Osteoblastoma of the cervical spine

Summary This case report demonstrates the importance of an exact workup in unclear neckpain. An osteoblastoma situated in the pedicule of C6 is described. During 36 months there was no diagnosis made. Only by a CT-scan a tumorous lesion in the pedicule of C6 with the histology of a benign osteoblastoma was found. The therapy consisted in excision of the tumor of C6. A fusion was added because important parts of the joint were involved.

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Zusammenfassung In der vorliegenden Arbeit wird das Vorkommen eines Osteoblastoms im rechten Pedunkel von C6 beschrieben. Auffallend daran ist die lange Behandlungszeit, bevor die endgültige Diagnose gestellt wurde (36 Monate). Diese wurde erst erhärtet, als ein Computertomogramm den rundlichen, tumorösen Defekt im Pedunkel des 6. Halswirbels aufdeckte. Die Therapie bestand in einer Excision des Tumors, die von dorsal durch Eröffnen des Gelenkfortsatzmassives von C6 durchgeführt wurde. Gleichzeitig mußte eine Spondylodese angeschlossen werden, da erhebliche Teile des Gelenkes mitbetroffen waren. Bei der Nachkontrolle 6 Monate postoperativ war die Patientin völlig beschwerdefrei.

     

Benign Osteoblastoma

Benign osteoblastoma is a benign bone-forming lesion, seen most commonly in the first three decades of life and having a predilection for the vertebral column and the short limb bones. It is distinguishable from osteoid osteoma on the bases of size (being more than one centimetre in diameter) and the absence of surrounding sclerosis. The two lesions, however, are probably of the same origin and behave differently because of their different situations. Treatment is by operation, either excision in whole if practicable, or thorough piecemeal excision and curettage, with bone grafting of the defect if indicated.     

Osteoblastoma of the spine.

Osteoid osteomas and osteoblastomas have similar histologic characteristics, although their clinical course in the spine may be significantly different. At the authors' institution, spinal osteoblastomas constituted 46% (30/65) of all osteoblastomas treated. Sixteen of the lesions occurred in the lumbar spine (53%), eight in the thoracic spine, and six in the cervical spine. In all regions of the spine, the posterior elements and pedicles were more frequently involved than the vertebral body. Twenty patients had pain or other symptoms for more than 12 months before diagnosis. Six of eight patients had thoracic lesions that demonstrated neurologic involvement. Twelve patients presented with painful scoliosis. Fourteen patients had lesions with well-circumscribed margins confined within the vertebral structure (Enneking Stage 2), and 16 had ill-defined margins with soft-tissue extension (Enneking Stage 3). Well-defined lesions were treated with curettage, with excellent results in 12 of 14 patients. The more extensive lesions were treated by intralesional excision (15/16) and adjuvant radiation therapy (9/16).     

Osteoblastoma in the skeletally immature

BACKGROUND: Osteoblastoma is a rare benign and sometimes locally aggressive tumor with peak incidence in the second decade. None of the available series addresses specifically the differences in presentation, management, and outcome between the pediatric and adult patient populations. METHODS: The medical records and radiographs of all children diagnosed with osteoblastoma during a 17-year period were reviewed. We recorded demographic information, time until diagnosis, location, clinical and radiographic characteristics, treatment, complications, and outcome at a minimum 2-year follow-up (range, 2-5 years). RESULTS: Seventeen children met the inclusion criteria. There were 10 boys and 7 girls, with an average age at diagnosis of 11 years (range, 20 months-15 years). The average time delay between onset of symptoms and diagnosis was 6.5 months (range, 2 months-2 years). There were 7 lesions in the lower extremity, 5 in the spine, 4 in the upper extremity, and 1 in the sternum. Pain at the tumor site was present in all cases. Two of the 5 patients with spine lesion had scoliosis. All patients underwent open incisional biopsy with intraoperative frozen section. In 16 cases, this was followed by a 4-step approach (extended curettage, high-speed burring, electrocauterization of cavity wall, and phenol 5% solution). Four of the 5 patients with spine lesions had instrumented posterior spine fusion after tumor removal. Two patients were referred to our institution with recurrent lesion after surgery elsewhere. Only 1 (6%) of 15 children initially treated at our institution had recurrence. All recurrences occurred in children younger than 6 years; all were successfully treated with a 4-step approach. CONCLUSIONS: Osteoblastomas can be successfully treated with a 4-step approach. Children younger than 6 years may have a higher likelihood of recurrence.     

骨母细胞瘤临床病理学研究

探讨良性骨母细胞瘤和恶性母细胞瘤的诊断和鉴别诊断标准，采用临床病理分析及常规病理学观察方法。骨母细胞瘤除出现经典的组织学特征外，尚可出现车辐状排列及血管瘤样变化。骨母细胞增生活跃及出现异型的巨型上皮样骨母细胞可作为恶性骨母细胞瘤的组织学诊断依据。恶性骨母细胞瘤是介于良性骨母细胞瘤和肉瘤之间的中间型病变，有其特殊临床及病理学意义，应与良性骨母细胞瘤和骨母细胞型骨肉瘤进行鉴别。     

Osteoblastoma causing rigidity of the elbow

A 21-year-old man complained of pain and rigidity of the elbow with a flexion contracture of 100°. A radio-graphic examination revealed an 1.5-cm osteolytic injury in the center of a sclerotic lesion in the distal humerus. The diagnosis of an osteoblastoma was later confirmed histologically. Once the tumor had been excised, the pain disappeared and functional mobility was reestablished.     

Current problem cases Osteoblastoma of the coccyx

Summary Osteoblastoma, defined as a benign bone tumor by Jaffe and Lichtenstein, together with osteoid osteoma and multifocal osteoblastoma, belongs to the osteoblastic tumors. Due to the variable features of this tumor, differential diagnosis comprises fibrous dysplasia, giant cell tumor, aneurysmal bone cyst and osteoid osteoma; histological analysis is the only way to obtain a definite answer about the tumor type. Occasionally differential diagnosis from aggressive osteoblastoma and osteosarcoma may be difficult. The history of symptoms is usually long and diagnosis may be difficult both clinically and histologically.     

Osteoblastoma of the distal phalanx of the hallux

Osteoblastoma is a very rare bone tumor infrequently reported in the podiatric literature. The authors present a review of this tumor and the types of modalities that may be used to detect and diagnose these tumors. They also present a surgical approach to the resection of these bone tumors.     

Osteoblastoma of the carpal scaphoid frequency and treatment

A rare case of osteoblastoma of the carpal scaphoid is presented. Review of the literature revealed two more cases that have been previously reported. The authors present the diagnostic difficulties and the treatment which was applied: proximal row carpectomy and tendon transfers for wrist stabilization. Treatment options, according to the literature, also include scaphoidectomy and tumor curettage with bone grafting.