Unusual Location of Osteoid Osteoma in the Acromion.

We present the clinical case of a 14-year-old female patient complaining of omalgia. A focus of osteoid osteoma located in the acromion was diagnosed. The lesion was removed using the arthroscopic technique, and the symptoms subsided completely. We also present a review of published papers regarding unusual locations of osteoid osteoma.

Clinical and radiological features and skeletal sequelae in childhood intra-/juxta-articular versus extra-articular osteoid osteoma.

BACKGROUND: To compare the clinical and radiological features of intra-/juxta-articular osteoid osteoma and extra-articular osteoid osteoma in skeletally immature patients, paying special attention to the skeletal complications. METHODS: Osteoid osteoma in 34 children (22 boys and 12 girls, mean age 10.4 years) was dichotomized according to the location of the nidus as intra-/juxta-articular (11 children) or extra-articular (23 children). The following features were compared: diagnostic delay, typical symptoms, synovitis and limited range of joint motion, response to treatment, typical radiographic findings, and skeletal complications. RESULTS: Eight of the 11 children with intra-/juxta-articular osteoid osteoma presented with synovitis in the involved joint, which led to a delayed diagnosis for a median 9.5 months. Pain disappeared in all children with surgical or medical interventions, but at the mean 4.9-year follow-up evaluation, skeletal abnormalities around the joint were noted in 5 children (4 proximal femur and 1 distal humerus) with intra-/juxta-articular osteoid osteoma, 2 of whom required subsequent surgeries for limited hip motion caused by femoroacetabular impingement and limited range of elbow motion, respectively. In contrast, typical clinical and radiological features were observed more often in extra-articular osteoid osteoma, and only 1 child showed overgrowth of the tibia, which did not have clinical significance. CONCLUSIONS: Intra-/juxta-articular osteoid osteomas in growing children exhibit different clinical and radiological features from extra-articular lesions. Skeletal abnormalities mainly develop in intra-/juxta-articular osteoid osteoma, and these may lead to permanent skeletal sequelae.

Evaluation of outcome of surgical excision of the nidus of osteoid osteoma of long bone.

Osteoid osteoma is a benign bone tumour usually found in the lower extremities of children and young adults. This tiny bone tumour causes pain out of all proportion to its size and hinders the daily activities. This Quasi-experimental study conducted in the department of Orthopaedic surgery of BSMMU from January 2008 to December 2009. Twenty one patients were included in the study where purposive sampling technique was used on the basis of inclusion and exclusion criteria and all the ethical conditions were fulfilled. Diagnosis was almost obtained by taking history, clinical examination, and relevant investigations. Clinical variables were age, sex, site, pain, swelling, deformity and outcome variables were painless active life, removal of swelling, prevention of deformity, rate of recurrence. After localization of the tumour with the help of C arm, the nidus was excised in a small block of bone. The outcome is categorized by consensus, as clinically successful, only if the patient was free of pain and was taking no medication. The treatment was considered to have failed if a subsequent procedure had been performed to remove tumour. Among 21 cases, 14(66.7%) were male and 7(33.7%) were female. Maximum number of patients 15(71.4%) was between 10 years to 20 years. Most of the patients (76.2%) affected by osteoid osteoma were young students and most of the patients (95.2%) experienced moderate aching pain, usually aggravating at night which was typically relieved by aspirin or other NSAIDs (71.4%). Lower limbs (76.2%) particularly femur and tibia were commonly affected. Out of 21 patients, 19(90.5%) patients have got immediate pain relief or required no medication. In only 2 patients (9.5%), subsequent procedure has been performed to relief pain. So, successful outcome (in 19 out of 21) was significantly (p<0.001) higher in comparison to failed. Surgical excision of the nidus is a simple and easy procedure and does not require extensive resection of bone. If localization is done properly success rate is high and patients can return to normal daily activities.

Osteoid osteoma: a pictorial review.

