Computed tomography and magnetic resonance imaging of an unusual intraconal orbital osteoma.

We report the case of a 64-year-old male patient with a 5 month history of proptosis, motility limitation and vision loss in OD. Visual acuity (VA) was 20/200 in OD and 20/20 in OS. CT showed a large, round, intraconal lesion, with bony density and no apparent connection to adjacent orbital walls. MRI showed a T1-weighted hypointense lesion surrounded by a contrast enhancing capsule. The orbital tumor was excised through a lateral orbitotomy revealing a nodular, round, osseous structure. Histological examination disclosed well-formed lamellar bone trabeculae, with no necrosis or mitosis figures. Immunohistochemical staining was negative for MDM2 and CDK4. After 3 years, there was no evidence of tumor recurrence and VA had improved to 20/30. Intraconal osteomas with no clear attachment to orbital walls are extremely rare. We are aware of a few reported cases in the lid, hand, thigh, tongue, pterygopalatine fossa and brain. To the authors' knowledge, this is the first report in English literature of an orbital intraconal osteoma without any visible relation to the orbital walls.

Management of giant osteoma in the mandible associated with minor trauma: a case report.

BACKGROUND: Osteoma is a benign tumor of the bones, which can be classified as central or peripheral. The occurrence in the jawbones is uncommon, but when it occurs, there is a greater prevalence of the mandible. The etiology is still unknown, and the hypothesis of its development is debated. CASE PRESENTATION: A 35-year-old Caucasian man presenting a tumor lesion in the right jawbone that had been growing for 8 years sought medical service complaining of speaking impairment. According to the patient, the tumor appeared shortly after a minor trauma caused by tooth extraction. The diagnosis of the lesion was made through clinical, radiographic, and histological methods, and the surgical treatment was successful and satisfactory for the patient as well as the surgical team, despite a short follow-up. CONCLUSION: Etiopathogenesis of osteoma is not determined in the majority of cases. In the present report, it was possible to hypothesize the association between a minor trauma and the development of the tumor, reinforcing the reactive theory of tumor development. The uncommon location of the osteoma, as well the possibility of identifying the possible cause of the lesion, makes this case particularly interesting.

Osteoma in Agapornis roseicollis / Osteoma em Agapornis roseicollis

Neoplasias are important causes of illness and death in domestic animals. However, in birds, they are less frequent compared with other species such as dogs and cats. Moreover, benign tumors of bone are even less frequent in captive birds being considered sporadic, which make it a poorly understood entity due to the lack of clinical and histopathological data. Thus, we present a case of an osteoma in a Peach-faced lovebird (Agapornis roseicollis) approaching clinical and morphological aspects. A two-years-old lovebird was referred to the veterinary hospital with a 4-month evolution round to oval tumoral mass on the wing. The nodule was firm, painful when manipulated. Radiographic examination revealed a radiopaque mass in the radius and ulna bones. The animal has died during the surgical procedures. The affected wing was submitted to pathology service and histopathology revealed an osteoma.

As neoplasias são importantes causas de doença e morte em animais domésticos. No entanto, em aves, são menos frequentes em comparação com outras espécies, como cães e gatos. Além disso, tumores ósseos benignos são ainda menos frequentes em aves de cativeiro sendo considerados esporádicos, o que o torna uma entidade pouco compreendida devido à falta de dados clínicos e histopatológicos. Assim, apresentamos um caso de osteoma em Periquito cara-de-pêssego (Agapornis roseicollis) abordando aspectos clínicos e morfológicos. Um periquito de dois anos foi encaminhado ao hospital veterinário com uma massa tumoral ovalada na asa com evolução de 4 meses. O nódulo era firme, doloroso quando manipulado. O exame radiográfico revelou uma massa radiopaca nos ossos rádio e ulna. O animal morreu durante os procedimentos cirúrgicos. A asa afetada foi submetida ao serviço de patologia e a histopatologia revelou um osteoma.

