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Yamaga K, Kuwamoto S, Tanishima S, Yamashita H, Asano N, Matsushita M, Akahori K, Osaki M, Hisaoka M, Nagashima H. An unresectable osteoblastoma of the axis controlled with denosumab. J Orthop Sci 2024; 29:379-383. [PMID: 35469739 DOI: 10.1016/j.jos.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/10/2022] [Accepted: 02/14/2022] [Indexed: 02/09/2023]
Affiliation(s)
- Kensaku Yamaga
- Division of Orthopedic Surgery, Department of Sensory and Motor Organs, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan.
| | - Satoshi Kuwamoto
- Department of Pathology, Tottori University Hospital, Yonago, Tottori, Japan
| | - Shinji Tanishima
- Division of Orthopedic Surgery, Department of Sensory and Motor Organs, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | | | - Naofumi Asano
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Michiko Matsushita
- Department of Pathobiological Science and Technology, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Keiichi Akahori
- Division of Orthopedic Surgery, Department of Sensory and Motor Organs, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Mari Osaki
- Division of Orthopedic Surgery, Department of Sensory and Motor Organs, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Masanori Hisaoka
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Hideki Nagashima
- Division of Orthopedic Surgery, Department of Sensory and Motor Organs, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
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Si Z, Meng W. Multimodal Imaging Evaluation and Clinical Progress of Spinal Osteoblastoma: A Comprehensive Review. World Neurosurg 2023; 170:28-37. [PMID: 36455846 DOI: 10.1016/j.wneu.2022.11.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 11/25/2022] [Accepted: 11/27/2022] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Zhiguang Si
- Department of Medical Imaging, People's Hospital of Dehong Prefecture, Yunan, P.R. China.
| | - Wangpin Meng
- Department of Surgery, People's Hospital of Dehong Prefecture, Yunan, P.R. China
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Hesni S, Lindsay D, Saifuddin A. Test Yourself Answer: A 22-year-old female with a 2-year history of progressive right lower back pain. Skeletal Radiol 2022; 51:2069-2070. [PMID: 35274179 DOI: 10.1007/s00256-022-04030-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 02/02/2023]
Affiliation(s)
- Susan Hesni
- Department of Radiology, Royal National Orthopaedic Hospital (RNOH), Brockley Hill, Stanmore, HA7 4LP, UK.
| | - Daniel Lindsay
- Department of Histopathology, Royal National Orthopaedic Hospital (RNOH), Stanmore, UK
| | - Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital (RNOH), Brockley Hill, Stanmore, HA7 4LP, UK
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Tang P, Zhang Y, Tian R, Yang G. Osteoblastoma of the Rib Mimicking Lymphomatous Involvement on 18F-FDG PET/CT Imaging. Clin Nucl Med 2022; 47:456-457. [PMID: 35025787 DOI: 10.1097/rlu.0000000000004010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
ABSTRACT We present a case of rib osteoblastoma in a patient with NK/T cell lymphoma. Osteoblastoma was incidentally found in a 63-year-old man in the axillary segment of the fifth rib and was misdiagnosed as lymphomatous involvement on staging 18F-FDG PET/CT. The radiological features in the CT component of PET/CT were atypical. After surgery, the diagnosis of osteoblastoma was confirmed by histopathologic findings.
