Giant osteoblastoma of temporal bone: case report

Abstract

-Benign osteoblastoma is an uncommon bone tumor accounting for approximately 1% of all bone tumors. There are only 35 cases of skull osteoblastoma reported in the literature. We describe the case of a 23 year old male with a giant osteoblastoma of temporal bone submitted to a total removal of the tumor after an effective embolization of all external carotid branches. The authors discuss diagnostic and management aspects of this uncommon skull tumor.KEY WORDS: osteoblastoma, temporal bone, embolization. Osteoblastoma gigante de osso temporal: relato de casoRESUMO -Osteoblastoma é tumor benigno raro representando cerca de 1% de todos os tumores ósseos. Até o momento apenas 35 casos com acometimento craniano foram descritos na literatura. Os autores descrevem um caso de osteoblastoma gigante de osso temporal em paciente de 23 anos do sexo masculino. O tumor foi completamente ressecado após embolização de ramos nutrientes oriundos da carótida externa. São discutidos aspectos diagnósticos e terapêuticos deste raro tumor craniano. PALAVRAS-CHAVE: osteoblastoma, osso temporal, embolização.Benign osteoblastoma is an uncommon bone tumor accouting for approximately 1% of all bone tumors 1 . This neoplasm was initially reported by Jaffe and Mayer in 1932 under various names such as "osteogenic fibroma of bone" and "giant osteoma osteoid" 2 . The current term was proposed in 1956 by Jaffe 3 and Lichtenstein 4 . Since then, there was an increasing number of cases reported in the literature, most of them arising in the axial skeleton ( spine and major long bones of the lower extremities ).Skull lesions have been sporadically described and count for 2.3 to 20% of all cases 4,5 , most of them in the temporal bone. Their incidence is still controversial but there is no more than 35 cases of skull osteoblastoma reported in the literature. We present a case of a giant temporal osteoblastoma and discuss the best pre and intraoperative management of these patients. CASE REPORTA 23 year old male presented with a 3 years history of headache and swelling in his left temporal region associated with hearing impairment in the ipsilateral ear. The local examination disclosed a hard and painful mass in the left temporal bone with extension to the parietal region. Neurological examination was normal except

Clinical characteristics and diagnostic imaging of cranial osteoblastoma

“…It can occur within any cranial bone but occurs most commonly in the temporal (31%), frontal (22%), and ethmoid (22%) bones [15,20,37,41,42,57]. It is more common in the skull base than in the cranial vault bones [35,37,39,56]. Whether by origin or by extension, the lesion can involve the orbit, the auditory pathway, and the nasal and paranasal cavities [14].…”

“…Of 18 reported cases of temporal bone osteoblastomas, five presented with symptoms of cranial nerve VII and/or VIII involvement or conductive hearing loss. The symptoms include tinnitus, hearing loss or disturbance, hypogeusia, facial hemiparesis, and intermittent bleeding [25,31,34,39,42,46,[49][50][51]58]. On examination, a mass may be visualized protruding into the external auditory canal [25,31,34,46,49,51].…”

“…It has been reported that high T2 signal areas correlate to the presence of focal osteoid production [78]. Nearly all lesions demonstrate at least heterogeneous contrast enhancement [10,14,16,18,[39][40][41][42][43]45,51,55,[57][58][59][65][66][67]71,77,[79][80][81].…”

“…It is usually differentiated from osteoblastoma based on size: osteoid osteoma are static lesions less than 1 to 2 cm in diameter, while osteoblastomas are capable of growth and are frequently greater than 2 cm in size [87,88]. Osteoid osteomas more commonly occur in the cortex rather than the medulla and do not expand the diploe, and they can have intense hyperostotic reaction around the lesion [15,22,39]. They also tend to be less vascular than osteoblastomas [26].…”

Multifocal osteoclastoma of the skull: case report

“…In addition to local intraosseous recurrence, surgery-related contamination may lead to implantation of cells of the tumor in the perilesional soft tissues in 10 -15% of patients. The use of radiotherapy should probably be limited to lesions that cannot be subjected to total excision, and that is an issue for further literature discussion [12][13][14][15] .…”