Clinical implications, diagnosis, and treatment of a giant frontoethmoid osteoma.

Osteomas are benign, asymptomatic fibro-osseous tumors that are most commonly observed in the paranasal sinuses and sometimes are found in imaging examinations that were taken for other reasons. Giant osteomas are rarely found in the frontal and ethmoid sinuses but, when they are, they may cause intracranial and orbital complications. The aims of this case report are to describe a frontoethmoid osteoma in a 40-year-old woman, discuss the characteristics of this lesion through cone beam computed tomography (CBCT) imaging, and review the options for treatment. A CBCT examination performed for the purpose of orthodontic diagnosis revealed the presence of a large, well-defined, lobular, hyperdense mass that occupied a sizeable area of the frontal sinus and extended to the ethmoid sinus. The patient did not report any pain. Based on the physical and imaging characteristics of the mass, the location and size of the lesion, and the patient's age, the diagnosis was a giant frontoethmoid osteoma. Due to its enhanced field of view, CBCT may enable earlier diagnosis of lesions that affect the maxillofacial region.

Clinical features and therapeutic management of choroidal osteoma: A systematic review.

Choroidal osteoma is a benign ossifying tumor within the choroid. Complications associated with choroidal osteoma, including disruption of retinal pigment epithelium, atrophy of photoreceptors, subretinal fluid, and choroidal neovascularization, present challenges for clinicians, and management remain controversial. We performed a comprehensive search in the PubMed, EMBASE, and Ovid databases for published studies and case reports relating to the management of choroidal osteoma. Since it was first described in 1978, various case reports of ocular complications associated with choroidal osteoma have been documented, and various therapies have yielded different outcomes. We systematically evaluate the literature published on this rare entity.

Acquired plate-like osteoma cutis.

Plate-like osteoma cutis is a rare disorder that has been historically classified as a congenital syndrome. It has a possible relationship to a mutation in the gene (GNAS1) that encodes the α-subunit of the stimulatory G protein, which regulates adenyl cyclase activity. We report a case of extensive plaque-like masses on the scalp and face with no abnormalities in calcium or phosphate metabolism and no preceding inflammatory cutaneous conditions. With less than ten reported cases, to our knowledge, this is one the few cases of acquired plate-like osteoma cutis described in the literature.

Calcaneal Bone Tumors.

Bone tumors of the foot are an uncommon finding. Most tumors are found incidentally on imaging and are benign. Care must be taken although due to the aggressive nature of malignant bone tumors that can occur in the calcaneus. Malignant lesions will more commonly present with symptoms of pain and swelling. Often misdiagnosed as soft tissue injuries, it is critical to be able to diagnose and treat these lesions early. Imaging plays an important role with plain films and advanced imaging. Surgical treatments can range from curettage with grafting to amputation for more aggressive lesions.

Frontal Sinus Osteoma Presenting with Meningitis and Epilepsy.

BACKGROUND: Osteomas are benign lesions of bone, most frequently seen in the paranasal sinuses; however, they are typically asymptomatic and without complication. We report a rare case of large frontal sinus osteoma with intracranial extension, associated with meningitis and the development of seizures. CASE DESCRIPTION: The patient is a 38-year-old man with a prolonged history of headache and seizures, who was seen by multiple specialists previously, all of whom deferred treatment. After years of worsening seizure activity, he finally underwent surgical resection of the lesion at our institution in a joint operation with neurosurgery and otolaryngology. We examine his course, presentation, and management, and examine the literature for cases of complicated sinus osteomas. CONCLUSIONS: This represents the fourth reported case of frontal sinus osteoma associated with meningitis. We believe this case demonstrates the value of a robust differential and a multidisciplinary approach.

[Tumours of the bony face in children the treated at the Paediatric ENT Clinic in Warsaw]. / Guzy twarzoczaszki u dzieci leczonych w Klinice Otolarynologii Dzieciecej w Warszawie.

