Case Of Osteoid Osteoma Research Articles

A Rare Case of Osteoid Osteoma of the Medial Cuneiform Bone at Tibialis Anterior Insertion Confirmed by Bone Scan SPECT/CT.

A 34-year-old man presented with progressive foot pain that was initially on the medial soft tissue but eventually localized to the medial side of midfoot. Despite undergoing various imaging tests and conservative treatments over 2 years, the patient remained undiagnosed. After 6 months, soft tissue and bone involvement were observed on the medial cuneiform. A needle biopsy was inconclusive. Since bone tumor is rare in the medial cuneiform, the patient was referred to our department for 99mTc-MDP bone scan. The imaging and clinical findings suggested osteoid osteoma as the likely diagnosis, which was confirmed as intraarticular nidus under tibialis anterior attachment, after surgical resection and pathological examination.

Novel Delivery of Cryoablation Through Transoral Surgical Approach for Atypical Presentation of Osteoid Osteoma of the C1 Lateral Mass: Technical Case Illustration

BACKGROUND AND IMPORTANCE: Neurosurgical literature rarely explores cases of osteoid osteomas of the atlas. Traditionally, neurosurgeons performed en bloc surgical resection for refractory osteoid osteomas in the subaxial and lumbar spine, but minimally invasive ablation therapies have gained favor. Complete lesioning of the nidus, either by surgical or minimally invasive therapies, produces curative results with recurrence only developing after partial lesioning. CLINICAL PRESENTATION: We discuss the case of a 16-year-old adolescent boy who presented with neck and occipital pain refractory to multimodal pain management. Prolonged workup demonstrated a subtle radiographic lesion of the left C1 lateral mass. Interventional radiologists attempted a posterior approach percutaneous computed tomography-guided radiofrequency ablation but aborted due to proximity of the vertebral artery. Surgeons then pursued an open transoral approach to provide a corridor for cyclical cryoablation therapy, which proceeded without complication. The patient was discharged on postoperative day one with remission of occipital pain at the 10-month follow-up. No clinical or radiographic evidence of instability appeared on postoperative cervical films. CONCLUSION: No reports exist in the literature of an osteoid osteoma of C1 treated by an open anterior approach and with cryoablation. The transoral approach is a safe, effective method to access ventral pathologies of C1. The transoral approach may minimize blood loss and reduce the risk of craniocervical instability, allowing for preserved cervical mobility and improved patient outcomes. Surgeons may especially consider cryoablation when the nidus is within proximity to critical neural structures.

Osteoid osteoma appearing after bony fracture in a girl with osteogenesis imperfecta.

Osteoid osteoma (OO) is a common, benign bone tumor. However, there are no case reports of OO associated with osteogenesis imperfecta (OI), or pathological fractures in OO. A 3-year-old girl with OI sustained a complete right tibial diaphyseal fracture. Bony fusion was completed after 4months of conservative therapy; nevertheless, 18months later spontaneous pain appeared at the fracture site, without any cause. Plain radiographs showed a newly apparent, rounded area of translucency 1cm in diameter, just overlapping the previous fracture. Images obtained using three-dimensional time-resolved contrast-enhanced magnetic resonance angiography showed strong central enhancement in the early phase, with an apparent nidus, suggesting the diagnosis of OO. Nineteen months after the first fracture, while skipping, the patient refractured her tibial diaphysis at the site of the previous fracture. This is a very rare case of OO, apparently co-existing with OI and leading to a bony fracture. In our case, the combination of bone fragility in OI and a recent fracture at the site of the OO may have caused the re-fracture.

