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Osteoblastoma

Giant Osteoid Osteoma

Osteoblastoma is a rare type of primary bone tumor, an osteoid tissue-producing neoplasm originating from osteoblasts. Major complications may arise from the compression of the adjoining structures.


Presentation

Young adults are most frequently affected by OB, and patients typically seek medical attention for dull bone pain. Soft tissue and bony swelling may be noted at the site of the lesion. A general predilection for the axial skeleton has been observed [4], and up to 40% of cases involve the spine, mainly the vertebral arches of the lumbar region [5]. Nevertheless, OB may also develop in the appendicular skeleton, affecting the long bones of arms and legs or distal parts of the limbs [6].

OB exert local mass effects and accordingly, patients may present with spinal cord compression, radiculopathy, visual impairment and additional neurological deficits [7], stiffness and reduced joint motion ranges, among others. Lateral deviations of the spine and other deformities may be observed [8].

Sneezing
  • The patient presented after forceful sneezing with nonspecific symptoms of headache, nausea, and vomiting. CT demonstrated a frontal collection of loculated air with mass effect within the left cerebral hemisphere.[ncbi.nlm.nih.gov]
Dysphagia
  • We present the first known case of osteoblastoma arising in the hyoid bone, in a patient who presented with a neck mass and dysphagia.[ncbi.nlm.nih.gov]
  • Laryngeal osteoblastoma usually presents as an inflammatory tumour which, as it progresses slowly, causes dyspnoea, dysphagia, and/or dysphonia.[elsevier.es]
Abdominal Mass
  • The patient subsequently developed a cutaneous lower abdominal mass that was diagnosed as an osteosarcoma. Meanwhile, the petrous apex tumor continued to grow despite treatment until the patient died from the burden of disease.[ncbi.nlm.nih.gov]
Progressive Hearing Loss
  • We report an interesting and rare case of aggressive osteoblastoma, with progressive hearing loss and facial palsy, involving the mastoid process of temporal bone and middle ear along with the description of cyto-morphological features.[ncbi.nlm.nih.gov]
  • When it arises from temporal bone and middle it may cause progressive hearing loss.[ijpmonline.org]
Photophobia
  • A 31 year old man came to our attention with a 7 month history of diplopia, photophobia, frontal headhaches and progressive exophthalmos with proptosis of the left eye.[ncbi.nlm.nih.gov]
Visual Impairment
  • OB exert local mass effects and accordingly, patients may present with spinal cord compression, radiculopathy, visual impairment and additional neurological deficits, stiffness and reduced joint motion ranges, among others.[symptoma.com]
Subcutaneous Mass
  • Although clinical presentation can vary depending on location, cranial osteoblastoma usually presents as a painful, non-mobile, subcutaneous mass or swelling.[ncbi.nlm.nih.gov]
Back Pain
  • Surgical resection of the lesion confirmed a benign osteoblastoma. 12 months follow-up revealed disappearance of right back pain.[ncbi.nlm.nih.gov]
Neck Pain
  • Even though the 18-month follow-up is still a very short interval in our case, the subject's neck pain has resolved completely and there has been no sign of tumor recurrence in the recently taken imaging.[ncbi.nlm.nih.gov]
Ankle Pain
  • We report a young male, presenting as chronic ankle pain, with a radiolucent lesion with a thick periosteal shell in the body of the talus. Analysis of clinical, radiological and histological findings confirmed the diagnosis of osteoblastoma.[ncbi.nlm.nih.gov]
  • ., Chb 2 The Foot & Ankle Journal 1 (6): 5 ISSN 1941-6806 doi: 10.3827/faoj.2008.0106.0005 Case History An 8 year old boy presents with history of ankle pain for 4 months. His pain is mainly to the anterior aspect of the ankle joint.[faoj.org]
Left Shoulder Pain
  • We present a case of a 19-year-old man with left shoulder pain for 1 year, with associated infraclavicular swelling for 8 months. Examination revealed a tender, bony, hard swelling measuring 3 4 cm.[ncbi.nlm.nih.gov]
Claustrophobia
  • The lengthy duration of an MRI examination and a history of claustrophobia in some patients are limiting the use of MRI.[en.wikipedia.org]
Facial Swelling
  • A 7-year-old male patient visited our department with chief complaints of left facial swelling and pain. A panoramic radiograph showed a homogeneous radio-opaque expansile lesion in the left maxilla.[ncbi.nlm.nih.gov]
  • CASE REPORT A 40 year-old male was referred to our University, with asymptomatic facial swelling and nasal obstruction. The patient reported that the lesion had been present for at least 8 years and has been showing slow but progressive enlargement.[arquivosdeorl.org.br]
Neck Mass
  • We present the first known case of osteoblastoma arising in the hyoid bone, in a patient who presented with a neck mass and dysphagia.[ncbi.nlm.nih.gov]
Radiculopathy
  • Their presentation can vary between diffuse pain, restriction of neck movements, torticollis, radiculopathy, and myelopathy. Complete excision is the best treatment to achieve a cure, but recurrence is not uncommon.[ncbi.nlm.nih.gov]
  • OB exert local mass effects and accordingly, patients may present with spinal cord compression, radiculopathy, visual impairment and additional neurological deficits, stiffness and reduced joint motion ranges, among others.[symptoma.com]
  • Neurologic symptoms, such as cranial nerve palsies, myelopathy, neuralgia, radiculopathy, paraparesis or paraplegia, may be associated if the spine is involved.[orpha.net]
Cranial Nerve Involvement
  • Clinical symptoms are non-specific and cranial nerve involvement is uncommon. The cytomorphological features of osteoblastoma are not very well defined and the experience is limited to only few reports.[ncbi.nlm.nih.gov]
Tonic-Clonic Seizure
  • The patient presented with a history of headache, vomiting and generalized tonic-clonic seizures. CT scan showed a hyperdense lesion in the posterior third ventricle with obstructive hydrocephalus.[ncbi.nlm.nih.gov]

