Aneurysmal bone cyst and osteoblastoma: an extremely rare combination in the pediatric spine.

STUDY DESIGN: Case report. OBJECTIVE: To report the clinical and imaging findings of a patient with the extremely rare association of aneurysmal bone cyst and osteoblastoma in the cervical spine. To our knowledge, only three cases have been reported in the published literature in children under 16 years of age with this condition in the cervical spine. METHODS: The patient's history, physical examination, imaging findings, and management with a complete 4-year medical history, surgical intervention and radiological follow-up are reported. RESULTS: A 4-year 11-month-old boy was diagnosed with aneurysmal bone cyst in association of osteoblastoma and was treated with CT-guided intralesional injection calcitonin and methylprednisolone. During the course of intralesional therapy, a pathological fracture of C2 was produced. Subsequently, a widened intralesional excision and instrumented fusion from occiput to cervical spine (C0-C4) was performed. CONCLUSION: The association of aneurysmal bone cyst and osteoblastoma in spine is extremely rare. Although both are benign lesions, in the cervical location, complete removal of the tumors is challenging. Wide resection with reconstruction of the segments for stability associated with adjuvant treatment with calcitonin and corticosteroids provides a good option.

Osteoblastoma con presentación atípica en cuboides / Osteoblastoma with atypical presentation in cuboid bone

Resumen: Introducción: El osteoblastoma es un tumor osteoblástico benigno, agresivo y poco frecuente. Su localización más frecuente es en elementos posteriores de la columna vertebral y el sacro. La presentación en cuboides es excepcional. Caso clínico: Masculino de 50 años que inició padecimiento en 2005, con dolor y aumento de volumen en región dorsolateral del mediopié. En las radiografías se observa injerto óseo y una lesión en cuboides, radiotransparente, heterogénea, multilobulada, con bordes irregulares que sobrepasa la cortical lateral. Se realizó angiotomografía donde se observó la lesión hipervascularizada; en la gammagrafía se observó captación del tecnecio 99 y en la resonancia magnética se reporta una lesión con cambios postquirúrgicos, quística, multilobulada. Se tomó biopsia transquirúrgica con abundante tejido fibroconectivo, osteoblastos, nidos de tejido osteoide e hipervascularidad del estroma, aumento de celularidad sin atipias y escasas células gigantes multinucleadas. Se clasificó Enneking 2. Se inició tratamiento con resección y curetaje del tumor, crioterapia y colocación de injerto tricortical en el defecto óseo. Mostró buena evolución postquirúrgica. A los tres años del procedimiento quirúrgico se encuentra sin datos de actividad tumoral y asintomático. A pesar de que el osteoblastoma no se presenta de forma habitual en cuboides, debe tomarse en cuenta como diagnóstico diferencial. Conclusión: Los tumores óseos, a pesar de tener localizaciones habituales, pueden presentarse en zonas poco frecuentes y por lo tanto, el estudio completo clínico radiográfico e histopatológico en cada paciente es fundamental.

Abstract: Introduction: Osteoblastoma is a benign, aggressive and rare osteoblastic tumor. Its most common location is in later elements of the spine and sacrum. The cuboid presentation is exceptional. Case report: A 50-year-old male who began her condition in 2005, with pain and increased volume in the dorsolateral region of the middle foot. X-rays show bone grafting and a cuboid lesion, radiotransparent, heterogeneous, multilobed, with irregular edges that exceeds the lateral cortical. Angiotomography was performed where hypervascularized injury was observed; bone scan showed uptake of technetium 99, and MRI reported an injury with post-surgical, cystic and multilobed changes. Trans surgical biopsy was taken, increased atypia-free cellularity and few multinucleated giant cells were reported and Enneking 2 qualified. Treatment was initiated with resection of the tumor, cryotherapy, and placement of tricortical graft in the bone defect. He exhibited good post-surgical evolution. At three years of the surgical procedure, he`s without tumor and asymptomatic. Although osteoblastoma does not usually occur in cuboid, it should be taken into account as a differential diagnosis. Conclusion: Bone tumors, despite having common locations, can occur in rare areas and therefore the complete radiographic and histopathological clinical study in each patient is critical.

