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León-Domínguez A, Cansino-Román R, Martínez-Salas JM, Farrington DM. Clinical examination and imaging resources in children and adolescent back pain. J Child Orthop 2023; 17:512-526. [PMID: 38050588 PMCID: PMC10693837 DOI: 10.1177/18632521231215860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/03/2023] [Indexed: 12/06/2023] Open
Abstract
Back pain is a relatively common complaint in children and adolescents. The pediatric patient presenting with back pain can often be challenging, and there are many well-known organic diagnoses that should not be missed. In younger children, an organic cause of back pain can often be found. However, back pain in older children and adolescents is often "non-specific." The differential diagnosis of back pain in children includes neoplasms, developmental, and inflammatory conditions. Basic steps should include an in-depth anamnesis, a systematic physical examination, and standard spine radiographs (anteroposterior and lateral). Nevertheless, advanced diagnostic imaging and laboratory studies should be included when indicated to avoid missing or delaying a serious diagnosis. If other types of imaging tests are necessary (magnetic resonance imaging, computed tomography, bone scan, or single photon emission computed tomography), they should be guided by diagnostic suspicion.
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Lacroix M, Khalifé M, Ferrero E, Clément O, Nguyen C, Feydy A. Scoliosis. Semin Musculoskelet Radiol 2023; 27:529-544. [PMID: 37816361 DOI: 10.1055/s-0043-1772168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
Scoliosis is a three-dimensional spinal deformity that can occur at any age. It may be idiopathic or secondary in children, idiopathic and degenerative in adults. Management of patients with scoliosis is multidisciplinary, involving rheumatologists, radiologists, orthopaedic surgeons, and prosthetists. Imaging plays a central role in diagnosis, including the search for secondary causes, follow-up, and preoperative work-up if surgery is required. Evaluating scoliosis involves obtaining frontal and lateral full-spine radiographs in the standing position, with analysis of coronal and sagittal alignment. For adolescent idiopathic scoliosis, imaging follow-up is often required, accomplished using low-dose stereoradiography such as EOS imaging. For adult degenerative scoliosis, the crucial characteristic is rotatory subluxation, also well detected on radiographs. Magnetic resonance imaging is usually more informative than computed tomography for visualizing associated canal and foraminal stenoses. Radiologists must also have a thorough understanding of postoperative features and complications of scoliosis surgery because aspects can be misleading.
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Affiliation(s)
- Maxime Lacroix
- Department of Radiology, Hôpital Européen Georges-Pompidou, AP-HP Centre, Université Paris Cité, Paris, France
- Department of Musculoskeletal Radiology, Hôpital Cochin, AP-HP Centre, Université Paris Cité, Paris, France
| | - Marc Khalifé
- Department of Orthopaedic Surgery, Hôpital Européen Georges- Pompidou, AP-HP Centre, Université Paris Cité, Paris, France
| | - Emmanuelle Ferrero
- Department of Orthopaedic Surgery, Hôpital Européen Georges- Pompidou, AP-HP Centre, Université Paris Cité, Paris, France
| | - Olivier Clément
- Department of Radiology, Hôpital Européen Georges-Pompidou, AP-HP Centre, Université Paris Cité, Paris, France
| | - Christelle Nguyen
- Department of Physical and Rehabilitation Medicine, Hôpital Cochin, Université Paris Cité, Paris, France
| | - Antoine Feydy
- Department of Musculoskeletal Radiology, Hôpital Cochin, AP-HP Centre, Université Paris Cité, Paris, France
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Ariyaratne S, Jenko N, Iyengar KP, James S, Mehta J, Botchu R. Primary Benign Neoplasms of the Spine. Diagnostics (Basel) 2023; 13:2006. [PMID: 37370901 DOI: 10.3390/diagnostics13122006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/30/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Benign tumours comprise the majority of primary vertebral tumours, and these are often found incidentally on imaging. Nonetheless, accurate diagnosis of these benign lesions is crucial, in order to avoid misdiagnosis as more ominous malignant lesions or infection. Furthermore, some of these tumours, despite their benign nature, can have localised effects on the spine including neural compromise, or can be locally aggressive, thus necessitating active management. Haemangiomas and osteomas (enostosis) are the commonest benign tumours encountered. Others include osteoid osteoma, osteoblastoma, fibrous dysplasia, osteochondroma, chondroblastoma, haemangioma, simple bone cysts, aneurysmal bone cysts, giant cell tumours, eosinophilic granuloma and notochordal rests. The majority of lesions are asymptomatic; however, locally aggressive lesions (such as aneurysmal bone cysts or giant cell tumours) can present with nonspecific symptoms, such as back pain, neurological deficits and spinal instability, which may be indistinguishable from more commonly encountered mechanical back pain or malignant lesions including metastases. Hence, imaging, including radiography, computed tomography (CT) and magnetic resonance imaging (MRI), plays a critical role in diagnosis. Generally, most incidental or asymptomatic regions are conservatively managed or may not require any follow-up, while symptomatic or locally aggressive lesions warrant active interventions, which include surgical resection or percutaneous treatment techniques. Due to advances in interventional radiology techniques in recent years, percutaneous minimally invasive techniques such as radiofrequency ablation, sclerotherapy and cryoablation have played an increasing role in the management of these tumours with favourable outcomes. The different types of primary benign vertebral tumours will be discussed in this article with an emphasis on pertinent imaging features.
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Affiliation(s)
- Sisith Ariyaratne
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham B31 2AP, UK
| | - Nathan Jenko
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham B31 2AP, UK
| | - Karthikeyan P Iyengar
- Department of Orthopedics, Southport and Ormskirk Hospital NHS Trust, Southport PR8 6PN, UK
| | - Steven James
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham B31 2AP, UK
| | - Jwalant Mehta
- Department of Spinal Surgery, Royal Orthopedic Hospital, Birmingham B31 2AP, UK
| | - Rajesh Botchu
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham B31 2AP, UK
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Abstract
Back pain is common, in up to 30% of children, increasing with age. Eighty percent is benign, mechanical type, improving within 2 weeks of conservative care. Required for those not improving is in-depth evaluation, including MRI, laboratory, and peer consultations. Spondylolysis and spondylolisthesis comprise almost 10% of pediatric back pain, often caused by lumbar hyperextension activities and treated conservatively in most cases. Osteoid osteomas and osteoblastomas constitute the most common benign spinal tumors in childhood. Aggressive and malignant tumors of the spine are rare but when present require tertiary care referral and a comprehensive oncology team for optimal life-sustaining outcomes.
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Affiliation(s)
- Kevin P Murphy
- Department of Physical Medicine and Rehabilitation, Sanford Health Systems, Bismarck North Dakota and Northern Minnesota, Northland Pediatric Rehabilitation Medicine LLC, 4710 Matterhorn Circle #309, Duluth, MN 55811, USA.
| | - Cristina Sanders
- Pediatric Rehabilitation Medicine, Monument Health Department Neurology and Rehabilitation, Monument Health System, 677 Cathedral Drive, Suite 240, Rapid City, SD 57701, USA
| | - Amy E Rabatin
- Division of Pediatric Rehabilitation Medicine, Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA; Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
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de Almeida Gonçalves Secco T, Meohas W, Costa FM, Corrêa DG. Test yourself answer: pain in the right hemithorax. Skeletal Radiol 2023; 52:1259-1262. [PMID: 36773083 DOI: 10.1007/s00256-023-04300-z] [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: 11/23/2022] [Revised: 01/03/2023] [Accepted: 01/31/2023] [Indexed: 02/12/2023]
Affiliation(s)
- Tatiana de Almeida Gonçalves Secco
- Department of Radiology, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rua Rodolpho Paulo Rocco 255, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, RJ, 21941-913, Brazil.
