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Osteoid osteoma in cancellous bone lacks the usual osteoblastic reaction that accompanies the classical cortical or juxtacortical osteoid osteoma. Familiarity with this type of presentation should instigate the appropriate diagnostic steps, including nuclear medicine studies using pin-hole collimation, and thin tomographic cuts.
A case of osteoid osteoma in the left lamina of the T-8 vertebra is reported. The roentgenograms of the thoracic spine showed a hyperostotic round mass with associated scoliotic changes and the myelograms revealed complete obstruction of the spinal subarachnoid space. By selective spinal angiography a peculiar ring-like vascular stain was visualized in the area of hyperostosis which may be characteristic of an osteoid osteoma.
Osteoid osteoma is a painful osteoblastic process. The pre-operative diagnosis is usually made by roentgenogram. Four surgically confirmed cases are examined where the preoperative diagnosis was clarified by bone scintigraphy. The clinical indications, the diseases process, the literature are reviewed.
Radiophosphate bone scans readily disclosed osteoid osteomas in 20 symptomatic patients, including nine patients whose radiographic findings had been negative. In five of the nine patients adjuvant radiogallium imaging was performed, and four showed a disproportionately low uptake relative to radiophosphate. When this occurs, osteoid osteoma can be distinguished from subacute osteomyelitis, which is particularly helpful if the radiograph is equivocal. Radiophosphate bone imaging's generally accepted excellent sensitivity in disclosing obscure symptom-producing focal bone disorders makes it the screening procedure of choice, especially if osteoid osteoma is considered in the differential diagnosis. Only abnormal areas need to be radiographed to add specificity and more precise delineation.
An osteoid osteoma, excised from the neck of the femur of a 23-year-old man, was cut into four 1.5 mm3 fragments and immediately transplanted into muscle pouches in athymic nude mice. One fragment was devitalized by lyophilization before implantation. The viable tumor cell xenografts grew, differentiated into uncalcified osteoid, and retained the characteristics of the original tumor. The killed implants were resorbed, but both the surviving viable and nonviable tumor tissue induced the connective tissue cells of the mouse host bed to proliferate and differentiate into normal cartilage and calcified bone. The mouse new bone deposits were remodeled and colonized by bone marrow, a tissue not seen in osteoid osteomas. These observations suggest that the sclerotic bone shell characteristic of osteoid osteomas may be an inductive reaction of host bed tissue to an osteoma cell product that is comparable to bone morphogenetic protein (BMP) produced by normal bone cells and transferred by normal bone matrix.
Osteoid osteomas occurred in siblings with a nearly simultaneous onset of symptoms, and with some unusual neoplastic characteristics. The combination of simultaneous occurrence and neoplastic change suggests that a viral or other infectious etiology is possible.
Excision of an osteoid-osteoma brings prompt and permanent relief from symptoms. Recurrence of pain indicates persistence or failure to totally remove the nidus (9 of 73 patients), and only rarely a true recurrence. Long symptom-free intervals may follow partial excision of the lesion.
Angiographic findings characteristic of osteoid-osteoma are described in two cases of osteoid-osteoma of the bones of the wrist. While the etiology of the disease is not understood, a developmental relationship between the osteoid-osteoma nidus and increased vascularity is suggested.
This report describes one case in which bone scintigraphy was helpful in establishing the diagnosis of osteoid osteoma and presents three other cases in which increased accumulation of 99mmTc-EHDP was found at the side of the osteoid osteoma. The study contributes to the observation by others that the osteoid osteoma occurs as a scintigraphic 'hotspot'. It is concluded that the diagnostic delay of the osteoid osteoma can be shortened when bone scintigraphy is performed more often and at an earlier stage in patients with unexplained bone pain or with a clinical history that leads to the suspicion of the presence of an osteoid osteoma.
Six cases of osteoid osteoma were studied histologically using the Gross technique. When the nidus is located centrally, it is reached by amyelinic fibers accompanying the vessel branches or as independent fibers. The pain is generally considered to reflect changes in vessel pressure and it could also be due to direct irritation of the nerve fibers included in or near the calcification focus.
