Osteoid osteoma of the glenoid: Arthroscopic treatment

A Missed Case of Osteoid Osteoma of the Acetabulum Treated with a Novel Computed Tomography-Guided Technique - A Case Report

Introduction:

Osteoid osteoma is a benign osteoblastic bone tumor that mostly arises from the long bones. The acetabulum is a rare site for osteoid osteoma. Moreover, juxta-articular location of the lesion can be associated with delayed diagnosis. We present a case of a juxta-articular osteoid osteoma of the acetabulum that was missed earlier. We also present a novel, easy, and cost-effective way to accurately localize and excise such a lesion, thereby avoiding failure and recurrence.

Case Report:

A 15-year-old female presented with a history of insidious onset pain in the right hip for 18 months. Pain was diffuse over the hip. She had undergone a failed biopsy in another hospital. She visited us 1 month later with persistent pain. Examination revealed tenderness over the right anterior hip joint line with painful terminal hip flexion. Computed tomography (CT) suggested an osteoid osteoma of the superolateral acetabular rim. The patient was planned for CT-guided mini-open excision biopsy of the lesion. CT-guided localization of the lesion was performed under local anesthesia in the CT room, followed by open excision of the nidus in the operating room. Histopathology confirmed the diagnosis and a complete excision. At last follow-up at 1 year, the patient was asymptomatic and returned to normal function.

Conclusion:

Osteoid osteoma of the acetabulum is uncommon and the diagnosis is usually delayed. A high index of suspicion is needed to avoid a missed diagnosis and CT-guided approach can help in accurate excision. Our technique to localize and completely excise the lesion is novel, simple, and cost effective and can be easily replicated.

Atypical presentation of an intra-articular osteoid osteoma in the proximal humerus excised with arthroscopy: a case report

An adult man presented with a 5-month history of anterior right shoulder pain. He denied previous trauma or night pain. On the otherwise normal physical examination, pain was elicited in maximum abduction and external rotation. Radiographs were negative. The primary imaging findings were bone marrow oedema of the inferomedial proximal metaphysis of the humerus on MRI and cortical demineralisation on CT located posteromedially. A superficial elevation was also observed around the lesion. A provisional diagnosis of an osteoid osteoma was made based on these imaging findings. Arthroscopic excision of the lesion was performed, and histopathological examination confirmed the diagnosis of an osteoid osteoma. Diagnosis of intra-articular osteoid osteomas may be challenging due to atypical symptomatology and lack of pathognomonic imaging findings. Arthroscopic excision of such lesions in the shoulder is a safe and reliable option and should be considered as the treatment of choice.

Osteoid Osteoma of the Scapular Neck: A Cause of Long-lasting Unexplained Pain

Introduction:

Osteoid osteoma (OO) is a common tumor of the diaphysis of long bone, where the reported incidence is up 10% of all benign bone tumors. Its presence in flat bone is seldom mentioned in literature and can be misleading when the bone involved is in proximity to a zone of wide variety of possible pathology. We report a case of a young patient with OO in a very rare location of the body –the scapular neck – that was misdiagnosed for a long period of time before receiving adequate therapy.

Case Report:

A 20-year-old female patient presented to the clinic with chronic left shoulder pain. During the past 2 years, she received medical and physical therapy, to deal with different diagnosis such as cervical spine pathology, muscular spasm, and rotator cuff disease. However, she did not improve. At time of presentation to our clinic, radiographs of the shoulder were done and turned to be inconclusively normal. After negative magnetic resonance imaging of the cervical spine, a computed tomography scan of the shoulder was done and showed a round well-defined lesion localized in the scapular neck with a focal lucent nidus within surrounding sclerotic reactive bone measuring 8.5 mm in largest diameter, compatible with OO. Bone scan showed increased uptake. The patient was given aspirin in an intention to test and treat. The patient had dramatic pain relieve at first, which confirmed the diagnosis of OO. But then, pain became unremitting, so a decision was made for radiofrequency ablation of the lesion which gave excellent results.

Conclusion:

OO is a common benign neoplasm with high variable clinical picture and anatomic localization. Despite being more common in long bone, flat bone OO localization should be always kept in mind. Careful history and physical examination should be done for each patient presenting with unexplained pain; night pain should always raise suspicion of this condition. Radiographs are not always conclusive, and the patient with high suspicion of this condition should undergo more investigation to make the diagnosis.