| | - Walter Meohas
- Department of Orthopedic Oncology, National Institute of Traumatology and Orthopedics, Av. Brasil, 500, Caju, Rio de Janeiro, RJ, 20940-070, Brazil
| | - Flavia Martins Costa
- Department of Radiology, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rua Rodolpho Paulo Rocco 255, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, RJ, 21941-913, Brazil
- Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI), Avenida das Américas, 4666, 302A, 303, 307, 325, 326, Barra da Tijuca, Rio de Janeiro, RJ, 2640-102, Brazil
| | - Diogo Goulart Corrêa
- Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI), Avenida das Américas, 4666, 302A, 303, 307, 325, 326, Barra da Tijuca, Rio de Janeiro, RJ, 2640-102, Brazil
- Department of Radiology, Federal Fluminense University, Rua Marquês de Paraná, 303, Centro, Niterói, RJ, 24070-035, Brazil
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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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Gami A, Schilling A, Ehresman J, Sciubba DM. Benign Brain and Spinal Tumors Originating from Bone or Cartilage. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:457-476. [PMID: 37452949 DOI: 10.1007/978-3-031-23705-8_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Benign osseocartilaginous tumors of the spine are overall uncommon, representing between 1 and 13% of all primary bone tumors and less than 10% of all spinal tumors. Tumors in this category include osteoblastic lesions such as the related osteoid osteoma and osteoblastoma, and cartilage-forming lesions including osteochondroma, chondroma, and chondroblastoma. Aneurysmal bone cysts, giant cell tumors of bone, and eosinophilic granulomas also comprise benign tumors of the spine arising from bone. There is significant heterogeneity in the epidemiology, molecular biology, imaging features, and optimal treatment of these lesions. For example, osteoid osteoma is characterized by high expression of the cyclooxygenase enzymes, making it amenable to treatment with anti-inflammatory drugs initially, whereas other lesions such as osteoblastoma may require intralesional curettage or en bloc resection sooner. Generally, en bloc resection is preferred when possible to minimize risk of recurrence. Further, some tumors may arise in the setting of syndromic conditions, such as multiple chondromas arising in Ollier disease or Maffucci syndrome, or as part of genetic disorders, such as osteochondromas in the context of hereditary multiple exostosis. These lesions may present with local pain, cause neurological compromise or be discovered incidentally on routine imaging. The Enneking classification and Weinstein-Boriani-Biagini system are routinely used to classify lesions and assist in surgical planning. More novel techniques such as radiofrequency ablation and laser photocoagulation have been applied for the treatment of osteoid osteoma and may have utility in the treatment of other lesion types. A multidisciplinary approach is critical in the management of benign lesions of the spine, and both chemotherapeutic and surgical approaches are routinely used.
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Affiliation(s)
- Abhishek Gami
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew Schilling
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeff Ehresman
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Montgomery CT, Miranda SP, Nelson E, Louka K, Nasrallah M, Zhang PJ, Stein J, Petrov D. Case Report: Multilevel Ossification of the Ligamentum Flavum in a Patient With Spinal Osteoblastoma. Front Surg 2022; 9:890965. [PMID: 35846967 PMCID: PMC9276984 DOI: 10.3389/fsurg.2022.890965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/01/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Spinal osteoblastomas are primary benign bone tumors most commonly presenting as diffuse back pain in young adults. Rarely, spinal osteoblastoma is associated with ossification of the ligamentum flavum (OLF), a form of ectopic bone formation, which can present with myelopathy. This report highlights a unique case of a patient with spinal osteoblastoma, associated OLF, and thoracic myelopathy. Case Description The patient presented with subtle myelopathy consisting of mid-thoracic back pain, paresthesias, and gait instability. Imaging findings were suggestive of spinal osteoblastoma with multifocal OLF. The patient was consented for thoracic decompression and stabilization at the T6-10 levels. Histopathology confirmed osteoblastoma with associated OLF. At follow up, the patient’s neurological symptoms had completely resolved. Conclusion This case describes management for a rare presentation of osteoblastoma with associated OLF and myelopathy. Surgeons should be wary of disproportionate neurological compromise when spinal osteoblastoma is associated with OLF. Further study is required to elucidate the pathogenesis of this condition.
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Affiliation(s)
- Canada T. Montgomery
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
- Correspondence: Canada T. Montgomery
| | - Stephen P. Miranda
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Ernest Nelson
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Katie Louka
- Department of Pathology, Stony Brook University Hospital, Stony Brook, New York, United States
| | - MacLean Nasrallah
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Paul J. Zhang
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Joel Stein
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Dmitriy Petrov
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
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Cao S, Chen K, Jiang L, Wei F, Liu X, Liu Z. Intralesional Marginal Resection for Osteoblastoma in the Mobile Spine: Experience From a Single Center. Front Surg 2022; 9:838235. [PMID: 35733437 PMCID: PMC9207176 DOI: 10.3389/fsurg.2022.838235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/12/2022] [Indexed: 11/13/2022] Open
Abstract
Osteoblastoma (OB) is a benign bone tumor with aggressive behavior and a tendency for local recurrence. The appropriate surgical strategy for spinal OB remains unclear. This retrospective study aimed to verify the clinical efficacy and safety of intralesional marginal resection of OB in the mobile spine. We enrolled 50 consecutive patients with spinal OB between January 2009 and December 2019. The tumors were staged based on the Enneking system, with 21 and 29 lesions being determined as stage 2 (St.2) and stage 3 (St.3), respectively. Among them, 42 patients underwent intralesional marginal resection, five underwent extensive curettage, and three underwent en bloc resection successfully since their lesions were limited to the posterior element in a single vertebra. We analyzed clinical characteristics, perioperative and follow-up images, surgical details, and follow-up data. Within a median follow-up duration of 50 (range: 24–160) months, six (12.0%) patients had local recurrence. The recurrence rates among patients who underwent intralesional marginal resection, curettage, en bloc resection were 7.1%(3/42), 60.0%(3/5), and 0%(0/3), respectively. The recurrence rate of intralesional marginal resection of St.3 lesions was slightly higher than that of St.2 lesions (7.7%[2/26] vs. 6.3%[1/16]). There were 16(38.1%), 3(60.0%), and 0 patients with surgical complications among those who underwent intralesional marginal resection, curettage, and en bloc resection, respectively. Local recurrence was observed in five (5/14, 35.7%) patients who had vertebral artery extension and in none who did not have vertebral artery extension (p = 0.02). Our findings suggest that intralesional marginal resection could be an appropriate treatment choice for patients with spinal OB, both St.2 and St.3 lesions, with an acceptable local recurrence rate and a low risk of complications. Vertebral artery extension could be a strong risk factor for local recurrence in patients with spinal OB.
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Primary Benign Tumors of the Spinal Canal. World Neurosurg 2022; 164:178-198. [PMID: 35552036 DOI: 10.1016/j.wneu.2022.04.135] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/29/2022] [Accepted: 04/30/2022] [Indexed: 11/23/2022]
Abstract
Benign tumors that grow in the spinal canal are heterogeneous neoplasms with low incidence; from these, meningiomas and nerve sheath tumors (neurofibromas and schwannomas) account for 60%-70% of all primary spinal tumors. Benign spinal canal tumors provoke nonspecific clinical manifestations, mostly related to the affected level of the spinal cord. These tumors present a challenge for the patient and healthcare professionals, for they are often difficult to diagnose and the high frequency of posttreatment complications. In this review, we describe the epidemiology, risk factors, clinical features, diagnosis, histopathology, molecular biology, and treatment of extramedullary benign meningiomas, osteoid osteomas, osteoblastomas, aneurysmal bone cysts, osteochondromas, neurofibromas, giant cell tumors of the bone, eosinophilic granulomas, hemangiomas, lipomas, and schwannomas located in the spine, as well as possible future targets that could lead to an improvement in their management.
