Intraoperative cone-beam computed tomography-guided curettage for osteoid osteoma

Recently, cone-beam computed tomography (CBCT)-guided surgeries have been developed for bone and soft tissue tumors. The present study aimed to evaluate the efficacy of CBCT-guided curettage for osteoid osteoma. Our study population included 13 patients who underwent primary curettage for osteoid osteoma using intraoperative CBCT in a hybrid operating room between April 2019 and November 2022. We collected the following data: sex, age, follow-up period, symptom onset to time of surgery, tumor size and location, length of skin incision, operating time, radiation dose, recurrence, postoperative complications, and visual analog scale for pain during the last follow-up. There were 10 male and 3 female patients, and the mean age was 25.0 years (range, 9-49 years). The mean follow-up period was 10.6 months (range, 0.4-24.0 months). The locations of the tumors were the proximal femur in 6 patients, the acetabular region in 2 patients, and the ilium, tibial shaft, calcaneus, cuboid, and talus in 1 patient each. The mean time of symptoms onset to surgery was 18.7 months (range, 2.3-69.9 months). The mean maximum diameter of the tumor was 5.9 mm (range, 3.5-10.0 mm). The mean length of the skin incision was 2.2 cm (range, 1.5-3.5 cm). The mean operating time was 96.9 minutes (range, 64-157 minutes). The mean dose of radiation was 193.2 mGy (range, 16.3-484.0 mGy). No recurrences, postoperative complications, and reoperation were observed in this study. All the patients reported 0 mm on the visual analogue scale for pain on the last follow-up. CBCT-guided curettage for osteoid osteoma was minimally invasive and reliable. This procedure can be effective for the treatment of lesions found in deep locations such as the pelvic bone and proximal femur or an invisible lesion that cannot be detected by regular fluoroscopy.

Neonatal osteoblastic tumor with a novel PTBP1::FOSB fusion

Congenital/neonatal bone neoplasms are extremely rare. We present the case of a patient with a neonatal bone tumor of the fibula that had osteoblastic differentiation and a novel PTBP1::FOSB fusion. FOSB fusions are described in several different tumor types, including osteoid osteoma and osteoblastoma; however, these tumors typically present in the second or third decade of life, with case reports as young as 4 months of age. Our case expands the spectrum of congenital/neonatal bone lesions. The initial radiologic, histologic, and molecular findings supported the decision for close clinical follow-up rather than more aggressive intervention. Since the time of diagnosis, this tumor has undergone radiologic regression without treatment.

Differential diagnosis of an osseous cranial tumor from Hellenistic Muğla, Turkey

OBJECTIVE

This project evaluates a cranial lesion from a Hellenistic-era individual excavated by the Muğla Archaeological Museum in Gülağzı, Turkey.

MATERIALS

An osseous tumor measuring 3.02 × 3.54 × 2.98 cm originating from the occipital bone of a probable young adult male.

METHODS

The tumor was examined using gross morphological inspection, plain radiography (x-ray), and computed tomography (CT) imaging to identify potential differential diagnoses for the osseous cranial tumor.

RESULTS

The lesion in question displays features highly consistent with both osteoid osteoma and osteoblastoma. The tumor had a non-sclerotic, sharply demarcated border, a radiolucent nidus measuring less than 2 centimeters in diameter, and homogeneous sclerotic bone surrounding the nidus.

CONCLUSIONS

Differential diagnosis determined the osseous tumor to be a benign neoplasm, and in this case the features of the tumor are highly consistent with a diagnosis of either osteoblastoma or osteoid osteoma.

SIGNIFICANCE

The identification of novel neoplastic cases in paleopathology represents an important contribution to ongoing discussions regarding the temporality and regional variability of neoplastic conditions in the past. Additionally, a rigorous diagnostic study augmented by x-ray, CT scans, and 3D modeling provides data that can be utilized in future paleopathological studies.

LIMITATIONS

Diagnostic interpretation would be aided by histological examination of the tumor, which was impossible in this case. Histological examination would provide a definitive diagnosis.

SUGGESTIONS FOR FURTHER RESEARCH

Given the high incidence of benign tumors in the clinical literature but a paucity of reports in the paleopathological record, further research is indicated to better understand the implications of benign neoplasms in antiquity.

Radiological Recovery of Osteoid Osteoma after CT Guided Percutaneous Radiofrequency Ablation

OBJECTIVE

To observe the necessity and usefulness of follow-up Magnetic Resonance Imaging (MRI) and Computed Tomography Imaging (CTI) after RFA of osteoid osteoma.

STUDY DESIGN

A descriptive study.

PLACE AND DURATION OF STUDY

Department of Radiology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey, between May 2015 and January 2020.

METHODOLOGY

Patients, who underwent CT-guided RFA for osteoid osteoma treatment, were followed-up both clinically and radiologically. MRI was recommended between the third and sixth months and CTI at 12th month or later for follow-up. All the pre and post-treatment radiological images were evaluated retrospectively. Radiological recovery was noted in three categories as complete/almost-complete, partial, and minimal-no recovery according to the healing of pre-treatment radiological findings.

RESULTS

One-hundred and thirty-one patients with at least one follow-up CT or MRI were included. All had technically and clinically successful RFA treatments. Of 131 patients, 64.1% had CTI and 82.4% had MRI follow-up. In follow-up images, complete/almost-complete-recovery was observed in 70.2%, partial recovery in 26.7%, and minimal recovery in 3.1% of the cases. Re-ablation therapies were applied in 2 cases in this study due to pain recurrence after three months of successful treatments.

CONCLUSION

Radiological follow-up is beneficial for the evaluation of outcome after RFA of osteoid-osteoma. At least one follow-up MRI may be helpful for the assessment of healing or recurrence. Follow-up CTI may not be needed unless planning a re-ablation.

KEY WORDS

Osteoma osteoid, Radiofrequency ablation, Tomography, Magnetic resonance imaging.

