A double nidus osteoid osteoma in a finger

The diagnosis of an osteoid osteoma in the proximal phalanx of the right index finger was suggested by the patient's history and the initial radiographs. The diagnosis was histologically confirmed postoperatively. One year later, however, persistent symptoms and typical radiographic findings, again suggested the presence of an osteoid osteoma. Subsequent en bloc resection of the second nidus, which was again histologically confirmed as an osteoid osteoma, was followed by complete resolution of the symptoms. The definitive diagnosis of a double-nidus osteoid osteoma was suggested after careful analysis of the initial radiographs demonstrated the existence of two distinct intracortical nidi.     

Osteoid osteoma of the distal phalanx: A case report

A sixteen-year-old male presented with pain and swelling of the distal phalanx of his right middle finger. X-ray examination demonstrated an osteolytic lesion which at operation was found to be an osteoid osteoma.     

Osteoid Osteoma of the Thumb: A Case Report

Osteoid osteoma is a rare occurrence in the hand, and only a small percentage affects the thumb and distal phalanges. An 18-year-old right-hand-dominant man presented to our office with an approximately 1-year history of left thumb pain without any history of trauma. He had seen several doctors previously and undergone multiple diagnostic tests with no definitive diagnosis. Plain radiographs and computed tomography at our institution were consistent with the diagnosis of osteoid osteoma. The patient was treated with surgical excision of the lesion without bone grafting. The diagnosis of osteoid osteoma was confirmed by pathology. At 6 months follow-up, the patient showed complete resolution of pain and full restoration of hand function. This case demonstrates that osteoid osteoma should not be forgotten as a differential diagnosis in patients with finger pain, especially in individuals who have not yet or just recently have reached skeletal maturity.     

Giant cell reaction of small bones

A radiographically nonspecific lytic lesion in the middle phalanx of the index finger with microscopic evidence of a benign fibrous stroma with giant cells and osteoid was investigated in an 18-year-old man. Giant cell reaction is a rare, benign lesion of the small bones of the hands and feet. Trauma as the cause of a giant cell lesion poses an interesting question.     

Painless osteoid osteoma of the finger in a child. Case report

The authors report the case of an 8-year-old child presenting with painless swelling of the middle phalanx of the ring finger. Radiology demonstrated simple hypertrophy of cortical bone with a clear zone. Bone biopsy showed the typical features of osteoid osteoma. Osteoid osteoma is rarely painless and generally corresponds to a superficial tumour (hand, foot, skull and thorax).     

Dactylitis: A pictorial review of key symptoms

Dactylitis refers to a global swelling of a finger or a toe giving it a clinical sausage-shape presentation. It is an extremely suggestive symptom as it guides the rheumatologist towards a shortlist of diagnoses. However, radiologists are less familiar with dactylitis. The aim of this review is to detail and illustrate the main causes of dactylitis using standard X-ray imaging, ultrasound, computed tomography and magnetic resonance imaging in order to make radiologists more familiar with this symptom by illustrating the various conditions that are associated with dactylitis including infection, peripheral spondyloarthritis, sarcoidosis, microcrystalline deposition, osteoid osteoma, and sickle cell disease.     

Ostéome ostéoïde de la phalange chez l’enfant et problème diagnostique. À propos d’un cas

Osteoid osteoma is a benign osseous tumor of unknown origin, which affects preferentially the long bones. The localization in the phalanx is unusual and difficult to diagnose. We present a case of a 13-year-old girl, presenting with a painful swelling of the first phalanx of the right middle finger of 5 months duration, not responding to anti-inflammatory drugs. The diagnosis of tuberculosis of the bones was suggested at first (tuberculosis is endemic in our country), but the biology and the bone biopsy did not confirm the diagnosis. The lesion was excised, and the histology confirmed the diagnosis of osteoid osteoma. Through our observation and after a review of the literature, we analyze the clinical and paraclinical appearance of this uncommon localization, the differential diagnosis, and finally the therapeutic possibilities.     