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Shi L, Tang Z, Tao P, Li X, Guo S, Wei X, Yu X, Liu W, Guo Z. The anti-infective outcomes of the distal femoral replacement coated with antibiotic cement in limb salvage surgery: A randomized clinical trial. Medicine (Baltimore) 2022; 101:e28648. [PMID: 35089205 PMCID: PMC8797527 DOI: 10.1097/md.0000000000028648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 12/28/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The aim of this study was to observe the anti-infective effect of the distal femoral tumor prosthesis coated with antibiotic cement during limb salvage treatment, and evaluate its potential prospect in clinic. METHODS In this randomized controlled trial, the en bloc resection and reconstruction were performed in 36 patients with distal femoral primary bone tumor. Patients were divided into 2 groups randomly according to the application of antibiotic bone cement coating, which included antibiotic cement coating group (16 cases) and control group (18 cases). There were 10 men and 6 women in anti-infection group, aged from 18 to 54 years (23.47 ± 3.53), and there were 12 men and 6 women in control group, aged from 19 to 56 years (24.16 ± 4.32). The tumor type, age, sex, and Enneking stage were enrolled with well-matched of the 2 groups of patients. There was no difference between bundles and routine standard care for each group. The antibiotic cement was coated on the surface of polyethylene jacket with punched holes during operation. The peri-prosthetic infection, local recurrence and distant metastasis were followed up and limb functions were evaluated by Musculoskeletal Tumor Society 93 (MSTS93) scoring system. RESULTS Patients were followed up till 34.7 months (range 18∼62 months). There was no periprosthetic infection in anti-infection group. Four cases in control group showed deep infection. Infection rate had significant differences between the 2 groups (P < .05). Infection-related prosthesis mortality was 0% (0/16) in anti-infection group and 16.67% (3/18) in control group. Local recurrence and distant metastasis occurred in 7 of 34 patients with primary malignant bone tumor, wherein 2 cases of local recurrence and 1 cases of distant metastasis occurred in anti-infective group; 2 cases of local recurrence and 2 cases of distant metastasis occurred in the control group. During a latest follow-up, MSTS93 function scoring revealed a mean of 25.6 ± 4.2 in anti-infection group and 18.5 ± 3.3 in control group. The survival rate of anti-infective group is 75%, and the survival rate of control group is 61.11%. CONCLUSION The antibiotic cement-coated technique on the surface of the polyethylene jacket of custom-made distal femoral prosthesis is simple and effective in controlling the periprosthetic infection after tumor prosthesis reconstruction.
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Affiliation(s)
- Lei Shi
- Orthopedic Oncology Department, Xijing Hospital, the Fourth Military Medical University, Xi’an, China
| | - Zhen Tang
- Orthopedic Oncology Department, Xijing Hospital, the Fourth Military Medical University, Xi’an, China
| | - Pengfei Tao
- Department of Spine Surgery, Wuhan No. 1 Hospital, Wuhan, Hubei, P.R. China
| | - Xiaokang Li
- Department of Orthopedics, Tangdu Hospital, the Fourth Military Medical University, Xi’an, China
| | - Shuo Guo
- Department of Orthopedics, Tangdu Hospital, the Fourth Military Medical University, Xi’an, China
| | - Xinghui Wei
- Orthopedic Oncology Department, Xijing Hospital, the Fourth Military Medical University, Xi’an, China
| | - Xiaodi Yu
- Orthopedic Oncology Department, Xijing Hospital, the Fourth Military Medical University, Xi’an, China
| | - Wenwen Liu
- Department of Orthopedics, Tangdu Hospital, the Fourth Military Medical University, Xi’an, China
| | - Zheng Guo
- Department of Orthopedics, Tangdu Hospital, the Fourth Military Medical University, Xi’an, China
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Tailored surgery on aggressive osteoblastoma involving the cervicothoracic junction: an oncological and spinal stability long-term follow-up. Spinal Cord Ser Cases 2021; 7:99. [PMID: 34789740 DOI: 10.1038/s41394-021-00463-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 10/18/2021] [Accepted: 11/02/2021] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Aggressive osteoblastoma (AO) represents a rare tumor with borderline features between benign osteoblastoma and osteosarcoma. Having a local aggressive behavior without metastasizing attitude, radical excision is a mainstay treatment. Conversely, spine fusion technique is still debated. We report a rare case of cervicothoracic junction (CTJ) AO and the tailored decision-making process to choose the best treatment. CASE PRESENTATION A 34-year-old man complaining of neck pain was admitted to our department. Cervicothoracic MRI revealed a well-circumscribed lesion involving C7 left lamina with cortical erosion and mild spinal canal invasion. Additionally, STIR sequences exhibited a bright signal spreading through the posterior third of the C7 and T1 vertebrae which on T1-weighted and T2-weighted sequences appeared isointense and hyperintense, respectively. Therefore, the patient underwent a C7 laminotomy. Histology revealed an aggressive variant of osteoblastoma. Therefore, tumor was classified as AO and surgical management was reconsidered. A combined anterior and posterior approach was recommended to reach oncological radicality and spinal stability. At 6-years follow-up, patient remained neurologically intact without signs of recurrence and/or of instability. DISCUSSION Due to its rarity and mimicking features, diagnosis of AO results challenging. Due to its aggressive behavior, radical surgery is the mainstay treatment. Conversely, the most suitable fusion technique is still debated. A proper surgical management should be focused on oncological radicality to guarantee the total tumoral removal avoiding progression or recurrences. Similarly, a proper evaluation of the long-term spinal balance should be assessed to avoid developing of spinal deformities or instrumentation failures.
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Anjos GMD, Bassan MAF, Gössling G, Pereira FDS, D'Avila R, Izetti P. Osteoblastoma agressivo recorrente da coluna cervical tratado com sucesso com radioterapia. Rev Bras Ortop 2021. [DOI: 10.1055/s-0041-1739300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
ResumoO osteoblastoma é uma doença benigna geralmente tratada com ressecção completa com intenção curativa e é responsável por 14% dos tumores ósseos benignos. Uma apresentação mais incomum refere-se a uma rápida apresentação em massa conhecida como osteoblastoma agressivo. Relatamos o caso de um jovem com inchaço cervical devido a uma massa progressiva no lado direito do pescoço com 3 meses de evolução. A biópsia incisional demonstrou osteoblastoma grau 3. Tentou-se uma ressecção cirúrgica radical, mas a ressecção completa não foi viável por causa da invasão cervical de C3 sem envolvimento espinal. Apesar da falta de dados robustos, a radioterapia modulada de intensidade foi realizada na região cervical ipsilateral em uma dose de 50 Gy em 25 frações até novembro de 2013. O paciente está sendo seguido regularmente sem evidências de recorrência desde então. O tratamento até agora bem-sucedido destaca a importância de uma abordagem multidisciplinar para o tratamento de pacientes com osteoblastoma agressivo.
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Affiliation(s)
| | | | | | | | - Rui D'Avila
- Hospital Ernesto Dornelles, Porto Alegre, RS, Brasil
| | - Patrícia Izetti
- Vitta Centro Avançado de Radioterapia, Porto Alegre, RS, Brasil
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Imaging Review of Pediatric Benign Osteocytic Tumors and Latest Updates on Management. J Clin Med 2021; 10:jcm10132823. [PMID: 34206870 PMCID: PMC8267885 DOI: 10.3390/jcm10132823] [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: 06/01/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 12/23/2022] Open
Abstract
Pediatric benign osteocytic tumors include osteoma, enostosis, osteoid osteoma, and osteoblastoma. In pediatric populations, benign bone tumors are more common than malignancies. Benign osteocytic tumors may have a unique clinical presentation that helps narrow the differential diagnosis. A systemic imaging approach should be utilized to reach the diagnosis and guide clinicians in management. Radiographs are the most prevalent and cost-effective imaging modality. Cross-sectional imaging can be utilized for tissue characterization and for evaluation of lesions involving complex anatomical areas such as the pelvis and spine. Computed Tomography (CT) is the modality of choice for diagnosis of osteoid osteoma. CT scan can also be utilized to guide radiofrequency ablation, which has been found to be highly effective in treating osteoid osteoma and osteoblastoma. Enostosis is a no-touch lesion. Osteoma is commonly located in the paranasal sinuses. Osteoma needs an excision if it causes complications due to a mass effect.
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Al-Qassab S, Lalam R, Botchu R, Bazzocchi A. Imaging of Pediatric Bone Tumors and Tumor-like Lesions. Semin Musculoskelet Radiol 2021; 25:57-67. [PMID: 34020468 DOI: 10.1055/s-0041-1723965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Bone lesions are commonly seen when reporting pediatric skeletal imaging. Distinguishing aggressive from nonaggressive lesions is essential in making the diagnosis. Not all aggressive lesions are neoplastic; indeed, osteomyelitis frequently presents with aggressive appearances and is far more commonly seen in the pediatric population than neoplastic lesions. In this article, we discuss an approach for the diagnosis of pediatric bone tumors and tumor-like conditions. The most common pediatric benign and malignant bone tumors are discussed in more detail.
