Clinicopathologic Features and Treatment of Osteoid Osteoma and Osteoblastoma in Children and Adolescents

Frassica, Frank J.; Waltrip, Robert L.; Sponseller, Paul D.; Loralie, D.; McCarthy, Edward F.

doi:10.1016/s0030-5898(20)32101-5

Cited by 173 publications

(38 citation statements)

References 53 publications

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“…Radiographically, as has been described elsewhere, 7,8 the presence and thickness of the sclerotic ring is less noticeable when the location is intra-or juxta-articular, which may further complicate diagnosis. OO in the bones of the foot does not usually present the typical ring-like x-ray images, and many changes may be seen, including generalized osteoporosis of the foot, an area of homogeneous or heterogeneous opacity without a clear halo, sclerotic cortical thickening with periosteal reaction, or a periosteal reaction surrounded by a geode.…”

Section: Discussionmentioning

confidence: 82%

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confidence: 99%

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Intra-Articular Osteoid Osteoma of the First Metatarsal

et al. 2013

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Osteoid osteoma (OO) is a solitary benign bone-forming tumor, which accounts for approximately 10% of all benign bone tumors. 8 Although most publications attribute the first report to Jaffe in 1935, 3,13 Bergstrand was probably the first to describe two cases, in 1930. 16,25,29 OO appears most commonly between the second and third decades of life, usually in men. 16,23,25 The most frequent location is in the cortical region of the diaphysis of long bones (especially the femur, tibia, and humerus), mainly in the lower limbs. The foot is only rarely involved. 27 In a review of a series of 860 cases of OO, Jackson found an incidence of less than 4% in the foot and of 1.7% in the metatarsals. 12 The typical clinical presentation is severe pain, in spite of the small size of the tumor. This pain is predominantly nocturnal and typically remits with anti-inflammatory drugs; 16 there is usually an increase in local temperature. 14 If the lesion is superficial there may also be slight local swelling, which may raise the suspicion of an infection. 9,24 The typical radiographic image when the tumor affects the cortical region shows a hypodense hypervascular focal area, or nidus, usually less than 1 cm in diameter, surrounded by a thickening of the cortical region of the reactive bone.Atypical location and clinical symptoms may hinder diagnosis. Shereff et al reported that this tumor is often located in the cancellous bone, or in the subperiosteal region in the small bones of the foot. 23 In these cases x-ray will not produce the standard image; in many cases the cortical reinforcement limiting the nidus is missing. 24,26 Moreover, when the OO is intra-articular, the symptoms may include arthritis as the tumor may cause inflammation of the synovium, thus adding the range of inflammatory joint diseases to the differential diagnosis and complicating clinical diagnosis even further. 7,24,25,27,29 Case Report A 26-year-old woman consulted for pain in the first metatarsophalangeal joint of the right foot over 7 months, with no previous history of trauma. The patient presented with swelling and slightly increased local temperature and painful limitation of joint mobility. The pain was worse at night, but remitted partially with oral anti-inflammatory drugs. Local palpation exacerbated the pain. There were no neurovascular disorders in the limb, and laboratory parameters were within normal limits. Plain x-ray ( Figure 1) showed a lytic lesion of about 4 mm in diameter on the dorsal side of the first metatarsal head. Bone scintigraphy with technetium-99 ( Figure 2) revealed a nonspecific focal increase in isotope uptake, located in the dorsal area of the first metatarsal head, which may have corresponded to an arthropathic process or even to a stress fracture. This picture was confirmed on CT (Figure 3), which detected an osteolytic lesion less than 1 cm in the first metatarsal head, with a sclerotic central area surrounded by a faint sclerotic rim, suggesting an osteoid osteoma. The lesion extended to the articular cartilage at th...

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Section: Discussionmentioning

confidence: 82%

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mentioning

confidence: 99%

Intra-Articular Osteoid Osteoma of the First Metatarsal

et al. 2013

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“…Some encourage its use as a valuable diagnostic tool, 32 while others find it to be equal or inferior to CT in revealing the nidus. 7,13 Intra-articular osteoid osteomas often have ambiguous symptomatic and radiographic presentations, which can lead to significant delays in diagnosis. This was demonstrated by Sendrozi et al, 32 who showed 3 times longer duration of symptoms before diagnosis when comparing intra-articular (26.6 mo) and extra-articular (8.5 mo) osteoid osteomas.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic Visualization and Assisted Excision of Osteoid Osteoma at the Knee

2007

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In describing 5 cases of benign osteoblastic tumors composed of osteoid and atypical woven bone, Jaffe 17 in 1935 introduced the term osteoid osteoma, although it had been previously described by Bergstrand 4 in 1930. Since then, this small (less than 1.5 cm), painful tumor has been reported in more than 1200 cases 19 and makes up approximately 10% of all benign bone tumors. 1,23 With a peak incidence in the first 3 decades of life, this tumor occurs approximately 3 times more commonly in males, 2,18 half of the time in the femur and tibia 11 and 13% of the time within a joint, with the most common site being the hip. 18,20 The typical patient with osteoid osteoma will have pain at night that is responsive to salicylates. In a young patient, this history, supplemented by classic imaging findings, tends to make the diagnosis of osteoid osteoma straightforward. However, if the tumor has intra-articular involvement, the diagnosis can become much more difficult, as an atypical picture may unfold both clinically and radiologically. 9,14,15,22 Clinically, the presence of joint effusions, synovitis, range of motion limitations, weakness, flexion deformity, atrophy, or contractures may exist. Radiologically, there may be a lack of characteristic osteoid osteoma imaging findings. 14,32 Although intra-articular involvement of osteoid osteomas have been described since 1935, there have only been 2 reported cases of osteoid osteomas within the synovial cavity of the knee. 6,16 From these reports, 1 was removed arthroscopically. In this article, we present the first published arthroscopic images of an osteoid osteoma at the knee joint and review the relevant literature.

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“…Classic clinical features of osteoid osteoma are the presence of a well-localized throbbing pain at night, relieved by analgesics and a limp. 5,6 Also, osteoid osteoma can cause leg length discrepancy or bowing of the extremity. 6 Juxta-articular osteoid osteoma is difficult to identify and can lead to misdiagnosis and delay in diagnosis.…”

Section: Osteoid Osteomamentioning

confidence: 99%

“…Localization is best done by bone scintigraphy. 5,8 Classic double density appearance in scintigraphy is highly specific for osteoid osteoma. 8 Additional imaging such as MRI may be useful in localization of the tumor nidus.…”

Section: Osteoid Osteomamentioning

confidence: 99%