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An Atlas of Musculoskeletal Oncology: Volume 1

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  • 1. Contents for Volume 1Osteoid osteoma--------------------------------Case 1-50Osteoblastoma----------------------------------Case 51-94Osteofibrous dysplasia-------------------------Case 95-101Ossifying fibroma of jawbone----------------Case 102-107
  • 2. OsteoidOsteoma
  • 3. Osteoid Osteoma The osteoid osteoma is the most common osteoid-forming tuseen in the skeletal system, accounting for 10% of all benignbone tumors. It is more common in males than females with thepeak incidence in the second decade of life. The lesions producsymptoms of dull, aching pain that is more severe at night. Thepain is relieved with anti-inflammatory medication such asaspirin or non-steroidal anti-inflammatory drugs (NSAID)that inhibit the high concentration of prostaglandins found inthe nidus of the osteoid osteoma. The lesions occur typically inthe cortical structures of long bones such as the femur or tibiabut can also be found in the small bones of the ankle, wrist orvertebral column. The lesion is characteristic for its dense,sclerotic response in the cortical bone resulting in a fusiformenlargement on the surface of the cortex as a response to thesmall inflammatory nidus or granuloma (measuring up to one
  • 4. centimeter in diameter) in the central area of the scleroticresponse. If the lesion is located in a central medullary area,such as the metaphysis or on the very superficial surface of abone, the sclerotic response is less severe. If the nidus islocated close to or within a joint structure, as in the femoralneck area, there will be a significant inflammatory synovitisin the adjacent joint that gives the clinical appearance of apyarthrosis. In the spine, the lesions are usually located in theposterior elements of the spine such as the laminae or pediclesThe lumbar spine is the most common location followed secondby the dorsal spine. Atypical secondary painful scoliosis willdevelop with the convexity seen on the side opposite theinflammatory lesion. The two most significant diagnostic imaging studies are a CTscan through the nidus area to identify its anatomic location andbone isotope scan which is invariably positive, especially in asymptomatic lesion. It is the current feeling that the osteoid.
  • 5. osteoma is a true benign neoplasm of bone in which a com-bination of osteoclastic and osteoblastic activity are seen.There are no inflammatory cells such as lymphocytes orplasma cells as would be seen in a Brodie’s abscess. Non-steroidal anti-inflammatory medications such as prostaglandininhibitors can be very effective in controlling the disablingsymptoms and helping the patient get thru a period of one ortwo years during which time the lesion will typically involuteinto a painless lesion that does not require surgery. However,if the patient is unable to live with the pain during this time,a surgical approach is indicated. Following exposure of thelesion, a high speed burr is used to burr into the inflammatorybone that is characterized by a pinkish hyperemia. When thenidus is found, a small curette is used to core the inflammatorynidus for pathological diagnosis and the cavity of the nidusis burred an additional 2 or 3 mm which usually results in a verydramatic relief of symptoms and a permanent cure from the
  • 6. disease process. It is not necessary to remove the largedense sclerotic bone surrounding the nidus; doing so couldresult in a pathologic fracture following surgery. In the spine,a simple laminectomy is frequently carried out. If the lesion islocated in the pedicle a simple burring into the pedicle willrelieve the patient of the inflammatory pain. More recently, relatively non-invasive techniques have beentried to remove the nidus of the osteoid osteoma by means of aCT guided burr placed through a protective trocar or by place-ment of a heat-producing radio frequency probe that, whenproperly positioned, can destroy the nidus through thermalcoagulation. These techniques are particularly valuable for deeseated lesions located in the acetabulum. For lesions located inthe pedicle of a vertebra one must be careful not to damage anadjacent spinal root or spinal cord.