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Affiliation(s)
- Sinan Al-Qassab
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, United Kingdom
| | - Radhesh Lalam
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, United Kingdom
| | - Rajesh Botchu
- The Royal Orthopaedic Hospital, Birmingham, United Kingdom
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16
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Dandurand C, Fisher CG, Rhines LD, Boriani S, Charest-Morin R, Gasbarrini A, Luzzati A, Reynolds JJ, Wei F, Gokaslan ZL, Bettegowda C, Sciubba DM, Lazary A, Kawahara N, Clarke MJ, Rampersaud YR, Disch AC, Chou D, Shin JH, Hornicek FJ, Laufer II, Sahgal A, Dea N. Feasibility of achieving planned surgical margins in primary spine tumor: a PTRON study. Neurosurg Focus 2021; 50:E16. [PMID: 33932923 DOI: 10.3171/2021.2.focus201091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 02/22/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Oncological resection of primary spine tumors is associated with lower recurrence rates. However, even in the most experienced hands, the execution of a meticulously drafted plan sometimes fails. The objectives of this study were to determine how successful surgical teams are at achieving planned surgical margins and how successful surgeons are in intraoperatively assessing tumor margins. The secondary objective was to identify factors associated with successful execution of planned resection. METHODS The Primary Tumor Research and Outcomes Network (PTRON) is a multicenter international prospective registry for the management of primary tumors of the spine. Using this registry, the authors compared 1) the planned surgical margin and 2) the intraoperative assessment of the margin by the surgeon with the postoperative assessment of the margin by the pathologist. Univariate analysis was used to assess whether factors such as histology, size, location, previous radiotherapy, and revision surgery were associated with successful execution of the planned margins. RESULTS Three hundred patients were included. The surgical plan was successfully achieved in 224 (74.7%) patients. The surgeon correctly assessed the intraoperative margins, as reported in the final assessment by the pathologist, in 239 (79.7%) patients. On univariate analysis, no factor had a statistically significant influence on successful achievement of planned margins. CONCLUSIONS In high-volume cancer centers around the world, planned surgical margins can be achieved in approximately 75% of cases. The morbidity of the proposed intervention must be balanced with the expected success rate in order to optimize patient management and surgical decision-making.
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Affiliation(s)
- Charlotte Dandurand
- 1Combined Neurosurgical and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charles G Fisher
- 1Combined Neurosurgical and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Raphaële Charest-Morin
- 1Combined Neurosurgical and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | - Feng Wei
- 6Peking University Third Hospital, Beijing, China
| | | | | | - Daniel M Sciubba
- 8Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Aron Lazary
- 9National Center for Spinal Disorders, Budapest, Hungary
| | | | | | | | | | - Dean Chou
- 14University of California, San Francisco, California
| | - John H Shin
- 15Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - IIya Laufer
- 17Memorial Sloan Kettering Cancer Center, New York, New York; and
| | - Arjun Sahgal
- 18Sunnybrook Hospital, University of Toronto, Ontario, Canada
| | - Nicolas Dea
- 1Combined Neurosurgical and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada
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17
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Aneurysmal bone cyst and osteoblastoma: an extremely rare combination in the pediatric spine. Spine Deform 2021; 9:615-620. [PMID: 33083998 DOI: 10.1007/s43390-020-00223-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 10/03/2020] [Indexed: 10/23/2022]
Abstract
STUDY DESIGN Case report. OBJECTIVE To report the clinical and imaging findings of a patient with the extremely rare association of aneurysmal bone cyst and osteoblastoma in the cervical spine. To our knowledge, only three cases have been reported in the published literature in children under 16 years of age with this condition in the cervical spine. METHODS The patient's history, physical examination, imaging findings, and management with a complete 4-year medical history, surgical intervention and radiological follow-up are reported. RESULTS A 4-year 11-month-old boy was diagnosed with aneurysmal bone cyst in association of osteoblastoma and was treated with CT-guided intralesional injection calcitonin and methylprednisolone. During the course of intralesional therapy, a pathological fracture of C2 was produced. Subsequently, a widened intralesional excision and instrumented fusion from occiput to cervical spine (C0-C4) was performed. CONCLUSION The association of aneurysmal bone cyst and osteoblastoma in spine is extremely rare. Although both are benign lesions, in the cervical location, complete removal of the tumors is challenging. Wide resection with reconstruction of the segments for stability associated with adjuvant treatment with calcitonin and corticosteroids provides a good option.
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18
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Hamouri S, AlQudah M, Al-Zoubi N, Al Gargaz W, Jarboa' H, Hecker E. Rib Osteoblastoma as a Cause of Neurogenic Thoracic Outlet Syndrome: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e928548. [PMID: 33556044 PMCID: PMC7883814 DOI: 10.12659/ajcr.928548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Female, 23-year-old Final Diagnosis: Thoracic outlet syndrome Symptoms: Cervical mass • pain • paresthesia Medication: — Clinical Procedure: CT scan • incisional biopsy • MRI • nerve conduction study • supraclavicular approach to the TOS Specialty: Surgery
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Affiliation(s)
- Shadi Hamouri
- Department of General Surgery and Urology, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad AlQudah
- Department of Pathology and Microbiology, Jordan University of Science and Technology, Irbid, Jordan
| | - Nabil Al-Zoubi
- Department of General Surgery and Urology, Jordan University of Science and Technology, Irbid, Jordan
| | - Wisam Al Gargaz
- Department of Special Surgery, Jordan University of Science and Technology, Irbid, Jordan
| | - Hamza Jarboa'
- Department of General Surgery and Urology, Jordan University of Science and Technology, Irbid, Jordan
| | - Erich Hecker
- Department of Thoracic Surgery, Ruhr District Thoracic Center in Herne, University of Duisburg-Essen Academic Teaching Hospital, Herne, Germany
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19
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Sheinberg DL, Bryant JP, Perez-Roman RJ, Niazi TN. Indeterminate Cell Histiocytosis of the Spine: A Case Report. Pediatr Neurosurg 2021; 56:465-470. [PMID: 34274927 DOI: 10.1159/000517331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/19/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Indeterminate cell histiocytosis is a rare neoplastic disease characterized by proliferation of dendritic cells that share morphologic and immunophenotypic features of Langerhans cells and non-Langerhans histiocytes. ICH lesions are typically restricted to the skin; however, there have been rare reports of extracutaneous and systemic involvement. CASE PRESENTATION We describe a case of a 13-year-old female presenting with complaints of worsening lower back pain for 1 year. CT and MRI of the lumbar spine demonstrated a well-defined bony, lytic, expansile lesion of the posterior and mid-endplate of the L4 vertebra with mass effect on the thecal sac. The patient underwent L3-L5 decompression and fusion with surgical excision of the vertebral body tumor. Microscopic examination of the lesion showed benign fibrohistiocytic proliferation with giant cells, and immunohistochemical staining revealed a phenotype consistent with indeterminate cell histiocytosis (S100+ CD1a+ langerin-). DISCUSSION/CONCLUSION ICH is an extraordinarily rare neoplastic disease of dendritic cells that has a poorly understood pathogenesis. This case expands the spectrum of potential ICH extracutaneous involvement to now include the spine, a location previously undocumented in the literature in the pediatric population.
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Affiliation(s)
- Dallas Louis Sheinberg
- Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Jean-Paul Bryant
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA,
| | - Roberto J Perez-Roman
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Toba N Niazi
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,Division of Pediatric Neurological Surgery, Nicklaus Children's Hospital, Miami, Florida, USA
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20
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Liu J, Han S, Li J, Yuan Y, Guo W, Yuan H. Spinal osteoblastoma: a retrospective study of 35 patients' imaging findings with an emphasis on MRI. Insights Imaging 2020; 11:122. [PMID: 33226535 PMCID: PMC7683662 DOI: 10.1186/s13244-020-00934-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/27/2020] [Indexed: 01/25/2023] Open
Abstract
Objective To investigate the values of multimodal imaging approaches in the diagnosis of spinal osteoblastomas with an emphasis on MRI findings. Materials and methods We retrospectively evaluated the imaging findings of 35 patients with spinal osteoblastomas. The imaging methods included radiography, whole-body bone scintigraphy (WBBS), CT and MRI. Results Radiography detected 87.1% (27/31) of the lesions; WBBS demonstrated increased radionuclide activity in all the lesions. CT could precisely show and localize all niduses, and calcification was always detected. MRI usually could adequately delineate the niduses of osteoblastomas, especially on T2WI (88.2%; 30/34). 71.9% (23/32) of osteoblastomas were surrounded with moderate or extensive bone marrow edema (BME) with soft tissue edema (STE). STE always extended along the muscle bundle adjacent to the lesion; there was no subcutaneous fat involvement. BME was eccentrically distributed in the vertebral body and spread inward from the sides of the nidus. The extent of BME in the vertebral body tended to be inversely proportional to the distance from the nidus. In addition, rare magnifications of osteoblastoma including multifocal diseases (n = 2), vertebra plana (n = 1) or with aneurysmal bone cysts (n = 6) were also observed in our study. Conclusions In patients showing moderate or extensive BME together with STE on MRI, both CT and MRI should be used to confirm nidus presence. The above-mentioned characteristics of edema on MRI of patients with spinal osteoblastoma are helpful in not only localizing the nidus, but also enhancing the diagnostic confidence.
