Surgical management of spinal osteoblastomas.

OBJECTIVE Osteoblastoma is a rare primary benign bone tumor with a predilection for the spinal column. Although of benign origin, osteoblastomas tend to behave more aggressively clinically than other benign tumors. Because of the low incidence of osteoblastomas, evidence-based treatment guidelines and high-quality research are lacking, which has resulted in inconsistent treatment. The goal of this study was to determine whether application of the Enneking classification in the management of spinal osteoblastomas influences local recurrence and survival time. METHODS A multicenter database of patients who underwent surgical intervention for spinal osteoblastoma was developed by the AOSpine Knowledge Forum Tumor. Patient data pertaining to demographics, diagnosis, treatment, cross-sectional survival, and local recurrence were collected. Patients in 2 cohorts, based on the Enneking classification of the tumor (Enneking appropriate [EA] and Enneking inappropriate [EI]), were analyzed. If the final pathology margin matched the Enneking-recommended surgical margin, the tumor was classified as EA; if not, it was classified as EI. RESULTS A total of 102 patients diagnosed with a spinal osteoblastoma were identified between November 1991 and June 2012. Twenty-nine patients were omitted from the analysis because of short follow-up time, incomplete survival data, or invalid staging, which left 73 patients for the final analysis. Thirteen (18%) patients suffered a local recurrence, and 6 (8%) patients died during the study period. Local recurrence was strongly associated with mortality (relative risk 9.2; p = 0.008). When adjusted for Enneking appropriateness, this result was not altered significantly. No significant differences were found between the EA and EI groups in regard to local recurrence and mortality. CONCLUSIONS In this evaluation of the largest multicenter cohort of spinal osteoblastomas, local recurrence was found to be strongly associated with mortality. Application of the Enneking classification as a treatment guide for preventing local recurrence was not validated.

Benign osteoblastoma of the temporal bone: Case report and review of the literature.

BACKGROUND: Benign osteoblastoma arising from the temporal bone is extremely rare in elderly patients. We reviewed the literature on benign osteoblastoma of the temporal bone and now propose a new classification of this pathologic entity based on its anatomical location in the temporal bone. CASE DESCRIPTION: A 68-year-old woman presented with tinnitus and hearing disturbance with a duration of 1 year. Her neurologic examination revealed mixed hearing disturbance and hypogeusia. Preoperative computed tomography showed a bony destructive isodensity mass with calcified component involving the temporal bone. The FDG-PET scan showed high uptake on the lesion. After preoperative embolization on the day before surgery, the patient underwent tumor removal via a left infratemporal approach under neuronavigated guidance. The pathologic examination revealed a benign osteoblastoma. CONCLUSION: We present the first case of FDG-PET showing high uptake on the lesion. Preoperative embolization is useful to reduce the amount of bleeding during the surgery.

Coarse pleural calcification in a mesothelioma patient raises the possibility of a rare tumour subtype: osteoblastic sarcomatoid mesothelioma.

It is often suggested that calcification seen in association with pleural thickening implies benign disease. However, we present a case of a patient presenting with coarse pleural calcification associated with a pleural effusion and thickening, which following biopsy was shown to represent osteoblastic sarcomatoid mesothelioma. We describe the imaging features associated with this and differentiate these findings from those seen with benign pleural calcification. Similarities are drawn to other rare cases described in the literature.