  • 7. CLASSICCase #119 yr old female painfulOsteoid osteoma nidusfemur
  • 8. CT scan nidus
  • 9. Macro section of nidus
  • 10. Photomic of nidus
  • 11. Case #229 year maleosteoid osteomafemur nidus
  • 12. CT scan nidus
  • 13. Case #3 11 yr male osteoid osteoma femur
  • 14. Bonescan
  • 15. CT scan nidus
  • 16. Photomic
  • 17. Case #4 nidus 5 yr male osteoid osteoma femur
  • 18. Case #512 yr maleosteoid osteomafemur nidus
  • 19. Case #610 yr maleosteoid osteomafemur nidus
  • 20. nidus
  • 21. nidusCT scan
  • 22. Case #730 yr femaleosteoid osteomafemur nidus
  • 23. nidusCoronal T-1 MRI
  • 24. nidus edemaAxial PD MRI
  • 25. nidusMacrosection
  • 26. Case #823 yr femaleosteoid osteomafemur nidus
  • 27. Bone Scan
  • 28. Nidus CT Scan
  • 29. Case #912 yr maleosteoid osteomafemur nidus
  • 30. Macro sectionnidus
  • 31. Photomic
  • 32. Case #10 nidus 10 yr female with osteoid osteoma femoral neck
  • 33. Photomic
  • 34. One yr after curettement
  • 35. Case #11 nidus 25 yr male with osteoid osteoma femoral neck
  • 36. nidusCT scan
  • 37. Case #12 nidus 6 yr male osteoid osteoma acetabulum
  • 38. nidus
  • 39. Bone scan
  • 40. Case #13 nidus11 yr maleosteoid osteomadistal femur
  • 41. Bone scan
  • 42. Case #14 nidus16 yr maleosteoid osteomadistal femur
  • 43. Case #156 yr maleosteoid osteomatibia nidus
  • 44. Bone scan
  • 45. Excessivebone blockresection nidus
  • 46. nidusMacro section of nidus
  • 47. Photomic
  • 48. Post op x-ray
  • 49. Resultant fractureone year later
  • 50. Case # 1610 yr maleosteoid osteomatibia
  • 51. Shaving down with osteotome
  • 52. Further shaving to find nidus
  • 53. Burred out nidus defect
  • 54. Case # 1715 yr maleosteoid osteomatibia
  • 55. Lateral view nidus
  • 56. Bone scan
  • 57. Coronal T-2 MRI nidus
  • 58. Coronal Gadcontrast MRI edema nidus
  • 59. nidus T-1 axial MRI
  • 60. Photomic
  • 61. Photomic
  • 62. Case #17.1 Osteoid osteoma 52 year old male with ankle pain for 3 mos.
  • 63. Sag T-1 T-2 Gad
  • 64. Axial T-1 T-2Gad
  • 65. Case #18 nidus17 yr maleosteoid osteomafemur
  • 66. Grossspecimen nidus
  • 67. Photomic
  • 68. Case #19 18 yr male Osteoid osteoma tibia
  • 69. Case #2018 yr femaleosteoid osteoma nidustibia
  • 70. Case #21 nidus 12 yr male with parosteal osteoid osteoma tibia
  • 71. Case #22 nidus17 yr maleosteoid osteomafibula
  • 72. Lateral view
  • 73. Case #23 nidus26 year female withepiphyseal osteoidosteoma prox radius
  • 74. Case #2416 yr femaleosteoid osteomaulna nidus
  • 75. Bone scan
  • 76. Case #2516 yr maleosteoid osteomahumerus nidus
  • 77. Case # 26 nidus14 yr maleosteoid osteomaL-4
  • 78. Bone scan
  • 79. Photomic
  • 80. Case # 27 nidus15 yr maleosteoid osteomaL-3
  • 81. Case #28 nidus46 yr maleosteoid osteomadorsal spine
  • 82. Bone scan
  • 83. Case #29 nidus 18 yr male with osteoid osteoma C-3
  • 84. nidusLaminogram
  • 85. Bone scan
  • 86. Case #30 nidus 12 yr male with osteoid osteoma C-3 spine
  • 87. Case #31 nidus25 yr maleosteoid osteomaC-5
  • 88. Case # 32 nidus 27 yr female with osteoid osteoma S-1
  • 89. Case #33 nidus 22 yr male with osteoid osteoma sacrum
  • 90. Case #34 nidus18 yr maleosteoid osteomafinger
  • 91. nidusX-ray
  • 92. nidusAP x-ray
  • 93. Case #35 nidus 24 yr male with osteoid osteoma thumb
  • 94. Bone scan
  • 95. Case #36 nidus 19 yr female with osteoid osteoma finger
  • 96. Case #37 nidus 20 yr male with osteoid osteoma thumb
  • 97. Case #37.1 nidus 17 year female with dull aching pain index finger 1 yr