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Affiliation(s)
- Jianfang Liu
- Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Songbo Han
- Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Jie Li
- Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Yuan Yuan
- Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Wei Guo
- Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Huishu Yuan
- Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China.
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21
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Typical and Atypical Radiographic Features of Symptomatic Osteoblastoma in the Spine. World Neurosurg 2020; 145:e209-e215. [PMID: 33065353 DOI: 10.1016/j.wneu.2020.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/01/2020] [Accepted: 10/03/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Spine osteoblastomas (OBs) are relatively rare. In contrast to osteoid osteoma, radiologic and clinical manifestations of OB can be varied and atypical. Typical radiographic features in spinal OB include peritumoral bone sclerosis, bone marrow edema, and soft tissue edema. Atypical radiographic features include lesions involving ≥3 segments, lesions with extensive (≥3 segments) bone sclerosis, excessive edema (≥3 segments) of soft tissue and bone marrow, no intralesional calcification, and location in the vertebral body only. The aim of this study was to identify typical and atypical features of OB. METHODS Pretreatment computed tomography scans and magnetic resonance imaging were reviewed retrospectively. Percutaneous biopsies were performed to confirm pathology in atypical cases. RESULTS A total of 50 images from patients with diagnosed OB were reviewed. Atypical radiographic features were found in 18 cases (36%). Pathologic diagnosis was confirmed as OB in 86.2% (25/29) cases after percutaneous computed tomography-guided biopsy. CONCLUSIONS Our results show that >30% of spinal OB cases might have atypical radiographic features. In cases with atypical radiographic features, computed tomography-guided biopsies are recommended.
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22
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Giebels F, Forterre F, Vincenti S, Geissbuehler U, Welle MM, Pool R, Soldati S, Maiolini A. A complex histopathological challenge: suspicion of an osteoblastoma-like osteosarcoma arising from the second thoracic vertebra in a cat. BMC Vet Res 2020; 16:378. [PMID: 33028314 PMCID: PMC7542901 DOI: 10.1186/s12917-020-02596-w] [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: 07/17/2020] [Accepted: 09/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reports of osteoblastic tumours are limited to a few case reports in veterinary medicine. Osteoblastoma-like osteosarcoma has been accepted by the World Health Organization as an intermediate form between an osteosarcoma and osteoblastoma. This type of tumour indicates an osteosarcoma, that may resemble osteoblastoma clinically, histologically, and radiologically and have the capability for metastasis. Osteoblastoma-like osteosarcoma has not been described in veterinary medicine so far. CASE PRESENTATION An eight-year old cat was presented due to progressive ataxia and paraparesis of the pelvic limbs. Imaging confirmed a well-defined, extradural mass originating from the spinous process of the second thoracic vertebra (T2) leading to severe compression of the spinal cord. Decompressive cytoreduction was achieved by removal of the mass after dorsal laminectomy of T1. After recovering from an acute worsening 3.5 weeks after surgery, the cat had an improved neurological status and the dorsal compression was resolved at follow-up 8 months later. A focal contrast enhancing lesion was still evident at the base of T2 spinous process and lung metastasis was additionally suspected. Based on histopathological, radiographic, and clinical features, an "osteoblastoma-like osteosarcoma" was suspected. CONCLUSIONS To the best of our knowledge, this is the first description of this tumour in veterinary medicine. In addition, this case report highlights the difficulty in the diagnosis and definition of osseous neoplasia in cats and provides a literature review.
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Affiliation(s)
- Felix Giebels
- Department of Clinical Veterinary Medicine, Division of Clinical Neurology, Vetsuisse Faculty of Bern, University of Bern, Bern, Switzerland.
| | - Franck Forterre
- Department of Clinical Veterinary Medicine, Division of Small Animal Surgery, Vetsuisse Faculty of Bern, University of Bern, Bern, Switzerland
| | - Simona Vincenti
- Department of Clinical Veterinary Medicine, Division of Small Animal Surgery, Vetsuisse Faculty of Bern, University of Bern, Bern, Switzerland
| | - Urs Geissbuehler
- Department of Clinical Veterinary Medicine, Division of Clinical Radiology, Vetsuisse Faculty of Bern, University of Bern, Bern, Switzerland
| | - Monika M Welle
- Institute of Animal Pathology, Vetsuisse Faculty of Bern, University of Bern, Bern, Switzerland
| | - Roy Pool
- Department of Veterinary Pathobiology, Veterinary Medicine and Biomedical Sciences, Texas A & M University, College Station, TX, USA
| | - Sabina Soldati
- Department of Veterinary Medicine, University of Milan, Lodi, Italy.,Mouse & Animal Pathology Lab (MAPLab), Fondazione UniMi, Milan, Italy
| | - Arianna Maiolini
- Department of Clinical Veterinary Medicine, Division of Clinical Neurology, Vetsuisse Faculty of Bern, University of Bern, Bern, Switzerland
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Cazzato RL, Garnon J, De Marini P, Auloge P, Dalili D, Koch G, Antoni D, Barthelemy P, Kurtz JE, Malouf G, Feydy A, Charles YP, Gangi A. French Multidisciplinary Approach for the Treatment of MSK Tumors. Semin Musculoskelet Radiol 2020; 24:310-322. [DOI: 10.1055/s-0040-1710052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
AbstractSeveral interventional treatments have recently been integrated into the therapeutic armamentarium available for the treatment of bone tumors. In some scenarios (e.g., osteoid osteoma), interventional treatments represent the sole and definitive applied treatment. Due to the absence of widely shared protocols and the complex multivariate scenarios underlying the clinical presentation of the remaining bone tumors including metastases, therapeutic strategies derived from a multidisciplinary tumor board are essential to provide effective treatments tailored to each patient. In the present review, we present the multidisciplinary therapeutic strategies commonly adopted for the most frequent bone tumors.
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Affiliation(s)
- Roberto Luigi Cazzato
- Service d’Imagerie Interventionnelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Julien Garnon
- Service d’Imagerie Interventionnelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Pierre De Marini
- Service d’Imagerie Interventionnelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Pierre Auloge
- Service d’Imagerie Interventionnelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Danoob Dalili
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Nuffield Orthopaedic Centre, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom
| | - Guillaume Koch
- Service d’Imagerie Interventionnelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Delphine Antoni
- Service de Radiothérapie, Institut de cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Philippe Barthelemy
- Service d’Oncologie Médicale, Institut de cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Jean Emmanuel Kurtz
- Service d’Oncologie Médicale, Institut de cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Gabriel Malouf
- Service d’Oncologie Médicale, Institut de cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Antoine Feydy
- Service de Radiologie, Hôpital Cochin, APHP, Université Paris V, Paris, France
| | - Yan-Philippe Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, Strasbourg, France
| | - Afshin Gangi
- Service d’Imagerie Interventionnelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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Newman WC, Vaynrub M, Bilsky MH, Laufer I, Barzilai O. Full endoscopic resection of a lumbar osteoblastoma: technical note. J Neurosurg Spine 2020; 33:252-255. [PMID: 32244220 DOI: 10.3171/2020.2.spine191091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 02/04/2020] [Indexed: 11/06/2022]
Abstract
Osteoblastomas are a rare, benign primary bone tumor accounting for 1% of all primary bone tumors, with 40% occurring within the spine. Gross-total resection (GTR) is curative, although depending on location, this can require destabilization of the spine and necessitate instrumented fixation. Through the use of minimally invasive, muscle-sparing approaches, these lesions can be resected while maintaining structural integrity of the spine. The authors present a case report and technical note of a single patient describing the use of a purely endoscopic technique to resect a right L5 superior articulating process osteoblastoma in a 45-year-old woman. The patient underwent an image-guided endoscopic resection of her superior articulating facet osteoblastoma. Intraoperative CT demonstrated GTR. On postoperative examination, she remained neurologically intact with resolution of her pain. At follow-up, she remained pain free. Resection of lumbar osteoblastoma through a fully endoscopic approach was a safe and effective technique in this patient. This technique allowed for GTR without compromising spinal structural integrity, thus eliminating the need for instrumented fixation.