Workup

Diagnostic imaging is required to confirm the presence of an osseous mass, to determine its extension and to identify possibly compromised adjacent structures. Plain radiography and computed tomography are most commonly employed and yield reliable results. Here, OB present as discrete lesions comprising both lytic and sclerotic regions [9]. Soft tissue involvement may be better assessable applying other imaging techniques.

A histopathological examination of biopsy specimens is crucial for the diagnosis of OB. In this context, it is important to obtain representative samples that ideally measure several millimeters in size. Fine-needle aspirates are usually insufficient. OB are hypocellular, mineralized tumors consisting of irregular, largely immature trabecular bone [7]. Giant cells may be present. There are no apparent differences between central and peripheral areas of the tumor. Lesions are well demarcated, and this feature helps to distinguish OB from osteosarcoma. However, the transition from benign OB to malignant osteosarcoma is smooth and aggressive types of OB have been described [10].

Based on radiological findings and histopathological analyses alone, the distinction between OB and osteoid osteoma may pose a major challenge. Still, a precise diagnosis is of major prognostic and therapeutic relevance: OB have considerable malignant potential, may show locally aggressive behavior,and recurrence is more likely than in patients diagnosed with osteoid osteoma [5]. Clinical criteria should be considered to support a tentative diagnosis of either bone tumor [4]:

  • OB usually develop in the axial skeleton, while osteoid osteomas primarily affect the long bones of the limbs.
  • Persistent bone pain is characteristic of OB, whereas osteoid osteoma patients frequently experience pain that worsens at night.
  • In patients suffering from osteoid osteoma, pain may be relieved by salicylates, but this is rarely the case in individuals suffering from OB.
  • Both are most commonly diagnosed in young adults but may affect patients of any age.

Treatment

  • Conservative treatment with anti-inflammatory medications before referral was unsuccessful. The authors present the diagnostic difficulties and the treatment that was applied: proximal row carpectomy.[ncbi.nlm.nih.gov]
  • The first route of treatment in Osteoblastoma is via medical means. Although necessary, radiation therapy (or chemotherapy) is controversial in the treatment of osteoblastoma.[en.wikipedia.org]

Prognosis

  • The first treatment significantly affects the prognosis as previously treated patients have worse prognosis.[ncbi.nlm.nih.gov]
  • Still, OB patients generally have a good prognosis and most of them are cured by means of a complete surgical resection of the neoplasm.[symptoma.com]

Etiology

  • In conclusion, the differential diagnosis for vertebra plana is extensive and we add spinal osteoblastoma as another etiology to the existing list.[ncbi.nlm.nih.gov]
  • Etiology of osteoblastoma is unknown; however it is considered to be a true neoplasm of bone (3). Itmost commonly affects vertebral column, sacrum, calvarium, long bones and small bones of hand and feet.[ijp.iranpath.org]
  • The exact etiology of osteoblastoma is unknown. Epidemiology In the United States, osteoblastoma accounts for approximately 1% of all primary bone tumors.[emedicine.medscape.com]