[Osteoblastoma with atypical presentation in cuboid bone]. / Osteoblastoma con presentación atípica en cuboides.

INTRODUCTION: Osteoblastoma is a benign, aggressive and rare osteoblastic tumor. Its most common location is in later elements of the spine and sacrum. The cuboid presentation is exceptional. CASE REPORT: A 50-year-old male who began her condition in 2005, with pain and increased volume in the dorsolateral region of the middle foot. X-rays show bone grafting and a cuboid lesion, radiotransparent, heterogeneous, multilobed, with irregular edges that exceeds the lateral cortical. Angiotomography was performed where hypervascularized injury was observed; bone scan showed uptake of technetium 99, and MRI reported an injury with post-surgical, cystic and multilobed changes. Trans surgical biopsy was taken, increased atypia-free cellularity and few multinucleated giant cells were reported and Enneking 2 qualified. Treatment was initiated with resection of the tumor, cryotherapy, and placement of tricortical graft in the bone defect. He exhibited good post-surgical evolution. At three years of the surgical procedure, he's without tumor and asymptomatic. Although osteoblastoma does not usually occur in cuboid, it should be taken into account as a differential diagnosis. CONCLUSION: Bone tumors, despite having common locations, can occur in rare areas and therefore the complete radiographic and histopathological clinical study in each patient is critical.

INTRODUCCIÓN: El osteoblastoma es un tumor osteoblástico benigno, agresivo y poco frecuente. Su localización más frecuente es en elementos posteriores de la columna vertebral y el sacro. La presentación en cuboides es excepcional. CASO CLÍNICO: Masculino de 50 años que inició padecimiento en 2005, con dolor y aumento de volumen en región dorsolateral del mediopié. En las radiografías se observa injerto óseo y una lesión en cuboides, radiotransparente, heterogénea, multilobulada, con bordes irregulares que sobrepasa la cortical lateral. Se realizó angiotomografía donde se observó la lesión hipervascularizada; en la gammagrafía se observó captación del tecnecio 99 y en la resonancia magnética se reporta una lesión con cambios postquirúrgicos, quística, multilobulada. Se tomó biopsia transquirúrgica con abundante tejido fibroconectivo, osteoblastos, nidos de tejido osteoide e hipervascularidad del estroma, aumento de celularidad sin atipias y escasas células gigantes multinucleadas. Se clasificó Enneking 2. Se inició tratamiento con resección y curetaje del tumor, crioterapia y colocación de injerto tricortical en el defecto óseo. Mostró buena evolución postquirúrgica. A los tres años del procedimiento quirúrgico se encuentra sin datos de actividad tumoral y asintomático. A pesar de que el osteoblastoma no se presenta de forma habitual en cuboides, debe tomarse en cuenta como diagnóstico diferencial. CONCLUSIÓN: Los tumores óseos, a pesar de tener localizaciones habituales, pueden presentarse en zonas poco frecuentes y por lo tanto, el estudio completo clínico radiográfico e histopatológico en cada paciente es fundamental.

Osteoblastoma of the mandible: systematic review of the literature and report of a case.

Benign osteoblastoma is a bone tumour that seldom occurs in the facial bones. The objective of this article is to add one more case of this rare lesion to the academic literature and to provide a systematic review of previously published cases. A new case of benign osteoblastoma is presented and clinical, radiographic and microscopic aspects, as well as differential diagnosis, treatment and follow-up are discussed. The importance of the correct diagnosis of this type of lesion is stressed, since it presents a clinical, radiographic and microscopic similarity to other bone lesions, including malignant tumours, which may lead the professional into conducting the case in an improper manner.

[Osteoblastoma: analysis of the treatment of 24 cases]. / Osteoblastoma: análise do tratamento de 24 casos.

The authors study 24 patients with the histologic diagnosis of osteoblastoma treated from 1953 to 1996, with a mean follow-up of 33.4 months. Two were considered as a malignant osteoblastoma. Twenty-two cases were operated, and in 2 of these was performed only a selective embolization to pelvic and spine localization. It was discussed clinical and radiographic aspects and the response to treatment. It was obtained 20 good and 4 poor results.