En Bloc Resection of Cervical Spine Osteoid Osteoma With O-Arm-Assisted 3D Navigation: A Case Report

CASE

A 22-year-old man presented with long-standing, progressive neck pain of unknown etiology. Investigation revealed a cervical spine osteoid osteoma affecting the right C4-5 facet joint. He underwent minimally invasive en bloc resection with O-arm-assisted 3-dimensional navigation without introducing iatrogenic spinal instability. Symptoms resolved after surgery, without recurrence or instability at the 2-year follow-up.

CONCLUSION

Cervical spine osteoid osteoma is a tumor that presents diagnostic and therapeutic challenges. Achieving precise, complete resection of the tumor with a minimally invasive approach while avoiding spinal instrumentation and arthrodesis is paramount to excellent surgical outcomes.

Computed tomography guided radiofrequency ablation of osteoid osteoma in children: a single center's experience

OBJECTIVE

To report a single center's experience evaluating the efficacy and safety of computed tomography-guided radiofrequency ablation for the treatment of osteoid osteoma in children.

MATERIALS AND METHODS

Institutional database research identified 33 symptomatic patients (≤ 18 years of age; male/female ratio: 21/12, mean age 13.09 ± 3.66) with osteoid osteoma who were treated by CT-guided RFA. Technical and clinical success as well as complication rates were recorded. The duration of the procedure, the number of computed tomography scans and the results of the biopsy were assessed. Pain, prior, the following morning and 1 week, 1/6/12 months after the procedure were compared by means of a numeric visual scale (NVS) questionnaire.

RESULTS

Mean lesion size was 8.28 ± 4.24 mm. Mean follow-up was 23.33 ± 17.61 months (range 12-62). Mean pain score prior to radiofrequency ablation was 9.06 ± 0.80 NVS units. On week 1 and 1/6/12 months, all patients were pain-free reporting 0 NVS units (p < 0.05). The mean procedure time was 54 min (range 51-59) and a mean of 7 CT scans were performed during the ablation session. RF electrode was successfully placed in the center of the nidus in all cases. In our study, none of our patient experienced recurrence of the pain, nor complications.

CONCLUSION

The present study demonstrates that percutaneous CT-guided radiofrequency ablation constitutes a safe and effective technique for osteoid osteoma treatment in children.

Safe surgical hip dislocation for acetabular osteoid osteoma excision

Excision of acetabular osteoid osteoma is technically difficult. We report osteoid osteoma of the quadrilateral plate in a 9-year-old girl who presented to us with persistent nocturnal pain, limp and restricted hip joint movement. The child was investigated with CT scan, MRI and triple-phase bone scan. The 0.7 cm nidus was located in the central portion of the cancellous bone in the quadrilateral plate, 1.94 cm inferior to the triradiate cartilage. The child was operated on through the safe surgical dislocation of the left hip. The location of the lesion was gauged from the preoperative CT scan measurement data and intraoperative fluoroscopic aid. The nidus with a sclerotic rim was burred down completely. Postoperative X-ray and CT scan revealed complete excision of the tumour, and the patient was pain-free. At 18 months follow-up, the patient is completely asymptomatic and walking normally.

Spindle Cell Squamous Cell Carcinoma of the Larynx with Malignant Osteoid Differentiation: A Case Report and Review of Literature

Spindle cell squamous cell carcinoma of the larynx is a rare, aggressive variant of squamous cell carcinoma. It comprises 0.6-1.5% of all laryngeal cancers. Heterologous mesenchymal differentiation as bone, cartilage, and muscle is uncommon, especially malignant osteoid differentiation, as a handful of cases reported in the literature. We present the case of a 66-year-old male active smoker who presented with dysphonia and acute stridor. On examination, a 2.0 cm pedunculated, broad-base, glottic mass involving the left true vocal cord and ventricle was noted, with extension to the anterior commissure causing a narrowing of the airway. The patient underwent localized left vocal cordectomy. The histopathologic and immunohistochemical findings were consistent with spindle cell carcinoma with malignant osteoid differentiation. The patient is alive, status-post adjuvant five cycles of cisplatin therapy, with no recurrence at 18 months of follow-up. We discuss a literature review of this rare entity with either malignant osteoid or osteocartilaginous differentiation.

[An adolescent man with pain at night in his lower right leg]

A 22-year-old man is referred to the orthopaedic surgeon. He has pain, mostly at night, in his proximal right tibia that greatly reduces with NSAIDs. The CT scan shows a focal lucent zone, called a nidus, in the tibia cortex, surrounded by reactive, sclerotic bone. This is typical for an osteoid osteoma, a benign bone tumour.

Osteoid osteoma: lower back pain combined with scoliosis

Osteoid osteoma is a small benign bone tumor that is primarily localized in long bone; lumbar osteoid osteoma combined with scoliosis has rarely been reported. Here, we describe a 9-year-old boy who complained of back pain and scoliosis. He underwent nidus resection and did not experience complications or osteoid osteoma recurrence. His pain and scoliosis were relieved after the operation. The findings in this case indicate that resection of osteoid osteoma is an effective and safe method of treatment. The lumbar spine is the most common location of osteoid osteoma, which causes painful scoliosis. Nidus resection can provide relief of back pain and scoliosis.

What's new in bone forming tumours of the skeleton?

Bone tumours are difficult to diagnose and treat, as they are rare and over 60 different subtypes are recognised. The emergence of next-generation sequencing has partly elucidated the molecular mechanisms behind these tumours, including the group of bone forming tumours (osteoma, osteoid osteoma, osteoblastoma and osteosarcoma). Increased knowledge on the molecular mechanism could help to identify novel diagnostic markers and/or treatment options. Osteoid osteoma and osteoblastoma are bone forming tumours without malignant potential that have overlapping morphology. They were recently shown to carry FOS and-to a lesser extent-FOSB rearrangements suggesting that these tumours are closely related. The presence of these rearrangements could help discriminate these entities from other lesions with woven bone deposition. Osteosarcoma is a malignant bone forming tumour for which different histological subtypes are recognised. High-grade osteosarcoma is the prototype of a complex karyotype tumour, and extensive research exploring its molecular background has identified phenomena like chromothripsis and kataegis and some recurrent alterations. Due to lack of specificity, this has not led to a valuable novel diagnostic marker so far. Nevertheless, these studies have also pointed towards potential targetable drivers of which the therapeutic merit remains to be further explored.