Epidemiology

  • Basic demographic and epidemiological data were recorded. Tumor characteristics, surgical parameters, and clinical follow-up data were noted. RESULTS: The mean follow-up was 21.9 months.[ncbi.nlm.nih.gov]
  • Introduction Aggressive benign osteoblastic tumor of bone "big brother" of osteoid osteoma ( nidus 2cm ) Epidemiology incidence relatively rare less common than osteoid osteoma demographics males females (2:1) majority of patients 10-30 years of age location[orthobullets.com]
  • Epidemiology In the United States, osteoblastoma accounts for approximately 1% of all primary bone tumors.[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • The pathophysiology of symptom development, evaluations, and management are presented. Because of the close proximity of the osteoblastoma to the vertebral artery canal, the artery suffered a minor laceration intraoperatively.[ncbi.nlm.nih.gov]
  • Pathophysiology and Etiology Regardless of where osteoblastomas originate within the musculoskeletal system, they are composed of numerous osteoblasts that produce osteoid and woven bone.[emedicine.medscape.com]
  • Pathophysiology, evaluation, and treatment. J Bone Joint Surg Am 2005;87(8):1848-64. 27. Riddle ND, Bui MM. Fibrous dysplasia. Arch Pathol Lab Med 2013;137(1):134-8. 28. Feller L, Neil H Wood, Razia AG Khammissa, et al.[jebmh.com]

Prevention

  • Preoperative embolization was performed to reduce intraoperative bleeding and to prevent intraoperative injury of the vertebral artery. A pathologic examination showed osteoblasts suggestive of osteoblastoma.[ncbi.nlm.nih.gov]

Summary

Osteoblastoma (OB) is a rare type of neoplasm, accounting for approximately 1% of primary bone tumors [1]. OB are benign tumors originating from osteoblasts, and they are characterized by their ability to produce osteoid. Thus, they form large masses with diameters exceeding 2 cm that exert local mass effects on adjacent tissues. Because OB most frequently affect the axial skeleton, central nervous system compromise is frequently seen in affected individuals. Furthermore, OB have been reported to undergo malignant transformation [2]. Still, OB patients generally have a good prognosis and most of them are cured by means of a complete surgical resection of the neoplasm [3].

References

Article

  1. Lucas DR. Osteoblastoma. Arch Pathol Lab Med. 2010; 134(10):1460-1466.
  2. Kraft CT, Morrison RJ, Arts HA. Malignant transformation of a high-grade osteoblastoma of the petrous apex with subcutaneous metastasis. Ear Nose Throat J. 2016; 95(6):230-233.
  3. Boriani S, Amendola L, Bandiera S, et al. Staging and treatment of osteoblastoma in the mobile spine: a review of 51 cases. Eur Spine J. 2012; 21(10):2003-2010.
  4. Greenspan A. Benign bone-forming lesions: osteoma, osteoid osteoma, and osteoblastoma. Clinical, imaging, pathologic, and differential considerations. Skeletal Radiol. 1993; 22(7):485-500.
  5. Kurugoglu S, Adaletli I, Mihmanli I, Kanberoglu K. Lumbosacral osseous tumors in children. Eur J Radiol. 2008; 65(2):257-269.
  6. Li Z, Zhao Y, Hou S, Mao N, Yu S, Hou T. Clinical features and surgical management of spinal osteoblastoma: a retrospective study in 18 cases. PLoS One. 2013; 8(9):e74635.
  7. Caltabiano R, Serra A, Bonfiglio M, et al. A rare location of benign osteoblastoma: case study and a review of the literature. Eur Rev Med Pharmacol Sci. 2012; 16(13):1891-1894.
  8. Poleksic ZR, Lalosevic VJ, Milinkovic ZB. Osteoblastoma of the spine. Acta Chir Iugosl. 2010; 57(1):63-68.
  9. Pelargos PE, Nagasawa DT, Ung N, et al. Clinical characteristics and diagnostic imaging of cranial osteoblastoma. J Clin Neurosci. 2015; 22(3):445-449.
  10. Harrington C, Accurso BT, Kalmar JR, et al. Aggressive osteoblastoma of the maxilla: a case report and review of the literature. Head Neck Pathol. 2011; 5(2):165-170.

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Last updated: 2019-07-11 22:10