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Affiliation(s)
- Pan Tang
- From the Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan
| | - Yifan Zhang
- Department of Nuclear Medicine, Qinghai Province People's Hospital, Xining, Qinghai, China
| | - Rong Tian
- From the Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan
| | - Guocai Yang
- Department of Nuclear Medicine, Qinghai Province People's Hospital, Xining, Qinghai, China
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Hung YP, Bredella MA, Lobmaier IVK, Lozano-Calderón SA, Rosenberg AE, Nielsen GP. Aneurysmal bone cyst and osteoblastoma after neoadjuvant denosumab: histologic spectrum and potential diagnostic pitfalls. APMIS 2022; 130:206-214. [PMID: 35114728 DOI: 10.1111/apm.13211] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/27/2022] [Indexed: 01/28/2023]
Abstract
The use of denosumab to treat giant cell tumors of bone (GCT) and other giant cell-containing bone tumors has become more common. While the clinicopathologic features of denosumab-treated giant cell tumors of bone have been well-illustrated, descriptions of other denosumab-treated bone tumors are very limited. Surgical pathology files of two institutions and consultation files from two authors were searched for denosumab-treated aneurysmal bone cysts and denosumab-treated osteoblastomas. Clinicopathologic features were reviewed and analyzed. We identified four patients with denosumab-treated bone tumors other than GCT from our surgical pathology and consultation files, including two aneurysmal bone cysts and two osteoblastomas. All were treated with denosumab for 0.5-7.0 (median 4.5) months. Radiologically, denosumab-treated tumors showed decreased size with increased ossification and mineralization on CT and heterogeneous intermediate to hypointense signal on MRI. Histologically, denosumab-treated aneurysmal bone cyst contained thin, elongated, curvilinear, and anastomosing strands of bone with empty lacunae, while denosumab-treated osteoblastoma showed circumscribed nodules of woven bone lined by small osteoblasts. Denosumab-treated aneurysmal bone cyst and osteoblastoma showed treatment-related morphologic changes that can mimic other bone neoplasms. Their recognition requires correlation with the clinical history of denosumab use and radiologic findings.
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Affiliation(s)
- Yin P Hung
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Miriam A Bredella
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ingvild V K Lobmaier
- Department of Pathology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | | | - Andrew E Rosenberg
- Department of Pathology and Laboratory Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - G Petur Nielsen
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Kieser DC, Soltani S, Hammer N, Koutp A, Hughes E, Reynolds JJ. Sacral insufficiency fractures are a risk of massive bleeding during sacrectomy: patient series. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE21493. [PMID: 36059720 PMCID: PMC9435545 DOI: 10.3171/case21493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 09/27/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sacrectomy carries significant risk of bleeding; however, specific risk factors, apart from medical comorbidities and tumor type, for this life-threatening complication remain unclear. This study describes two cases of massive bleeding, including one death during sacrectomy attributable to adherence of the internal iliac vein (IIV) and its neuroforaminal tributaries from sacral insufficiency fractures. OBSERVATIONS The authors presented two cases involving patients who received sacrectomy for a chordoma and experienced massive bleeding from the IIV due to adherence of the IIV and its neuroforaminal tributaries around sacral insufficiency fractures. They assessed their institution’s previous two decades’ experience of sacrectomies to determine risk factors for massive bleeding and performed anatomical dissection of 20 hemipelvises, which revealed the close proximity of the IIV to the sacral foraminae and the consistency of neuroforaminal tributaries arising from the foraminae. LESSONS Sacral insufficiency fractures may cause scarring that adheres to the IIV and its neuroforaminal tributaries, which risks massive bleeding during sacrectomy.
