Atypical osteoid osteomas

Abstract

Osteoid osteoma is a very painful benign bone tumor that affects young adults. It is exceptional before 5 and after 30 years of age. It can be seen in any part of the skeleton. Presentation of the tumor may be intracortical, juxta-cortical or cancellous. In long bones, the tumor is frequently intracortical, and in the spine, it is usually located at the posterior elements. Osteoid osteomas having radiologic and clinical features other than classical presentation of osteoid osteoma are called atypical osteoid osteomas. Atypical osteoid osteomas are important because the diagnosis and treatment are often complicated in these cases. Misdiagnosis with prolonged impairment and sometimes overtreatment appears as a major problem concerning atypical osteoid osteomas. This paper gives brief general information about the classical presentation of osteoid osteoma, discusses the pathogenesis of the lesion and focuses on the clinical presentation, radiologic features and characteristics of atypical osteoid osteomas as well as their treatment modalities.

Partial excision of the nidus of an atypical cancellous osteoid osteoma by use of a bone marrow biopsy needle under fluoroscopic guidance

“…Classical invasive surgical methods to treat an OO include en bloc resection and burr-down excision techniques. However, percutaneous radiofrequency ablation and percutaneous laser coagulation have become popular as minimally invasive techniques [2,9,10,12]. Other minimally invasive techniques include CT-guided excision [13,14] and excision with arthroscopy [15].…”

“…A CT scan with contrast is preferable to differentiate these lesions from an OO. Legg Calve Perthes disease also has to be considered in cases without typical imaging findings [12]. Epiphyseal OOs may occur in or near intra-articular sites and may occasionally present with clinical findings ranging from joint effusion to decrease in range of movement.…”

Benign Bone Tumors about the Hip

“…Ciftdemir et al summarized the reports in the literature of multicentric osteoid osteomas and other atypical findings. 38 Treatment of osteoid osteomas is dependent on the location of the lesion. Generally, the first-line treatment is an NSAID with observation as many of these lesions are selflimiting.…”

“…While osteoblastomas are most common in posterior elements of the spine, the long bones are affected in 30% of cases, with a predilection for the femur and tibia. 38 On X-ray, these tumors appear as lytic or mixed lyticblastic lesions with a radiolucent nidus surrounded by sclerotic bone. However, in the hip region, the initial radiographic changes are often atypical, leading to a misdiagnosis and delay of treatment.…”

Benign Pediatric Tumors and Tumor-Like Conditions of the Hip

“…OOs generally present with a single nidus; however, multicentric OOs have been described in the literature. 19 A bone scan can help to detect lesions in other areas of the body as OOs exhibit an intense area of focal uptake at the nidus. Cross-sectional imaging, such as a CT or MRI can be used to better visualize and localize the tumor.…”