Osteoma de oído medio asintomático / Asymptomatic middle ear osteoma

Resumen El osteoma de oído medio es un tumor poco común, de crecimiento lento y características benignas. Frecuentemente cursa de forma asintomática y su diagnóstico suele ser casual como en el caso que exponemos. Se presenta el caso de un varón de 26 años, que consultó por odinofagia y otalgia derecha en el contexto de una infección de vía aérea alta. Al explorarlo mediante otoscopia se visualizó en el oído izquierdo una lesión blanquecina y redondeada retrotimpánica compatible con osteoma de oído medio. El tratamiento de elección en pacientes con osteomas de oído medio sintomáticos es la cirugía. Sin embargo, en pacientes asintomáticos el seguimiento es la opción más recomendada.

Abstract The middle ear osteoma is a benign, infrequent, slow-growing tumor. This lesion is frequently asymptomatic and its diagnosis is usually accidental, as the case presented here. We present a case of a 26-year-old man who consulted for odynophagia and right ear pain in the context of an upper airway infection. By otoscopy in the left ear, we observed a whitish retrotympanic lesion that was compatible with a middle ear osteoma. To manage symptomatic patients with middle ear osteomas, surgery is the treatment of first choice. Nevertheless, for asymptomatic patients, follow up is recommended.

Osteoma periférico de inusual localización mandibular. Presentación de un caso / Peripheral osteoma of unusual mandibular location. Case report / Osteoma periférico de localização mandibular incomum. Apresentação de um caso

RESUMEN Se presentó el caso de una paciente femenina de 40 años de edad que acudió a consulta por presentar aumento de volumen en la región parotídea izquierda. Se realizó ortopantomografía, radiografías simples anteroposterior y lateral de cráneo que revelaron la presencia de una imagen radiolúcida en la región lateral de la rama mandibular izquierda. El diagnóstico clínico fue de osteoma periférico a este nivel, por lo que se realizó remoción quirúrgica total de la lesión. La biopsia confirmó el diagnóstico de osteoma ebúrneo periférico. El osteoma es una neoplasia benigna de tejido óseo, poco frecuente y, rara vez, se localiza de manera aislada en la mandíbula. No se diagnosticaron complicaciones posoperatorias y la paciente mostró satisfacción con la atención estomatológica brindada.

ABSTRACT A 40-year-old female patient came to the consultation due to an increase in volume in the left parotid region. Orthopantomography and simple anteroposterior and lateral skull radiographies were performed, revealing the presence of a radiolucent image in the lateral region of the left mandibular side. The clinical diagnosis at this point was of peripheral osteoma, for which a total surgical removal of the lesion was performed. The biopsy confirmed the diagnosis of peripheral osteoma. An osteoma is a rare benign neoplasm of bone tissue, and is rarely found isolated in the mandible. Postoperative complications were not diagnosed and the patient was satisfied with the dental care provided.

RESUMO Foi apresentado o caso de uma paciente do sexo feminino, 40 anos de idade, que compareceu à consulta por aumento de volume na região da parótida esquerda. Foram realizadas ortopantomografia, radiografias simples ântero-posterior e lateral do crânio, que revelaram a presença de imagem radiotransparente na região lateral do ramo mandibular esquerdo. O diagnóstico clínico foi de osteoma periférico a este nível, para o qual foi realizada a remoção cirúrgica total da lesão. A biópsia confirmou o diagnóstico de osteoma periférico ebúrneo. O osteoma é uma neoplasia benigna do tecido ósseo, pouco frequente e raramente localizada de forma isolada na mandíbula. Complicações pós-operatórias não foram diagnosticadas e o paciente ficou satisfeito com o atendimento odontológico prestado.