INTRODUCTION: The tumours of bony face at in children are rare. Among the most commonly found are inflammatory tumours and development anomalies. In histopathology, the most frequent fund are neuroma, fibromas, osteoma, lipomas. In inflammatory tumours there are abscess and inflammatory infiltration. Malignants tumours in this area are rare in children, but are mainly sarcomata or melanoma. Developmental tumours include cyst and fistula. OBJECTIVE: To analyse tumours of the bony face treated in Paediatric ENT Clinic in Warsaw. MATERIAL: There were thirty cases of bony face tumours treated in Paediatric ENT Clinic in Warsaw between 2005 and 2007. RESULTS: One cases (3%) provedto be malignant, and one (3%) locally malignant. Twenty-one cases (70%) were found to be developmental tumours, three cases (10%) of abscesses, and four cases (13%) of benign tumours. CONCLUSIONS: The most frequently-found tumours of bony face in children are developmental tumours. All tumours must be the subject of histopatological examination. In the case of cancers tumours it has to be established if the tumour is a primary or a metastatic. In the group analysed group the rare tumour were epithelioma, ganglioma.

[Long-term follow-up and management of choroidal osteoma].

OBJECTIVE: To report the clinical characteristics, long-term follow-up and management of choroidal osteoma. METHODS: Eighteen eyes of 12 cases (5 male and 7 female) of choroidal osteoma were studied. Best corrected vision, intraocular pressure, perimetry, anterior segment and eye fundus were examined routinely. Special tests included phytochrome of eye fundus, fluorescein angiography and/or indocyanine green angiography; B-ultrasonogram, CT, perimetry and electrophysiology. (1) Eight eyes of 6 cases treated with vitamins and anti-inflammatory drug and followed-up periodically for 1-26 years (median 2.5 years). (2) Four eyes of 2 cases were treated with Krypton laser photocoagulation, 2 of them were superimposed with transpupillary thermotherapy (TTT). (3) TTT was given primarily for 6 eyes of 4 cases with infrared dione laser; the spot size was 3 mm, 1-5 spots were conducted conjunctly to cover the tumor surface. Power was 800-1200 mw at 60-90 seconds. The procedure was completed in 1-3 recessions with an interval of 4-6 weeks. RESULTS: (1) In the medical treatment group, gradual growth of the tumor with pseudopodium along the margin was disclosed. One eye showed spontaneously regression during the long-term follow-up. (2) Laser photocoagulation was effective for 2 eyes, but residual flat serous detachment around the optic disc persisted in another 2 eyes and subsided with TTT. (3) Choroidal osteoma complicated with CNV treated primarily with TTT, prominent improvement was demonstrated. CONCLUSIONS: Choroidal osteoma grows gradually in the natural course and shows pseudopodial margin. Laser photocoagulation was effective for certain cases. TTT is a method of choice either used primarily or supplementary after laser photocoagulation, it is recommended for cases complicated with CNV.

Benign sinonasal neoplasms: a focus on inverting papilloma.

Benign sinonasal neoplasms are a pathologic and clinically varied group of tumors. Inverting papilloma is a notable member of this group, and it is renowned for its high rate of recurrence, its ability to cause local destruction, and its association with malignancy. This article aimed to familiarize the clinician with all the practical aspects of inverting papilloma and its management. The treatment algorithm for this tumor has undergone a complex evolution that continues today.

Paranasal sinus osteomas: Diagnosis and treatment.

INTRODUCTION: Osteoma is the most common benign tumor of the nose and paranasal sinuses. It is a slow-growing bony tumor, often asymptomatic, occurring mainly in frontal and ethmoid sinuses. Theories regarding the origin of osteomas are still discussed. The aims of the study were to describe diagnosis circumstances in our series and to set out our respective indications for open and endoscopic approaches in the treatment of nasosinusal osteomas. PATIENTS AND METHODS: A retrospective study was conducted on the files of all the patients treated for a paranasal sinus osteoma in our department between 1990 and 2013. Diagnosis circumstances and kind of treatment were collected and analyzed. RESULTS: The files of 45 patients (mean age: 49.2; sex-ratio: 1.19) could be collected. The most common symptom was headache found in all patients. The most common location was the frontal sinus (30 cases). Thirty-nine open procedures were performed. Four osteomas were removed under endoscopic assistance. In one case, a combined approach has been used. Overall complication rate was 11.1%. Symptoms improved in all patients. Two recurrences were observed. DISCUSSION: Surgical indications in paranasal sinus osteomas are theorically well codified. However, approaches remain controversial. In our experience, the preferred approach was the open one. Endoscopic techniques, when indicated, are more challenging and need sophisticated instrumentation and a long learning curve.