  • 98. Case #38 nidus 23 yr male with osteoid osteoma capitate
  • 99. Case #39 nidus 25 yr male with osteoid osteoma narvicular
  • 100. Case # 40 nidus 34 yr female with osteoid osteoma 2nd metatarsal
  • 101. double nidusCT scan
  • 102. edemaAxial T-2 MRI
  • 103. Case #41nidus 24 yr female with osteoid osteoma big toe
  • 104. nidusGross Specimen
  • 105. Photomic
  • 106. Photomic
  • 107. Case #42 nidus Osteoid osteoma talus
  • 108. Photomic
  • 109. Case #43Osteoid osteomapseudotumor Brodie’s abscess13 yr femaletibia nidus
  • 110. tunnelGopher’s sign
  • 111. Case # 44Osteoid osteomapseudotumorBrodie’s abscess nidustibia38 yr male
  • 112. nidus Axial T-2 MRI
  • 113. Case #45 pseudo-nidus fracture line Osteoid osteoma pseudotumor stress fracture femoral neck 38 yr male
  • 114. Bone scan
  • 115. Case #46Osteoid osteomapseudotumor33 year femaleEarly stressfracture femoralneck with painfor 3 mos
  • 116. Bone scan
  • 117. One month later
  • 118. Case #47 pseudonidus Osteoid osteoma pseudotumor stress fracture femoral neck 50 yr female
  • 119. pseudonidusAxial T-2 MRI
  • 120. fracture lineCoronal T-2 MRI
  • 121. Case #48 OO pseudotumor Stress fracture 20 year old male with pre-tibial pain for 3 months
  • 122. Sag T-1 PD Gad
  • 123. Case #49Pseudo osteoidosteoma femurChronic stressperiostitis fromadductor pull14 yr male
  • 124. pseudonidus CT scan
  • 125. Bone scan
  • 126. Case #50Pseudo osteoidosteoma femur38 yr maleBone island
  • 127. Bone scan
  • 128. CoronalT-1 MRI pseudonidus
  • 129. Osteoblastoma
  • 130. Osteoblastoma The so-called osteoblastoma is considered by most to be a laor giant form of the similar clinical entity known as the osteoidosteoma. As with the osteoid osteoma, it is found in children andyoung adults, more often in males than females. It is less commthan the osteoid osteoma, representing approximately 1% of allbone tumors. It is found mostly in metaphyseal areas of long boand in the posterolateral elements of the axial skeleton wherenearly 50% of the lesions are identified. Radiographically theselesions are more osteolytic than the osteoid osteoma and havecentral nidus that measures more than 1.5 cm in diameter withless reactive sclerosis seen at the periphery than an osteoidosteoma. It is not unusual for an aneurysmal component to beassociated with the osteoblastoma, similar to the reaction seenadjacent to chondroblastomas and giant cell tumors. The micro-scopic appearance of the nidus material is almost identical to
  • 131. that of the osteoid osteoma and under higher power cannot bedifferentiated by even the most competent pathologists. Themajor concern is a microscopic appearance similar to an osteo-sarcoma and, for this reason, multiple samples must be evaluatein order to establish the correct diagnosis in cases where theselesions arise from the metaphyseal areas of long bone. In the spinal area, the osteoblastoma is typically located in thposterolateral elements where it can cause problems with spinalcord or nerve root compression that may require aggressivesurgical decompression and even spinal stabilization. On occasian osteoblastoma will spontaneously convert into an osteo-sacoma, especially if it has been treated with radiation therapy.The primary treatment for the osteoblastoma is a surgical one wa fairly aggressive curettement of the lesion. There is no particulreason to take wide margins because the recurrence rate is quitelow and in some cases the lesions resolve spontaneously with oany surgery at all, similar to what occurs with osteoid osteomas.