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Affiliation(s)
| | - Max Vaynrub
- 2Orthopedic Oncology, Memorial Sloan Kettering Cancer Center; and
| | - Mark H Bilsky
- Departments of1Neurological Surgery and
- 3Department of Neurological Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Ilya Laufer
- Departments of1Neurological Surgery and
- 3Department of Neurological Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
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Ma W, Quan Z, Wang J, Li X, Li G. The one-in-all diagnostic value of 99mTc-MDP bone scan combining with single-photon emission tomography (SPECT)/CT imaging in spinal osteoblastoma. J Orthop Surg Res 2020; 15:181. [PMID: 32448317 PMCID: PMC7245782 DOI: 10.1186/s13018-020-01653-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 03/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Osteoblastoma (OB) is an intermediate lesion, which makes the accurate preoperative diagnosis very important. 99mTc-methylene diphosphonate (99mTc-MDP) bone scan and SPECT/CT imaging were evaluated for their diagnostic value in spinal OB. METHODS This study was a retrospective analysis of patients with spinal OB lesions confirmed by pathology and diagnosed with bone scan and SPECT/CT for preoperative diagnosis from January 2008 to December 2018. The uptake levels of OB on planar bone scan were divided into low, medium, and high groups by visual assessment referring to the uptake of the normal rib, spine, and bladder. X-ray, CT, MRI, bone scan, and SPECT/CT imaging of the patients were analyzed for characteristics summary. RESULTS Twenty-five patients were diagnosed for spinal OB (17 males and 8 females with a proportion of 2.1:1), and the average age was 26.8 ± 10.8 years (range 5~59). There were 8 lesions located in the cervical, 6 in the thoracic, and 11 in the lumbar vertebrae. Twenty-four lesions involved posterior elements, especially the pedicles (14/25). Symptoms were predominantly painful with a duration of 18.3 ± 13.9 months (range 0.5~60 months). The lesion size ranged from 9 to 35 mm. All the lesions were low to high uptake in the planar bone scan, and the percentages of low to high levels were 1 (4%), 8 (32%), and 16 (64%) cases. CONCLUSIONS Spinal OB mainly involved the posterior area, and elderly patients should be considered as well. SPECT/CT combined the characteristics of bone uptake and anatomical features of bone tumors, proving its one-in-all diagnostic value for spinal OB and other osteogenic tumors.
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Affiliation(s)
- Wenhui Ma
- Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, 127# West Changle Road, Xi'an, 710032, Shaanxi Province, China
| | - Zhiyong Quan
- Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, 127# West Changle Road, Xi'an, 710032, Shaanxi Province, China
| | - Jing Wang
- Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, 127# West Changle Road, Xi'an, 710032, Shaanxi Province, China
| | - Xiangdong Li
- Department of Orthopedic Oncology, Xijing Hospital, Fourth Military Medical University, 127# West Changle Road, Xi'an, 710032, Shaanxi Province, China.
| | - Guoquan Li
- Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, 127# West Changle Road, Xi'an, 710032, Shaanxi Province, China.
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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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Cady-McCrea CI, de Witt ME, Galgano MA. Laminopedicular Osteotomy for En-bloc Resection of Posterolateral Thoracic Osteoblastoma: Technical Note. World Neurosurg 2020; 138:418-421. [PMID: 32251818 DOI: 10.1016/j.wneu.2020.03.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 03/18/2020] [Accepted: 03/19/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Osteoblastomas are a type of primary osseous neoplasm that exhibit a proclivity for the spine, primarily the posterior elements. While generally considered benign, some variants of osteoblastoma exhibit aggressive growth with lytic osseous destruction and soft tissue invasion, with some recurring after initial treatment. Given their proximity to vital structures and potential for rapid growth, these tumors are often managed with aggressive surgery, with en-bloc resection preferred. METHODS Here we describe our osteotomy technique for resecting en bloc a posterolateral thoracic osteoblastoma causing rapidly progressive myelopathy in a 17-year-old male. RESULTS Successful treatment of osteoblastoma in a 17-year-old male demonstrates the efficacy of our laminopedicular osteotomy technique in treating 1 instance of a rapidly presenting spinal tumor. CONCLUSIONS This case bolsters the growing body of literature that favors the outcomes of a more conservative approach to en-bloc resection of spinal tumors.
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Affiliation(s)
- Clarke I Cady-McCrea
- Department of Neurological Surgery, State University of New York, Upstate Medical University, Syracuse, New York, USA
| | - Michelle E de Witt
- Department of Neurological Surgery, State University of New York, Upstate Medical University, Syracuse, New York, USA
| | - Michael A Galgano
- Department of Neurological Surgery, State University of New York, Upstate Medical University, Syracuse, New York, USA.
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Safaee MM, Carrera DA, Chin CT, Mashhood A, Eisenmenger L, Liang NE, Lewis KM, Chou D, Ames CP, Weinstein PR. Diagnostic Challenges in Primary Sacral Tumors and the Yield of Computed Tomography-Guided Needle Biopsy in the Modern Era. World Neurosurg 2020; 138:e806-e818. [PMID: 32222551 DOI: 10.1016/j.wneu.2020.03.094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 03/15/2020] [Accepted: 03/16/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Primary sacral tumors pose unique challenges because of their complex radiographic appearances, diverse pathologic entities, and dramatically different treatment paradigms based on tumor type. Magnetic resonance imaging and computed tomography (CT) can provide valuable information; however, sacral lesions can possess unique radiographic features and pose diagnostic dilemmas. CT-guided percutaneous needle biopsy is a critical component of the diagnostic workup. However, limited data are available on its efficacy for primary sacral tumors. METHODS The data from patients with newly diagnosed primary sacral lesions during a 12-year period at our hospital were analyzed. The preoperative magnetic resonance imaging findings, biopsy results, and pathological data for patients who required surgery were analyzed. Unique cases in which the final pathologic result was unexpected from the preoperative imaging findings have been highlighted. RESULTS Of 38 patients who underwent percutaneous needle biopsy, diagnostic tissue was obtained on the first attempt for 31 (82%). Five of the remaining 7 obtained diagnostic tissue on the second attempt, yielding 95% diagnosis, with only two requiring open biopsies. In 2 patients with diagnostic tissue on CT-guided biopsy, an open biopsy was still recommended because of the clinical scenario. In both patients, the open biopsy results matched those of the CT-guided biopsy. For the 18 patients who required surgery, we found 100% correlation between the percutaneous needle biopsy findings and the final pathological diagnosis. No biopsy-induced complications or extraspinal tumor seeding occurred. CONCLUSIONS CT-guided biopsy is a safe and effective technique. It represents a critical component of the diagnostic algorithm, given the diverse pathological findings of primary sacral lesions and dramatic differences in treatment.
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Affiliation(s)
- Michael M Safaee
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Diego A Carrera
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Cynthia T Chin
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Arian Mashhood
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Laura Eisenmenger
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Norah E Liang
- Department of Neurological Surgery, School of Medicine, San Francisco, California, USA
| | - Kristin M Lewis
- Department of Neurological Surgery, School of Medicine, San Francisco, California, USA
| | - Dean Chou
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Philip R Weinstein
- Department of Neurological Surgery, University of California, San Francisco, California, USA.