Aspectos descriptivos imagenológicos del osteoma de los maxilares: Revisión de la literatura / Descriptive imagenological aspects of osteoma in the jaws: review of the literature

El osteoma es una lesión osteogénica benigna, derivado de hueso compacto o esponjoso. Se caracteriza por ser de crecimiento lento y aparece con más frecuencia entre los 20 y los 50 años de vida, con una prevalencia mayor en hombres con respecto a las mujeres. Clínicamente asintomáticos, los podemos encontrar en la región craneofacial, particularmente en los senos paranasales y la mandíbula, y pueden presentarse de tres formas: central, periférica y extraósea, siendo más comunes los solitarios, a diferencia de los múltiples que están relacionados con el síndrome de Gardner. El tratamiento de los osteomas es quirúrgico cuando causan complicaciones. Los estudios por imágenes, como la radiografía panorámica y la TCHC, son las modalidades de mayor uso para determinar la ubicación, la extensión y las relaciones anatómicas de la lesión. Las características imagenológicas pueden presentarse como una excrecencia ósea de hueso compacto, esponjoso o mixto. El conocimiento de esta lesión nos permitirá tener mejores propuestas diagnósticas. (AU)

Osteomas are benign osteogenic lesions derived from compact or spongy bone. They are characterized by their slow growth and appear more frequently between 20 and 50 years of age, with a higher prevalence in men than in women. These lesions are clinically asymptomatic and can be found in the craniofacial region, particularly in the paranasal sinuses and the mandible, and may have a central, peripheral or extraosseous presentation. Multiple osteomas are related to Gardner's Syndrome. Treatment of osteoma is surgical when complications develop. Imaging studies such as panoramic radiography and cone beam computed tomography are the modalities most widely used to determine the location, extent, and anatomical relationships of the lesion. Imaging features may present as a bony excretion of compact, spongy, or mixed bone. Adequate knowledge of these lesions allows adequate diagnosis and better treatment planning. (AU)

Tumores fibroóseos de cavidades paranasales: experiencia en el Hospital Clínico de la Universidad de Chile y revisión de la literatura / Fibro-osseous tumors of paranasal cavities: experience in the Hospital Clínico de la Universidad de Chile and review of the literature

Los tumores de cavidades paranasales presentan una baja frecuencia. Dentro de éstos, entre los benignos destacan las lesiones fibroóseas que se caracterizan por el reemplazo de hueso normal por estroma celular fibroso. Dentro de estas lesiones se describen osteoma, displasia fibrosa y fibroma osificante. Se revisan 3 casos de pacientes del Hospital Clínico de la Universidad de Chile y se presenta una revisión bibliográfica en cuanto a las lesiones fibroóseas, su clínica, diagnóstico, imagenología y tratamiento.

The tumors of paranasal cavities present a low frequency. Among the benign tumors are fibro-osseous lesions characterized by the replacement of normal bone by fibrous cell stroma. Osteoma, fibrous dysplasia, and ossifying fibroma are described within these lesions. Three cases of patients from the Hospital Clínico de la Universidad de Chile are reviewed and a bibliographic review is presented regarding the fibro-osseous lesions, their clinical features, diagnosis, imaging and treatment.

Gardner syndrome imaging features in plain radiographs and computed tomography: a case report / Síndrome de Gardner: Características imaginológicas por meio da radiografia convencional e tomografia computedorizada

Gardner syndrome (GS) is a genetic disease with high penetration characterized by a signal triad of colonic polyposis, multiple osteomas and mesenchymal tumors in the soft tissues and skin. The colonic polyposis is associated to the development of malignant disease. Patients may also present maxillomandibular alterations such as impacted teeth, supernumerary teeth, congenital missing teeth and odontomas. Bone lesions and maxillomandibular alterations usually precedes the gastrointestinal alterations; hence dentists should be aware of GS syndrome main radiographic signals, in order to detect the disease and proper referred the patient to medical treatment and surveillance. Thus, in this report, it is described a case of GS in a male patient, as well as discussed GS features.(AU)