  • 132. A variant of the osteoblastoma, the so-called aggressive or“malignant” osteoblastoma, is a clinical entity halfway between thclassic benign osteoblastoma and a full blown malignant osteo-sarcoma. This “malignant” osteoblastoma appears and behavesclinically at the local site like an osteosarcoma but has no potentito metastasize to distant parts. In this situation, local treatmentmust be more aggressive and probably would require a wide locaresection to avoid a local recurrence because radiation therapy oeven systemic chemotherapy is not effective for this aggressive bbenign entity.
  • 133. CLASSICCase #5126 yr maleosteoblastoma L-4
  • 134. Lateral view
  • 135. Bone scan
  • 136. CT scan
  • 137. Sagittal T-2 MRI
  • 138. Photomic
  • 139. Photomic
  • 140. 5 yrs post op with spontaneous fusion
  • 141. AP x-ray 5 yrs post op
  • 142. Sagittal gad contrast MRI 5 yrs post op
  • 143. Axial gad contrast MRI 5 yrs post op
  • 144. Case #52 nidus 23 yr male with osteoid osteoma L-5
  • 145. nidusCT scan
  • 146. Photomic
  • 147. Photomic
  • 148. RecurrenceRecurrence 8 mos post op laminectomy
  • 149. CT Recurrence as an osteoblastoma
  • 150. Secondary ABCbehind osteoblastomaSagittal T-2 MRI ABC osteoblastoma
  • 151. fluid-fluid levelAxial T-2 MRI
  • 152. ABC histology
  • 153. ABC histology
  • 154. Osteoblastoma histology
  • 155. Osteoblastoma histology
  • 156. Post op posteriorresection and fusion
  • 157. AP x-raypost op fusion
  • 158. CT scan later shows anterior recurrence
  • 159. Post op anteriorresection and bonecement reconstruction
  • 160. Lateral x-ray showinganterior reconstructionwith cement cement
  • 161. cementbonegraft CD rodsPost op CT scan showing cement reconstruction
  • 162. cementgraft Post op CT
  • 163. Case #53 surgical towel clip26 yr male with osteoblastoma L-4 following a laminectom curettement three years previous for an osteoid osteom
  • 164. CT scanAppearance 4 months later with a 1.5 cm nidus
  • 165. A curettement at this time revealed an osteoblastoma
  • 166. Myelogram 4 yrslater
  • 167. burned-out lesionCT scan at same time and no pain
  • 168. Another CT cut
  • 169. Burnt out lesionSagittal T-1 MRI at same time
  • 170. Sagittal T-2 MRI same time
  • 171. T-2 MRI with residual ABC in inactive lesion
  • 172. Axial T-1 MRI same time
  • 173. Axial T-2 MRI with residual ABC component
  • 174. Case #547 yr femaleosteoblastoma L-2
  • 175. Bone scan
  • 176. T-2 MRI showshigh signal ABCposterior to low signalosteoblastoma osteoblastoma ABC
  • 177. osteoblastomaSagittal ABCT-2 MRI
  • 178. Osteoblastoma Photomic
  • 179. AP x-raypost op posteriorspinal fusion
  • 180. Lateral X-raypost op
  • 181. Case #5514 yr femaleosteoblastoma L-5
  • 182. Oblique X-ray
  • 183. Bone scan
  • 184. CT scan
  • 185. CT scan
  • 186. Case #56 24 yr male with osteoblastoma L-3
  • 187. Lateral view
  • 188. Oblique view
  • 189. Opposite oblique
  • 190. Case #57 22 year male with osteoblastoma L-1 vertebra
  • 191. Oblique view
  • 192. Case #58 23yr male with burned out obteoblastoma L-4
  • 193. Case #5914 yr maleosteoblastoma C-3
  • 194. Oblique view
  • 195. Opposite oblique
  • 196. One yearpost op posteriorfusion and recurrenttumor anterior
  • 197. Anterior viewwith recurrence
  • 198. Post op anteriordebriedment andfusion
  • 199. Case #6018 yr maleosteoblastomaC-7
  • 200. Oblique view
  • 201. Lateral view2 mo later