Direct and indirect measurements of osteoid seam width in human iliac crest trabecular bone

The osteoid thickness index, calculated from the relative osteoid volume and surface, has been compared with the mean osteoid seam width, measured directly, in iliac crest trabecular bone from 57 normal subjects and 33 patients with privational or malabsorption metabolic bone disease. In normal biopsies the osteoid thickness index overestimated mean osteoid seam width by a variable amount and the two variables were only weakly correlated (r = 0.32, P < 0.01). In patients with hyperosteoidosis there was a stronger correlation between the osteoid thickness index and the true mean seam width (r = 0.89, P < 0.001). Examination of the mean width of individual seams pooled from 15 randomly selected patients in each group revealed a skewed distribution with thin seams predominating, especially in normal biopsies. Median seam width was significantly lower than mean seam width in both groups studied.We conclude that osteoid thickness index is an inaccurate method of predicting the mean osteoid seam width, especially in biopsies with normal osteoid amount. Median values of osteoid seam width are more representative of average seam width, both in normal and abnormal biopsies.     

Wide area detector CT perfusion: Can it differentiate osteoid osteomas from other lytic bone lesions?

PurposeTo compare the enhancement dynamics of osteoid osteomas with other benign and malignant lytic bone lesions using CT perfusion.Patients and methodsCT perfusion parameters of 15 patients with a final diagnosis of osteoid osteoma, 15 patients with lesions that mimic osteoid osteomas and 26 patients with other bone lytic lesions were compared.ResultsEnhancement curve morphology of the osteoid osteomas was significantly different from its mimickers. All osteoid osteomas had an early enhancement with a delay between nidus and arterial peak below 30 seconds. Eighty percent of the mimickers demonstrated a slow and progressive enhancement. The perfusion parameters of the other lytic bone lesions were similar to those of the osteoid osteomas in 46.1% of the patients.ConclusionEarly enhancement is suggestive but not pathognomonic of osteoid osteomas. Absent or delayed enhancement in similar lesions should evoke an alternative diagnosis. The same contrast enhancement dynamics of osteoid osteomas can be seen in other bone lesions, both malignant and benign.     

Computer-assisted localization of osteoid osteoma: an initial experience

This article evaluates our initial experience with computer-assisted localization of osteoid osteoma. Nine patients with osteoid osteoma underwent minimally invasive computer-assisted surgery. Patients were followed prospectively for symptomatic relief and complications for an average of 31 months. Successful localization of osteoid osteoma occurred in 7 of 9 patients. Mean operative time was 88 minutes, and mean time to discharge was 1 day (range: same day to 2 days). No fractures, infections, or neurovascular complications occurred. Minimally invasive computer-assisted surgical excision of osteoid osteoma is a safe and feasible option for the surgical localization of osteoid osteoma. It is especially attractive for lesions located in poorly accessible anatomic sites.     

Late diagnosis of intraarticular osteoid osteoma treated as hip osteoarthritis--case report and review of the literature

A 34-year old men with left hip pain caused by intraarticular osteoid osteoma localized in the left femoral head is described. He was treated as a hip osteoarthritis for one year before the accurate diagnosis was established. Magnetic resonance imaging showed lesion indicating osteoid osteoma. Accurate diagnosis was established based on typical appearance of the osteoid osteoma on the computed tomography (CT). Osteoid osteoma rarely occures after 30 years of age and intraarticular locallisation is uncommon. This case report pinpoints the importance of careful analysis of monoarticular pain in order to avoid the possibile misdiagnosis of osteoid osteoma especially in young adult with an isolated osteoarthritis feature on the conventional radiography and normal laboratory findings. CT is specific and sensitive imaging modality for diagnosis of osteoid osteoma.     