A comparative study assessing the efficacy and safety of radiofrequency ablation versus surgical treatment for osteoid osteoma: retrospective analysis in a single institution

ObjectiveWe aim to evaluate the efficacy of CT-guided percutaneous radiofrequency ablation (RFA) and surgical treatment in osteoid osteoma (OO) treated at the Medical University of Graz.Materials and methodsIn a single-institution study, we analysed data from January 2005 to January 2021 of patients with histological/radiological diagnosis of OO. CT and MRI scans were reviewed for typical findings. Means (with SD) and medians (with IQR) were reported for normally and non-normally distributed variables. Differences between groups were assessed using chi-squared tests and t-tests.ResultsOne hundred nineteen patients (mean age: 21.6 ± 10.9 years; 63.9% males) with confirmed OO were retrospectively evaluated. 73 and 43 patients underwent RFA and surgery, respectively. In three cases, RFA combined with surgery was performed. Pre-intervention, 103 patients (88.8%) had undergone CT, and 101 had an MRI (87.1%). The nidus was confirmed in 82.5% of cases with CTs (85/103) and 63.4% with MRIs (64/101). The majority of nidi were located cortically (n = 96; 82.8%), most frequently in the femur (38 patients, 33.3%) with a median size of 8.0 mm (IQR: 5.0–12.0 mm). Median symptom duration before treatment was 6.0 (IQR: 4.0–13.0) months. The complication rate was 12.1% (14/116; 15.1% RFA vs. 7.0% surgery; p = 0.196). In total, 11.2% of patients had persistent symptoms after one week with clinical success rates of RFA and surgery, 86.3% and 90.7% (p = 0.647), respectively.ConclusionCompared to surgical treatment, CT-guided percutaneous RFA is a safe, minimally invasive, reliable, and efficient treatment option for OO.Critical relevance statementThis article critically assesses the diagnosis and treatment of osteoid osteoma, emphasising accurate imaging, and detailing a non-invasive option for effective management.Key points• This study analyses 116 cases of OO at one institution, focusing on symptom persistence, recurrence in short-term follow-up, and complications in two study groups.• Surgery showed higher, though not statistically significant, success despite comparable symptom persistence; CT displayed typical OO features more than MRI, regardless of the intramedullary, cortical and subperiosteal location as well as the site of the affected bone.• CT-guided RFA is an effective therapeutic alternative for OO compared to surgical intervention. In case of atypical OO appearance, RFA is not the first-line treatment.Graphical

Osteoid Osteoma in the Hand

Abstract Many patients associated with non-traumatic wrist or hand pain receive symptomatic treatment. Although temporary improvements are seen with these treatments, the underlying cause is masked, and delayed, or missed. Two patients with osteoid osteoma (OO) localized in the capitate and proximal phalanx are presented in this article. OO is a benign bone tumor typically seen in children, affecting long bones. While cases located in the upper extremities are shared, it is rare in the hand. Surgical intervention remains the primary treatment option. Favorable outcomes are achieved with complete excision of the nidus in an early-detected OO cases.

CT-GUIDED PERCUTANEOUS TREPHINATION OF NIDUS IN OSTEOID OSTEOMA– A SAFE APPROACH FOR DIFFICULT TO ACCESS LESIONS

Introduction: Osteoid osteoma is a benign painful bony lesion that often affects children and young adults. It is 3% of all bone tumors. It may result in growth disturbance, bony deformity, joint swelling and contractures. Long bones especially of the lower limb are the most commonly affected regions. During the initial period, the resection of nidus was performed by open surgery where a bone block was removed. This was followed by development of computed tomography (CT)-guided procedures for complete removal of nidus using various percutaneous techniques. These include CT-guided radiofrequency ablation (RFA) or trephination. If these lesions are near any important vascular structures, it becomes difficult to use RFA due to risk of injuring them. While the results of RFA are well studied, percutaneous trephination is still not widely researched. Objectives: We evaluated the results of 14 cases of osteoid osteoma treated with percutaneous drilling resection of the nidus under CT guidance and discussed the positive and negative impact of the same. Material and Methods: We included 14 patients who presented, from October 2017 to September 2020, at a tertiary level health care center. The diagnosis was established by clinical as well as imaging modalities. The patients underwent CT scan and the exact site was localized. Safe zone for percutaneous drilling was identified using contrast for vascular bundle. Percutaneous drilling was done using 8 mm reamer and complete lesion was removed under CT guidance. Patients were followed up for 2 years after the procedure and the final results were obtained in terms of pain, functional ability of limb and recurrence. Results: 13 out of 14 patients were pain-free at the end of the follow-up. One patient did have some pain after 1 year and on repeat imaging, there were changes suggestive of recurrence. The success rate was thus 13/14 patients (92.8%). The mean pre-operative pain score improved from 2.3 (range, 0–4) to 4.85 (range, 4–5) after procedure. There was no functional deficit of the limb recorded at the end of final follow up. Conclusion: CT-guided percutaneous trephination is a cost-effective alternative to available treatments protocols for Osteoid osteoma. Although newer techniques such as radio-frequency ablation are available, they are neither easily accessible nor affordable for the masses in developing countries.