Osteoid osteoma is a small, benign osteoblastic bone tumor most commonly found in long bones, such as the femur or tibia. Osteoid osteomas account for roughly 10% of all benign bone tumors and characteristically present with dull aching pain, worse at night, and often relieved with NSAIDS. They typically present in young individuals, most commonly between the ages of seven and 25 years and in a male to female ratio of 3:1. An understanding of its classic radiographic appearance is necessary for diagnosis.

The distribution of heat in bone during radiofrequency ablation of an ex vivo bovine model of osteoid osteoma.

Osteoid osteoma is treated primarily by radiofrequency (RF) ablation. However, there is little information about the distribution of heat in bone during the procedure and its safety. We constructed a model of osteoid osteoma to assess the distribution of heat in bone and to define the margins of safety for ablation. Cavities were drilled in cadaver bovine bones and filled with a liver homogenate to simulate the tumour matrix. Temperature-sensing probes were placed in the bone in a radial fashion away from the cavities. RF ablation was performed 107 times in tumours < 10 mm in diameter (72 of which were in cortical bone, 35 in cancellous bone), and 41 times in cortical bone with models > 10 mm in diameter. Significantly higher temperatures were found in cancellous bone than in cortical bone (p < 0.05). For lesions up to 10 mm in diameter, in both bone types, the temperature varied directly with the size of the tumour (p < 0.05), and inversely with the distance from it. Tumours of > 10 mm in diameter showed a trend similar to those of smaller lesions. No temperature rise was seen beyond 12 mm from the edge of a cortical tumour of any size. Formulae were developed to predict the expected temperature in the bone during ablation.

Osteoid osteoma in a 16-year-old boy presenting with atrophy of the left thigh: diagnostic difficulties.

Osteoid osteoma is an osteoblastic benign lesion of the bone. The pathognomonic symptom is significant pain, which responds well to nonsteroidal antiinflammatory drugs. When typical clinical and radiological features are present, the diagnosis is not difficult. However, if the lesion is in an area not clearly seen on plain radiographs, or clinical features are atypical, then diagnosis becomes difficult. We present a case of osteoid osteoma with delayed diagnosis that presented itself with neurological signs. Prominent features present in the patient included pain that responded well to medication and muscle atrophy, which led to a wider differential diagnosis. Diagnosis was made approximately two years after the onset of his initial symptoms, after having been investigated and treated both in our own hospital and elsewhere. This case illustrates clinical and radiological diagnostic problems of osteoid osteoma, demonstrating that it can present itself with neurological signs. Correct diagnosis then requires detailed history and clinical awareness.

Osteoid osteoma causing subtalar joint arthralgia: a case report.

The authors describe a juvenile patient with an osteoid osteoma in the foot-a relatively rare location for this type of lesion. The appearance of this lesion in a juxtaarticular location is even more rare. An 11-year-old boy with a 6-month history of limping secondary to subtalar joint pain presented with a juxtaarticular osteoid osteoma located within the calcaneus. The lesion was present beneath the sinus tarsi and the subtalar joint region. Plain radiographs showed equivocal changes; however, magnetic resonance imaging clearly showed a central nidus. The lateral aspect and midbody of the calcaneus showed a spherical focus of diminished signal on both the T1- and T2-weighted images. This focus had a surrounding rim of significantly diminished signal on all sequences. Thus, findings were most consistent with an osteoid osteoma, although a Brodie abscess could not be ruled out. Surgical excision was performed and led to complete resolution of pain and limping. The pathology report confirmed the diagnosis of osteoid osteoma.

Osteoid osteoma: elevation of cardiac and respiratory rates at biopsy needle entry into tumor in 10 patients.

