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Osteoid Osteoma and Osteoblastoma Areosteogenic Commonly Bone Seen Neoplasms

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Osteoid Osteoma and Osteoblastoma Areosteogenic Commonly Bone Seen Neoplasms Review Article Osteoid Osteoma and Osteoblastoma 12/02/2019 on u/IbxyW10PyB2YElQSx553TwN8VxsYCiZA5XrK0/cP/SCpUSBb7JMj6d1Ekjs016BH/IiOppl5yk1QrhahWY4dmkQx6hwiC5aPRlV2DVnBAgWs7gdhpPEkx2dlG58Dkr8eqv7+kEVTc= by https://journals.lww.com/jaaos from Downloaded Abstract Downloaded Kivanc I. Atesok, MD, MSc Osteoid osteoma and osteoblastoma are commonly seen benign osteogenic bone neoplasms. Both tumors are typically seen in the from Benjamin A. Alman, MD, https://journals.lww.com/jaaos FRCSC second decade of life, with a notable predilection in males. Emil H. Schemitsch, MD, Histologically, these tumors resemble each other, with FRCSC characteristically increased osteoid tissue formation surrounded by Amos Peyser, MD vascular fibrous stroma and perilesional sclerosis. However, by osteoblastomas are larger than osteoid osteomas, and they exhibit u/IbxyW10PyB2YElQSx553TwN8VxsYCiZA5XrK0/cP/SCpUSBb7JMj6d1Ekjs016BH/IiOppl5yk1QrhahWY4dmkQx6hwiC5aPRlV2DVnBAgWs7gdhpPEkx2dlG58Dkr8eqv7+kEVTc= Henry Mankin, MD greater osteoid production and vascularity. Clinically, osteoid osteoma most commonly occurs in the long bones (eg, femur, tibia). The lesions cause night pain that is relieved with nonsteroidal anti-inflammatory drugs (NSAIDs). Osteoblastoma is most frequently located in the axial skeleton, and the pain is usually not worse at night and is less likely to be relieved with NSAIDs. Osteoblastoma can be locally aggressive; osteoid osteoma lacks growth potential. Osteoid osteoma may be managed nonsurgically with NSAIDs. When surgery is required, minimally invasive methods (eg, CT-guided excision, radiofrequency ablation) are preferred. Osteoblastoma has a higher rate of recurrence than does osteoid osteoma, and patients must be treated surgically with intralesional curettage or en bloc resection. steoid osteoma and osteoblas- mors.1,5 This lesion most commonly Otoma are benign bone-forming occurs in persons aged 5 to 25 years, From the Institute of Medical skeletal neoplasms that are charac- with a male:female ratio of 2:1.6,7 In Science, University of Toronto, terized by the formation of osteoid >50% of cases, the lesion occurs in Toronto, ON, Canada (Dr. Atesok), or mature bone directly by the tumor the Division of Orthopaedic Surgery, the metaphysis and diaphysis of the 1 The Hospital for Sick Children, cells. Together, these tumors repre- long bones, particularly the femur Toronto (Dr. Alman), the Division of sent approximately 15% of all be- and tibia.6,7 Other anatomic sites of Orthopaedics, Department of nign skeletal neoplasms, and they are involvement include the spine, upper Surgery, St. Michael’s Hospital, on University of Toronto, Toronto commonly encountered by orthopae- extremity, pelvis, sacrum, ribs, 12/02/2019 2,3 (Dr. Schemitsch), the Department of dic surgeons in the clinical setting. hands, and feet4 (Table 1). Orthopedics, Shaare Zedek Medical Center, Jerusalem, Israel Gross Structure and (Dr. Peyser), and the Department of Osteoid Osteoma Orthopaedic Surgery, Massachusetts Histology General Hospital, Boston, MA (Dr. Mankin). Osteoid osteoma was first described Observed grossly, the lesion is usu- in 1935 by Jaffe, who also coined the ally <1.5 cm in diameter and con- J Am Acad Orthop Surg 2011;19: term.4 It is the most commonly seen be- 678-689 tains a discrete central area known nign bone-forming lesion, accounting as the nidus that is surrounded by Copyright 2011 by the American for 10% to 12% of all benign bone tu- dense sclerotic bone tissue.8 In gen- Academy of Orthopaedic Surgeons. mors and 3% of all primary bone tu- eral, osteoid osteoma is a solitary le- 678 Journal of the American Academy of Orthopaedic Surgeons Kivanc I. Atesok, MD, MSc, et al Table 1 Features of Osteoid Osteoma and Osteoblastoma Osteoid Osteoma Osteoblastoma Incidence ≈12% of all benign bone tumors ≈3% of all benign bone tumors ≈3% of all primary bone tumors ≈1% of all primary bone tumors Age 5to25yr 10to25yr Sex Male:female ratio of 2:1 Male:female ratio of 2:1 Size <2 cm in diameter (typically <1.5 cm) >2 cm in diameter (average, 3.5 to 4 cm) Location >50% of lesions in the lower extremity long bones >35% of lesions in the vertebral column (posterior ele- (ie, femur, tibia). Other common sites: spine, upper ments). Other common sites: long bones, craniofacial extremity, hands, feet, and pelvis bones, hands, and feet Clinical features Local pain that is most severe at night and can be re- Dull, aching, progressive local pain. Due to higher inci- lieved with nonsteroidal anti-inflammatory drugs. De- dence of spinal involvement, patients may experience pending on location, patients