Osteoid osteoma

There is here recorded the detailed history of an instance of an osteoid of the neck of the astragalus in a child. In the early stages of the disease there was such a marked swelling of the ankle extending up along the heel cord that the clinical appearance suggested the diagnosis of a tuberculous arthritis. Immobilization gave no relief, and an arthrotomy did not disclose the real pathological process. The persistence of the greatest pain and tenderness in the anterior portion of the ankle in the region of the astragalus, and the final appearance of a localized rarefaction in the neck of the astragalus led to the correct diagnosis, and the surgical cure of the disease. The specific purpose of this report is to direct attention again to the disease, osteoid osteoma, which is fairly common. It is a lesion with a triad of characteristic subjective and objective symptoms. Osteoid osteoma will be recognized more frequently if these symptoms and the possible existence of this disease are kept in mind.     

Osteoid osteoma of scaphoid

Osteoid osteoma is infrequently localized to the hand. Initially the lesion may cause nonspecific symptoms. A 14-year-old boy presented with spontaneous onset swelling and pain wrist for 2 months. Initially he was suspected of having tuberculosis, but radiographs revealed a sclerotic lesion of the scaphoid and the sedimentation rate was not high. CT scan of the wrist showed a double-ring sign, indicating osteoid osteoma. Lesion was curetted and the nidus excised. This resulted in rapid resolution of the symptoms.     

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 and osteoblastoma

In conclusion, while similar histologically, osteoid osteoma and osteoblastoma have the potential of being significantly different clinically. Osteoid osteoma tends to be a problem of pain and not of great oncologic significance. Osteoblastoma, on the other hand, has the potential for local bone destruction and aggressiveness as well as the rare occurrence of metastases. For this reason, the latter tumor needs to be respected from an oncologic standpoint and appropriate surgical excision performed.     

Osteoid osteoma of the acetabulum

Summary Osteoid osteoma of the acetabulum can be expected to cause nonspecific symptoms of hip inflammation. In a sixteen year old girl, investigation by routine radiographs and a bone scan suggested a focus of inflammation with a nidus and sclerosis of the acetabulum and overgrowth of the head and neck of the femur. Removal of the lesion by an anterior approach with dislocation of the hip gave excellent results when seen after three years with a normal gait and normal hip motion.

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Résumé Les auteurs présentent un cas d'ostéome ostéoïde développé au niveau du fond du cotyle chez une jeune fille de 16 ans. Les symptômes n'étaient pas spécifiques et pouvaient évoquer une coxite chronique. Le diagnostic a été essentiellement permis par la tomodensitométrie. La masse tumorale a été réséquée par voie antérieure après luxation de la tête fémorale. Les résultats, avec un recul de trois ans, sont excellents.

     

Osteoid osteoma of the pisiform

Osteoid osteoma of the pisiform seems not to have been previously reported. In both the cases reported in this paper there was diagnostic difficulty and delay. Complete surgical removal of the nidus was curative.