Osteoid osteoma and osteoblastoma

Osteoid osteoma and osteoblastoma are commonly seen benign osteogenic bone neoplasms. Both tumors are typically seen in the second decade of life, with a notable predilection in males. Histologically, these tumors resemble each other, with characteristically increased osteoid tissue formation surrounded by vascular fibrous stroma and perilesional sclerosis. However, osteoblastomas are larger than osteoid osteomas, and they exhibit greater osteoid production and vascularity. Clinically, osteoid osteoma most commonly occurs in the long bones (eg, femur, tibia). The lesions cause night pain that is relieved with nonsteroidal anti-inflammatory drugs (NSAIDs). Osteoblastoma is most frequently located in the axial skeleton, and the pain is usually not worse at night and is less likely to be relieved with NSAIDs. Osteoblastoma can be locally aggressive; osteoid osteoma lacks growth potential. Osteoid osteoma may be managed nonsurgically with NSAIDs. When surgery is required, minimally invasive methods (eg, CT-guided excision, radiofrequency ablation) are preferred. Osteoblastoma has a higher rate of recurrence than does osteoid osteoma, and patients must be treated surgically with intralesional curettage or en bloc resection.     

Osteoid osteoma of the coccyx: a case report

The spine is a rare localization of osteoid osteoma and the coccyx even more exceptional. We report a case of osteoid osteoma of the coccyx in a young man who consulted for sacrococcygeal pain partially relieved with salicylates. Computed tomography of the region demonstrated a typical osteoid osteoma lesion. CT-guided localization enabled complete resection of the nidus as demonstrated by the CT of the operative specimen Pathology confirmed the diagnosis of osteoid osteoma. Outcome has been quite favorable at two years.     

Synovitis of the wrist joint caused by an intraarticular perforation of an osteoid osteoma of the scaphoid

Uncommon location and atypical presentation of the osteoid osteomas of the scaphoid can pose a diagnostic challenge. Because of its intraarticular location, scaphoid osteoid osteoma can present with synovitis which is the more commonly reported presentation for other intraarticular locations like in hip and elbow and only rarely reported at the wrist. We report a case of perforation of the osteoid osteoma into the wrist joint, resulting in exuberant synovitis. The clinical significance of this report is to reinforce that synovitis can be a presentation of osteoid osteoma and it should be considered in the differential diagnosis of monoarticular arthritis. Prolonged synovitis may cause damage to the other joint surfaces of the wrist and hence carpal osteoid osteoma should be considered for early surgical excision.     

Fewer bone histomorphometric abnormalities with intermittent than with continuous slow-release sodium fluoride therapy

To help resolve the uncertainty whether sodium fluoride (NaF) therapy should be given intermittently or continuously, we examined iliac crest bone biopsies (before and after treatment) and fragility fracture rates in 35 intermittently treated (group I) and 69 continuously treated (group C) patients; all received calcium. The following statistically significant results were obtained. Reduction in vertebral fracture rate was similar in the two groups. Trabecular thickness and the structurally more important mineralized thickness increased only in group I. Group I also accumulated less excess osteoid (surface, volume). Mean osteoid thickness did not change in either group because of a bimodal distribution of wide seams with osteoblasts and double tetracycline labels, and thin seams without osteoblasts or labels. Osteoid was lamellar. Osteoid in abnormal sites (within bone marrow or bone, or around osteocytes) was found less frequently in group I. Adjusted apposition rate declined and mineralization lag time increased in both groups because of extended unlabelled osteoid seams. Erosion surface increased only in group C. Hook and/or tunnel erosion was seen less frequently in group I; it was closely associated with osteoid in abnormal sites and correlated with osteoid surface. Extended osteoid surface may have forced osteoclasts to hollow out trabeculae, leaving the empty osteoid shell in marrow. Excess osteoid volume and eroded surface and osteoid and erosion in abnormal sites correlated with bone fragility in group C. We conclude that intermittent therapy is to be preferred because it (1) increased mineralized trabecular thickness, (2) did not cause excessive osteoid accumulation and erosion, (3) showed less osteoid and erosion in abnormal sites and (4) led to a similar reduction in the vertebral fracture rate as did continuous treatment. The question of whether intermittency of therapy has some other effect independent of the cumulative dose of fluoride administered cannot be answered by this study.     