Resection of an Osteoid Osteoma of the Talus by Arthroscopy: About A Case

Osteoid osteoma is a benign primary bone tumor. This tumor is relatively commom; it represents 12 % of all benign bone tumors and about 2 to 3 % of all bone tumors. We report in this work a case of osteoid osteoma which underwent arthroscopic resection. This study concerns a 19-year-old patient referred for chronic ankle pain evolving for 6 months.

Osteoid osteoma in the bones of the hand: a systematic literature review

IntroductionOsteoid osteoma (OO) is a common benign bone tumor. OO is observed most frequently in the long bones, especially in the tibia and femur. When occurring in the bones of the hand, OO can be a diagnostic and therapeutic challenge. The aim of this study was to provide a systematic review of occurrence, symptoms, diagnosis and treatment options regarding OO in hand bones.Materials and methodsWe performed a systematic review of the literature. All studies from the online databases PubMed and SpringerLink, which reported cases of osteoid osteomas in the bones of the hand, were included. By summarizing the literature, we evaluated the localization within the hand as well as diagnostic and therapeutic options.ResultsWe included 133 studies reporting 401 cases. OO was mostly common in the phalanges. The diagnosis was mostly made by CT (computed tomography) scan. Most of the OO were treated surgically by open curettage or en bloc resection.ConclusionsOsteoid osteomas in the bones of the hand are rare and a delayed diagnosis is common. In cases of pain combined with particular symptoms such as nail hypertrophy and swelling OO should be considered. Of the most used imaging methods, CT scans have the highest sensitivity.

Osteoid Osteomas of Spine: From Open to Minimally Invasive Excision of the Nidus – A Case series

Osteoid osteomas of spine are not uncommon and majority of which occurs in posterior elements of lumbar spine. Management of such lesions in spine ranges from open en bloc excision to percutaneous radiofrequency ablation. In this series, we have managed three cases of osteoid osteomas of spine, each managed differently from conventional open technique to minimally invasive method. All three cases underwent appropriate radiological investigations and followed by surgical excision of the lesion and histopathological analysis post-operatively. First case was managed with open excision of the lesion with conventional unilateral pedicle screw stabilisation. Second case, who underwent open excision of the lesion developed recurrence which was managed by re-excision without any further complications. Last case underwent microendoscopic quadrant tubular excision of the tumour with unilateral MISS with pedicle screws. The technique of Microendoscopic quadrant tubular excision of posterior element benign tumour had advantages of small skin incision, less bleeding, clear macroscopic visualisation of the small tumour (enables complete excision of the nidus thus decreasing the recurrence), early mobilisation and shorter hospitalization with effective and complete excision of the tumour better than open method. Further, histological evidence of tumour will be available. The complete excision of nidus using microendoscopic tubular retractors with unilateral fixation in young age gives encouraging results. This case series is followed by review of literature highlighting the role of COX-2 inhibitors in osteoid osteoma, cause for scoliosis and neurological deficit in osteoid osteoma and management of osteoid osteomas of spine. Keywords: Tumor, Osteoid osteoma, Minimally invasive, Dorsolumbar spine, Excision biopsy

Osteoid Osteoma of Scaphoid Treated with Radiofrequency Ablation

Osteoid osteoma is one of the commonest benign bone tumour of adolescence. Diagnosis is based upon the typical clinical features, site of occurrence and imaging findings. Occurrence of this lesion in an atypical site is associated with delay in diagnosis and challenges in management. We present a rare case of osteoid osteoma in scaphoid in a 14-year-old girl. Comprehensive work-up using radiograph, computerized tomography (CT), magnetic resonance imaging and Tc99-multidetector methylene diphosphonate (MDP) bone scan was used to make the correct diagnosis over other conditions with similar presentation like de Quervain tenosynovitis, intersection syndrome and inflammatory arthropathies. We also describe the treatment using CT-guided percutaneous radiofrequency ablation of this lesion and a brief literature review regarding the incidence of this lesion and treatment options available. Level of Evidence: Level V (Therapeutic).

