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Osteoid+Osteoma
Osteoid+Osteoma
Osteoid+Osteoma
Osteoid+Osteoma
Osteoid+Osteoma
Osteoid+Osteoma
Osteoid+Osteoma
Osteoid+Osteoma
Osteoid+Osteoma
Osteoid+Osteoma
Osteoid+Osteoma
Osteoid+Osteoma
Osteoid+Osteoma
Osteoid+Osteoma
Osteoid+Osteoma
Osteoid+Osteoma
Osteoid+Osteoma
Osteoid+Osteoma
Osteoid+Osteoma
Osteoid+Osteoma
Osteoid+Osteoma
Osteoid+Osteoma
Osteoid+Osteoma
Osteoid+Osteoma
Osteoid+Osteoma
Osteoid+Osteoma
Osteoid+Osteoma
Osteoid+Osteoma
Osteoid+Osteoma
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Osteoid+Osteoma

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  • 1. OsteoidOsteoma
  • 2. Index
    Introduction
    Special features
    Incidence
    Sites of predilection
    Symptoms
    Other Clinical Features
  • 3. Gross Appearance
    Microscopy
    Radiological findings
    Why relief with aspirin !!!!
    Differential Diagnosis
    Treatment
    Conclusion
  • 4. Introduction
    Osteoid osteomas are bone tumors less than 2 cm in greatest dimension and usually occur in patients in their teens and twenties.
    In fact, 75% of patients are under age 25.
    Osteoid osteomas can arise in any bone but have a predilection for the appendicular skeleton.
  • 5. 50% of cases involve the femur or tibia, where they commonly arise in the cortex.
  • 6. Osteoid osteomas are painful lesions.
    The pain is caused by excess prostaglandin E2 which is produced by the proliferating osteoblasts.
    It characteristically occurs at night and is dramatically relieved by aspirin.
  • 7. Special features
    Failure to increase in size with time
    Spontaneous regression
    Replacement by scar tissue
    These features are unlike those
    of other benign tumors
    suggesting that the etiology
    still remains an enigma.
  • 8. Incidence
    10-11% of all benign bone tumors
    2.5%-5% of all bone tumors
    First three decades of life
    Most common-second decade
    Most common-in men (2:1)
  • 9. Sites of predilection
    Diaphysis of femur and tibia
    Medial side of neck of femur
    Posterior elements of spine
    Humerus
    Phalanges of hand
    Fibula
    Talus
    Ribs
    Skull
  • 10. Symptoms
    Pain which has characteristic pattern described variously as sharp,dull,boring deep,or intense often worst at night and very frequently relieved by salicylates*(aspirin)
    Limp
    Muscular atrophy due to disuse
    Swelling and warmth if it is superficial
  • 11. Adjacent joint stiffness
    Scoliosis
    In children overgrowth and angular deformities
    Nerve root compression or cord compression
    Point tenderness over the lesion
  • 12. Gross Appearance
    Cherry red to gray red tissue
    Overlying cortex distorted
    Reactive periosteal new bone formation
    Nidus may vary
    from few mm to
    1.5 cm in diameter.
    Surrounding reactive bone
    usually thick hard and
    extensive..
  • 13. Microscopy
    Numerous osteoblasts forming highly irregular trabeculae of osteoid and woven bone
    Numerous osteoclasts
    Woven bone trabeculae variably mineralized
    Calcification more near centre of lesion.
  • 14. At times no calcification of nidus
    Surrounding bone shows reactive bone formation which is lamellar bone in contrast to woven bone of nidus
    Thin zone of fibrovascular tissue between nidus and reactive bone .
  • 15. Radiological findings
    Small to round to oval focus of decreased density called nidus .sometimes nidus also sclerotic.
    Surrounding area of sclerosis which is normal reactive bone .
  • 16. Lesions usually in diaphysis
    Mostly cortical sometimes inside medullary canal or subperiosteally
    Periosteal reaction when occurs is large but smooth in contrast to “codman triangle” of malignant lesions
  • 17. Bone scan
    Useful in detecting small lesions
    “Double density sign” which is a focal area of increased activity with a second smaller area of increased uptake superimposed on it is said to be diagnostic.
  • 18. CT scan and MRI
    Sometimes required to localise the lesion accurately.
  • 19. Osteoidosteoma. A lateral view (A) of the proximal tibia shows a very dense lesion in the posterior cortex. A darker central area contains a white nidus. This lesion in a 20-year-old man caused pain in this area, relieved by aspirin. B, A nuclear medicine bone scan in a different patient with an osteoidosteoma in the left lower tibia shows increased activity (arrows) at the site of the lesion.
  • 20. Osteoidosteomas, especially those that arise beneath the periosteum, usually elicit a tremendous amount of reactive bone formation that encircles the lesion. The actual tumor, known as the nidus, manifests radiographically as a small round lucency that is variably mineralized
    Specimen radiograph of intracortical osteoid osteoma. The round radiolucency with central mineralization represents the lesion and is surrounded by abundant reactive bone that has massively thickened the cortex.
  • 21. Why relief with aspirin !!!!
    High levels of prostaglandins present in osteoid osteoma which mediate pain receptor pathway
    Aspirin (salicylates) act as prostaglandin synthetase inhibitors
  • 22. Differential Diagnosis
    Osteoblastoma
    Osteosarcoma
    EosinophilicGranuloma
    Ewings Sarcoma
    Brodie’s Abscess
    Stress Fractures
  • 23. Treatment
    Surgical removal of lesion
    To relieve pain.secondary manifestations like synovitis ,scoliosis, nerve root compression
  • 24. Principle of surgery
    Necessary to remove the “NIDAL” tissue
  • 25. Surgical options
    Block resection of the nidus
    Increases risk of subsequent # if lesion is in cortical bone
    Alternative method is to shave the reactive bone with sharp osteotome until the nidus is exposed ,then curette the exposed nidus
  • 26. Intraoperativelocalization of nidus possible with pre operatively injected technetium labelledmethylenediphosphonate and sterile wrapped geigercounter.
    Intraoperativexrays of excised specimen to document complete removal of nidus
  • 27. Excision of nidus using CT assisted localization
    K-wire inserted into the nidus
    Biopsy punch inserted over k-wire
    Percutaneous CT guided resection using a trephine 2mm larger then the lesion to ensure complete removal.
  • 28. Radiofrequency ablation
    Done percutaneously
    Initial core needle biopsy after which radiofrequency electrode is inserted through cannula of biopsy needle
    Temperature at the tip raised to 90 degrees centigrade for 6 minutes
    Results:claim to be equivalent to surgical excision
    Used only in extraspinal lesions that are away from neurovascular structures
  • 29. Conclusion
    Osteoid osteomas’ are considered benign and are normally treated by conservative surgery. However there is a possibility of malignant transformation. This is rare except when treated with radiation, which promotes this complication.

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