  • 202. AP view1 mo later
  • 203. Resected nidus
  • 204. Photomic
  • 205. Photomic
  • 206. Case #61CT scan 55 yr female with osteoblastoma C-6
  • 207. Bone scan
  • 208. Sagittal T-1 MRI
  • 209. Sagittal T-2 MRI
  • 210. Axial T-2 MRI
  • 211. Case #62 25 yr female with osteoblastoma C-6
  • 212. AP x-ray
  • 213. 10 yrs later
  • 214. Lateral view 10 yrs later
  • 215. Photomic
  • 216. Photomic
  • 217. Case #63CT scan 40 yr male with osteoblastoma C 5-6
  • 218. CT scan
  • 219. Sagittal T-2 MRI
  • 220. SagittalT-2 MRI showingbulge in floor ofvertebral canal
  • 221. Case #64 13 yr female with osteoblastoma C-6
  • 222. Lateral view
  • 223. Post op X-rayAfter anteriorinterbody fusion
  • 224. Case #65AP X-ray 14 yr female with osteoblastoma C-7
  • 225. AP myelogram
  • 226. Arteriogram showingpressure on vertebralartery
  • 227. Post op debriedment
  • 228. Case #66CT scan 43 yr female with osteoblastoma T-8
  • 229. Axial T-2 MRI
  • 230. Sagittal T-1 MRI
  • 231. Post op posteriorspine fusion
  • 232. Case #67 28 yr male with osteoblastoma thoracic spine
  • 233. CT scan
  • 234. Post op resection
  • 235. CT scan post op resection
  • 236. Case #6821 yr maleosteoblastoma S-1
  • 237. 2 years later
  • 238. 5 years later
  • 239. Lateral view 5 years later
  • 240. Photomic
  • 241. Photomic
  • 242. Case #69 8 yr male with ostoblastoma sacrum
  • 243. Case #70 26 yr female with osteoblastoma acetabulum
  • 244. Close up AP
  • 245. Photomic
  • 246. Photomic
  • 247. X-ray 3 mosfollowing THA
  • 248. Case #71 19 yr male with aggressive osteoblastoma acetabulum
  • 249. Bone scan
  • 250. Gross specimen from curettement
  • 251. Photomic
  • 252. Photomic
  • 253. Post op internalhemipelvectomy
  • 254. Recurrence 4 months later
  • 255. tumorAblative hemipelvectomy specimen
  • 256. tumor Hemipelvectomy specimen
  • 257. Several years later with recurrent tumor on sacrum
  • 258. Lateral view of recurrence
  • 259. Case #7238 yr maleosteoblastomapelvis
  • 260. Frog lateral
  • 261. Post op x-ray following curettage and cementation
  • 262. Case #73 33 yr female with osteoblastoma acetabulum
  • 263. Axial T-1 MRI
  • 264. Coronal T-2 MRI
  • 265. Case #74 26 yr male with osteoblastoma acetabulum
  • 266. Frog lateral
  • 267. Case #75 24 yr male with osteoblastoma pelvis
  • 268. 18 mos later
  • 269. Case #76 22 yr male with osteoblastoma ischium
  • 270. nidusX-ray of resected specimen
  • 271. Case #77 26 yr male with osteoblastoma ilium
  • 272. CT scan
  • 273. Post op x-ray appearance after resection and cementa
  • 274. Case #7823 yr maleosteoblastomafemur
  • 275. CT scan
  • 276. T-2 MRI
  • 277. Sagittal T-2 MRI
  • 278. Photomic
  • 279. Case #78.119 year male withtibial pain for 6 mos
  • 280. T-1 T-2 Gad +Axial
  • 281. Coronal T-1 T-2 Gad
  • 282. X-ray 3 months post op
  • 283. Case #7915 yr maleosteoblastomafemur
  • 284. Bone scan
  • 285. CT scan
  • 286. Axial T-2 MRI
  • 287. Coronal T-1MRI
  • 288. X-ray at time ofsurgery with markerin tumor defect
  • 289. Photomic of nidus
  • 290. Case #79.1 CT scan Sclerosing osteomyelitis of Garre 14 yr male with dull aching thigh pain for 1 year
  • 291. Coronal T-1 Coronal T-2
  • 292. Sagittal T-2 Axial T-2
  • 293. Case #80 13 yr male with osteoblastoma femoral neck frog lateral view
  • 294. AP view
  • 295. Bone scan
  • 296. Case #81 22 yr male with osteoblastoma talus
