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This document provides a summary of 50 cases of osteoid osteoma and osteoblastoma. Case 1-50 cover osteoid osteoma, with the classic presentation of a painful nidus most commonly in long bones that is diagnosed using imaging such as CT scan and bone scan. Case 51-94 cover osteoblastoma, a larger variant of osteoid osteoma that is treated surgically via curettage. The remainder of cases provide further examples and variations of these two conditions.
Vol 1 ppt
- 1. Contents for Volume1 Osteoid osteoma--------------------------------Case 1-50 Osteoblastoma----------------------------------Case 51-94 Osteofibrous dysplasia-------------------------Case 95-101 Ossifying fibroma of jawbone----------------Case 102-107
- 2.
- 3. Osteoid Osteoma The osteoid osteoma is the most common osteoid-forming tumor seen in the skeletal system, accounting for 10% of all benign bone tumors. It is more common in males than females with the peak incidence in the second decade of life. The lesions produce symptoms of dull, aching pain that is more severe at night. The pain is relieved with anti-inflammatory medication such as aspirin or non-steroidal anti-inflammatory drugs (NSAID) that inhibit the high concentration of prostaglandins found in the nidus of the osteoid osteoma. The lesions occur typically in the cortical structures of long bones such as the femur or tibia but can also be found in the small bones of the ankle, wrist or vertebral column. The lesion is characteristic for its dense, sclerotic response in the cortical bone resulting in a fusiform enlargement on the surface of the cortex as a response to the small inflammatory nidus or granuloma (measuring up to one
- 4. centimeter in diameter)in the central area of the sclerotic response. If the lesion is located in a central medullary area, such as the metaphysis or on the very superficial surface of a bone, the sclerotic response is less severe. If the nidus is located close to or within a joint structure, as in the femoral neck area, there will be a significant inflammatory synovitis in the adjacent joint that gives the clinical appearance of a pyarthrosis. In the spine, the lesions are usually located in the posterior elements of the spine such as the laminae or pedicles. The lumbar spine is the most common location followed second by the dorsal spine. Atypical secondary painful scoliosis will develope with the convexity seen on the side opposite the inflammatory lesion. The two most significant diagnostic imaging studies are a CT scan through the nidus area to identify its anatomic location and a bone isotope scan which is invariably positive, especially in a symptomatic lesion. It is the current feeling that the osteoid .
- 5. osteoma is atrue benign neoplasm of bone in which a com- bination of osteoclastic and osteoblastic activity are seen. There are no inflammatory cells such as lymphocytes or plasma cells as would be seen in a Brodie’s abscess. Non- steroidal anti-inflammatory medications such as prostaglandin inhibitors can be very effective in controlling the disabling symptoms and helping the patient get thru a period of one or two years during which time the lesion will typically involute into 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 the lesion, a high speed burr is used to burr into the inflammatory bone that is characterized by a pinkish hyperemia. When the nidus is found, a small curette is used to core the inflammatory nidus for pathological diagnosis and the cavity of the nidus is burred an additional 2 or 3 mm which usually results in a very dramatic relief of symptoms and a permanent cure from the
- 6. disease process. Itis not necessary to remove the large dense sclerotic bone surrounding the nidus; doing so could result in a pathologic fracture following surgery. In the spine, a simple laminectomy is frequently carried out. If the lesion is located in the pedicle a simple burring into the pedicle will relieve the patient of the inflammatory pain. More recently, relatively non-invasive techniques have been tried to remove the nidus of the osteoid osteoma by means of a CT guided burr placed through a protective trocar or by place- ment of a heat-producing radio frequency probe that, when properly positioned, can destroy the nidus through thermal coagulation. These techniques are particularly valuable for deep- seated lesions located in the acetabulum. For lesions located in the pedicle of a vertebra one must be careful not to damage an adjacent spinal root or spinal cord.
- 7. CLASSIC Case #1 19 yrold female painful Osteoid osteoma nidus femur
- 9. CT scan nidus
- 10. Macro section ofnidus
- 11.
- 12. Case #2 29 yearmale osteoid osteoma femur nidus
- 13. CT scan nidus
- 14. Case #3 11 yr male osteoid osteoma femur
- 15.