[Soft-tissue osteomas in buccal space: a case report and review of the literatures].

Osteoma is a benign tumor, which is composed of mature differentiated bone tissue .Osteoma can be central, peripheral or extraskeletal. Extraskeletal osteoma also is called soft-tissue osteoma. Extraskeletal soft-tissue osteoma is exceedingly rare, especially in the oral cavity. This article reported a case with soft-tissue osteomas in buccal space. The histogenesis, differential diagnosis, pathologic type and treatment were discussed. Surgical resection is suggested as the main treatment for this disease.

Management of neoplasms of the head and neck in children. 1. Benign tumors.

The otolaryngologist who treats children must have knowledge of the neoplasms that can occur in childhood. Such tumors are usually mesenchymal in origin and may be benign or malignant. Diagnosis and management of the more common benign tumors are undertaken by the otolaryngologist because local excision is generally curative. The proper treatment of malignant lesions requires a more extensive, multidisciplinary team, which includes a pediatric oncologist, diagnostic and therapeutic radiologist, and pathologist, in addition to the otolaryngologist. The purposes of this paper are to outline the types of benign and malignant neoplasms that occur in childhood and to discuss current approaches to therapy.

Fibrous tumors of bone.

Benign and malignant fibrous tumors of bone are some of the most common tumors encountered by the orthopedic surgeon. Fibrous dysplasia, fibrous cortical defect, non-ossifying fibroma, benign fibrous histiocytoma and osteofibrous dysplasia are benign tumors best treated conservatively or by intralesional/marginal excision. Desmoplastic fibromas are locally aggressive and require a wide margin for surgical cure. Malignant fibrous histiocytoma and fibrosarcoma of bone are malignant bone tumors and must be treated with wide/radical margins and for malignant fibrous histiocytoma adjunctive chemotherapy.

Primary multiple miliary osteoma cutis and exogenous ochronosis.

Multiple miliary osteoma cutis (MMOC), a rare disorder characterized by the appearance of numerous bony nodules on the face, was initially classified as a consequence of severe, long-standing acne vulgaris. However, several cases have now been described in patients with no preceding history of acne or other inflammatory conditions. We report such a case of primary MMOC in a 75-year-old African American woman and highlight the differences between these conditions. We also note the incidental histologic finding of exogenous ochronosis, which, in our case, indicates the patient's use of hydroquinone-containing bleaching creams in an attempt to treat the disorder.

Choroidal osteoma.

The choroidal osteoma is a benign, ossifying tumor of the choroid that typically is found in young, healthy women in the second or third decade of life. Its pathogenesis is unknown. This tumor is clinically unilateral in 75% of cases and tends to be located in the juxtapapillary region. Choroidal neovascularization may occur in up to one-third of cases. The choroidal osteoma must be differentiated from other intraocular tumors as well as cases of dystrophic and metastatic calcification. Ultrasonography and computed tomography may help in the diagnosis by demonstrating a calcified plaque at the level of the choroid. Fluorescein angiography and ICG videoangiography may demonstrate choroidal neovascularization, which may be amenable to treatment by laser photocoagulation.

Choroidal neovascular membrane associated with choroidal osteoma (CO) treated with trans-pupillary thermo therapy.

Choroidal neovascular membrane, a known complication of choroidal osteoma causing visual loss when located subfoveally, can be successfully treated with transpupillary thermo therapy.

Diagnosis and management of middle ear osteomas: a case report and literature review.

