Benign Osteoblastoma Research Articles

Osteoblastoma in the retromolar region - Report of an unusual case and Review of literature

Benign osteoblastoma is a rare tumor of bone representing less than 1% of all tumors of the maxillofacial region. There is a slight predilection for the mandible. More frequent sites for this tumor are the vertebral column, sacrum, long bones, and calvarium. A small predilection in males exists. The age of occurrence ranges from 5 to 37 years, with an average of 16.5. Clinically, patients have pain and swelling. The tumor contains a well-vascularized, osteoblastic connective tissue stroma. Osteoclasts may also be present. Osteoid with varying degrees of calcification, as well as immature bone, is noted. Very few cases of osteoblastomas occurring in the jaws have been reported in the literature. This is one such a rare case report of OB occurring in a 45 year old female patient with a swelling in right lower back region since 5 years. Osteoblastoma has to be differentiated from other bone lesions for correct diagnosis. Many bone producing lesions possess some overlapping clinical, radiographic or histopathological findings similar to osteoblastoma. Understanding and correlating all these features is of utmost importance. This helps in correctly diagnosing and helps in adequate management of this rare entity, giving a good prognosis.

Osteoblastoma in the Nasal Cavity

A benign osteoblastoma of the nasal cavity is very rare. A 57-year-old woman, who had a radical hysterectomy for carcinoma of the uterine cervix 5 years ago, underwent F-18 FDG PET/CT. An expansile bone tumor with high glucose metabolism in the middle turbinate of the left nasal cavity was incidentally demonstrated. A subsequent Tc-99m methylene diphosphonate 3-phase bone scan revealed focal increased uptake of radionuclide in all 3 phases at the corresponding tumor. Histology confirmed a benign osteoblastoma that was composed of proliferating osteoblasts with woven bone spicules and rich vascular stroma. Scintigraphic findings, including F-18 FDG PET/CT and 3-phase bone scan, reflected the pathologic features well.

Benign osteoblastoma in an unusual mastoid location

Benign osteoblastoma (OB) is an unusual primary bone tumor. The preferred locations are the posterior arch of vertebrae and long bones. We report herein an extremely rare location of an OB in the mastoid process of the temporal bone. A 22-year-old woman presented with painful left retro-auricular swelling. Computed tomography features were suggestive of an aggressive osteolytic lesion of the left mastoid. The pathologic examination of bone curettage material revealed a benign OB. A complete resection of the tumor was performed later, with no evidence of recurrence at 1 year. To our knowledge, this is the 14th reported case of OB confined to the mastoid process of temporal bone. Its histological diagnosis can be difficult and osteosarcoma is its principal differential diagnosis. Although generally regarded as benign, OB has potential for recurrence and local invasion. As such, complete resection, whenever possible, is preferred over conventional curettage.

Intraosseous schwannoma originating from the posterior column of the thoracic spine

Only eight cases of intraosseous schwannoma of the mobile spine have been reported in the English literature. We report herein a rare case of intraosseous schwannoma mimicking benign osteoblastoma originating from the posterior column of the thoracic spine. A 60-year-old man presented with a history of back pain for several months. The patient subsequently developed gait disturbance and numbness on bilateral lower limbs. Preoperative computed tomography and magnetic resonance imaging showed a neoplastic lesion occupying the posterior column of the ninth thoracic vertebra. The most likely preoperative diagnosis was osteoblastoma. The patient underwent tumor excision and posterior fusion with instrumentation. No nerve involvement of the tumor was identified intraoperatively. Histological diagnosis was schwannoma. To the best of our knowledge, this represents the first report of intraosseous schwannoma originating from the posterior column of the mobile spine.

Benign Osteoblastoma Located in the Parietal Bone

Benign osteoblastoma is an uncommon primary bone tumor, extremely rare in calvarium. We present a case of a 25-year-old female with an osteoblastoma of parietal bone which was totally resected. The authors discussed the clinical presentation, radiographic finding, differential diagnosis and management of the benign calvarial osteoblastoma with a review of the literature.

Malignant transformation of an osteoblastoma of the mandible: case report and review of the literature

Benign osteoblastoma is a rarely seen tumor of the facial bones. The authors present a case of a 30-year-old man with a tumor of the mandibular body and ramus. The histopathological diagnosis was one of osteoblastoma. Postoperative recurrence with soft tissue infiltration suggested an osteosarcoma radiologically, but the histological examination again revealed the presence of an osteoblastoma. A second recurrence occured in the pharyngo-glossal region and this time the tumor was histologically diagnosed as an osteoblastoma, but with foci of well-differentiated osteosarcoma. The patient was given a course of radiotherapy, but clinical and radiological examination 8 months later revealed lung metastases and chemotherapy was started. Unfortunately, the patient died months later. While osteoblastomas are rare, and their sarcomatous change even rarer, our experience with this case lead us to suggest that a therapeutic preventative approach, involving both chemotherapy and total excision of the tumor, is the regime to adopt with osteoblastomas which involve soft tissues and have radiological features suggesting malignancy.