- 16. CT scan nidus
- 17.
- 18. Case #4 nidus 5 yr male osteoid osteoma femur
- 19. Case #5 12 yrmale osteoid osteoma femur nidus
- 20. Case #6 10 yrmale osteoid osteoma femur nidus
- 21.
- 22.
- 23. Case #7 30 yrfemale osteoid osteoma femur nidus
- 24.
- 25. nidus edema Axial PD MRI
- 26.
- 27. Case #7.1 Parosteal osteoid osteoma 6 year male with throbbing pain left hip for 3 months
- 28. CT scan Bone scan
- 29. Cor T-1 STIR Gad
- 30. Axial T-1 T-2
- 31. Case #8 23 yrfemale osteoid osteoma femur nidus
- 32.
- 33. Nidus CT Scan
- 34. Case #9 12 yrmale osteoid osteoma femur nidus
- 35.
- 36.
- 37. Case #10 nidus 10 yr female with osteoid osteoma femoral neck
- 38.
- 39. One year aftercurettement
- 40. Case #11 nidus 25 yr male with osteoid osteoma femoral neck
- 41.
- 42. Case #12 nidus 6 yr male osteoid osteoma acetabulum
- 43.
- 44.
- 45. Case #13 nidus 11 yr male osteoid osteoma distal femur
- 46.
- 47. Case #13.1 OO distal femur 8 year old male with dull aching pain right distal thigh 3 mos
- 48.
- 49. Axial T-2 Gad
- 50.
- 51. Case #14 nidus 16 yr male osteoid osteoma distal femur
- 52. Case #15 6 yrmale osteoid osteoma tibia nidus
- 53.
- 54.
- 55.
- 56.
- 57.
- 58.
- 59. Case # 16 10yr male osteoid osteoma tibia
- 60. Shaving down withosteotome
- 61. Further shaving tofind nidus
- 62. Burred out nidusdefect
- 63. Case # 17 15yr male osteoid osteoma tibia
- 64. Lateral view nidus
- 65.
- 66. Coronal T-2 MRI nidus
- 67. Coronal Gad contrast MRI edema nidus
- 68.
- 69.
- 70.
- 71. Case #17.1 Osteoid osteoma 52 year old male with ankle pain for 3 mos.
- 72. Sag T-1 T-2 Gad
- 73. Axial T-1 T-2 Gad
- 74. Case #18 nidus 17 yr male osteoid osteoma femur
- 75. Gross specimen nidus
- 76.
- 77. Case #19 18 yr male Osteoid osteoma tibia
- 78. Case #20 18 yrfemale osteoid osteoma nidus tibia
- 79. Case #21 nidus 12 yr male with parosteal osteoid osteoma tibia
- 80. Case #22 nidus 17 yr male osteoid osteoma fibula
- 81.
- 82. Case #23 nidus 26 year female with epiphyseal osteoid osteoma prox radius
- 83. Case #24 16 yrfemale osteoid osteoma ulna nidus
- 84.
- 85. Case #25 16 yrmale osteoid osteoma humerus nidus
- 86. Case # 26 nidus 14 yr male osteoid osteoma L-4
- 87.
- 88.
- 89. Case # 27 nidus 15 yr male osteoid osteoma L-3
- 90. Case #28 nidus 46 yr male osteoid osteoma dorsal spine
- 91.
- 92. Case #29 nidus 18 yr male with osteoid osteoma C-3
- 93.
- 94.
- 95. Case #30 nidus 12 yr male with osteoid osteoma C-3 spine
- 96. Case #31 nidus 25 yr male osteoid osteoma C-5
- 97. Case # 32 nidus 27 yr female with osteoid osteoma S-1
- 98. Case #33 nidus 22 yr male with osteoid osteoma sacrum
- 99. Case #34 nidus 18 yr male osteoid osteoma finger
- 100.
- 101.
- 102. Case #35 nidus 24 yr male with osteoid osteoma thumb
- 103.