Osteomas of the middle ear are exceedingly rare benign neoplasms. To date, 16 cases have been reported in the literature, the vast majority of which appear as middle ear masses in young males with a progressive conductive hearing loss. In most patients, the diagnosis is confirmed by computed tomography (CT) or at the time of surgical exploration. Although these lesions have been described as slow-growing, no long-term follow-up has been reported. We present the seventeenth case of a middle ear osteoma in a 33-year-old man who remains asymptomatic and without evidence of tumor growth after nine years of follow-up. We suggest that asymptomatic middle ear osteomas can be appropriately managed without removal in a select group of patients.

Choroidal osteoma in Oriental patients.

BACKGROUND: Choroidal osteoma is a rare tumour of the choroid. This is the first report of cases of choroidal osteoma in Thai patients. OBJECTIVE: To report the clinical characteristics, imaging findings and long-term follow-up of choroidal osteoma in four Oriental patients. METHOD: Four cases of choroidal osteoma were observed for 5 years or more. RESULTS: All patients were young female patients whose ages ranged from 24 to 37 years. Three were unilateral and one was bilateral. The tumors were located at the juxtapapillary and macular area with overlying serous retinal detachment. Two patients had previous thyroid diseases and one was pregnant when the tumors were diagnosed. Osteoma did not develop in the vicinity of posterior staphyloma of high myopic eyes. Echography showed acoustic features of a plano-convex sonically dense lesion with high reflectivity echoes which persisted despite lower system sensitivity. None had subretinal neovascularization. Subretinal fluid disappeared spontaneously within one to 14 months in three patients. Gradual growth of the tumor in a pseudopodium manner developed from two to six years after initial examination. Decalcification occurred spontaneously or after laser ablation. CONCLUSIONS: The authors presented four Oriental patients with choroidal osteoma who were observed for at least 5 years. Echography is the best method for identifying this lesion and has unique acoustic features. Subretinal fluid can be seen in the absence of subretinal neovascularization and resorbs spontaneously. Decalcification occurred as a natural process or after laser ablative treatment. Hormonal changes may implicate the development of this tumor.

[Osteoma of the mastoid: apropos of 2 cases]. / Ostéome de la mastoïde: à propos de deux cas.

The authors report two cases of mastoid osteoma: it is a rare benign tumor attached to the cortex of the mastoid bone, approximatively fifty cases have been described in the english language literature and eight in the french literature. The clinical and radiological characteristics combined with histopathologic evidence demonstrate the diagnosis of mastoid osteoma, the most common type being the compact osteoma. Differential diagnosis should be considered with others benign bone-forming lesions (osteochondroma, chondroma, osteoblastoma, exostosis, fibrous dysplasia...) and with malignant lesions (osteosarcoma...). Surgical removal proposed for cosmetic deformity is a simple procedure for the vast majority of small osteomas. Early surgical intervention is recommended to avoid the evolution toward giant osteoma with potential risks of surgical complications.

Endoscopic ultrasonic curette-assisted removal of frontal osteomas.

Indications for endoscopic resection of fronto-ethmoidal osteomas have been progressively expanded thanks to optimization of surgical exposure and the development of dedicated instruments. Curved cutting drills are still suboptimal to treat hard osseous neoplasms of the frontal sinus. We present two patients affected by frontal osteoma treated with an endoscopic procedure using an ultrasonic bone curette. The ultrasonic bone curette may be considered an effective tool to reduce soft tissue manipulation, optimize surgical time and accelerate the healing process. However, the technique requires significant shape innovations to reach the lateral recesses and to manage pure intrasinusal lesions.

[Choroidal osteoma]. / Aderhautosteom.

Choroidal osteoma is a rare benign osseous tumor of the choroid usually affecting young healthy women. The diagnosis can be confirmed by the clinical appearance and with use of fluorescein or indocyanine angiography, optical coherence tomography, computed tomography or magnetic resonance imaging. A direct therapy of the tumor is indicated only for a few cases. The main reasons for vision loss are choroidal neovascularization, subretinal fluid and changes in the photoreceptor layer or the retinal pigment epithelium. Choroidal neovascularization and subretinal fluid in particular can be treated with laser therapy, photodynamic therapy or vascular endothelial growth factor inhibitors.