异体软骨痂移植的初步结果

目的 通过观察异体软骨痂移植后的生物学过程判断其作为植骨材料的可行性。方法 将1只SD大鼠的双侧股骨干造成闭合骨折,1周时切开获取软骨痂,－196℃冻存2周后移植于5只SD大鼠的左侧胫骨干部分缺损区（此骨缺损模型的成骨活动只表现为膜内化骨的方式）,右侧植入异体松质骨作为对照组。将取材标本制成不脱钙切片,经亮绿和藏红T染色。结果 术后1周取材1例,缺损区实验侧和对照侧均未见有软骨组织和骨组织形成。术后2周处死其余4只大鼠,实验侧（3／4）可见有软骨组织和骨组织形成。骨组织内已有髓腔形成,骨组织周围是软骨组织,与宿主骨之间有纤维组织相隔。结论 异体软骨痂移植后未被吸收,可经软骨内化骨的方式产生骨组织,为软骨痂作为植骨材料的进一步研究和开发提供了初步依据。     

Osteoid osteoma that occurred in a former fracture site

Diagnosis of osteoid osteoma often is delayed, despite its high incidence, because of similarities in presenting symptoms with other pathologic entities. The current case report describes a posttraumatic osteoid osteoma. Three years after osteosynthesis of a distal tibial fracture an osteoid osteoma was diagnosed at the former fracture site. After excluding osteomyelitis as a possible diagnosis, the tumor was excised successfully. Based on current knowledge of the pathogenesis of osteoid osteoma, it is unlikely that the lesion observed in the patient was attributable to the previous fracture.     

Ultrastructural features of the osteoid of patients with fibrogenesis imperfecta ossium

The osteoid of a patient with Fibrogenesis Imperfecta Ossium is described. Three iliac crest biopsies were taken; firstly before treatment, secondly after calcitriol therapy and finally after successful treatment with melphalan and prednisolone. In the pretreatment biopsy the osteoid was greatly enlarged, showed complete absence of the birefringence characteristic of oriented collagen fibers, and at ultrastructural level was shown to be composed of abnormal collagen fibrils. The fibrils were often curved and were extremely variable in thickness. Calcification within the osteoid took the form of calcospherites and spread of calcification from these to collagen fibrils was greatly delayed. In the second biopsy two aspects of osteoid ultrastructure were noted; some samples resembled the first biopsy, but others had a different organization. The osteoid of these samples had two regions: an inner region containing abnormal collagen fibrils and an outer region composed of moderately electron-dense amorphous material. The osteoblasts associated with this region were clearly highly biosynthetically active. The third biopsy, after treatment with Melphalan and prednisolone, showed a reversion to more normal bone ultrastructure with uniform, oriented collagen fibrils and prompt mineralization resulting in narrow osteoid seams. Remnants of the original abnormal osteoid were present in the marrow space as calcified debris. Reasons for the success of this therapeutic regime are unclear; however, some speculation is made as to the possible roles of the cytotoxic drug and the glucocorticoid in the regression of this condition.     

Histomorphologic changes in the tibial epiphysis after diaphyseal fracture

The amount of osteoid tissue, osteoclasts, and active osteoblasts was measured in biopsy specimens from the proximal end of the tibia in 20 patients who had sustained tibial shaft fractures. As compared with samples from 42 control subjects without fractures, there was a vast increase in the amount of osteoid tissue. The histologic appearance deviated from that of other skeletal conditions in that poorly calcified (osteoid) layers were found throughout the trabeculae, which, in some instances, were completely osteoid. The frequency of active osteoblasts (corrected for osteoid) was not increased in the patients with fractures, whereas osteoclasts were noted four times more frequently.     

Percutaneous radiofrequency thermalablation of osteoid osteoma

Osteoid osteoma is a common benign bone lesion that affects adolescents and young adults. Spontaneous resolutionof pain is unreliable and may take years to resolve. Relief with non-steroidal anti-inflammatory drugs (NSAIDS) is often unpredictable and requires prolonged administration. Surgical en bloc resection has been the treatment of choice for these tumors. Recently, however, percutaneous radiofrequency thermal ablation, a technique that delivers a discrete, controlled thermal injury to the targeted tissue, has been applied to the treatment of osteoid osteoma, with positive results. This report reviews the pathophysiology and natural history of osteoid osteoma, the basic science of radiofrequency thermal ablation, and our clinical experience of its use in the treatment of osteoid osteoma. Finally, the technique of percutaneous radiofrequency ablation for the treatment of osteoid osteoma is described in detail.