may present with bone neurologic symptoms, scoliosis, or torticollis. Local deformity, gait disturbance, limb-length discrepancy, tenderness and swelling may be seen. or synovitis. Imaging findings Plain radiograph is obtained initially, but supportive Plain radiograph obtained initially. Lesions are larger. imaging is required. Supportive imaging is required. Bone scan: Sensitive and valuable in localizing the Bone scan: Sensitive. Shows high uptake of radionu- lesion. Shows high uptake. clide at the lesion site. CT: Imaging method of choice. Shows the low- CT: Imaging method of choice. Larger lesion, central attenuated nidus with surrounding sclerosis. mineralization, expansile bone growth, less reactive MRI is controversial: Nonspecific findings with frequent sclerosis, thin marginal bone shell. misinterpretation. MRI is controversial: Nonspecific findings with overesti- mation of tumor extent and nature. Histology and Central nidus composed of tiny osteoid islands lined Centrally, lesions demonstrate a less organized osteoid nature by osteoblasts. The area peripheral to the nidus ap- pattern than osteoid osteoma, with greater vascularity. pears clearer because of osteoclastic resorption. Bony trabeculae lined by osteoblasts. Presence of Dense sclerotic bone surrounds the nidus. Benign. epithelioid osteoblasts indicates aggressiveness. Less No growth potential. sclerotic bone with a thin shell of newly formed peri- osteal bone at the margin. Benign. Growth is local- ized, with aggressive potential. sion; in rare cases, however, more gives rise to a clearer area at the pe- Biology and than one nidus may be circumscribed riphery of the circular nidus. The ni- Pathophysiology 9,10 by a single block of sclerotic bone. dus is surrounded by a region of ac- Schulman and Dorfman11 demon- Microscopically, the nidus is com- tive bone formation that appears as strated abundant nerve fibers within posed of thin seams of osteoid or sclerotic dense bone with various the nidus matrix adjacent to areas woven bone lined with osteoblasts, patterns of maturation.1,4 rich in arterioles. High levels of pros- which represents a process of bone Osteoid osteoma does not grow or taglandin synthesis in the nidus of remodelling with osteoblastic activ- behave in a locally aggressive man- osteoid osteoma have been reported ity (Figure 1). Osteoclastic bone re- ner, and it has no potential for malig- in several other studies.12,13 This find- sorption occurs simultaneously and nant transformation.4,6 ing was supported by studies demon- Dr. Atesok or an immediate family member serves as a board member, owner, officer, or committee member of the International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine and the Orthopaedic Research Society. Dr. Alman or an immediate family member serves as a board member, owner, officer, or committee member of the Pediatric Orthopaedic Society of North America. Dr. Schemitsch or an immediate family member has received royalties from Stryker; serves as a paid consultant to Amgen, Stryker, Synthes, Smith & Nephew, Baxter, Wright Medical Technology, and Kuros; has received research or institutional support from Smith & Nephew; has received nonincome support (such as equipment or services), commercially derived honoraria, or other non-research–related funding (such as paid travel) from the Canadian Institutes of Health Research, BrainLAB, OMEGA, Smith & Nephew, Zimmer, and Stryker; and serves as a board member, owner, officer, or committee member of the Orthopaedic Trauma Association, Canadian Orthopaedic Association, and Osteosynthesis and Trauma Care Foundation. Neither of the following authors nor any immediate family member has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Peyser and Dr. Mankin. November 2011, Vol 19, No 11 679 Osteoid Osteoma and Osteoblastoma Figure 1 Figure 2 A, AP radiograph demonstrating an osteoid osteoma nidus in the base of the Histologic appearance of an area fifth metatarsal (arrows). B, Bone scintigraphy image demonstrating within a nidus in a patient with increased radionuclide uptake by the lesion in the affected foot, at the left, osteoid osteoma. The bony and no abnormal findings in the contralateral foot at the right. (Panel A trabeculae are rimmed by adapted with permission from Peyser A, Applbaum Y: Radiofrequency osteoblasts (arrow). Capillaries can ablation of bone tumors. Current Orthopaedic Practice 2009;20[6]:616-621.) be detected between the bony trabeculae (arrowhead) (hematoxylin-eosin, high-power view). (Adapted with permission from Zbojniewicz AM, Hartel J, pending on the proximity to a joint, the tumor often leads the clinician to Nguyen T, Wilks K, Mace A, Hogg clinician may note effusion, synovitis, strongly consider a diagnosis of os- JP: Neoplastic disease of the degenerative changes,
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