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Affiliation(s)
- David C. Kieser
- Department of Orthopaedics and Musculoskeletal Medicine, University of Otago, Christchurch School of Medicine, Christchurch, New Zealand
| | - Scheherezade Soltani
- Department of Spinal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Niels Hammer
- Department of Macroscopic and Clinical Anatomy, Medical University of Graz, Graz, Austria
- Fraunhofer IWU, Medical Branch, Dresden, Germany; and
- Department of Orthopaedic and Trauma Surgery, University of Leipzig, Leipzig, Germany
| | - Amir Koutp
- Department of Macroscopic and Clinical Anatomy, Medical University of Graz, Graz, Austria
| | - Eleanor Hughes
- Department of Spinal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Jeremy J. Reynolds
- Department of Spinal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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Wong K, Chantharasamee J, Nelson S, Eckardt MA, Motamedi K, Hornicek FJ, Singh AS. Aggressive osteoblastoma with a secondary aneurysmal bone cyst treated with denosumab. Rare Tumors 2021; 13:20363613211034710. [PMID: 34484648 PMCID: PMC8408893 DOI: 10.1177/20363613211034710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/06/2021] [Indexed: 11/16/2022] Open
Abstract
Osteoblastomas and aneurysmal bone cysts (ABC) are rare benign bone tumors that make up about 1%-2% of primary bone malignancies, typically occurring in young patients with a median age of 20 years, most commonly effecting the axial skeleton. ABCs may develop independently as primary lesions, or secondary to other bony lesions including osteoblastomas, chondroblastomas, and giant cell tumors. Treatment of unresectable or extensive osteoblastomas can be challenging. In 2013, the Food and Drug Administration (FDA) approved denosumab for the treatment of giant cell tumors of the bone due to its efficacy in these morbid bony lesions. Various case reports have shown that osteoblastomas can respond to denosumab. Furthermore, numerous ABC case reports have described the efficacy of denosumab in these situations. We herein describe a unique case of a young patient with an aggressive osteoblastoma and secondary ABCs who was successfully treated with denosumab.
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Affiliation(s)
- Karlton Wong
- Division of Hematology/Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | - Jomjit Chantharasamee
- Division of Hematology/Oncology, University of California Los Angeles, Los Angeles, CA, USA.,Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Scott Nelson
- Department of Pathology, University of California Los Angeles, Los Angeles, CA, USA
| | - Mark A Eckardt
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA.,Division of Surgical Oncology, University of California Los Angeles, Los Angeles, CA, USA.,Department of Surgery, Greater Los Angeles Veterans Health Administration, Los Angeles, CA, USA
| | - Kambiz Motamedi
- Department of Radiology, University of California Los Angeles Medical Center, Los Angeles, CA, USA
| | - Francis J Hornicek
- Department of Orthopedic Surgery, University of California Los Angeles, Los Angeles, CA, USA
| | - Arun S Singh
- Division of Hematology/Oncology, University of California Los Angeles, Los Angeles, CA, USA
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Huang Z, Fang T, Si Z, Li Y, Zhang L, Zheng C, Li S, Su M, Liu X, Li X, Wu Y. Imaging algorithm and multimodality evaluation of spinal osteoblastoma. BMC Musculoskelet Disord 2020; 21:240. [PMID: 32290828 PMCID: PMC7158089 DOI: 10.1186/s12891-020-03252-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/31/2020] [Indexed: 11/25/2022] Open
Abstract
Background To analyze the features of CT, MRI and PET/CT and their diagnostic value for spinal osteoblastomas (OBs). Methods The radiological and clinical data of 21 patients with histopathologically-confirmed spinal OBs were analyzed retrospectively. Results Sixteen of the 21 cases were benign and 5 were aggressive OBs. Tumors were located in the lumbar (n = 11), cervical (n = 4), thoracic (n = 5), and sacral (n = 1) spinal regions. Nineteen cases were centered in the posterior elements of the spine, 13 of which extended into the vertebral body. Punctate or nodular calcifications were found in all cases on CT with a complete sclerotic rim (n = 12) or incomplete sclerotic rim (n = 8). The flare phenomenon (indicative of surrounding tissue inflammation) was found in 17/21 cases on CT, thin in 11 cases and thick in 6 cases, and in 19/19 cases on MRI, thin in 1 case and thick in 18 cases. On 18F-FDG PET/CT, all cases (8/8) were metabolically active with the SUVmax of 12.3–16.0; the flare sign was observed in 8 cases, including 7 cases of hypometabolism and 1 case of coexistence of hypermetabolism and hypometabolism. Based on CT, 3, 12, and 6 cases were classified as Enneking stage 1, 2 and 3, respectively. Of 19 cases with MRI, 1 and 18 cases were classified as Enneking stage 2 and 3, respectively. Conclusions Spinal OB has multiple unique characteristic radiological features. Although a larger sample size is needed, combining CT, MRI and PET may be beneficial to optimize preoperative diagnosis and care of patients with OBs.