- 104. Case #36 nidus 19 yr female with osteoid osteoma finger
- 105. Case #37 nidus 20 yr male with osteoid osteoma thumb
- 106. Case #37.1 nidus 17 year female with dull aching pain index finger 1 yr
- 107. Case #38 nidus 23 yr male with osteoid osteoma capitate
- 108. Case #39 nidus 25 yr male with osteoid osteoma narvicular
- 109. Case # 40 nidus 34 yr female with osteoid osteoma 2nd metatarsal
- 110.
- 111.
- 112. Case #41 nidus 24 yr female with osteoid osteoma big toe
- 113.
- 114.
- 115.
- 116. Case #42 nidus Osteoid osteoma talus
- 117.
- 118. Case #43 Osteoid osteoma pseudotumor Brodie’s abscess 13 yr female tibia nidus
- 119.
- 120. Case # 44 Osteoidosteoma pseudotumor Brodie’s abscess nidus tibia 38 yr male
- 121. nidus Axial T-2 MRI
- 122. Case #44.1 Brodie’sabscess femur 42 year old male with the flue 2 mos ago followed by acute onset of pain R thigh
- 123. CT scan AP Lat
- 124. Axial T-1 Gad
- 125.
- 126. Case #45 pseudo-nidus fracture line Osteoid osteoma pseudotumor stress fracture femoral neck 38 yr male
- 127.
- 128. Case #46 Osteoid osteoma pseudotumor 33year female Early stress fracture femoral neck with pain for 3 mos
- 129.
- 130.
- 131. Case #47 Pseudo nidus Osteoid osteoma pseudotumor stress fracture femoral neck 50 yr female
- 132.
- 133.
- 134. Case #48 OO pseudotumor Stress fracture 20 year old male with pre-tibial pain for 3 months
- 135. Sag T-1 PD Gad
- 136. Case #49 Pseudo osteoid osteomafemur Chronic stress periostitis from adductor pull 14 yr male
- 137. Pseudo nidus CT scan
- 138.
- 139. Case #50 Pseudo osteoid osteomafemur 38 yr male Bone island
- 140.
- 141. Coronal T-1 MRI Pseudo nidus
- 142.
- 143. Osteoblastoma The so-called osteoblastoma is considered by most to be a large or giant form of the similar clinical entity known as the osteoid osteoma. As with the osteoid osteoma, it is found in children and young adults, more often in males than females. It is less common than the osteoid osteoma, representing approximately 1% of all bone tumors. It is found mostly in metaphyseal areas of long bone and in the posterolateral elements of the axial skeleton where nearly 50% of the lesions are identified. Radiographically these lesions are more osteolytic than the osteoid osteoma and have a central nidus that measures more than 1.5 cm in diameter with less reactive sclerosis seen at the periphery than an osteoid osteoma. It is not unusual for an aneurysmal component to be associated with the osteoblastoma, similar to the reaction seen adjacent to chondroblastomas and giant cell tumors. The micro- scopic appearance of the nidus material is almost identical to
- 144. that of theosteoid osteoma and under higher power cannot be differentiated by even the most competent pathologists. The major concern is a microscopic appearance similar to an osteo- sarcoma and, for this reason, multiple samples must be evaluated in order to establish the correct diagnosis in cases where these lesions arise from the metaphyseal areas of long bone. In the spinal area, the osteoblastoma is typically located in the posterolateral elements where it can cause problems with spinal cord or nerve root compression that may require aggressive surgical decompression and even spinal stabilization. On occasion an 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 with a fairly aggressive curettement of the lesion. There is no particular reason to take wide margins because the recurrence rate is quite low and in some cases the lesions resolve spontaneously with out any surgery at all, similar to what occurs with osteoid osteomas.
- 145. A variant ofthe osteoblastoma, the so-called aggressive or “malignant” osteoblastoma, is a clinical entity halfway between the classic benign osteoblastoma and a full blown malignant osteo- sarcoma. This “malignant” osteoblastoma appears and behaves clinically at the local site like an osteosarcoma but has no potential to metastasize to distant parts. In this situation, local treatment must be more aggressive and probably would require a wide local resection to avoid a local recurrence because radiation therapy or even systemic chemotherapy is not effective for this aggressive but benign entity.
- 146. CLASSIC Case #51 26 yrmale osteoblastoma L-4
- 147.
- 148.
- 149.
- 150.
- 151.
- 152.