  • 297. Sagittal T-1 MRI
  • 298. Coronal T-2 MRI
  • 299. Coronal T-2 MRI
  • 300. Photomic
  • 301. Case #8225 yr maleosteoblastomatalus
  • 302. Lateral view
  • 303. Close up lateral
  • 304. Photomic
  • 305. Case #83 18 yr female with osteoblastoma talus
  • 306. Mortise view
  • 307. X-ray 1 yr after curettage
  • 308. Case #84 23 yr male with osteoblastoma talus
  • 309. Case #85 25 yr female with osteoblastoma os calcis
  • 310. Os calcis view
  • 311. X-ray several months with progression of disease
  • 312. Case #86 29 yr male with osteoblastoma os calcis
  • 313. Case #87 53 yr male with osteoblastoma distal humerus
  • 314. X-ray 3 years later
  • 315. tumor edema Axial T-2 MRI
  • 316. edema nidusCoronal T-2 MRI
  • 317. Post op x-rayfollowing distalhumeral resectionand allograftreconstruction
  • 318. Case #889 yr femaleosteoblastomadistal humerus
  • 319. Coronal T-1 MRI edema
  • 320. tumoredema Axial T-2 MRI
  • 321. Case #88.1 nidus11 yr male with ABC response to osteoblastoma humeru
  • 322. Sag T-1Sag T-2
  • 323. Axial T-2 MRI shows the multiloculated aneurysmal cys
  • 324. Case #89 21 yr male with osteoblastoma ring finger
  • 325. AP and Lateral radiographs
  • 326. Gross specimen
  • 327. Photomic
  • 328. Case #90 18 yr male with osteoblastoma finger
  • 329. Case #91 21 yr male with osteoblastoma thumb
  • 330. Case #92 10 yr female with osteoblastoma finger tip
  • 331. AP X-ray
  • 332. Case #939 yr femaleosteoblastoma tibia
  • 333. AP x-ray
  • 334. Case #94 24 yr male with osteoblastoma fibula
  • 335. Lateral view
  • 336. Osteofibrous Dysplasia
  • 337. Osteofibrous Dysplasia Osteofibrous dysplasia is a rare condition occurringin children less than 10 years of age. This benign lesionhas radiographic and microscopic features similar to fibrousdysplasia of the tibia, the main difference being the presenceof more heavily ossified tissue at the periphery of the lesiongiving it a soap-bubbly appearance on x-ray. Microscopicallyit has a similar “alphabet-soup” metablastic bone appearancein a benign fibrous tissue stroma but with the additional featureof heavy osteoblastic rimming of the trabeculae not seen infibrous dysplasia. It typically arises from the anterior cortex ofthe tibia at mid shaft and causes a progressive anterior bowingof the tibia over time, creating a cosmetic deformity associatedwith pain of a dull, aching nature. The radiographic appearanceIs very similar to and impossible to separate from that of theMalignant adamantinoma that also affects the tibia in children
  • 338. and, for this reason, a biopsy must be performed to rule out themalignant possibility. Occasionally osteofibrous dysplasia of thetibia can progress gradually into a well-differentiated formof the adamantinoma, which will have the microscopicfeatures of both osteofibrous dysplasia and adamantinomain the same lesion. As far as treatment is concerned, earlysurgical debriedment and bone grafting before age 15 yearsresults in a high local recurrence rate and thus should bediscouraged until the child reaches full bone maturity at whichtime a definitive debriedment and bone grafting procedurecan be performed without significant risk of recurrence. Thislesion occurs bilaterally in a very small percentage of casesand can also involve the fibula on the same side. This processin newborns appears to be more osteolytic and destructive innature.