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Giordano M, Caccavella VM, Leone A, Montano N, Gessi M, Olivi A, Polli FM. Lumbar Extraosseous Intraforaminal Osteoblastoma: Case Report and Review of the Literature. World Neurosurg 2020; 138:339-343. [PMID: 32217174 DOI: 10.1016/j.wneu.2020.03.081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Osteoblastomas are rare primary bone tumors with a predilection for the spine. The extraosseous growth pattern is rare, and to our knowledge, only 2 cases of fully extraosseous osteoblastomas have been previously reported. CASE DESCRIPTION A man aged 36 years presented with a 7-month history of low back pain radiating to the gluteal area. On examination, a typical L5 radiculopathy was noted. The radiologic examinations conducted in the previous months pointed out the rapid growth of an extraosseous mass occluding the right L5-S1 foramen. Partial laminectomy was performed to achieve gross total resection. Histological analysis was consistent with osteoblastoma. CONCLUSIONS Osteoblastomas with extraosseous extension are uncommon, and an exclusively extraosseous presentation is anecdotal. This can lead to preoperative misdiagnosis when typical radiologic characteristics of bone-forming tumors are missing. We describe the case of an extraosseous lumbar osteoblastoma whose clinical and radiologic presentation was suggestive of malignancy.
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Affiliation(s)
- Martina Giordano
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Valerio Maria Caccavella
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Leone
- Institute of Radiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nicola Montano
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Gessi
- Institute of Pathology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Olivi
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Filippo Maria Polli
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Hobbs JG, Mehta AI. Commentary: Factors Affecting Prognosis of Patients With Osteoblastoma of the Mobile Spine: A Long-Term Follow-up Study of 70 Patients in a Single Center. Neurosurgery 2020; 86:E11-E12. [DOI: 10.1093/neuros/nyz106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 03/06/2019] [Indexed: 11/14/2022] Open
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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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Jia Q, Liu C, Yang J, Yin H, Zhao J, Wei H, Liu T, Yang X, Yang C, Zhou Z, Xiao J. Factors Affecting Prognosis of Patients With Osteoblastoma of the Mobile Spine: A Long-Term Follow-up Study of 70 Patients in a Single Center. Neurosurgery 2020; 86:71-79. [PMID: 30481353 DOI: 10.1093/neuros/nyy570] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 10/31/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Osteoblastoma (OBL) in the mobile spine is a benign tumor with aggressive potential. There is not much published information on OBL of the mobile spine as a result of rarity of the disease. There are controversies over the aggressive subtype and prognostic factors of the condition. OBJECTIVE To explore the aggressive subtype and investigate prognostic factors of OBLs in the mobile spine. METHODS A retrospective analysis of spinal OBL was performed by survival analysis. Patients in 2 cohorts were analyzed based on the Enneking grade and pathological evaluation. Local recurrence-free survival (RFS) was estimated using the Kaplan-Meier method to identify potential prognostic factors. Factors with P ≤ .05 were subjected to multivariate analysis by Cox regression analysis. P ≤ .05 were considered statistically significant. RESULTS Included in this study were 70 patients with spinal OBL who were followed up by a mean of 67.1 mo (range 24-188). Local recurrence was detected in 9 cases after initial surgery, and death occurred in 2 cases. The result of statistical analysis suggested that Epithelioid OBL (EO) with Enneking stage 3 (St.3) and total spondylectomy were independent prognostic factors for RFS. CONCLUSION St.3 or EO lesions seem to be more aggressive than St.2 or conventional osteoblastomas, but St.3 and EO should be considered simultaneously in predicting the aggressiveness of the lesion and the risk of recurrence. Total spondylectomy performed either by en bloc or piecemeal could significantly reduce recurrence of OBLs in the mobile spine.
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Affiliation(s)
- Qi Jia
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Chao Liu
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jian Yang
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Huabin Yin
- Department of Orthopedics, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University, 100 Haining Road, Shanghai, China
| | - Jian Zhao
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Haifeng Wei
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Tielong Liu
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Xinghai Yang
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Cheng Yang
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Zhenhua Zhou
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jianru Xiao
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
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Spinal osteoid osteoma recurring as an aggressive osteoblastoma. Neurocirugia (Astur) 2019; 31:146-150. [PMID: 31488355 DOI: 10.1016/j.neucir.2019.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/26/2019] [Accepted: 06/08/2019] [Indexed: 11/24/2022]
Abstract
We report an uncommon case of osteoid osteoma recurring as an aggressive osteoblastoma of the spine. A 15-years-old male consulted in our department with long-term painful scoliosis. The CT-scans and MRI revealed a sclerotic bone forming tumor of 7mm diameter consistent with a osteoid osteoma. A percutaneous radiofrequency ablation was performed with complete resolution of the symptoms. After 6 months, the symptoms recurred. A new CT and a MRI showed a growth of the nidus on the right L4 lamina, with a size of 15mm. Therefore, a marginal resection by laminectomy of L4 was performed. Pathology confirmed an epithelioid osteoblastoma. A year later, subsequent imaging studies showed a new recurrence with aggressive features and invasion of the spinal canal. The patient then underwent an "in block surgery" needing concurrent stabilization of the spine. Histopathology confirmed the diagnosis of epithelioid osteblastoma.
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Wu M, Xu K, Xie Y, Yan F, Deng Z, Lei J, Cai L. Diagnostic and Management Options of Osteoblastoma in the Spine. Med Sci Monit 2019; 25:1362-1372. [PMID: 30785872 PMCID: PMC6391855 DOI: 10.12659/msm.913666] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
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.
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Affiliation(s)
- Minhao Wu
- Department of Bone and Musculoskeletal Tumor Center, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China (mainland)
| | - Keke Xu
- Department of Bone and Musculoskeletal Tumor Center, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China (mainland)
| | - Yuanlong Xie
- Department of Bone and Musculoskeletal Tumor Center, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China (mainland)
| | - Feifei Yan
- Department of Bone and Musculoskeletal Tumor Center, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China (mainland)
| | - Zhouming Deng
- Department of Bone and Musculoskeletal Tumor Center, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China (mainland)
| | - Jun Lei
- Department of Bone and Musculoskeletal Tumor Center, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China (mainland)
| | - Lin Cai
- Department of Bone and Musculoskeletal Tumor Center, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China (mainland)
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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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Bazán PL, Gonzalez RA, Ciccioli NM, Casco EA, Borri ÁE, Medina M. BLOCK RESECTION OF LUMBAR OSTEOBLASTOMA. PRESENTATION OF A CASE AND BIBLIOGRAPHICAL UPDATE. COLUNA/COLUMNA 2018. [DOI: 10.1590/s1808-185120181704179649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To present the clinical case and update the bibliography. Methods: A male patient, 24 years of age, sought treatment for right lumbosciatalgia of 3 years of evolution with topography L5 and motor deficit (M4). The radiograph showed a radiopaque lesion between the fourth and fifth lumbar vertebrae, with right pedicle effacement of L4. The tomography identified a lytic lesion, partially surrounded by sclerosis with a central nest of 3 centimeters in diameter located in the right pedicle with involvement of the transverse apophysis and reaction of the intertransverse space (Enneking 3). It was complemented by magnetic resonance and bone scintigraphy. The percutaneous biopsy guided by tomography yielded a diagnosis of osteoblastoma and foci of necrosis. A radical block resection was performed with clear tumor margins and instrumented stabilization. Results: After the surgical treatment, the patient evolved favorably, reversing the motor deficit. The anatomopathological study of the specimen confirms the preoperative diagnosis. Discussion: Intralesional resection may be an option in Enneking stage 2. In Enneking stage 3, a percutaneous diagnostic biopsy may be useful, and block resection is the preferred definitive treatment. Conclusions: The management of spinal osteoblastoma requires an exhaustive clinical-imaging analysis. Block resection with clear margins is preferred in advanced cases for management and to decrease the risk of recurrence. Level of Evidence IV; Case seriesh.