FOS Expression in Osteoid Osteoma and Osteoblastoma: A Valuable Ancillary Diagnostic Tool

Osteoblastoma and osteoid osteoma together are the most frequent benign bone-forming tumor, arbitrarily separated by size. In some instances, it can be difficult to differentiate osteoblastoma from osteosarcoma. Following our recent description of FOS gene rearrangement in these tumors, the aim of this study is to evaluate the value of immunohistochemistry in osteoid osteoma, osteoblastoma, and osteosarcoma for diagnostic purposes. A total of 337 cases were tested with antibodies against c-FOS: 84 osteoblastomas, 33 osteoid osteomas, 215 osteosarcomas, and 5 samples of reactive new bone formation. In all, 83% of osteoblastomas and 73% of osteoid osteoma showed significant expression of c-FOS in the osteoblastic tumor cell component. Of the osteosarcomas, 14% showed c-FOS expression, usually focal, and in areas with severe morphologic atypia which were unequivocally malignant: 4% showed more conspicuous expression, but these were negative for FOS gene rearrangement. We conclude that c-FOS immunoreactivity is present in the vast majority of osteoblastoma/osteoid osteoma, whereas its expression is usually focal or patchy, in no more than 14% of osteosarcoma biopsies. Therefore, any bone-forming tumor cases with worrying histologic features would benefit from fluorescence in situ hybridization analysis for FOS gene rearrangement. Our findings highlight the importance of undertaking a thorough assessment of expression patterns of antibodies in the light of morphologic, clinical, and radiologic features.

The safety and the efficacy of computed tomography guided percutaneous radiofrequency ablation of osteoid osteoma

Objective

The aim of this study was to investigate the efficacy and safety of Computed Tomography (CT) guided percutaneous Radiofrequency Ablation (RFA) in the treatment of osteoid osteoma (OO).

Methods

A total of 116 patients (82 male and 34 female patients; mean age of 17.7 years; age range 13-months-42 years) who had 118 CT guided RFA treatment between June 2015 and November 2018 (42 moths) with the diagnosis of OO were included in this study. All the patients had pre-procedural CT examinations. The clinical and technical success and the safety of the treatment were evaluated by assessing the clinical pain symptoms, complication rates and recovery of posture and gait.

Results

All the patients had a favorable immediate relief of the known pain caused by osteoid osteoma in 24 h after the procedure. Only in two patients (15-years-old boy with OO in right femoral neck and a 12 years old boy with OO in femur diaphysis) pain relapse was occurred in 3 months and 12 months after RFA and a second RFA was performed. During follow-up they had no pain. The technical success and efficacy-rates of the procedure were recorded as 100% and 98% respectively in this study. No significant complication was observed during treatment or recovery period. Seven minor complications were noted which were successfully treated.

Conclusion

The rapid relief of pain symptoms, low relapse rate and low complication rates demonstrate the efficacy and safety of RFA therapy. RFA is an out-patient procedure that patients can be mobilized immediately after the procedure. RFA can be safely used as a first choice of treatment method in OO therapy.

Level of evidence

Level IV, therapeutic study.

[An update for the treatment of osteoid osteoma]

Osteoid osteoma is frequent benign tumor, descripted initially by Bergstrand in 1930 followed by Jaffe in 1935. The painful feature of the osteoid osteoma explains the specific consideration by the medical community for this entity. The debate was focused on pathologic and imaging pattern as well as the treatment modalities. Currently, the treatment options are varied and percutaneous treatment is increasingly used. The radiofrequency is widely validated as efficient method without serious adverse and with low rate of recurrence. We hope through this this work to revue the current knowledge of the treatment of osteoid osteoma.

Imaging features and differential diagnosis of multiple diaphyseal sclerosis: A case report and review of literature

RATIONALE

Multiple diaphyseal sclerosis (MDS), known as Ribbing disease, is a rare congenital bone disease resulting from autosomal recessive inheritance. The case study involved a 22-year-old female patient who had been diagnosed with chronic sclerosing osteomyelitis due to lack of knowledge about MDS. Previous studies reported rarely on this condition.

PATIENT CONCERNS

A 22-year-old female with MDS was analyzed.

DIAGNOSES

MDS is characterized radiographically by a fusiform widening of the diaphyseal portion of the long bones, which is caused by a thickening of the cortex with obstruction of the medullary cavity. The pathologies are observed utilizing diagnostic imagery and are often difficult to identify.

INTERVENTION

The patient was following a suggested regimen of oral celecoxib capsules at 200 mg/day for 6 days.

OUTCOMES

The patient's diagnosis was revised to the rare condition of Ribbing disease by reviewing the clinical history and distinctive radiography images and because the symptoms were alleviated by celecoxib capsule. We also present a review of the literature on the diagnosis and differential diagnosis of MDS based on clinical and imaging features.

LESSONS

MDS is rare and may often be initially misdiagnosed as another type of sclerosing bone dysplasia, thus, it is important to be aware of the existence of MDS. Once MDS is suspected, differential diagnosis should be performed to exclude other sclerosing bone dysplasias, taking into account clinical history, distinctive radiographic appearance, distribution, and laboratory and histopathologic findings. Laboratory evaluation and pathologic findings are nonspecific but assist in excluding other diagnoses. More evidence is needed to illustrate the effectiveness of medical or surgical treatments for patients with MDS.

An open-label, prospective, observational study of the efficacy of bisphosphonate therapy for painful osteoid osteoma

OBJECTIVES

To assess the efficacy of bisphosphonate therapy on bone pain in patients with osteoid osteoma (OO) (main objective), and to describe bisphosphonate-induced changes in nidus mineralisation and regional bone-marrow oedema (BMO).

METHODS

A prospective, observational study was conducted from 2011 to 2014. Patients with risk factors for complications of percutaneous or surgical ablation or recurrence after ablation, were offered once monthly intravenous bisphosphonate treatment until significant pain alleviation was achieved.