Thirteen cases of osteoid osteoma of the phalanxes are reported: 10 fingers and 3 toes. Any phalanx may be affected, with no preference for a particular site, in the young adult. Segmentary tumefaction of the soft parts near the lesion is a more consistent sign than pain, which is often quite minimal. Radiographies demonstrate the increase in the size of the phalanx, whose matrix is condensed. All radiographic techniques must be used to determine the exact location of the nidus, that is always very small (1 to 2 mm), and whose total removal is the only guarantee of cure.
Osteoid osteoma is a relatively common benign tumor of bone which occurs most often in adolescents and young adults. The pattern of the pain with its characteristic response to aspirin and the roentgenographic findings make the clinical diagnosis easy and virtually certain. An example is presented to help the pediatrician become familiar with the tumor and its diagnosis.
Four cases of osteoid osteoma of the terminal phalanx--a very rare location--are presented. The clinical picture of cell cases is essentially the same, gradual swelling of the terminal phalanx with enlargement of the nail and pain, particularly at night and relievable by aspirin. The treatment was operative and of double value. 1. The osteoid osteoma is removed; 2. Cosmetic result is obtained by reduction of the size of the terminal phalanx.
A case of osteoid osteoma of the spine that recurred as an osteoblastoma 16 years after surgery is reported. Consequently, the authors suggest that osteoid osteoma and osteoblastoma originate from the same cellular element and are of the same nature. The only differences are their size and the reaction of the bone at the site of the lesion, which gives controversial clinical pictures and roentgenologic appearances, simulating two unrelated tumors.
A case of an osteoid osteoma occurring in the cervical spine and presenting as scapular and arm pain has been described. Correct diagnosis was delayed for 2 years. Plain radiographs may fail to demonstrate a lesion in the spine. Radiographic evaluation, when osteoid osteoma is a possibility, should include bone scanning. If the bone scan is abnormal, tomography of the area is indicated. If the diagnosis is still unclear, selective angiography may reveal the tumor blush typical of osteoid osteoma. In certain instances, a myelogram may be helpful to establish whether there is encroachment on the spinal canal or nerve root.
A study of 9 new cases of osteoid osteoma and 3 new cases of osteoblastoma demonstrated very similar histologic findings. Both lesions were extremely vascular and frequently showed areas with histologic features of an aneurysmal bone cyst. Differentiation between the 2 lesions often depended on their clinical features and radiographic appearances. A review of 851 osteoid osteomas and 181 osteoblastomas from the literature supported a difference, however, in the natural history of the 2 lesions with osteoid osteomas tending toward regression, and osteoblastomas tending toward progression and possible late malignant transformation. Osteoid osteomas were found to have a 4.5% recurrence rate compared with a 9.8% recurrence rate for osteoblastomas (p less than 0.01). No recurrence has ever been reported after complete en-bloc resection of either lesion and this must be considered the surgical treatment of choice for both lesions where possible. Despite apparent incomplete excisions, cures are achieved in many cases among both lesions.
A long-term follow-up of three patients suffering from osteoid osteoma who have not undergone surgery is reported. Only eight similar cases have been reported in the literature. It is shown that over a period of years the pain of osteoid osteoma eventually disappears but the radiological appearance may remain unaltered or gradually resolve. Surgical management of osteoid osteoma is advised because of the prolonged symptoms.
Three cases of osteoid osteoma and one of benign osteoblastoma in children are described. The main complaint was severe pain which was worse at night; it was relieved by aspirin or other analgesics. The diagnosis was made on clinical and radiological grounds and was confirmed on histological examination of the central nidus removed at operation. The pain was relieved in the patients with osteoid osteoma, and it was very much less after operative removal of the benign osteoblastoma. Both conditions are probably variations of the same disease process, depending on the anatomical site and the type of bone affected.