Transnasal Endoscopic Approach for Osteoid Osteoma of the Odontoid Process in a Child: Technical Note and Systematic Review of the Literature.

Osteoid osteoma (OO) is a primary benign tumor that accounts for up to 3% of all bone tumors. The cervical spine is less affected by OOs, and very few cases of C2 OOs have been reported in the literature, both in adults and children. Surgery may be required in case of functional torticollis, stiffness, and reduced range of motion (ROM) due to cervical OOs refractory to medical therapy. Several posterior and anterior surgical techniques have been described to remove C2 OOs. In particular, anterior approaches to the cervical spine represent the most used surgical route for treating C2 OOs. We describe the first case of OO of the odontoid process removed through a transnasal endoscopic approach with the aid of neuronavigation in a 6-year-old child. No intraoperative complications occurred, and the post-operative course was uneventful. The patient had immediate relief of neck pain and remained pain-free throughout the follow-up period, with complete functional recovery of the neck range of motion (ROM). In this case, based on the favorable anatomy, the transnasal endoscopic approach represented a valuable strategy for the complete removal of an anterior C2 OO without the need for further vertebral fixation since the preservation of ligaments and paravertebral soft tissue.

Three cases of osteoid osteoma of foot

Three cases of osteoid osteoma of foot

P091 Osteoid osteoma of the trapezoid bone: a diagnostic pitfall of a wrist chronic monoarthritis

Abstract Background Osteoid osteoma is a benign bone tumor representing ∼10% of all benign bone tumors. Although osteoid osteoma of the long bones is usual, the location in the carpus, especially, in the trapezoid bone is rare [1,2]. The Objective is toreport a case of osteoid osteoma of the trapezoid bone with extension to the adjacent second metacarpal bone that was missed diagnosis at initial presentation. Methods We describe the clinical, radiological features and outcomes after surgical resection. Results A 24-year-old right-handed female, presented with a three-year history of pain at the left wrist, particularly, in the radial-side. She didn’t report any trauma to the wrist. The pain increased over time. She couldn’t use her hand in daily activities and could hardly sleep because of increasing pain at night. Before being referred to our department, she consulted a surgeon. She was treated with oral anti-inflammatory drugs, steroids, several intraarticular steroid injections without relieving pain. The Magnetic resonance imaging (MRI) showed bone marrow oedema in the trapezium and the trapezoid bone, synovial effusion, and tenosynovitis of the flexors of the thumb. A synovectomy was performed and the histopathology revealed non-specific chronic inflammation. One year later in our department, examination showed wrist swelling, tenderness and pain on palpation. The erythrocyte sedimentation rate was 12 mm/h and the mean C-reactive protein was 2 mg/l. Autoantibodies testing were negative. Initial radiography was read as normal. Initially, Naproxen (550 mg/day) and Morphine (60 mg/day) were prescribed with partially relieving pain. Scintigraphy showed increased uptake of 99mTc in the radial-side of the left wrist. Then, a bone tumor was suspected. The Computed tomography (CT) images revealed a well-demarcated sclerotic nidus surrounded by a halo of radiolucent osteoid tissue, consistent with an osteoid osteoma of the trapezoid bone and the adjacent second metacarpal bone. Surgical resection of the osteoid osteoma was performed. Histopathological examination confirmed the diagnosis. The patient reported complete pain relief since her surgery. She had no recurrence to date. Conclusion Osteoid osteoma should be in the differential diagnosis list of chronic wrist pain/arthritis. In this case, careful attention is necessary for patients unresponsive to treatment with long-lasting symptoms. If radiographs are inconclusive, CT or MRI should be considered to better visualize the nidus of osteoid osteoma in the small bones of the hand.

Effects of control temperature, ablation time, and background tissue in radiofrequency ablation of osteoid osteoma: A computer modeling study.