PURPOSE: To evaluate changes in cardiac and respiratory rates in a consecutive series of patients who underwent percutaneous treatment for lesions presumed to be osteoid osteoma in whom general anesthesia was established. MATERIALS AND METHODS: Changes in cardiac and respiratory rates were evaluated after establishment of stable general anesthesia in 14 patients who underwent needle biopsy and radio-frequency treatment. Cardiac and respiratory rates were recorded at penetration of skin, muscle, periosteum, cortex, and tumor. Treatment was performed before the biopsy report was available. RESULTS: Biopsy results revealed osteoid osteoma in 10 patients, chondroblastoma in one, and a herniation pit in one. Results in the two remaining patients were nondiagnostic and were excluded. Puncture of skin, muscle, and periosteum caused no detectable change. However, in the 10 patients with biopsy-proved osteoid osteoma, puncture of the tumor caused the mean cardiac rate to increase an average of 26 beats per minute (40%) to 91 (range, 62-114; P <.001) and the mean respiratory rate to increase an average of 12 breaths per minute (50%) to a mean of 37 (range, 25-52; P <.001). These changes occurred within seconds of tumor puncture and were often the first indication to the surgeon that the tumor had been entered. In the two patients with other diagnoses at biopsy, no such change was apparent. CONCLUSION: Mean cardiac and respiratory rates increase significantly at needle puncture of osteoid osteoma.

[Double localization of osteoid osteoma of the tibia--case report]. / Podwójne ognisko kostniaka kostnawego piszczeli u 9-letniego chlopca--opis przypadku.

Osteoid osteoma is a common, benign lesion of bone. Most patients who have osteoid osteoma have a history of pain in a limb, that is characteristically worse at night and is relieved dramatically by salicylates. There is general agreement in the literature that complete excision is the treatment of choice and that incomplete removal of the nidus leads to recurrence of symptoms. Usually, the affected bone is easily accessible to the surgeon, and it is not difficult to excise the lesion en bloc or, less commonly, to perform cortical shaving and curettage of the cavity of the nidus. The case nine years old boy of double nidus localization of osteoid osteoma of the tibia is presented. No reports on patients who were treated with double nidus localization have been published, to our knowledge.

Osteoid osteoma of olecranon process of ulna in subchondral location.

We present a case of a 15-year-old girl with osteoid osteoma in an unusual subchondral localization of the olecranon. Unspecific complaints and minimal X-ray findings at the onset of the disease led to an incorrect diagnosis and more than 2 years of inefficient treatment.

Osteoid osteoma of the carpal bones.

Osteoid osteoma is a benign bone tumor that rarely localizes in the hand or the carpal bones. We report two cases of osteoid osteoma localized in two different carpal bones. Unremitting wrist pain was a major clinical symptom. Surgical treatment including excision of the nidus was dramatically curative. In young patients, osteoid osteoma should be considered in the differential diagnosis of chronic wrist pain.

Osteoid osteoma. Direct visual identification and intralesional excision of the nidus with minimal removal of bone.

We describe 100 consecutive patients with osteoid osteoma. Of the 97 who had operations, 89 were treated by intralesional excision and eight by wide resection. The three remaining patients were not operated on because the osteoid osteoma was almost painless, or was found in the pedicle of the 12th thoracic vertebra at the site of entrance of the artery of Adamkjewicz. The diagnosis was confirmed histologically in all specimens. No local recurrences were observed at a minimum follow-up of one year. All except one patient were mobilised two to four days after surgery. A precise preoperative diagnosis of the lesion is mandatory, based on clinical findings, standard radiographs, thin-section CT and a bone scan. We compared our operative technique with 247 cases in which the percutaneous technique of removal or coagulation of the nidus had been performed. The latter procedure has a less constant rate of primary cure (83% v 100%). Its principal indication appears to be for osteoid osteomas in the proximal femur and the pelvis.

Osteoma osteoide del astrágalo

El osteoma osteoide del astrágalo comprende el 5 por ciento de estos tumores, y es usualmente de presentación clínica confusa y de diagnóstico radiológico difícil. Presentamos un caso de osteoma osteoide localizado en el cuello del astrágalo, en un joven de 18 años, el cual llevaba 4 años de sintomatología sin mejoría, por lo que se le realizó resonancia magnética. en ella que visualizó un patrón de edema medular e irregularidad cortical en el cuello que sugirieron el diagnóstico, comprobándose posteriormente con tomografía e histología

Osteoid osteoma as a cause of knee pain. A review of 10 cases.

Osteoid osteoma is a benign tumor frequently situated around the knee. It should therefore be considered as a possible cause of atraumatic knee pain in young adults. The mean interval from onset of symptoms to diagnosis is 14 months. Clinical symptoms are the most reliable diagnostic factors. Block resection is the treatment of choice. A retrospective study of 10 patients is presented.