RESULTS

We included 23 patients. The first two patients received pamidronate and the next 21 zoledronic acid (mean, 2.95 infusions per patient). Bisphosphonate therapy was successful in 19 patients (83%), whose mean pain visual analogue scale score decreased by 76.7%; this pain-relieving effect persisted in 17 patients (74%) with a mean follow-up time of 36 months. Computed tomography (CT) demonstrated a mean nidus density increase of 177.7% (p = 0.001). By magnetic resonance imaging (MRI), mean decreases were 38.4% for BMO surface area and 30.3% for signal intensity (p = 0.001 and p = 0.000, respectively).

CONCLUSIONS

In 17/23 patients with painful OO managed conservatively with bisphosphonates, long-term final success was achieved. Bisphosphonates may accelerate the spontaneous healing of OO.

KEY POINTS

• 19/23 patients with OO managed with bisphosphonates experienced significant pain relief • Pain relief was sustained in 17/23 patients, mean follow-up of 36 months • CT demonstrated a significant increase in nidus mineralisation • MRI demonstrated a significant decrease in bone marrow oedema • Bisphosphonate therapy may accelerate the spontaneous healing of OO.

Bone-Forming Tumors

Bone-forming tumors are defined by neoplastic cells that differentiate along the lines of osteoblasts that deposit neoplastic bone. The morphology and biological spectrum of bone-forming tumors is broad, and their accurate diagnosis requires the careful correlation of their clinical, morphologic, and radiologic characteristics. Immunohistochemical and molecular analyses have an important role in select instances. At present, the identification of neoplastic bone largely depends on histologic analysis, which can be subjective. The major types of osteosarcoma are defined according to their morphology, origin within or on the surface of the bone, and their histologic grade.

OSTEOID OSTEOMA OF THE CORACOID PROCESS: CASE REPORT WITH LITERATURE REVIEW

Osteoid osteoma (OO) is the most common benign osteogenic bone tumor that predominantly affects young adults. OO is commonly localized in long bones, and therefore, it is rarely considered in differential diagnosis of chronic shoulder pain. We report a case of a 22-year-old male athlete, without history of previous trauma, who presented to our Department with chronic shoulder pain, which escalated during the night and responded to nonsteroidal anti-inflammatory drug treatment. Considering these typical symptoms, diagnostic pathway was immediately directed towards OO, with magnetic resonance and computed tomography confirming the diagnosis of OO of the coracoid process (CP). Since neurovascular structures are in the proximity of CP, and this very delicate area does not support radiofrequency ablation, we decided to perform an open procedure with drilling of the lesion and excochleation. The pain withdrew immediately after the procedure, and on six-month follow up the patient remained pain free. In the treatment of OO of the CP, we recommend open surgical procedure with tumor ablation by drilling instead of CP resection, presenting a safe, simple and low-cost method that simultaneously completely destroys the lesion and preserves the anatomical and functional role of CP

[RARE LOCALIZATION OF OSTEOID OSTEOMA--DISTAL PHALANX OF THE RING FINGER]

With this clinical observation we would like to bring to mind osteoid osteoma as a possible cause of problems of distal phalanx of the fingers. Osteoid osteoma occurs rarely at this location and has atypical presentation. The main symptoms are swelling and redness of the fingertip with nail deformity, while typical night pain may not be present. Unusual clinical and x-ray presentation of tumor in this localization can make diagnosis of osteoid osteoma very difficult. A 20-year-old patient reported pain in the fingertip of his right ring finger persisting for five years. Swelling and redness of the fingertip combined with nail deformity was also present. X-rays showed osteolysis in the base of distal phalanx. Magnetic resonance imaging showed suspicion of osteoid osteoma, which was confirmed by computed tomography (CT). We performed surgical removal of osteoid osteoma in February 2014. The tumor was approached by longitudinal incision on the lateral side of the distal phalanx of the ring finger and the basal part of distal phalanx was cut with a small chisel to enable access to cystic change of the bone. Tumor removal with excochleation was performed and the material thus obtained was sent for histopathologic analysis. After surgery, the ring finger was immobilized in a plaster splint for a three-week period. After removal of immobilization, the patient was referred to physical therapy consisting of individual exercises in order to obtain the full range of motion in all joints of the hands and strengthen hand and forearm muscles. After surgical removal of osteoid osteoma, all symptoms disappeared completely. Histopathologic findings confirmed the diagnosis of osteoid osteoma. After physical therapy, he returned to daily activities without any problems. On regular follow ups at 3, 6 and 12 months after surgery, clinical findings were normal and the patient had no pain or discomforts. Full recovery was shown by the result of the DASH questionnaire three months after the procedure. Preoperative DASH score 54.4 decreased to 0. Distal phalanx of the finger is a very rare localization of osteoid osteoma, and typical night pain may not be present. In addition, appearance on x-rays is not typical. Instead of central enlightenment surrounded with sclerosis, x-rays usually show a lytic lesion. For this reason, it may be difficult to make the diagnosis of osteoid osteoma. The main symptom is permanent pain, swelling and redness of the finger, with nail deformity. The imaging method of choice is CT, which must be performed with thin layers of 1 to 2 mm. Furthermore, cooperation of surgeon and radiologist is extremely important to reach the accurate diagnosis. Many treatment options are described in the literature, such as CT-guided percutaneous thermocoagulation, destruction of lesions with alcohol, or CT-guided radiofrequency ablation. However, due to the proximity of neurovascular structures, tendons and joints, the best method for treatment osteoid osteoma in distal phalanx of the fingers is surgical excision or excochleation. Our conclusion is that one should always bear in mind that osteoid osteoma can be the cause of swelling of distal phalanx of the finger with nail deformity, and pain that alleviated with the use of non-steroidal anti-infl ammatory drugs. Surgical excision or excochleation is the best method for the treatment osteoid osteoma of distal phalanx of the finger.

Phase I/II Multi-Institutional Study of Percutaneous Radiofrequency Ablation for Painful Osteoid Osteoma (JIVROSG-0704)

PURPOSE

This multicenter prospective study was conducted to evaluate the safety and efficacy of percutaneous radiofrequency ablation (RFA) for painful osteoid osteoma (OO).