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Affiliation(s)
- Zihuan Huang
- The First Clinical Medical College, Southern Medical University, Guangzhou, Guangdong, 510515, People's Republic of China
| | - Tingsong Fang
- Department of Radiology, Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong, 510515, P.R. China
| | - Zhiguang Si
- Department of Radiology, Dehongzhou People's Hospital, Dehongzhou, Yunan, 678400, P.R. China
| | - Youcai Li
- Department of PET/CT Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510000, P.R. China
| | - Lan Zhang
- The First Clinical Medical College, Southern Medical University, Guangzhou, Guangdong, 510515, People's Republic of China
| | - Chunling Zheng
- The First Clinical Medical College, Southern Medical University, Guangzhou, Guangdong, 510515, People's Republic of China
| | - Shenmei Li
- The First Clinical Medical College, Southern Medical University, Guangzhou, Guangdong, 510515, People's Republic of China
| | - Manting Su
- The First Clinical Medical College, Southern Medical University, Guangzhou, Guangdong, 510515, People's Republic of China
| | - Xiaomin Liu
- Department of Medical Imaging, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou, Guangzhou, Guangdong, 510515, P.R. China
| | - Xiaodan Li
- Department of Medical Imaging, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou, Guangzhou, Guangdong, 510515, P.R. China
| | - Yuankui Wu
- Department of Medical Imaging, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou, Guangzhou, Guangdong, 510515, P.R. China.
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Sim DS, Karunanithi J, Selvarajan S, Soh RCC. Surgical Excision of Thoracic Osteoblastoma with Secondary Aneurysmal Bone Cyst from a 12-Year-Old Child. Pediatr Neurosurg 2020; 55:280-288. [PMID: 33176325 DOI: 10.1159/000510015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 07/07/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Osteoblastoma is a primary benign tumour which commonly presents in the younger population during the second decade of life. However, more aggressive osteoblastomas may present with features of aneurysmal bone cyst, and these can occur at uncommon locations. CASE PRESENTATION We report the case of a 12-year-old child having an osteoblastoma on the left side of T11 with secondary aneurysmal bone cyst presenting with neurological deficits and myelopathic symptoms. Surgical debulking of the lesion with decompression laminectomy and posterior instrumentation of the spine was performed. The child is currently recovering well with improvement of neurological deficits. DISCUSSION/CONCLUSION Osteoblastoma with aneurysmal bone cyst of the thoracic spine is a rare condition with few reports in the literature, and surgical intervention with complete excision has been demonstrated here with recovery of neurological function.
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Affiliation(s)
- David Shaoen Sim
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore, Singapore,
| | - Jayanthi Karunanithi
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
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Mishra A, Pruthi N, Nandeesh BN, Shukla D. Cervical Spine Osteoblastoma with an Aneurysmal Bone Cyst in a 2-Year-Old Child: A Case Report. Pediatr Neurosurg 2019; 54:46-50. [PMID: 30673670 DOI: 10.1159/000495065] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 10/30/2018] [Indexed: 11/19/2022]
Abstract
Osteoblastomas and aneurysmal bone cysts are uncommon benign tumors of the spine. Their presentation can vary between diffuse pain, restriction of neck movements, torticollis, radiculopathy, and myelopathy. Complete excision is the best treatment to achieve a cure, but recurrence is not uncommon. A combination of the two conditions in the pediatric population is extremely rare. To the best of the authors' knowledge, only 2 cases of such a combination in the cervical spine have been reported in the literature. We report the case of a 2-year-old child having a right C4 lateral mass osteoblastoma with an aneurysmal bone cyst. The child underwent complete surgical excision of the lesion with fusion.
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Affiliation(s)
- Ajit Mishra
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Nupur Pruthi
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India,
| | - B N Nandeesh
- Department of Neuropathology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Dhaval Shukla
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
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