A síndrome de Gardner (GS) é uma doença genética caracterizada pela seguinte tríade: polipose colônica, múltiplos osteomas e tumores mesenquimais em tecidos moles e pele. A polipose colônica está associada ao desenvolvimento de tumores malignos. Os pacientes também podem apresentar alterações maxilomandibulares, como dentes impactados, dentes supranumerários, agenesia congênita e odontomas. Lesões ósseas e alterações maxilomandibulares geralmente precedem as alterações gastrointestinais; portanto, os dentistas devem estar cientes dos principais sinais imaginológicos da GS, a fim de detectar a doença e encaminhar adequadamente o paciente para tratamento. Neste relato de caso é descrito um caso de GS em um paciente do gênero masculino, além de discutir as características da GS.(AU)

Um raro diagnóstico de osteoma periférico em palato duro: relato de caso / A rare diagnosis of peripheral osteoma in the hard palate: case report

Objetivo: relatar uma biópsia excisional de um osteoma periférico no palato duro direito de uma paciente jovem, do sexo feminino e não sindrômica. Relato de caso: paciente do sexo feminino, 32 anos de idade, melanoderma e normossitêmico, buscou atendimento no ambulatório de diagnóstico estomatológico da Faculdade de Odontologia da Universidade Federal de Uberlândia com queixa quanto ao surgimento de lesão na região de palato. Após avaliação clínica e imaginológica, foi decidido realizar biópsia excisional sob anestesia local da lesão. Foram levantadas três hipóteses de diagnóstico: osteoma periférico, exostose ou osteossarcoma. O material coletado foi enviado para análise histopatológica, que confirmou a hipótese de osteoma periférico. Considerações finais: os osteomas periféricos na região de palato duro são raríssimos. Essa lesão geralmente é assintomática ­ exceto quando há impacto traumático durante a mastigação ­, de crescimento lento, podendo se desenvolver em osso cortical ou medular. O tratamento de escolha é a remoção cirúrgica e o índice de recorrência é raro. O caso enfatiza a condição rara, pois foram encontrados apenas seis casos semelhantes relacionados na literatura. (AU)

Objective: To report an excisional biopsy of a peripheral osteoma in the right hard palate in a non-syndromic young female patient. Case Report: A 32-year-old female patient, black, and normosystemic sought assistance in the stomatological diagnosis outpatient clinic of the School of Dentistry of the Federal University of Uberlândia, Brazil, complaining about the appearance of a lesion in the palate region. After clinical and imaging assessment, it was decided to perform an excisional biopsy under local anesthesia of the lesion. Three diagnostic hypotheses were raised - peripheral osteoma, exostosis, or osteosarcoma. The material collected was sent for histopathological analysis, which confirmed the hypothesis of peripheral osteoma. Final considerations: Peripheral osteomas in the hard palate region are very rare. This lesion is usually asymptomatic, except when there is a slow-growing chewing impact during mastication, which may develop in cortical or spinal bone. Surgical removal is the treatment of choice and the rate of recurrence is rare. The case emphasizes the rare condition, considering only six similar cases were found in the literature. (AU)

Gardner syndrome with maxillofacial manifestation: A case report.

Gardner syndrome is a hereditary disease in which patients develop gastrointestinal polyps, osteomas, desmoid tumors, epidermoid cysts, fibromas, lipomas, and retinal lesions. Dental abnormalities such as supernumerary or impacted teeth, odontomas and dentigerous cysts are also reported. The most serious concern in this syndrome is the extremely high risk of gastrointestinal polyps undergoing malignant transformation. Since the maxillofacial findings usually precede gastrointestinal polyps, the dentist plays a crucial role in the diagnosis of Gardner syndrome, and panoramic radiography is an important tool in the diagnosis of the disease. We report here a case of Gardner syndrome in a patient showing mandibular osteomas and impacted teeth. Also, cases of Gardner syndrome with maxillofacial manifestations reported in the literature were reviewed and compared with ours. According to the findings, osteomas are important manifestations of this syndrome, and regardless of the absence of family history of intestinal polyposis, their occurrence should prompt diagnostic evaluation for this disease.