To study the effects of the control temperature, ablation time, and the background tissue surrounding the tumor on the size of the ablation zone on radiofrequency ablation (RFA) of osteoid osteoma (OO). Finite element models of non‐cooled temperature‐controlled RFA of typical OOs were developed to determine the resulting ablation radius at control temperatures of 70, 80, and 90°C. Three different geometries were used, mimicking common cases of OO. The ablation radius was obtained by using the Arrhenius equation to determine cell viability. Ablation radii were larger for higher temperatures and also increased with time. All geometries and control temperatures tested had ablation radii larger than the tumor. The ablation radius developed rapidly in the first few minutes for all geometries and control temperatures tested, developing slowly towards the end of the ablation. Resistive heating and the temperature distribution showed differences depending on background tissue properties, resulting in differences in the ablation radius on each geometry. The ablation radius has a clear dependency not only on the properties of the tumor but also on the background tissue. Lower background tissue's electrical conductivity and blood perfusion rates seem to result in larger ablation zones. The differences observed between the different geometries suggest the need for patient‐specific planning, as the anatomical variations could cause significantly different outcomes where models like the one here presented could help to guarantee safe and successful tumor ablations.

Arthroscopic Excision of Intra-Articular Osteoid Osteoma of the Hip: A Case Series

1) To identify the clinical features of intra-articular osteoid osteoma (OO) of hip, 2) to evaluate the clinical effect of arthroscopic excision for intra-articular OO.3) to summarize the characteristics of revision cases of hip OO and the revision surgery under arthroscopy on these cases. We retrospectively reviewed the data of 25 patients who underwent arthroscopic excision of hip OO. The case series included 10 patients who underwent revision surgery. Lesion location, presenting symptoms, and symptom duration were analyzed; postoperative improvement was assessed using the modified Harris Hip Score (mHHS) and international Hip Outcomes Tool (iHot-12) scores. We examined the reasons for need of revision surgery and the characteristics of OO progression after the first surgery. The most common presenting symptom was groin pain that was relieved by nonsteroidal anti-inflammatory drugs (NSAIDs). Varying degree of limitation of range of motion (ROM) was present in all patients. The osteosclerosis around the tumor nest in CT scan is a characteristic radiographic feature in this disease. However, the classic radiographic feature was only apparent on plain x-rays in 2 out of 25 patients. As a kind of efficient radiological method, MRI can help in distinguishing OO from femoroacetabular impingement (FAI), as the latter is characterized by a large effusion and bone marrow edema at the atypical site of impingement. For the patients who had only one arthroscopic resection, the mean mHHS and iHot-12 scores were 70.30 ± 9.06 (51-86) and 75.07 ± 7.69 (57-88), respectively. At last follow-up, the mean scores were 98.30 ± 2.15 (94-100) and 97.76 ± 2.04 (94-100). respectively (Table 3). For revision cases, the mean mHHS and iHot-12 scores were 68.55 ± 3.77 (60-72) and 67.88 ± 5.39 (56-76), respectively. At last follow-up, the mean scores were 97.11 ± 2.47 (94-100) and 95.22 ± 1.78 (94-100). respectively. In the present study, 24 of 25 patient (96%) reached the MCID of mHHS and 21 of 22 patients (95.2%) reached the MCID of iHot-12. Among the revision patients, the most common misdiagnosis at first surgery was FAI. Another feature is that a wrong diagnosis or incomplete intra-articular OO resection can stimulate the tumor and cause an inflammatory reaction and rapidly progressive OA, necessitating prompt revision surgery for complete removal. The degree of joint degeneration was related to the time since the first operation. OO of the hip joint typically presents with pain and limited joint activity. Misdiagnosis as FAI or synovitis is common and so that patient who has limit ROM, night pain and can be relieved by NASIDs should be suspected OO, and more advanced radiological evaluation, such as CT scan, should be performed. Arthroscopic excision appears to be an effective method for the treatment of OO of the hip joint. IV, case series.

Full-Endoscopic Resection of Osteoid Osteoma in the Thoracic Spine: A Case Report.