- 153. 5 yrs postop with spontaneous fusion
- 154. AP x-ray 5yrs post op
- 155. Sagittal gad contrastMRI 5 yrs post op
- 156. Axial gad contrastMRI 5 yrs post op
- 157. Case #52 nidus 23 yr male with osteoid osteoma L-5
- 158.
- 159.
- 160.
- 161. Recurrence Recurrence 8 mospost op laminectomy
- 162. CT Recurrence as an osteoblastoma
- 163. Secondary ABC behind osteoblastoma Sagittal T-2 MRI ABC osteoblastoma
- 164. fluid-fluid level Axial T-2 MRI
- 165.
- 166.
- 167.
- 168.
- 169. Post op posterior resectionand fusion
- 170. AP x-ray post opfusion
- 171. CT scan latershows anterior recurrence
- 172. Post op anterior resectionand bone cement reconstruction
- 173. Lateral x-ray showing anteriorreconstruction with cement cement
- 174. cement bone graft CD rods Post op CT scan showing cement reconstruction
- 175. cement graft Post op CT
- 176. Case #53 surgical towel clip 26 yr male with osteoblastoma L-4 following a laminectomy curettement three years ago for an osteoid osteoma
- 177. CT scan Appearance 4months later with a 1.5 cm nidus
- 178. A curettement atthis time revealed an osteoblastoma
- 179.
- 180. burned-out lesion CT scan at same time and no pain
- 181.
- 182. Burnt out lesion Sagittal T-1 MRI at same time
- 183. Sagittal T-2 MRIsame time
- 184. T-2 MRI withresidual ABC in inactive lesion
- 185. Axial T-1 MRIsame time
- 186. Axial T-2 MRIwith residual ABC component
- 187. Case #54 7 yrfemale osteoblastoma L-2
- 188.
- 189. T-2 MRI shows highsignal ABC posterior to low signal osteoblastoma osteoblastoma ABC
- 190. osteoblastoma Sagittal ABC T-2 MRI
- 191.
- 192. AP x-ray post opposterior spinal fusion
- 193.
- 194. Case #55 14 yrfemale osteoblastoma L-5
- 195.
- 196.
- 197.
- 198.
- 199. Case #56 24 yr male with osteoblastoma L-3
- 200.
- 201.
- 202.
- 203. Case #57 22 year male with osteoblastoma L-1 vertebra
- 204.
- 205. Case #58 23yr male with burned out osteoblastoma L-4
- 206. Case #59 14 yrmale osteoblastoma C-3
- 207.
- 208.
- 209. One year post opposterior fusion and recurrent tumor anterior
- 210.
- 211. Post op anterior debriedmentand fusion
- 212. Case #60 18 yrmale osteoblastoma C-7
- 213.
- 214. Lateral view 2 molater
- 215. AP view 1 molater
- 216.
- 217.
- 218.
- 219. Case #61 CT scan 55 yr female with osteoblastoma C-6
- 220.
- 221.
- 222.
- 223.
- 224. Case #62 25 yr female with osteoblastoma C-6
- 225.
- 226.
- 227. Lateral view 10yrs later
- 228.
- 229.
- 230. Case #63 CT scan 40 yr male with osteoblastoma C 5-6
- 231.
- 232.
- 233. Sagittal T-2 MRI showing bulgein floor of vertebral canal
- 234. Case #64 13 yr female with osteoblastoma C-6
- 235.
- 236. Post op X-ray Afteranterior interbody fusion
- 237. Case #65 AP X-ray 14 yr female with osteoblastoma C-7
- 238.
- 239. Arteriogram showing pressure onvertebral artery
- 240.
- 241. Case #66 CT scan 43 yr female with osteoblastoma T-8
- 242.
- 243.
- 244. Post op posterior spinefusion
- 245. Case #67 28 yr male with osteoblastoma thoracic spine
- 246.
- 247.
- 248. CT scan postop resection
- 249. Case #68 21 yrmale osteoblastoma S-1
- 250.
- 251.
- 252. Lateral view 5years later
- 253.
- 254.
- 255. Case #69 8 yr male with ostoblastoma sacrum
- 256. Case #70 26 yr female with osteoblastoma acetabulum
- 257.