Profiling of high-grade central osteosarcoma and its putative progenitor cells identifies tumourigenic pathways

Background:Osteosarcoma is the most prevalent primary malignant bone tumour in children and young adults, with poor survival in 40% of patients. To identify the signalling pathways involved in tumourigenesis, we compared gene expression in osteosarcoma with that in its presumed normal counterparts.Methods:Genome-wide expression profiles were generated from 25 high-grade central osteosarcoma prechemotherapy biopsies, 5 osteoblastomas, 5 mesenchymal stem cell (MSC) populations and these same MSCs differentiated into osteoblasts. Genes that were differentially expressed were analysed in the context of the pathways in which they function using the GenMAPP programme.Results:MSCs, osteoblasts, osteoblastomas and osteosarcomas clustered separately and thousands of differentially expressed genes were identified. The most significantly altered pathways are involved in cell cycle regulation and DNA replication. Several upstream components of the Wnt signalling pathway are downregulated in osteosarcoma. Two genes involved in degradation of β-catenin protein, the key effectors of Wnt signalling, Axin and GSK3-β, show decreased expression, suggesting that Wnt signalling is no longer under the control of regular signals. Comparing benign osteoblastomas with osteosarcomas identified cell cycle regulation as the most prominently changed pathway.Conclusion:These results show that upregulation of the cell cycle and downregulation of Wnt signalling have an important role in osteosarcoma genesis. Gene expression differences between highly malignant osteosarcoma and benign osteoblastoma involve cell cycle regulation.

Destructive tumours of the larynx mimicking osteosarcoma: two cases of osteoblastoma with organ-saving resection and follow-up

Osteoblastoma of the larynx is an extremely rare type of locally progressive and destructive tumour which is mimicking osteosarcoma radiologically and histologically. Since prognostic and therapeutic strategies for benign osteoblastoma differ from the more common osteosarcoma of the larynx, a meticulous pre-operative histological diagnosis is required to avoid over-therapy. We report about two patients with osteoblastoma of the larynx with organ-saving resection and long-period follow-up without tumour recurrence. A review of the literature detected five further osteoblastomas of the larynx, all in elderly men, like our observations. This situation is quite different from the usual osteoblastomas of bone, which occur in young adults of both sexes equally.

Benign Osteoblastoma of the Sphenoid Bone

Osteoblastoma is an uncommon benign bone tumor that accounts for 1% of all primary bone tumors. Well documented in the spine and long bones, it is rarely found in the skull, namely in the sphenoid bone, with only five cases reported in the literature. We report a case of an 11-year-old girl with a histologically confirmed benign osteoblastoma in an unusual location and an atypical aspect on the imaging studies.

Osteoblastoma of the Temporal Bone

Benign osteoblastoma is an uncommon primary tumor of the bone. Any area of the skeleton may be affected by this tumor, but its occurrence in the temporal bone and middle ear is extremely rare. Clinical symptoms are nonspecific, even in the middle ear, and the diagnosis is often difficult in spite a complete physical and radiological examination. A biopsy is usually necessary for definitive diagnosis. Because of its potential for recurrence, local invasion, and, rarely, malignant transformation, a complete surgical excision remains the treatment of choice for osteoblastoma. We report a case of benign osteoblastoma involving the temporal bone and the middle ear and a review of the literature.

Osteoblastoma in the maxilla: report of a case

A case of maxillary osteoblastoma in a 29-year-old man is presented. The patient developed a painful swelling on the right hard palate. Panoramic radiographs revealed a mixed radiolucent/radio-opaque mass surrounded by a narrow radiolucent zone in the apical area of the right maxillary first molar. Under the clinical diagnosis of apical periodontitis, root canal treatment for the molar was carried out. Bleeding from the root canal was observed during the treatment, and the painful swelling disappeared immediately. Shortly afterward, when the bleeding from the root canal stopped, the painful swelling recurred. CT showed a subcortical nodule in the right maxilla. Histopathological examination revealed the lesion was composed of immature bone with broad osteoid matrix at the periphery. The osteoid matrix of the immature bone was fringed with numerous plump osteoblasts without nuclear atypia. Some small foci composed of the neoplastic osteoblasts were associated with the osteoid. Histopathological diagnosis of the biopsy was benign osteoblastoma, and excision of the tumor completely relieved the pain. There has been no recurrence for 7 years. Reduction in vessel pressure due to root canal therapy was considered to have temporarily relieved the pain of osteoblastoma.

