Brodie's abscess of the femoral neck simulating osteoid osteoma

Subacute osteomyelitis (Brodie's abscess) is essentially a problem of diagnosis, and there may be considerable difficulty in distinguishing it from other benign and malignant bone lesions. Though reported in the metaphyseal region of the femur, Brodie's abscess is rarer in the femoral neck. The authors present a case of Brodie's abscess in the femoral neck, which clinico-radiologically simulated an osteoid osteoma. Retrospectively, the presence of a cortical sinus tract should have aroused suspicion.     

Intracortical haemangioma simulating osteoid osteoma.

A case of intracortical haemangioma in the tibial diaphysis is reported. The radiological and macroscopic features were identical with osteoid osteoma. In view of this similarity, haemangiomata, despite their rarity at this site, must be considered in the differential diagnosis of osteoid osteoma.     

Arthroscopically assisted excision of osteoid osteoma involving the hip

Two cases of arthroscopically assisted excision of osteoid osteoma involving the femoral neck and acetabulum are presented. This technique allows for percutaneous excision of this benign bone lesion in those rare circumstances when it occurs in an intra-articular location. The approach enables direct visualization of the tumor as well as histologic confirmation. There was minimal morbidity, excellent relief of symptoms, and rapid functional restoration.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 1 (January), 2001: pp 56–61     

Juxta-articular osteoid osteoma

Osteoid osteomas that arise at the end of a long bone, within the insertion of the joint capsule (juxta-articular, intra-articular), may cause misleading clinical, radiographic, and histologic findings, resulting in unnecessary diagnostic tests and a delay in definitive treatment. To clarify optimum diagnostic procedures, we reviewed 20 cases of juxta-articular osteoid osteomas and found a mean delay from presentation to correct diagnosis of 24 months. Plain radiographs were either negative or showed only secondary changes. A periosteal reaction and proliferative synovitis with chronic inflammation was common, which could be misinterpreted as rheumatoid arthritis. Optimum diagnostic procedures were a bone scan followed by plain tomograms and an excisional biopsy of the nidus.     

Vertebral osteoid osteoma

The early diagnosis of vertebral osteoid osteoma is frequently delayed due to the absence of radiographic changes. A bone scan is more helpful because it shows an increased uptake of isotope when plain radiographs still appear normal. The use of computed tomography will confirm the diagnosis, allow precise delineation of the lesion and enable planning of the correct operation.     

Costal osteoid osteoma]

We report about a rare case of osteoid osteoma of the 9th rib in a 32 year old woman. A search of medical literature yielded only 16 reports about costal osteoid osteoma. This tumor should be considered in cases of painful rib without anamnestic trauma.     

Subperiosteal juxta-articular osteoid osteoma

Subperiosteal osteoid osteoma in a juxta-articular site presents a diagnostic challenge. The clinical features of joint stiffness, synovitis, muscle atrophy and local warmth may suggest arthritis rather than osteoid osteoma, while radiographs, bone scans and angiograms may not be diagnostic. We describe four cases of this rare condition.     

Subchondral osteoid osteoma of the glenoid

Osteoid osteoma of the scapula is a rare benign lesion. This is a case report of a subchondral osteoid osteoma that involved the anterior rim of glenoid. Surgical approach in this atypical area may seem difficult. The excision of the lesion and grafting was performed by a deltopectoral approach. One year after the surgery, the patient remains pain free and has full range of motion with no recurrence of the tumour.     

CT引导下经皮穿刺微波热消融术治疗髋部骨样骨瘤

目的 探讨CT引导下经皮穿刺微波热消融术治疗髋部骨样骨瘤的可行性.方法 2006年8月至2010年1月对8例髋部骨样骨瘤患者采用CT引导下经皮穿刺微波热消融治疗,男5例,女3例;年龄12～25岁,平均18.8岁.患者均有髋部疼痛症状,夜间加剧.病史2个月至10年.病变部位:股骨颈4例、股骨小转子2例、股骨大转子1例,股骨转子间1例.术中应用CT薄层横断扫描确定病灶部位,将骨穿刺针经皮穿入瘤巢中心.行CT扫描证实穿刺针位置准确后撤出针芯,用穿刺针套管刮除瘤壁及瘤巢内肿瘤组织送病理学检查.再将微波探针沿骨穿刺针穿入瘤巢中心,将瘤巢中心温度逐渐加热至90℃,保持4～6min.术后预防性应用抗生素2 d.结果 3例病理学检查诊断为骨样骨瘤,另5例仅获得诊断性描述.全部病例随访6～21个月.术后24 h内疼痛均有不同程度缓解,1例随访5个月时仍有轻度夜间隐痛,再次行微波热消融治疗,随访8个月无复发.所有患者均未见股骨头坏死及其他并发症.结论 CT引导下骨样骨瘤经皮穿刺微波热消融术可以有效缓解或消除髋部疼痛症状,术后并发症少,短期疗效好,是一种安全、有效的新方法.     

Prostaglandins in osteoid osteoma

Summary Osteoid osteoma is a tumour of bone characterised by pain which is relieved by aspirin and nonsteroidal anti-inflammatory drugs. Very high levels of prostaglandins have been found in the lesion. In five patients with osteoid osteoma, prostaglandin E ₂ (PGE ₂ ) and prostacyclin (PGI ₂ ) synthesis in the nidus yielded 1155.6±496.5 (mean±SD) and 245.2±89.8 pg/mg respectively, values which are 33 and 26 times higher than in fragments of normal bone. The sclerotic bone around the nidus produced both prostaglandins at the same rate as normal bone. In three patients the excretion rate of the major urinary metabolite of systemic PGI ₁ was reduced to 50% one month after removal of the tumour. The urinary excretion rate of 6-keto-PGF ₁ , reflecting intrarenal PGI ₂ synthesis, was not changed after operation. These results offer new insight into the pain mechanism in osteoid osteoma.

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Résumé L'ostéome ostéoïde est une tumeur osseuse caractérisée par des douleurs qui sont calmées par l'aspirine et les anti-inflammatoires non stéroïdiens. Des taux très élevés de prostaglandines ont été trouvés dans cette lésion. Chez trois malades présentant un ostéome ostéoïde la prostaglandine E ₂ (PGE ₂ ) et la prostacycline (PGI ₂ ) synthétisés dans le nidus atteignaient respectivement 1155.6±496.5 et 245.2±89.8 pg/mg, valeurs qui étaient 33 et 26 fois plus élevées que dans des fragments d'os normal. L'os scléreux entourant le nidus produisait les deux prostaglandines au même taux que l'os normal. Chez trois malades le taux d'excrétion des principaux métabolites urinaires de la PGI ₂ systémique était réduit de moitié un mois après l'ablation de la tumeur. Le taux d'excrétion urinaire de la 6-keto-PGF1, traduisant la synthèse rénale de la PGI ₂ , n'a pas été modifié par l'opération. Ces résultats permettent une nouvelle approche du mécanisme de la douleur dans l'ostéome ostéoöide.