- 258.
- 259.
- 260.
- 261. Case #71 19 yr male with aggressive osteoblastoma acetabulum
- 262.
- 263. Gross specimen fromcurettement
- 264.
- 265.
- 266.
- 267. Recurrence 4 monthslater
- 268.
- 269. tumor Hemipelvectomy specimen
- 270. Several years laterwith recurrent tumor on sacrum
- 271. Lateral view ofrecurrence
- 272. Case #72 38 yrmale osteoblastoma pelvis
- 273.
- 274. Post op x-rayfollowing curettage and cementation
- 275. Case #73 33 yr female with osteoblastoma acetabulum
- 276.
- 277.
- 278. Case #74 26 yr male with osteoblastoma acetabulum
- 279.
- 280. Case #75 24 yr male with osteoblastoma pelvis
- 281.
- 282. Case #76 22 yr male with osteoblastoma ischium
- 283. nidus X-ray of resectedspecimen
- 284. Case #77 26 yr male with osteoblastoma ilium
- 285.
- 286. Post op x-rayappearance after resection and cementation
- 287. Case #78 23yr male osteoblastoma femur
- 288.
- 289.
- 290.
- 291.
- 292. Case #78.1 19 yearmale with tibial pain for 6 mos
- 293. T-1 T-2 Gad + Axial
- 294. Coronal T-1 T-2 Gad
- 295. X-ray 3 monthspost op
- 296. Case #79 15 yrmale osteoblastoma femur
- 297.
- 298.
- 299.
- 300.
- 301. X-ray at timeof surgery with marker in tumor defect
- 302.
- 303. Case #79.1 CT scan Sclerosing osteomyelitis of Garre 14 yr male with dull aching thigh pain for 1 year
- 304. Coronal T-1 Coronal T-2
- 305. Sagittal T-2 Axial T-2
- 306. Case #80 13 yr male with osteoblastoma femoral neck frog leg lateral view
- 307.
- 308.
- 309. Case #81 22 yr male with osteoblastoma talus
- 310.
- 311.
- 312.
- 313.
- 314. Case #82 25 yrmale osteoblastoma talus
- 315.
- 316.
- 317.
- 318. Case #83 18 yr female with osteoblastoma talus
- 319.
- 320. X-ray 1 yrafter curettage
- 321. Case #84 23 yr male with osteoblastoma talus
- 322. Case #85 25 yr female with osteoblastoma os calcis
- 323.
- 324. X-ray several monthslater with progression of disease
- 325. Case #86 29 yr male with osteoblastoma os calcis
- 326. Case #87 53 yr male with osteoblastoma distal humerus
- 327. X-ray 3 yearslater
- 328. tumor edema Axial T-2 MRI
- 329. edema nidus Coronal T-2 MRI
- 330. Post op x-ray followingdistal humeral resection and allograft reconstruction
- 331. Case #88 9 yrfemale osteoblastoma distal humerus
- 332. Coronal T-1 MRI edema
- 333. tumor edema Axial T-2 MRI
- 334. Case #88.1 nidus 11 yr male with ABC response to osteoblastoma humerus
- 335.
- 336. Axial T-2 MRIshows the multiloculated aneurysmal cysts
- 337. Case #89 21 yr male with osteoblastoma ring finger
- 338. AP and Lateralradiographs
- 339.
- 340.
- 341. Case #90 18 yr male with osteoblastoma finger
- 342. Case #91 21 yr male with osteoblastoma thumb
- 343. Case #92 10 yr female with osteoblastoma finger tip
- 344.
- 345. Case #93 9 yrfemale osteoblastoma tibia
- 346.
- 347. Case #94 24 yr male with osteoblastoma fibula
- 348.
- 349.