MATERIALS AND METHODS

Patients with OO (femur: n = 17, tibia: n = 2, humerus: n = 1, rib: n = 1) were enrolled and treated with RFA. In phase I, nine patients were evaluated for safety. In phase II, 12 patients were accrued, and an intent-to-treat analysis was performed on all patients. The primary endpoint was to evaluate the treatment safety. The secondary endpoint was to evaluate the efficacy for pain relief by the visual analogue scale (VAS) at 4 weeks after RFA. Treatment efficacy was classified as significantly effective (SE) when VAS score decreased by ≥5 or score was <2, moderately effective when VAS score decreased by <5-≥2 and score was ≥2, and not effective (NE) when VAS score decreased by <2 or score was increased. Cases where the need for analgesics increased after treatment were also NE.

RESULTS

RFA procedures were completed in all patients. Minor adverse effects (AEs) were observed as 4.8-14.3 % in 12 patients, and no major AEs were observed. Mean VAS score was 7.1 before treatment, 1.6 at 1 week, 0.3 at 4 weeks, and 0.2 at 3 months. All procedures were classified as SE. Pain recurrence was not noted in any patient during follow-up (mean: 15.1 months).

CONCLUSION

RFA is a safe, highly effective, and fast-acting treatment for painful extraspinal OO. Future studies with a greater number of patients are needed.

[Osteoid osteoma: about a case]

Osteoid osteoma is a benign primary bone tumor. This tumor is relatively frequent, accounting for 12% of all benign bone tumors and about 2-3% of all bone tumors. We report a new case of osteoid osteoma confirmed histologically. A 30-year old patient was referred for evaluation of chronic ankle pain. Front and lateral radiographs of the ankle showed a heterogeneous lesion located in the neck of the talus without soft tissue abnormalities. The CT scan of the ankle showed a nodular, hypodense lesion located in the neck of the talus with a limited osteosclerotic reaction.

Osteoid Osteoma of the Talar Neck With Subacute Presentation

Osteoid osteoma of the talar neck is a rare clinical entity that is frequently missed on initial assessment in patients with ankle pain. We present a case report of an adolescent with talar neck osteoid osteoma who presented with persistent pain after an injury. We review the differential diagnosis of persistent anterior ankle pain and review the treatment options for osteoid osteoma of the talar neck.

[Elbow pain in a young athlete revealing osteoid osteoma of the coronoid process: report of a case]

L'ostéome ostéoïde de l'apophyse coronoïde est exceptionnel, pose des problèmes diagnostiques et thérapeutiques. La douleur représente le maître symptôme. La perte d'extension complète est classique, cependant celle de la pronation et supination est très rare. Le scanner constitue l'examen radiologique de référence à condition de réaliser des coupes fines. La résection monobloc à foyer ouvert constitue le traitement de référence. Les traitements percutanés sont aussi efficaces mais au coude la proximité des éléments vasculo-nerveux et du cartilage articulaire rendent leurs indications plus limitées.

[Osteoid osteoma in the distal phalanx of the thumb]

We present a rare case of osteoid osteoma in the distal phalanx of the thumb. Symptoms had started seven months prior with pain and swelling and later progressed to enlargement of the nail. The patient lacked the classic symptoms of nocturnal pain and relief from NSAID. The ostoid osteoma was located in relation to the physis and was on the initial X-rays believed to be normal closure of the physis. MRI showed abnormality but the CT scan gave the right diagnosis and was used to plan en-bloc surgery.

Conservative treatment for osteoid osteoma of the odontoid process of the axis: a case report

BACKGROUND

Osteoid osteoma is a primary benign bone lesion, which constitutes about 10% of all primary benign bone tumors and 3% of all primary bone tumors. The spine is involved in 10% of the cases, and the lumbar spine is the most commonly affected whereas the tumor is rarely seen in the cervical spine. With regard to the osteoid osteoma being located at the odontoid process of the axis, limited cases have been reported in the literature.

CASE PRESENTATION

An osteoid osteoma of the odontoid process of the axis was diagnosed by computed tomography in an 18-year-old male patient with a 3-month history of pain. The patient's parents refused surgery for fear of surgical risks and high expense. Considering the benign nature of osteoid osteoma, we prescribed celecoxib 200 mg per day to the patient. With the treatment, the patient's pain was alleviated gradually and the range of motion of the cervical spine also recovered to normal. At the two-year phone follow-up, the patient was free of symptoms.

CONCLUSIONS

For this kind of benign tumor, conservative treatment plus close follow-up is applicable whereas surgery bears significant risks and a heavy economic burden.

Evaluation of outcome of surgical excision of the nidus of osteoid osteoma of long bone

Osteoid osteoma is a benign bone tumour usually found in the lower extremities of children and young adults. This tiny bone tumour causes pain out of all proportion to its size and hinders the daily activities. This Quasi-experimental study conducted in the department of Orthopaedic surgery of BSMMU from January 2008 to December 2009. Twenty one patients were included in the study where purposive sampling technique was used on the basis of inclusion and exclusion criteria and all the ethical conditions were fulfilled. Diagnosis was almost obtained by taking history, clinical examination, and relevant investigations. Clinical variables were age, sex, site, pain, swelling, deformity and outcome variables were painless active life, removal of swelling, prevention of deformity, rate of recurrence. After localization of the tumour with the help of C arm, the nidus was excised in a small block of bone. The outcome is categorized by consensus, as clinically successful, only if the patient was free of pain and was taking no medication. The treatment was considered to have failed if a subsequent procedure had been performed to remove tumour. Among 21 cases, 14(66.7%) were male and 7(33.7%) were female. Maximum number of patients 15(71.4%) was between 10 years to 20 years. Most of the patients (76.2%) affected by osteoid osteoma were young students and most of the patients (95.2%) experienced moderate aching pain, usually aggravating at night which was typically relieved by aspirin or other NSAIDs (71.4%). Lower limbs (76.2%) particularly femur and tibia were commonly affected. Out of 21 patients, 19(90.5%) patients have got immediate pain relief or required no medication. In only 2 patients (9.5%), subsequent procedure has been performed to relief pain. So, successful outcome (in 19 out of 21) was significantly (p<0.001) higher in comparison to failed. Surgical excision of the nidus is a simple and easy procedure and does not require extensive resection of bone. If localization is done properly success rate is high and patients can return to normal daily activities.