Mastoid osteoma in a prehispanic cranium (1390 A.D.) from Northern Chile.

OBJECTIVE: Osteomas are slow-growing benign tumors that can affect the skull, most frequently the parietal and frontal. Temporal bone osteomas are more common in the external acoustic meatus and exceptional in the mastoid region. The rarity of mastoid osteomas is confirmed by the fact that very few cases have been reported in the clinical and paleopathological literature. The aim of this paper is to report a new paleopathological case of mastoid tumor in a Pre-Hispanic adult cranium. MATERIALS: The skull derives from the Chunchuri (today Dupont-1 site) Pre-Hispanic site in Northern Chile (1390 A.D). METHODS: Macroscopical examination and high-resolution tomography were used to assess the cranium. RESULTS: The CT scan revealed a well demarcated lesion suggestive of a mastoid osteoma. CONCLUSIONS: This case adds new evidence regarding the antiquity of primary neoplasms in ancient populations and reinforces the importance of high resolution imaging in paleopathological research. SIGNIFICANCE: Due to the antiquity of the remains this is probably the oldest reported case of mastoid osteoma. LIMITATIONS: The patrimonial nature of the remains did not allow histopathological studies. SUGGESTIONS FOR FURTHER RESEARCH: Further intensive review of archeological skeletal collections is needed to better understand the epidemiology of neoplastic lesions in past populations.

Osteoma compacto do seio maxilar ­ relato de caso / Osteoma of the maxillary sinus ­ case report

Os osteomas são tumores benignos de crescimento ósseo, compostos de osso compacto, esponjoso ou misto, comumente associado ao esqueleto craniofacial, com maior frequência nos seios paranasais e menor frequência nos ossos gnáticos. Tem predileção pelo sexo masculino entre a segunda e quinta décadas de vida. Sua etiologia é incerta, podendo estar associada à infecção, trauma, influência genética ou embriológica. O tratamento cirúrgico dos osteomas está reservado para os casos de crescimento rápido, infecção, sintomatologia dolorosa, alteracões funcionais ou deformidades estéticas. Casos de osteomas pequenos e assintomáticos permitem tratamento conservador. O presente trabalho tem por objetivo relatar um caso de osteoma em seio maxilar associado à sintomatologia dolorosa (cefaleia) tratado cirurgicamente (AU).

Osteomas are benign tumors of bone growth, composed of compact, spongy or mixed bones, commonly associated with the craniofacial skeleton, more frequently in the paranasal sinuses and less frequently in the gnathic bones. It mostly affects men between 20 and 50 years old. Its etiology is uncertain and may be associated with infection, trauma, genetic or embryological influence. Surgical treatment of osteomas is reserved for cases of rapid growth, infection, painful symptomatology, functional alterations or aesthetic deformities. Cases of small asymptomatic osteomas allow conservative treatment. The present study aims to report a case of osteoma in the maxillary sinus associated with painful symptomatology (headache) treated surgically (AU).

Peripheral Osteoma of Mandibular Angulus: Analysis of the Literature and Report of a New Case / Osteoma periférico del ángulo mandibular: Análisis de la literatura e informe de un nuevo caso

Abstract Osteoma is a benign osteogenic neoplasm originating from the continuous proliferation of compact and/or cancellous mature bone. The tumor can be classified as peripheral, central or extra-skeletal regarding location and it commonly seen in the cranio-facial region especially at the skull and paranasal sinuses. The exact etiology of the tumor is still controversial; however, it is considered that infection, trauma, muscle activity contributes the occurrence of the tumor. Due to the slow growing nature of osteoma, it is coincidentally detected on radiographs or when the tumor reaches a large size enough to trigger symptoms and cause facial disfigurement. Although mainly detected in the craniofacial bones, osteomas are rarely located in the jaw bones. The purpose of this review, is to present the diagnosis and treatment plan of a peripheral osteoma in the mandibular angulus region of an 8-year-old boy together with a review of published cases of peripheral osteomas of mandibular angulus.