Osteoblastoma of the Temporal Bone: A Case Report

Benign osteoblastoma is an unusual primary bone tumor. It affects usually long bones or the vertebral column. Osteoblastoma affecting the calvarium is extremely rare. A 23-year-old man presented with a two-month history of swelling and tenderness in the right temporal region. Computed tomography revealed an expansile, lytic lesion in the left temporal bone. T1- and T2-weighted magnetic resonance (MR) images demonstrated an isointense lesion in the temporal bone. After gadolinium DTPA injection, MR images revealed dense enhancement. The histopathological findings proved that the lesion was a benign osteoblastoma. To date, very few cases of the benign osteoblastoma arising in the calvarium have been reported in the literature. We discuss diagnostic and management aspects of this uncommon tumor.

Foot Pain - Marathon Runner

HISTORY: A 46-year-old male runner was out for a two mile run 1 ½ weeks prior to office visit, and experienced pain in medial plantar left foot. It was of sudden onset, and there was no precipitating trauma. That night he had difficulty just walking. Since onset he has continued having a difficult time walking at all. He denies swelling and bruising. Currently he is also experiencing patellar tendonitis. He had plantar fasciitis in the past. Current symptoms are different. PHYSICAL EXAMINATION: Exam shows antalgic gait. Tenderness is present to palpation in plantar rear-foot slightly anterior and medial to plantar fascia origin. Inspection of left ankle shows no swelling and no bruising. No pain to palpation at medial or lateral malleolus, 5th metatarsal, proximal fibula, distal tibia/fibula joint, talar dome or posterior tibial tendon. Pulses are intact. Ankle exam including tib/fib squeeze test, anterior drawer, and external rotation were all negative for pain. Foot exam: No deformity of left foot noted. ROM at the ankle, subtalar joint, mid-metarsal, and MTP joint all within normal limits. Strength is 5/5 with dorsiflexion, plantarflexion, eversion and inversion. On follow-up visit: There is exquisite tenderness on the medial midfoot - talar head, plantar navicular. Pain not provoked with great toe dorsiflexion. DIFFERENTIAL DIAGNOSIS: 1) Plantar fasciitis 2) Stress fracture to tarsal bone 3) Plantar fascial nodules 4) Flexor Tendonitis 5) Knot of Henry tenosynovitis TEST AND RESULTS: MRI of left foot with gadolinium. Enhancing bone lesion within the anteromedial calcaneus. Eccentrically positioned with irregular erosion of cortex. Somewhat aggressive features are present. Ligaments and tendons intact. Lesion measures 1.5x1x1.4. Reactive change within muscular soft tissue. Surgical intervention: Needle biopsy - lateral cortex of calcaneus. Frozen section consistent with benign osteoblastoma. FINAL WORKING DIAGNOSIS: Left foot benign aneurismal bone cyst TREATMENT AND OUTCOMES: 1) Curettage and allograft bone grafting of left medial calcaneus - biopsy and visual inspection consistent with benign aneurismal bone cyst. 2) Await wound healing before return to activity. Anticipate return to long distance running.

Aggressive (Epithelioid) Osteoblastoma Arising in Soft Tissue

Aggressive (epithelioid) osteoblastoma arising in soft tissue has never been described. It is important to differentiate this benign osteoblastoma, a potentially locally aggressive tumor, from extraskeletal osteosarcoma. This report describes an aggressive (epithelioid) osteoblastoma arising in a focus of heterotopic ossification in the axilla of a 21-year-old man.

Extraosseous osteoblastoma of larynx presenting with acute airway obstruction

We report the case of an osteoblastoma of the larynx arising from the vocal fold, which presented with acute airway obstruction and cardiopulmonary arrest. The histopathological findings, differential diagnoses and a novel method of treating laryngeal osteoblastoma, using transoral laser therapy, are discussed. Benign osteoblastoma is a rare primary bone tumour usually presenting in young patients in the spine and sacrum. Its occurrence in the larynx is very rare, with only three similar case reports in the literature, none involving tumour arising from the vocal fold. Differential diagnoses must be considered and excluded using both histopathological and clinical features. Once the diagnosis is confirmed, successful treatment is achieved with surgical excision. Osteoblastoma of the larynx is rare, and the clinical features can vary with the anatomical site of the lesion. The recommended treatment is surgical excision which, if available, may be achieved by transoral laser microsurgery. Due to its potential rapid growth, careful follow up is essential in order to detect recurrence.