Blue Rubber-Bleb Nevus Syndrome: Report of a Case Associated with Osteoid Osteomas

Blue rubber-bleb nevus syndrome (BRBNS), or Bean's syndrome, is a rare angiomatosis characterized by multiple cavernous hemangiomas of the skin, mucosae and frequently of other sites. A 49-year-old male patient had been affected since birth by multiple angiomas localized in the skin, lips, oral cavity, cranial theca, and central nervous system; intrauterine rupture of angiomas in the right parietal lobe had caused partial hypotrophic paralysis of the left hemisoma. In addition to BRBNS, the patient was affected by three osteoid osteomas: this never-described clinical association is here discussed.

Radiofrequency ablation of osteoid osteomas: analgesia and patient satisfaction in long-term follow-up

PURPOSE

To review the long term clinical outcomes in the treatment of osteoid osteoma (OO) using radiofrequency ablation (RFA).

MATERIALS AND METHODS

Our retrospective study included 59 patients who were treated in the period from April 2001 to December 2012 due to a symptomatic OO using RFA. Here, the occurrence of complications and postoperative recurrence, as well as postoperative patient satisfaction were examined. Patients satisfaction was assessed by means of a telephone interview with the visual analogue scale (VAS).

RESULTS

Mean follow-up was 50 months (2 –116 months). The average size of the nidus was 6mm (range 2 – 14 mm). After initial radiofrequency ablation 11.8 % (7/59) of patient showed a recurrence of symptoms. Symptoms could successfully be treated by a second ablation in 5 patients. Assisted success rate was therefore 96.6 % (57/59). The complication rate was 5.1 % (2 major and one minor complication). Furthermore we report a very high patient satisfaction and acceptance of therapy.

CONCLUSION

RFA is a very successful therapy of symptomatic OOs with a high patient satisfaction.

KEY POINTS

Osteoid osteomas (OO) are rare benign bone tumors of the childhood and adolescence. Treatment of OOs with minimal-invasive radiofrequency ablation (RFA) shows a high patient satisfaction. RFA is by now the standard therapy of symptomatic OOs.

Radiofrequency ablation of phalangeal osteoid osteoma: technical challenges encountered in small bones

Osteoid osteoma, a benign bone tumor, is characterized by a generally less than 1 cm nidus surrounded by a zone of reactive sclerosis. It is frequently located in the femur and tibia; on the other hand in up to 5% of cases it may be presented in upper extremities. In previous years, its treatment was usually open surgery with en-bloc resection or curettage of the tumor. Various minimal invasive percutaneous treatments including radiofrequency ablation became popular in last years. In this report, the difficulties encountered during radiofrequency ablation treatment in small bones is described in a 19-year-old female case of osteoid osteoma.

Thoracoscopic en bloc extirpation for subperiosteal osteoid osteoma of thoracic vertebral body: a rare variety and its therapeutic consideration

BACKGROUND CONTEXT

Osteoid osteoma is a rare benign osteoblastic tumor. Approximately 10% to 20% of osteoid osteomas occur in the spine with a high trend to involve the posterior components; in turn, vertebral body involvement is uncommon. Osteoid osteoma has been classified into cortical, cancellous, and subperiosteal subtypes according to the localization of the nidus. Subperiosteal osteoid osteoma is extremely rare and has been reported mainly in the femoral neck and small bones of the hands and feet. To the best of our knowledge, subperiosteal osteoid osteoma arising in spine has never been reported previously.

PURPOSE

To illustrate a rare case of a 23-year-old female with painful scoliosis because of subperiosteal osteoid osteoma of ninth thoracic vertebra that was treated by thoracoscopic intervention.

STUDY DESIGN/SETTING

A case report and review of literature.

METHODS

Magnetic resonance imaging revealed the inflammation/edema pattern intensity at right side of both 9th and 10th thoracic vertebrae. Computed tomography demonstrated the round radiolucency surrounded by reactive bone formation (nidus) at the right anterolateral aspect of ninth thoracic vertebra. Taken all findings including anatomical localization of the lesion into consideration, we decided to use thoracoscopic intervention. Improvement of scoliosis was achieved 2 months after surgery. At the time of final follow-up, the patient was free of symptom and there was no clinical and radiologic evidence of recurrence of the tumor 1.5 years postoperatively.

RESULTS

Thoracoscopic intervention achieved en bloc extirpation of the nidus after partial removal of the 10th rib head. Thoracoscopic treatment has never been reported as a treatment modality of spinal osteoid osteoma. Within a few hours after the operation, the pain disappeared completely. Histopathological examination revealed that extracted lesion was compatible with osteoid osteoma.

CONCLUSIONS

The lesion described here demonstrates an extremely rare variety of spinal osteoid osteoma, which was successfully treated by an unprecedented thoracoscopic intervention. This alternative surgical approach enabled en bloc extirpation and effective correction of scoliosis while achieving a cosmetic satisfaction.

Expression of master regulatory genes controlling skeletal development in benign cartilage and bone forming tumors

Recent progress in skeletal molecular biology has led to the clarification of the transcriptional mechanisms of chondroblastic and osteoblastic lineage differentiation. Three master transcription factors-Sox9, Runx2, and Osterix-were shown to play an essential role in determining the skeletal progenitor cells' fate. The present study evaluates the expression of these factors in 4 types of benign bone tumors-chondromyxoid fibroma, chondroblastoma, osteoid osteoma, and osteoblastoma-using immunohistochemistry and tissue microarrays. Osteoid osteoma and osteoblastoma showed strong nuclear expression of Osterix and Runx2. In contrast, only a few chondroblastomas showed positive nuclear expression of Osterix. Strong nuclear expression of Sox9 was detected in all chondroblastomas, whereas nearly half of the osteoblastomas showed focal weak cytoplasmic expression of Sox9.