  • 339. CLASSICCase #959 yr maleosteofibrous dysplasiatibia
  • 340. AP and lateral x-ray
  • 341. Photomic
  • 342. Case #96 6 year female osteofibrous dysplasia tibia
  • 343. Same case
  • 344. Case #97 16 year female osteofibrous dysplasia tibia
  • 345. Case #98 8 yr male osteofibrous dysplasia tibia
  • 346. X-ray appearance3 yrs later
  • 347. 8 yrs later withspontaneous healing
  • 348. Case #98.1 Burnt out osteofibrous dysplasia 61 year old male with incidental finding in tibia for years
  • 349. Bone scan
  • 350. Sag T-1 PD FS Gad
  • 351. Cor STIR Gad
  • 352. Axial T-1 T-2 FS Gad
  • 353. Case #99 15 yr female osteofibrous dysplasia tibiaAP x-ray
  • 354. Lateral x-ray
  • 355. Case #100 Newborn with osteofibrous dysplasia tibia
  • 356. edemaT-2 axial MRI
  • 357. Photomic
  • 358. Photomic
  • 359. X-ray 1 yr later
  • 360. Case #101Another newbornosteofibrous dysplasiatibia
  • 361. Another view
  • 362. Ossifying Fibroma of Jawbone
  • 363. Ossifying Fibroma of Jawbone Ossifying fibroma of jawbone is a benign condition similar toosteofibrous dysplasia of the tibia in that histologically they arealmost identical. It is also a condition that is related to fibrousdysplasia, which can have a very similar radiographic appearanbut in the case of fibrous dysplasia of jawbone osteoblasticrimming of the trabecular bone is not seen under microscopicevaluation. As with fibrous dysplasia, this condition is found inchildren and is almost always an asymptomatic process resultinin cosmetic deformation of the maxilla or mandible, usually onone side but can be bilateral. The condition can result insignificant malocclusion of the teeth because of deformationof the subadjacent alveolar ridge or maxillary structures. It alsocan create problems with normal drainage from the air sinuses ithe maxilla that can lead to infection requiring surgical drainageMost of the surgical treatment for this condition is for cosmeticdeformity.
  • 364. Case #1025 yr femaleossifying fibromamaxilla
  • 365. tumorMaxillary view
  • 366. tumorTomogram cut
  • 367. tumorCT scan
  • 368. tumorAnother cut
  • 369. Another cut
  • 370. Photomic
  • 371. Case #103 18 yr female with ossifying fibroma mandible
  • 372. Oblique view
  • 373. Photomic
  • 374. Closeup of alphabet-soup metaplastic bone
  • 375. Case #104 tumor 12 yr female with ossifying fibroma mandible
  • 376. Opposite ramus
  • 377. Case #105 14 yr female with ossifying fibroma mandible
  • 378. Case #106 Young adult tumor osteoma skull
  • 379. tumorOccipital view
  • 380. Lateral view
  • 381. Case #107 Cementoma mandible
  • 382. Oblique view