Resumen El osteoma es una neoplasia osteogénica benigna que se origina de la proliferación continua de hueso maduro compacto y/o esponjoso. El tumor se puede clasificar como periférico, central o extraesquelético con respecto a la ubicación y se ve comúnmente en la región craneofacial, especialmente en el cráneo y los senos paranasales. La etiología exacta del tumor sigue siendo controvertida; sin embargo, se considera que la infección, el trauma y la actividad muscular contribuyen a la aparición del tumor. Debido a la naturaleza de crecimiento lento del osteoma, se detecta casualmente en las radiografías o cuando el tumor alcanza un tamaño grande lo suficiente como para desencadenar síntomas y causar desfiguración facial. Aunque se detecta principalmente en los huesos craneofaciales, los osteomas rara vez se localizan en los huesos de la mandíbula. El objetivo de esta revisión es presentar el diagnóstico y el plan de tratamiento de un osteoma periférico en la región angular mandibular de un niño de 8 años junto con una revisión de casos publicados de osteomas periféricos de angulación mandibular.

Giant fronto-ethmoidal osteoma - selection of an optimal surgical procedure / Osteoma fronto-etmoidal gigante - escolha do procedimento cirúrgico ideal

Abstract Introduction Osteomas of the paranasal sinuses are benign bone tumours that produce clinical signs depending on their size and location. In most reported cases large tumours are excised by an external approach or in conjunction with an endoscopic technique. Endoscopic treatment of such tumours is a huge challenge for the operator. Objective Determine the optimal surgical approach by analysing giant osteomas of the frontal and ethmoidal sinuses in the literature. Methods Group of 37 osteomas obtained from the literature review. A group of osteomas removed only by endoscopy was compared with a group in which an external approach (lateral rhynotomy or craniotomy) or combined external and endoscopic approach was applied. Results The authors, based on the statistical analysis of the literature data, have found that the average size of osteomas excised endoscopically and those removed by external approaches does not differ statistically, when the osteomas are located in the ethmoidal cells (p = 0.2691) and the frontal sinuses (p = 0.5891). Conclusion The choice of surgical method appears to be independent of the osteoma size and the decision is likely to be taken based on the experience of the surgeon, available equipment and knowledge of different surgical techniques.

Resumo Introdução Osteomas dos seios paranasais são tumores ósseos benignos cujas manifestações clínicas ocorrem em função de seu tamanho e localização. Na maioria dos casos relatados os tumores grandes são excisados por uma abordagem externa ou associada a uma técnica endoscópica. O tratamento endoscópico destes tumores ainda é um grande desafio para o cirurgião. Objetivo Determinar a abordagem cirúrgica ideal ao analisar osteomas gigantes dos seios frontal e etmoidal na literatura. Método Um total de 38 osteomas foram avaliados a partir da revisão da literatura. Um grupo de osteomas removidos apenas por cirurgia endoscópica foi comparado com um grupo para o qual foi utilizado uma abordagem externa (rinotomia lateral ou craniotomia) ou uma abordagem combinada, externa e endoscópica. Resultados Os autores, com base na análise estatística dos dados da literatura, observaram que o tamanho médio dos osteomas excisados endoscopicamente e daqueles que foram removidos através de uma abordagem externa não diferiram estatisticamente, tanto para osteomas localizados no seio etmoidal (p = 0.2691) quanto para os localizados no seio frontal (p = 0.5891). Conclusão A escolha do método cirúrgico parece ser independente do tamanho do osteoma e a decisão provavelmente será tomada com base na experiência prévia do cirurgião, nos equipamentos disponíveis e conhecimento de diferentes técnicas cirúrgicas.