Arthroscopic management of intra- and juxta-articular osteoid osteoma of the upper extremity: a systematic review of the literature

BACKGROUND

Intra- and juxta-articular osteoid osteoma (OO) is rare and can result in irreversible joint damage. Recently, arthroscopic surgery is being used more and more to avoid complications associated with other treatment modalities.

METHODS

On October 13, 2019, we conducted a systematic review of the literature available in PubMed and EMBASE regarding the arthroscopic management of OO involving the joints of the upper extremity. Predetermined inclusion criteria were used to include any relevant article published on and before that date for further analysis. Treatment success rate and tumor recurrence rate were considered the primary outcomes in our analysis.

RESULTS

Out of 113 studies, 19 met our inclusion criteria. Of the 32 reported cases in these 19 articles, ten involved the shoulder joint, 19 involved the elbow joint and three involved the wrist joint. Overall treatment success rate was 93.8%. Tumor recurrence rate was 0.0%. No postoperative complications (0.0%) were reported among cases involving the shoulder joint. Two out of 24 (8.3%) patients with elbow OO failed arthroscopic treatment due to incomplete excision, and two (4%) experienced minor complications. Among the three cases of wrist OO, two (66.7%) patients had residual postoperative pain and decreased hand grip strength.

CONCLUSION

Arthroscopic management of OO of the upper extremity joints is highly successful and results in no tumor recurrence; however, there is a risk of incomplete resection in areas more difficult to access by arthroscopy.

Osteoid osteoma of scapular glenoid: A case report

•

Osteoid osteoma of scapular glenoid is rare.

•

The presence of lesions in unusual locations along with atypical history could misinterpret the diagnosis.

•

Osteoid osteoma should be considered in differential diagnosis of chronic shoulder pain if no response to initial treatment.

Introduction

Presentation of case

Discussion

Conclusion

Histological, epidemiological and anatomical analysis of 193 bone tumours of the scapula

Backround

This study aimed to determine the frequency and distribution of bone tumours of the scapula as well as the histological and anatomical characteristics of these rare lesions in a large case series.

Methods

The records of all lesions of the scapula collected from 1975 to 2018 in our bone tumour registry and institute of pathology were evaluated. During these 43 years, 223 cases were identified. Analysis included assessment of age, gender, side, imaging findings, tumour location, and histological evaluation with the assignment of each lesion to one of the bone tumours according to the World Health Organization (WHO) classification of bone tumours.

Results

Bone tumours of the scapula were found in 193 cases. Mean patient age was 38.4 years (2.6–82.4). Most of the lesions were of cartilage origin (47%). 59 bone tumours were benign (30.6%), 29 were intermediate (15.0%), and 105 were malignant (54.4%). The most commonly found bone tumour was Osteochondroma (23.3%), followed by Chondrosarcoma (17.6%), Bone metastases (16.6%), Ewing sarcoma (8.8%), and Osteosarcoma (7.8%). The percentage of malignant bone tumours increased with increasing age. In patients >50 years of age, 91% had a malignant lesion of the scapula.

Conclusions

Evaluation of 193 bone tumours of the scapula revealed a high incidence of malignancy in this series, while increased patient age was identified as a potential risk factor for the development of a malignant lesion of the scapula. These findings highlight the importance of early diagnosis and treatment of suspicious lesions of the scapula to improve patient outcome.

Anterior Impingement Syndrome of the Ankle Caused by Osteoid Osteoma in the Talar Neck Treated with Arthroscopy and 3D C-Arm-Based Imaging

Osteoid osteoma in periarticular lesions tends to have an unusual presentation that likely leads to a delayed or missed diagnosis compared with a typical osteoid osteoma in the metaphysis or diaphysis of the long bone. In cases that are unresponsive to conservative treatment, surgical interventions including en bloc resection, computed tomography-guided percutaneous treatment, and arthroscopic resection have been performed; however, these methods frequently result in inadequate tumor resection and recurrence. Here we present a case of a 16-year-old girl with osteoid osteoma in the talar neck presenting as anterior impingement syndrome due to marked synovitis in the ankle joint which was successfully treated without complications by arthroscopic synovectomy and tumor resection followed by intraoperative 3D C-arm-based imaging confirming complete tumor lesion removal. Her pain was relieved immediately after the surgery, and there was no recurrence at 12 months of follow-up. This is the first case report of the surgical treatment of the osteoid osteoma in the talar neck with the combination methods of arthroscopy and 3D C-arm-based imaging.