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Affiliation(s)
- Pedro Luis Bazán
- HIGA San Martín, Argentina; Hospital Italiano La Plata, Argentina
| | | | | | | | | | - Martín Medina
- HIGA San Martín, Argentina; Hospital Italiano La Plata, Argentina
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Lai Q, Wang Q, Liu H, Chen D, Wan Z, Yu X, Guo R, Liu X, Dai M, Zhang B. A rare case of giant osteoblastoma of the sacrum. DER ORTHOPADE 2018; 48:343-347. [PMID: 30194630 DOI: 10.1007/s00132-018-3638-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND An osteoblastoma is a rare benign bone tumor characterized by formation of osteoid tissue and primitive bone and occurs more often in men than in women. They are often secondary to an osteoid osteoma and can be located at any site on the skeleton. Lesions generally involve the posterior elements of the spine, such as the pedicle and the lamina. CASE PRESENTATION This study reports the case of a 25-year-old female who suffered from an osteoblastoma of the right sacrum with repeated swelling and pain in the right lumbosacral region for approximately 6 months. Computed tomography (CT) and magnetic resonance imaging (MRI) of the pelvis revealed a segmented, expansive, multiseptate lesion. Resection with wide margins was performed and a huge cavity of approximately 15 × 8 × 4.4 cm in the right sacrum and pelvis was formed after complete curettage of the tumor. The pathological analysis of the resected tissue was consistent with a benign osteoblastoma. A follow-up was performed 2 years later and the patient was eventually relieved of the pain, the mobility of the right leg was improved and the CT scan demonstrated no evidence of recurrence. CONCLUSION Osteoblastomas most commonly occur in the spine but rarely also in the sacrum. Large core needle biopsies play an important role in the diagnostics. Intralesional surgery can be performed for treatment of osteoblastomas.
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Affiliation(s)
- Qi Lai
- Department of Orthopedics, The First Affiliated Hospital of Gannan Medical University, 341000, Ganzhou, Jiangxi, China
| | - Qiang Wang
- Department of Orthopedics, Fujian Longyan First Hospital, Longyan First Affiliated Hospital of Fujian Medical University, 364000, Longyan, Fujian, China
| | - Hucheng Liu
- Department of Orthopedics, Artificial Joints Engineering and Technology Research Center of Jiangxi Province and Multidisciplinary Therapy Center of Musculoskeletal Tumor, The First Affiliated Hospital of Nanchang University, 330006, Nangchang, Jiangxi, China
| | - Dejian Chen
- Department of Orthopedics, Artificial Joints Engineering and Technology Research Center of Jiangxi Province and Multidisciplinary Therapy Center of Musculoskeletal Tumor, The First Affiliated Hospital of Nanchang University, 330006, Nangchang, Jiangxi, China
| | - Zongmiao Wan
- Department of Orthopedics, Artificial Joints Engineering and Technology Research Center of Jiangxi Province and Multidisciplinary Therapy Center of Musculoskeletal Tumor, The First Affiliated Hospital of Nanchang University, 330006, Nangchang, Jiangxi, China
| | - Xiaolong Yu
- Department of Orthopedics, Artificial Joints Engineering and Technology Research Center of Jiangxi Province and Multidisciplinary Therapy Center of Musculoskeletal Tumor, The First Affiliated Hospital of Nanchang University, 330006, Nangchang, Jiangxi, China
| | - Runsheng Guo
- Department of Orthopedics, Artificial Joints Engineering and Technology Research Center of Jiangxi Province and Multidisciplinary Therapy Center of Musculoskeletal Tumor, The First Affiliated Hospital of Nanchang University, 330006, Nangchang, Jiangxi, China
| | - Xuqiang Liu
- Department of Orthopedics, Artificial Joints Engineering and Technology Research Center of Jiangxi Province and Multidisciplinary Therapy Center of Musculoskeletal Tumor, The First Affiliated Hospital of Nanchang University, 330006, Nangchang, Jiangxi, China
| | - Min Dai
- Department of Orthopedics, Artificial Joints Engineering and Technology Research Center of Jiangxi Province and Multidisciplinary Therapy Center of Musculoskeletal Tumor, The First Affiliated Hospital of Nanchang University, 330006, Nangchang, Jiangxi, China
| | - Bin Zhang
- Department of Orthopedics, Artificial Joints Engineering and Technology Research Center of Jiangxi Province and Multidisciplinary Therapy Center of Musculoskeletal Tumor, The First Affiliated Hospital of Nanchang University, 330006, Nangchang, Jiangxi, China.
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Case of Spinal Osteoblastoma in Elderly: Is It Really a Young Patient's Disease? World Neurosurg 2018; 112:243-246. [PMID: 29421450 DOI: 10.1016/j.wneu.2018.01.180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/26/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Osteoblastoma is a benign bone-forming tumor, sometimes locally invasive, that may involve any bone. The highest incidence is between 20 and 30 years of age, and there are no cases described in the elderly. METHODS We report a case of an elderly patient with a lesion in the lumbar spine in which osteoblastoma diagnosis was made. CONCLUSIONS Osteoblastoma is a rare tumor older than 50 years of age, but it should be considered in the differential diagnosis of bone lesions of the spine in adulthood and in the elderly, to avoid a delay in the treatment.
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Abstract
The purpose of this paper is to present an overview of the imaging features of the most prevalent benign bone tumors involving the spine. Benign tumors of the osseous spine account approximately for 1% of all primary skeletal tumors. Many lesions exhibit characteristic radiologic features. In addition to age and location of the lesion, radiographs are an essential step in the initial detection and characterization but are limited to complex anatomy and superposition. CT and MR imaging are often mandatory for further characterization, assessment of local extension and guiding biopsy.
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Ozaki M, Nishioka K, Kimura A, Kondo T, Nakao N. Activation of the arachidonic acid metabolic pathway and induction of sleep disturbance by sacral osteoblastoma: A case report. Mol Clin Oncol 2017; 7:237-240. [PMID: 28781793 DOI: 10.3892/mco.2017.1313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 05/10/2017] [Indexed: 11/05/2022] Open
Abstract
Osteoblastomas are benign bone tumors that produce prostaglandin and promote inflammation. The aim of the present study was to describe the clinical and radiological characteristics of a pediatric osteoblastoma case over an 8-month postoperative follow-up. The case involved an 11-year-old female patient with normal somatic development, presenting with a chief complaint of sleep disturbance. The patient had no spontaneous pain or other readily evident possible causes. Magnetic resonance imaging (MRI) revealed a neoplastic lesion in the sacrum, with peritumoral edema. Intraoperative fast-frozen biopsy raised the suspicion of osteosarcoma. However, the final diagnosis was osteoblastoma and a second operation was performed for total resection. The edematous peritumoral bone and muscle tissues were preserved. Following total removal of the tumor, the sleep disturbance resolved. Eight months after the surgery, MRI revealed no recurrence of the tumor and reduction of the peritumoral edema. On immunohistochemical examination, cyclooxygenase (COX)-1 and COX-2 were strongly positive, indicating that the tumor activated the arachidonic acid metabolic pathway and produced prostaglandin. The inflammatory process subsequently promoted the development of peritumoral edema and induced the sleep disturbance.
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Affiliation(s)
- Mitsunori Ozaki
- Department of Neurological Surgery, Wakayama Medical University, Wakayama 641-0012, Japan
| | - Kazuya Nishioka
- Department of Neurological Surgery, Wakayama Medical University, Wakayama 641-0012, Japan
| | - Akihiko Kimura
- Department of Forensic Medicine, Wakayama Medical University, Wakayama 641-0012, Japan
| | - Toshikazu Kondo
- Department of Forensic Medicine, Wakayama Medical University, Wakayama 641-0012, Japan
| | - Naoyuki Nakao
- Department of Neurological Surgery, Wakayama Medical University, Wakayama 641-0012, Japan
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Preoperative Embolization and Complete Tumoral Resection of a Cervical Aggressive Epithelioid Osteoblastoma. World Neurosurg 2017; 106:1051.e1-1051.e4. [PMID: 28710051 DOI: 10.1016/j.wneu.2017.06.183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/28/2017] [Accepted: 06/30/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Epithelioid "aggressive" osteoblastoma (EOB) is a rare and more aggressive subtype of osteoblastoma (OB) with a higher recurrence rate, greater risk of malignant transformation, larger size, and greater intraoperative blood loss. The present case report illustrates that preoperative angioembolization of an EOB can be safely performed with low intraoperative blood loss. CASE DESCRIPTION A 21-year-old male patient presented to our institution with a 4-month history of neck discomfort, radicular pain in the proximal right arm, and mild weakness of the right biceps and triceps muscles. Imaging was suggestive of EOB, and computed tomography-guided biopsy confirmed the diagnosis. The patient underwent same-day preoperative angioembolization of the major feeding vessels and subsequent complete tumor resection. During the procedure, he experienced minimal blood loss and did not require blood transfusion. CONCLUSIONS EOB is a highly vascular primary bony lesion. To minimize intraoperative blood loss, preoperative angioembolization should be considered in the treatment of cervical spine EOB.
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