Neurological manifestations of osteoid osteoma.

The clinical and radiological features of 38 children with osteoid osteomas were analysed retrospectively. Twenty nine patients had lesions of the femur (n = 17) or tibia (n = 12). The mean duration from the onset of symptoms to diagnosis was 13.8 months. In seven patients the history of pain and abnormalities on examination suggested a possible neurological disorder. Fourteen of 29 patients (48%) with femoral or tibial osteomas had localised muscle atrophy, and 10 patients (34%) had diminished or absent deep tendon reflexes in the affected limb. Two patients had painless lesions. Six patients had normal plain radiographs. Delay in the diagnosis of osteoid osteoma may be prevented by the knowledge that pain may be referred or radicular, that the concomitant occurrence of muscle atrophy and depressed deep tendon reflexes are relatively common findings, and that the characteristic radiological features may only appear late in the course of the disease.

Subtalar arthralgia caused by juxtaarticular osteoid osteoma.

Juxtaarticular osteoid osteomas in the ankle are frequently misdiagnosed because their symptoms mimic arthritis and may precede roentgenographic findings. In addition, these tumors are rare compared to arthritis and other sources of ankle pain. Four cases of osteoid osteoma of the talus or calcaneus are reported, indicating some of the problems encountered with their identification, and suggestions are made for appropriate investigations to aid in the early and correct diagnosis. The use of plain tomograms, thin-section computed tomograms, and radionuclide scans aid an early and correct diagnosis. Arthroscopy and arthrotomy are often inappropriate.

Interleukin-1 alpha and phorbol ester inhibit collagen synthesis in osteoblastic MC3T3-E1 cells by a transcriptional mechanism.

The effects of recombinant human interleukin-1 alpha (IL-1) on procollagen gene expression were examined in the clonal mouse osteoblastic cell line MC3T3-E1. Cells were grown in Dulbecco's Modified Eagle's Medium containing 10% fetal calf serum and 50 micrograms/ml ascorbic acid. Collagen synthesis was assessed as [3H]proline incorporation into collagenase-digestible protein (CDP). Procollagen mRNA levels were determined by Northern blot analysis using a 32P-labeled alpha 1(I) cDNA. Transcription rates were determined by nuclear run-off assay. IL-1 at 1-1000 pg/ml caused a concentration-dependent inhibition of CDP, which was maximally reduced by 75-80%, and a parallel reduction of procollagen alpha 1(I) mRNA levels. The effects of IL-1 were mimicked by the tumor promoter phorbol 12-myristate 13-acetate (PMA) at 1-100 nM, which inhibited CDP and reduced procollagen alpha 1(I) mRNA levels to a similar extent. The effects of IL-1 and PMA were independent of prostaglandin production, since indomethacin did not alter the inhibitory effect of either agent on CDP. Neither IL-1 (up to 10 ng/ml) nor PMA (100 nM) affected adenylate cyclase activity, while forskolin (10 microM), PTH (10 nM) and prostaglandin E2 (1 microM) stimulated adenylate cyclase activity 3- to 5-fold. However, forskolin (10 microM) and (Bu)2cAMP (100 microM) failed to alter CDP or procollagen alpha 1(I) mRNA levels. IL-1 (1 ng/ml) and PMA (100 nM) reduced transcription of the alpha 1(I) procollagen gene by 70% and 80%, respectively, while alpha 2(I) transcription was decreased by 59% and 53%. Neither IL-1 nor PMA affected transcription of the beta-actin or beta-tubulin genes.(ABSTRACT TRUNCATED AT 250 WORDS)

Atlanto-axial rotational limitation secondary to osteoid osteoma of the axis. Case report.

An unusual case of atlanto-axial rotational limitation secondary to an osteoid osteoma of the axis is presented. Transoral microsurgical resection followed by physical therapy improved the clinical symptoms. This case illustrates several unique problems within the cervical spine as well as the efficacy of the transoral approach to the axis.