoblastoma is a rare bone tumor mostly affecting the young adults and commonly involving the spinal cord and long bones. Talus is the uncommon site of presentation, and if involved, then the neck is more commonly involved than the body of talus. The cytological diagnosis of osteoblastoma is limited, and to the best of our knowledge, its fine-needle aspiration (FNA) in the talus has still not been reported in the literature. The present case of osteoblastoma is, therefore, being reported due to the unusual presentation in elderly male in the body of talus and showing extensive involvement on X-ray. The case was initially diagnosed on FNA cytology excluding the possibility of giant-cell tumor and osteosarcoma. The case also highlights the importance of vigilant observation of subtle cytological features of this rare tumor which may be helpful in avoiding diagnostic pitfalls, especially at an uncommon site and with unusual presentation. An early precise diagnosis by cytology may be followed by appropriate treatment and thus avoiding any further complications.

Intraoperative crush smear cytology of vertebral chondroblastoma: A diagnostic challenge

Chondroblastoma is a rare, cartilage producing primary neoplasm of the bone. Although generally benign, chondroblastoma is placed in the "intermediate, rarely metastasizing" category in the 2013 World Health Organization classification of bone tumors. It typically involves the epiphysis of long tubular bones and is exceptionally located in the vertebral column. To the best of our knowledge, less than 35 cases of vertebral chondroblastoma have been reported in the literature. We report a case of chondroblastoma involving D₆ -D₇ vertebrae in a 17-year-old male patient, diagnosed on intraoperative crush cytology and later confirmed on histopathology. Intraoperative crush cytology is rarely been used for the diagnosis of bone lesions. Till date, this is the third case of vertebral chondroblastoma being diagnosed on cytology and first case being diagnosed on intraoperative crush smear cytology. Previous two cases were diagnosed on fine-needle aspiration cytology. Chondroblastoma possesses distinct and diagnostic cytological features, which allows correct diagnosis even in the rarer locations like vertebral column. Crush cytology can be helpful in the rapid intraoperative diagnosis of vertebral chondroblastoma leading to early proper management of the patient.

Osteoblastomas of the spine: a comprehensive review

Osteoblastomas are primary bone tumors with an affinity for the spine. They typically involve the posterior elements, although extension through the pedicles into the vertebral body is not uncommon. Histologically, they are usually indistinguishable from osteoid osteomas. However, there are different variants of osteoblastomas, with the more aggressive type causing more pronounced bone destruction, soft-tissue infiltration, and epidural extension. A bone scan is the most sensitive radiographic examination used to evaluate osteoblastomas. These osseous neoplasms usually present in the 2nd decade of life with dull aching pain, which is difficult to localize. At times, they can present with a painful scoliosis, which usually resolves if the osteoblastoma is resected in a timely fashion. Neurological manifestations such as radiculopathy or myelopathy do occur as well, most commonly when there is mass effect on nerve roots or the spinal cord itself. The mainstay of treatment involves surgical intervention. Curettage has been a surgical option, although marginal excision or wide en bloc resection are preferred options. Adjuvant radiotherapy and chemotherapy are generally not undertaken, although some have advocated their use after less aggressive surgical maneuvers or with residual tumor. In this manuscript, the authors have aimed to systematically review the literature and to put forth an extensive, comprehensive overview of this rare osseous tumor.