Common symptoms such as axial pain or nocturnal pain, associated with warning signs that are often worrisome in addition to nonspecific radiological findings, can characterize benign lesions in the spine, and osteoid osteoma is among them. We describe here a clinical case of a pediatric patient with an expansive bone lesion in the thoracic spine discovered after investigation for thoracic pain, mainly at night, which, despite a good response to simple analgesics, evolved in the short term with global spinal deformity. After a multidisciplinary evaluation, she underwent surgical resection using a pioneering endoscopic technique that allowed the definitive anatomopathological diagnosis of osteoid osteoma and guaranteeing very satisfactory treatment and evolution. Although there are already several therapeutic techniques described and with good results in specific cases of osteoid osteomas and other benign neoplastic lesions of the spine, full-endoscopic resection appears as an innovative and potentially promising option for diagnosis and treatment, especially since it is a safe, effective, and not too morbid intervention.

Intra-articular osteoid osteoma of tempromandibular joint: A rare entity

Osteoid osteomas are benign neoplasms of bone that generally manifests in the long bones. Intra-articular osteoid stoma of tempromandibular joint is a rare manifestation. We report a rare case of osteoid osteoma of the mandibular condyle encompassing the intra-articular space with emphasis on how to differentiate it from other benign neoplasms of the bone that affects the jaws.

A RARE CASE OF OSTEOID OSTEOMA IN MANDIBLE MIMICKING A PERIAPICAL INFLAMATORY LESION-case report

Osteoid osteoma is an uncommon non odontogenic benign bone neoplasm that rarely occurs in the jaw bones. This article presents a rare case of osteoid osteoma in mandible mimicking a periapical inflammatory lesion. The patient reported without symptoms and in good general health. Intraorally, there was a swelling in the periapical region of the left mandibular first bicuspid. Vitality test was negative. Orthopantomography depicted a well defined unilocular periapical radiolucency incasing the apical third of the mandibular first bicuspid, with osteosclerotic rim on its distal prospect. Such clinical findings were appropriate for chronic periapical inflammatory lesion, so periapical surgery was scheduled. During surgery, apicoectomy was performed, the lesion removed and sent for histopathology. The result showed irregularly proliferated trabeculae with disrupted architecture and visible osteoid accumulations typical for osteoid osteoma. Periodic follow ups were scheduled.  No recurrence was noted. Although rare, osteoid osteoma in mandible can mimic a periapical inflammatory lesion. Surgical removal and histology contributed to proper diagnostics. Complete surgical removal prevented recurrence. Keywords: osteoid osteoma, mandible, periapical inflammatory lesion, surgery, nonvital bicuspid, histology

Osteoid Osteoma of Cuboid Bone- A Rare Cause of Chronic Foot Pain in Childhood –A Case Report

Chronic foot pain in pediatric age group is less common. The usual differential diagnosis may vary from musculoskeletal injury to serious diseases such as osteomyelitis. Benign bone tumor such as osteoid osteoma of foot is exceedingly rare in this age group. Here we present a rare case of osteoid osteoma of cuboid mimicking osteomyelitis. Patient was managed conservatively by Non-steroidal Anti-inflammatory drugs (NSAIDs) with good clinical outcome. Osteoid osteoma of foot bones should be kept in mind in cases with normal blood parameters.

Spinal Osteoid Osteoma Revealed by Radiculopathy: Case Report and Literature Review.

Osteoid osteoma (OO) is a benign tumor that usually occurs in long bones of young males. We report a rare case of spinal OO in a 25-year-old woman, revealed by a sciatica. Spinal radiographs and computed tomography scan were normal, although performed at 6 months of symptom evolution. On magnetic resonance imaging, however, an important edema of the right transverse process of L5 vertebrae was depicted but was inconclusive. The diagnosis of OO was finally retained on a second computed tomography scan with thinner slices focused on the edematous area. The patient had an en-bloc excision of the tumor with complete regression of symptoms. Due to the atypical clinical presentation and the absence of common findings in imaging, the diagnosis was delayed by 12 months. Radiculopathy caused by spinal OO is a rare condition with no more than 30 cases reported in the literature. In fact, spinal OO usually presents with inflammatory back pain or painful scoliosis. This case emphasizes the importance of early suspicion and diagnostic interventions in the detection and treatment of OO.