Benign bony and soft tissue tumors of the hand

It is important to be familiar with the wide variety of benign tumors that may present in everyday hand surgery practice. The treatment of many of these tumors in the hand is based on studies with small numbers of patients or the treatment of similar lesions elsewhere in the body. The purpose of this review is to summarize the recent literature relevant to benign bony and soft tissue tumors in the hand.

Osteoid osteoma and osteoblastoma of the cervical spine: the cause of unusual persistent neck pain

BACKGROUND

The most important symptom in patients with osteoid osteoma and osteoblastoma is a resistant localized neck pain and stiffness in the spine.

OBJECTIVE

To evaluate and analyze 6 cases of osteoid osteoma and osteoblastoma of the cervical spine that were surgically treated over a 7-year period and to emphasize the unusual persistent neck pain associated with osteoid osteoma and osteoblastoma of the cervical spine.

STUDY DESIGN

Retrospective study.

METHODS

Six patients, 3 male and 3 female, with a mean age of 21 years (range 16-31) diagnosed with osteoid osteoma or osteoblastoma during 2003 to 2009 were analyzed retrospectively. The preoperative neurological and clinical symptoms, neck pain duration, preoperative deformity, location of lesion, radiological findings, surgical technique and clinical follow-up outcomes of each patient were evaluated.

RESULTS

The average follow-up duration was 40.5 months (range, 19 to 83 months). Three patients had osteoid osteoma (2 female and one male), and 3 patients had osteoblastoma (one female and 2 male). Two male patients had recurrent osteoblastoma. The locations of the lesions were as follows: C7 (2 patients), C3 (one patient), C2 (one patient), C3-C4 (one patient) and C5-C6 (one patient). The most common symptom was local neck pain in the region of the tumor. Among all patients, only one patient, who had osteoblastoma, had neurological deficits (right C5-C6 root symptoms). The other patients had no neurological deficits. All patients were treated with surgical resection using microsurgery. Two patients underwent only tumor resection, one patient underwent tumor resection and fusion, and the other 3 patients underwent tumor resection, fusion and spinal instrumentation. No perioperative complications developed in any of our patients. There was no tumor recurrence during the follow-up period.

LIMITATIONS

A retrospective study with 6 analyses of cases.

CONCLUSION

Surgical treatment of osteoid osteoma and osteoblastoma of the spine has been standardized. The most common symptom of osteoid osteoma and osteoblastoma of the cervical spine is local persistent neck pain in the region of the tumor. This symptom can be significant in the diagnosis of these tumors.

[Percutaneous CT guided radio-frequency ablation of osteoid osteoma and osteoblastoma]

BACKGROUND

Osteoid osteoma (OO) is a benign osteoblastic bone lesion that causes severe local pain mainly at night, and usually responds to oral administration of NSAID. The lesion is located around the proximal thigh in more than 50% of the cases. Osteoblastoma is similar to OO in their histopathology features, but emerges frequently in the spine, and has a larger diameter than OO. Percutaneous CT-guided radiofrequency ablation (RFA) is becoming the treatment of choice for osteoid osteoma and non-aggressive osteoblastoma in the last decade.

METHODS

During the period 2005-2009, 38 patients were diagnosed with osteoid osteoma (n = 34), and osteoblastoma (n = 4). A total of 34 patients were treated with RFA using a water-cooled, variable ablation size tip. Two patients underwent an open procedure, and 2 had spontaneous remission.

RESULTS

Thirty three patients (97%) reported complete remission of their pain after a single treatment; one patient needed a second RFA treatment, and reported full remission of his symptoms after the 2nd treatment.

CONCLUSIONS

Percutaneous CT-guided radiofrequency ablation of osteoid osteoma and non-aggressive osteoblastoma is simple, safe, and reliable. Meticulous placement of the probe inside the tumor, and the usage of water-cooled, variable ablation size tip, improves the overall outcome and decrease complication rates.

Osteoid osteoma distal to a hip arthroplasty

The authors report a case of osteoid osteoma distal to a hip prosthesis in a 56-year-old patient. This rare association was difficult to diagnose; at first, the pain seemed to be of mechanical origin, suggesting a delayed painful reaction to the prosthesis. The results of bone scan as well as the CT scan ones helped orient the diagnosis. Excision biopsy, using bone trephining, completed by an iliac bone auto-graft resulted in a cure with no residual instability of the prosthesis above the tumor. Bone scan with radio-isotopes to localize the lesion was particularly helpful in this instance to secure the final diagnosis.

Cancellous osteoma of the maxillary tuberosity: case report

The osteoma is a benign, bone-forming lesion that is not considered a true neoplasm. It almost exclusively affects the flat bones of the skull and face. Jaw lesions may cause facial deformity and impair oral function. Multiple osteomas may be associated with Gardner's syndrome. Clinically and radiographically, osteomas may need to be differentiated from other bone-forming lesions. This article describes a cancellous osteoma of the left maxillary molar and tuberosity area and differentiates it from other benign and malignant lesions, including the parosteal osteosarcoma.

Subperiosteal osteoid osteoma of the neck of talus

Juxta-articular, subperiosteal osteoid osteomas arising around the ankle are unusual. Tumors arising on the neck of the talus commonly produce symptoms mimicking monoarticular arthritis. Patients are usually treated for arthritis or ankle sprain, which often leads to a delay in definitive diagnosis. Here we present a case of osteoid osteoma of neck of talus which was presented as ankle pain. It puzzled us until MRI was done. Diagnostic dilemma and delay can be avoided by high index of suspicion. The patient was treated with open removal of the tumor. We also present brief review of literature about juxta-articular, subperiosteal osteoid osteoma which is uncommon from the typical osteoid osteoma occurring elsewhere in the body.

[Osteoid osteoma of the mandibular condyle: report of one case]

Osteoid Osteoma is rare in mandibular condyle. A case of osteoid osteoma in the condyle was reported in this paper. The clinical manifestation, radiographic characteristic, pathologic diagnosis were discussed. Nidus is the key in diagnosing osteoid osteoma, and the final diagnosis is based on pathological findings.