Osteoblastoma of the Orbit

We describe a case of benign orbital tumour involving the frontal sinus and ethmoidal cells. CT findings were typical of "bone tumour of the orbit", histological analysis yielded a diagnosis of benign osteoblastoma. A review of the literature disclosed only 13 well documented cases. We compared out radiological findings with the features described in these reports. CT patterns were similar in most cases. The lesion generally appears as a heterogeneous mass where it is possible to appreciate both high density portions and low density areas. On MRI osteoblastoma shows an iso- low signal both in T1 and in T2 sequences. Less frequently the lesion may yield a high signal in T2 images. The orbit is rarely involved by bone tumours, but all bone tumours may theoretically involve the orbit, often making it difficult to establish the right differential diagnosis by imaging. Thirteen cases are insufficient to describe general radiological criteria to improve the specificity in detection of this disease and a broader outlook is essential. For this reason we also examined the radiological signs of bone tumours involving other portions of the body. Even though many literature reports suggest CT is the landmark in bone tumour diagnosis, we think it should always be accompanied by MRI. MRI is known to overestimate local staging, but its contribution to differential diagnosis among various tumours may be decisive.

A huge occipital osteoblastoma accompanied with aneurysmal bone cyst in the posterior cranial fossa

Osteoblastoma is an infrequent benign tumor and skull involvement is extremely rare. The occipital bone is much less frequently involved. We report an unusual case of a huge occipital osteoblastoma with aneurysmal bone cyst in the posterior cranial fossa of a 20-year-old young man. MRI scan and CT three-dimensional reconstruction revealed that the tumor (approximately 8.5 cm × 6 cm × 5 cm) occupied nearly half volume of the posterior cranial fossa. The cerebellum, the forth ventricle and brain stem were compressed remarkably and hydrocephalus was noted. The tumor mass was multiloculated cystic and highly vascular. Excessive bleeding occurred during operation and total removal was achieved. The patient was symptom-free and MRI scan revealed no evidence of recrudescence after a follow-up period of 18 months. Pathological examination revealed that the lesion was a benign osteoblastoma with secondary aneurysmal bone cyst (ABC). ABC constitutes a highly vascular lesion while complete surgical resection is often impeded by excessive intraoperative bleeding. Preoperative embolization may reduce the risk. Despite the benign nature of osteoblastoma, local recurrence after incomplete resection is not rare and malignant transformation during recurrence may occur even after adequate surgery. Our case confirms the findings of previous investigators that if osteoblastoma is removed completely, no recurrence is expected even without adjuvant irradiation and chemotherapy.

Benign osteoblastoma of the odontoid process of the axis with secondary aneurysmal bone cyst component: a case report

The authors report their experience on one patient with osteoblatoma of the odontoid process of the axis with secondary aneurysmal bone cyst. According to their knowledge, this is the first case, reported in the literature, of this kind of lesion in that particular anatomical region. Because of the rarity of this lesion, it was difficult to have a certain preoperative diagnosis. Therefore, the patient underwent a biopsy via a transoral route. The biopsy was performed over the noncalcified component of the lesion. The intraoperative histological examination showed the benign nature of the lesion. Thereafter, the lesion was totally removed, succeeding in preserving the remaining part of the odontoid process and the anterior arch of C1. In the follow-up, there was no evidence of cranio-vertebral instability. The histological examination revealed an osteoblastoma of the odontoid process of the axis with a secondary aneurysmal bone cyst. To the best of our knowledge, this is the first case reported in the literature.

Long-standing pain in a 25-year-old patient with a non-diagnosed cervical osteoblastoma: a case report

Benign osteoblastomas are infrequent tumors, representing less than 1% of all bone tumors. The spinal location accounts for 40-50% of all osteoblastomas from which only 20% are located in the cervical spine. The majority of the spinal osteoblastomas arise from the posterior elements: pedicles, laminas, transverse or spinous processes. We present a case report of a young male that due to the lack of specific symptoms was diagnosed of a cervical osteoblastoma 14 months after the first symptoms. The tumor was located in the right C7 pedicle. We then operated, resected the tumor and a posterior C6-T1 bilateral instrumentation was performed to stabilize the spine. Nowadays, this delay in diagnosis may be avoided by the routine use of MRI or CT for unspecific cervical symptoms. The treatment of this lesion is the complete surgical resection based on a correct preoperative planning with CT and MRI in order to define precisely the location, size and extension of the tumor. Currently, percutaneous or minimally invasive surgery is not commonly used in the treatment of this lesion.

Benign osteoblastoma of maxillary sinus: A rare presentation

Benign osteoblastoma of paranasal sinuses is a rare tumor of the 2(nd) decade of life with only few cases reported till date. It arises most commonly from the ethmoid sinus and present as an intra-nasal mass leading to broadening of the nasal bridge. Here we present a case of benign osteoblastoma in a 8 year old girl presenting with a large intranasal mass seen through nostril and leading to facial deformity.