- 350. Osteofibrous Dysplasia Osteofibrous dysplasia is a rare condition occurring in children less than 10 years of age. This benign lesion has radiographic and microscopic features similar to fibrous dysplasia of the tibia, the main difference being the presence of more heavily ossified tissue at the periphery of the lesion giving it a soap-bubbly appearance on x-ray. Microscopically it has a similar “alphabet-soup” metablastic bone appearance in a benign fibrous tissue stroma but with the additional feature of heavy osteoblastic rimming of the trabeculae not seen in fibrous dysplasia. It typically arises from the anterior cortex of the tibia at mid shaft and causes a progressive anterior bowing of the tibia over time, creating a cosmetic deformity associated with pain of a dull, aching nature. The radiographic appearance is very similar to and impossible to separate from that of the malignant adamantinoma that also affects the tibia in children
- 351. and, for thisreason, a biopsy must be performed to rule out the malignant possibility. Occasionally osteofibrous dysplasia of the tibia can progress gradually into a well-differentiated form of the adamantinoma, which will have the microscopic features of both osteofibrous dysplasia and adamantinoma in the same lesion. As far as treatment is concerned, early surgical debriedment and bone grafting before age 15 years results in a high local recurrence rate and thus should be discouraged until the child reaches full bone maturity at which time a definitive debriedment and bone grafting procedure can be performed without significant risk of recurrence. This lesion occurs bilaterally in a very small percentage of cases and can also involve the fibula on the same side. This process in newborns appears to be more osteolytic and destructive in nature.
- 352. CLASSIC Case #95 9yr male osteofibrous dysplasia tibia
- 353. AP and lateralx-ray
- 354.
- 355. Case #96 6year female osteofibrous dysplasia tibia
- 356.
- 357. Case #97 16year female osteofibrous dysplasia tibia
- 358. Case #98 8yr male osteofibrous dysplasia tibia
- 359.
- 360. 8 yrs laterwith spontaneous healing
- 361. Case #98.1 Burned out osteofibrous dysplasia 61 year old male with incidental finding in tibia for years
- 362.
- 363. Sag T-1 PD FS Gad
- 364. Cor STIR Gad
- 365. Axial T-1 T-2 FS Gad
- 366. Case #99 15yr female osteofibrous dysplasia tibia AP x-ray
- 367.
- 368. Case #99.1 1-09 Osteofibrous dysplasia 15 yr female with tender lump over tibia for years
- 369. 4-2010 New onset ofpain in knee
- 370. 4-2010 Cor T-1 T-2 Gad
- 371. Sag T-1 T-2 Gad
- 372. Axial T-1 T-2 mid tibia Gad
- 373. Axial T-1 T-2 Upper tibia Gad
- 374. Distal osteofibrous dysplasiaphotomic Proximal osteosarcoma photomic
- 375. Surgical reconstruction withrotating hinge Compress prosthesis
- 376.
- 377. Case #100 Newborn with osteofibrous dysplasia tibia
- 378.
- 379.
- 380.
- 381. X-ray 1 yrlater
- 382. Case #101 Another newborn osteofibrousdysplasia tibia
- 383.
- 384. Ossifying Fibroma of Jawbone
- 385. Ossifying Fibroma ofJawbone Ossifying fibroma of jawbone is a benign condition similar to osteofibrous dysplasia of the tibia in that histologically they are almost identical. It is also a condition that is related to fibrous dysplasia, which can have a very similar radiographic appearance, but in the case of fibrous dysplasia of jawbone osteoblastic rimming of the trabecular bone is not seen under microscopic evaluation. As with fibrous dysplasia, this condition is found in children and is almost always an asymptomatic process resulting in cosmetic deformation of the maxilla or mandible, usually on one side but can be bilateral. The condition can result in significant malocclusion of the teeth because of deformation of the subadjacent alveolar ridge or maxillary structures. It also can create problems with normal drainage from the air sinuses in the maxilla that can lead to infection requiring surgical drainage. Most of the surgical treatment for this condition is for cosmetic deformity.
- 386. Case #102 5yr female ossifying fibroma maxilla
- 387.
- 388.
- 389.
- 390.
- 391.
- 392.
- 393. Case #103 18 yr female with ossifying fibroma mandible
- 394.
- 395.
- 396. Close up ofalphabet soup metaplastic bone
- 397. Case #104 tumor 12 yr female with ossifying fibroma mandible
- 398.
- 399. Case #105 14 yr female with ossifying fibroma mandible
- 400. Case #106 Youngadult tumor osteoma skull
- 401.
- 402.
- 403. Case #107 Cementoma mandible
- 404.