Primary endo-orbital osteoid osteoma

Osteiod osteoma is a small, benign, osteoblastic tumor, which usually affects the long bone of the lower extremities and vertebrae. Herein, we report the first case of endo-orbital osteoid osteoma. A 22-year-old man presented with eyelid edema, proptosis and pain in the left eye 1 year after the beginning of the symptoms. Imaging studies showed a small (15 x 11 mm in size) lesion on the roof of the left orbit with contrast enhancement. The lesion was removed and histopathological section was consistent with osteoid osteoma. Eighteen month after the operation, the patient was free of symptoms.

Osteoid osteoma with a multicentric nidus: a case report and review of the literature

To date, 23 cases with osteoid osteoma (OO) including multiple nidi in single bone have been reported in the world literature. A case report of an 18-year-old boy with an OO on his left femoral neck, which contained double nidi is presented. Plain radiography, computed tomography (CT) and magnetic resonance imaging (MRI) of the proximal femur showed OO with a multicentric nidus. Bone scintigraphy demonstrated increased activity in the left femoral neck region. The tumor was removed with curettage and shaving using lateral approach. The patient was asymptomatic for 5 years after surgery.

Computed-tomography-guided percutaneous radiofrequency thermoablation for the treatment of osteoid osteoma-2 to 5 years follow-up

The purpose of this study is to evaluate the efficacy of the computed tomography (CT)-guided percutaneous radiofrequency thermoablation (PRT) method with a minimum of 2 years follow-up. Twenty-eight patients who were followed for more than 2 years among 35 patients who underwent CT-guided PRT between April 1999 and May 2005 were included in this study. The mean age was 24.5 years (range 7-55 years) and the mean follow-up period was 40.1 months (range 24-66 months). With a radiofrequency electrode, the lesion was heated to 80 degrees C or 90 degrees C for 6.5 mins (range 3-9 mins). Clinical success was assessed at the out-patient clinic by symptoms and radiographs. Twenty-six patients (90%) experienced a total loss of symptoms and additional PRT also relieved the ongoing symptoms in all of the recurrent patients. PRT appears to be a safe and effective method for treating osteoid osteoma and is also effective in recurrent cases. This treatment modality is a minimally invasive procedure and is a good alternative to open surgical treatment.

Osteoid osteoma of the zygoma: report of an unusual case

BACKGROUND

Osteoid osteoma is a benign tumor of bone characterized by pain, usually occurring at night, that shows a dramatic response to aspirin. The literature contains reports of only a few cases in the head and neck region.

CASE DESCRIPTION

The authors present an unusual case of an osteoid osteoma of the craniofacial bones. The patient sought an evaluation of pain in the area of the right zygoma. One of the authors, an oral and maxillofacial surgeon, noted a small area of swelling. The patient underwent radiographic, computed tomographic and nuclear medicine studies. On the basis of the images and the biopsy report, the authors made a diagnosis of osteoid osteoma. In this article, they describe the treatment of and new modalities of therapy for this condition.

CLINICAL IMPLICATIONS

The general dentist should be aware of any lesion that is not common. If the generalist has any doubt about the nature or management of an unusual oral lesion, referral to appropriate specialists is mandatory.

Osteoid osteoma of the cervical spine: surgical treatment or percutaneous radiofrequency coagulation?

Osteoid osteoma (OO) of the cervical spine is frequently located close to the vertebral artery, spinal cord, or nerve roots and complete surgical excision is sometimes difficult by a limited approach and more extended surgery can require spinal fusion. Percutaneous radiofrequency coagulation (PRC) has demonstrated efficacy in the treatment of OO of the pelvis and limbs however, its role in the cervical spine is still nuclear. The Authors present a series of nine cases of OO of the cervical spine, six treated with surgical excision and three with PRC. No neurological or vascular complications occurred in both series. One case of the surgical series had only partial relief of persistent pain for 1 year due to incomplete excision, but is doing well 4 years after surgery. All the other surgical cases had complete relief of symptoms immediately after surgery and are symptom-free 3-10 years later. Two cases of PRC had complete relief of symptoms 24-48 h after surgery and are symptom-free 2 and 3 years later. One case of recurrent OO after surgery and treated with PRC with a reduced dose improved only, and still requires anti-inflammatory drugs 2 years after the procedure. Our still limited experience suggests that PRC can be safely performed in local anaesthesia with the patient awake, enabling to check for signs and symptoms of possible neurological injury. PRC can substitute extensive posterior approaches and reconstructions for OO of the posterior arch and joint pillar.

The healing pattern of osteoid osteomas on computed tomography and magnetic resonance imaging after thermocoagulation

OBJECTIVE

To compare the healing pattern of osteoid osteomas on computed tomography (CT) and magnetic resonance imaging (MRI) after successful and unsuccessful thermocoagulation.

MATERIALS AND METHODS

Eighty-six patients were examined by CT and 18 patients by dynamic gadolinium-enhanced MRI before and after thermocoagulation for osteoid osteoma. Thermocoagulation was successful in 73% (63/86) and unsuccessful in 27% (23/86) of patients followed by CT. Thermocoagulation was successful in 72% (13/18) of patients followed by MRI. After treatment, the healing of the nidus on CT was evaluated using different healing patterns (complete ossification, minimal nidus rest, decreased size, unchanged size or thermonecrosis). On MRI the presence of reactive changes (joint effusion, "oedema-like" changes of bone marrow and soft tissue oedema) and the delay time (between arterial and nidus enhancement) were assessed and compared before and after thermocoagulation.

RESULTS

Complete ossification or a minimal nidus rest was observed on CT in 58% (16/28) of treatment successes (with > 12 months follow-up), but not in treatment failures. "Oedema-like" changes of bone marrow and/or soft tissue oedema were seen on MR in all patients before thermocoagulation and in all treatment failures. However, residual "oedema-like" changes of bone marrow were also found in 69% (9/13) of treatment successes. An increased delay time was observed in 62% (8/13) of treatment successes and in 1/5 of treatment failures.

CONCLUSION

Complete, or almost complete, ossification of the treated nidus on CT correlated with successful treatment. Absence of this ossification pattern, however, did not correlate with treatment failure. CT could not be used to identify the activity of the nidus following treatment. The value of MR parameters to assess residual activity of the nidus was limited in this study.