The diagnostic dilemma created by osteoid osteoma that presents as knee pain

Purpose: Osteoid osteoma is a rare benign bone lesion with a high incidence in adolescents and young people. The objective of our study was to illustrate the difficulties in diagnosis of osteoid osteoma in patients presenting with atypical knee pain. Type of Study: Retrospective case series. Methods: In 10 patients who presented to our department with atypical knee pain between 1984 and 1999, the diagnosis of an osteoid osteoma was delayed. Retrospective review of these 10 cases was performed using interviews and re-evaluation of medical histories, radiographs, computed tomography (CT) scans, isotope bone scan, and magnetic resonance imaging (MRI). Results: Initial radiographs showed features of osteiod osteoma in only 2 cases. In addition, in 1 case, not only initial but also repeated radiographs of the knee joint were still normal 10 months after the delineation of the nidus using MRI. Four unnecessary arthroscopies were performed on 4 of the 10 patients and the final diagnosis was established using MRI, CT, and isotope bone scan. The mean time interval between arthroscopy and osteiod osteoma diagnosis was 11.5 months. Conclusions: Osteoid osteoma must be included in the differential diagnosis of persistent unexplained knee pain, especially when objective findings of the knee are vague. The presence of the lesion juxta-articular to the knee joint or in the midshaft or upper end of the femur may be referred as pain to a nearby joint. Plain radiographs have a low diagnostic value in the detection of the lesion whereas isotope bone scan and MRI are reliable imaging techniques. The evaluation of the ipsilateral hip joint should not be overlooked.     

Basic and clinical studies of percutaneous radiofrequency ablation of osteoid osteoma using a standard electrosurgical generator

 For percutaneous radiofrequency ablation of osteoid osteoma for pain management, we used a standard electrosurgical generator instead of the radiofrequency generator system. First, we used the standard electrosurgical generator to determine the diameter of the coagulated area of normal femurs and humeruses of dogs under general anesthesia and to detect damage to normal tissue around the bone. We then used a standard electrosurgical generator to perform percutaneous radiofrequency ablation of the osteoid osteoma. All three patients were almost pain-free within the first 24 h after the procedure, and they were discharged the day after the operation, being hospitalized for only 2 days. We thus confirmed that percutaneous radiofrequency ablation using a standard electrosurgical generator produced results similar to those achieved with the radiofrequency generator system. Received: August 19, 2002 / Accepted: January 11, 2003 RID="*" ID="*" Offprint requests to: A. Takeda     

Case of a horn-shaped osteoma

A Case of osteoma with horn shape is rare. A 79-years-old man, in whom the osteoma with horn shape was not demonstrated three years ago. Slowly, the osteoma becomes accompanied with pain, and the slow growth of a horn. Computed tomography showed a bone tumor arising from the right parietal bone, but, the patient didn't request treatment. The osteoma changed its form, and an ulcer developed. The patient eventually accepted our advice about surgery, but with bad grace. On operation, the tumor proved to be hard. The tumor was detaches from the skull and the surrounding cranial bone was removed. The histological diagnosis was that it was a case of a compact type osteoma. The postoperative recovery of the patient was satisfactory and his pain disappeared, but, he died of pneumonia on the 40th postoperative day. We believe that the osteoma in our case must have grown slowly with time and ossification of the surrounding tissue.     

带血供肱骨下段内侧骨（膜）瓣的移位术

目的：为上肢骨不连、骨缺损以及肘关节软骨缺损提供一种新的供骨区。方法：选择４０侧成人上肢要同测了尺侧下副动脉、尺侧返动脉的起始、走行、分布和吻合。通过解剖学研究，设计带血供的肱骨下段内侧骨（膜）瓣移位术治疗骨缺损和骨不连接。结果：从１９９５年开始，经临床应用９例（肱骨中段骨不连３例，骨缺损２例；尺、桡骨中、上段骨不连３例；肘关节面软骨缺损１例），均取得良好治疗效果。结论：以尺侧下副动脉为供养血管的     

Osteoid Osteoma of the Cuboid Managed by Percutaneous Radiofrequency Ablation

We present details of a case of osteoid osteoma of the tarsal cuboid bone. Osteoid osteoma arising in the foot is not very common, and localization in the cuboid is rare. To our knowledge, this is the first case of osteoid osteoma of the cuboid bone treated successfully by percutaneous radiofrequency ablation.     

Juxtacortical liposarcoma. A case report and review of the literature

Juxtacortical liposarcoma is an uncommon entity. The purpose of this paper is to report the case of a 63-year-old man with juxtacortical liposarcoma. Liposarcomas arising as surface lesions of bone are extremely rare. Histologically, juxtacortical liposarcoma is composed of myxoid and round-cell areas. Because of the extent of compartmental involvement and the high-grade malignancy, limb-sparing surgery was not considered for the patient. A review of the English literature on diagnosis and treatment indicates a grave prognosis.     

Osteoid osteoma of the capitate bone.

A case of osteoid osteoma of the capitate bone is presented. The osteoma was accompanied by synovial changes in the neighbouring intercarpal joint, and this characterized the clinical features. Resection of the osteoma afforded relief from symptoms.     

A Painless Subungual Osteoid Osteoma

BACKGROUND: Osteoid osteoma is a benign bone tumor. Its etiology is not fully understood and the role of trauma is still elusive. OBJECTIVE: Osteoid osteoma mostly presents with a poorly localized pain that is worst at night and characteristically relieved by salicylates. It usually occurs on the weight-bearing bones of the lower extremities, but toe location is quite rare. Here, we present a case of painless osteoid osteoma located subungually on the dorsum of the great toe. RESULT: A 29-year-old woman presented with a painless subungual mass on the dorsum of her great toe. Subungual exotosis, osteochondroma, and osteoma were considered in the differential diagnosis and the lesion was totally excised. Histopathologic examination showed characteristic findings of osteoid osteoma. CONCLUSION: A painless osteoid osteoma is rarely seen and it can be easily misdiagnosed if it occurs in an atypical location such as the subungual area.     

Age-dependence of bone material quality shown by the measurement of frequency of resonance in the ulna

In women before and after the age of peak bone mass, identical values of bone mineral density (BMD) can be obtained. However, there is a much higher incidence of osteoporotic fractures in older women. We investigated whether a deterioration of bone material quality with increasing age might contribute to this phenomenon. Material properties of bone tissue can be characterized by the modulus of elasticity, which is correlated to the square of sound transmission velocity. In this study, sound transmission velocity was determined in cortical bone by measuring the frequency of resonance in the ulna in the direction of the bone's longitudinal axis and correcting the values by multiplying by ulna length. Validation of this method indicated acceptable reproducibility: interobserver variability determined as the mean coefficient of variation was 1.82%. In a clinical study, 21 young women (22.5±1.2 years old) were compared with 21 middle-aged women (52.9±2.7 years old). Pairs were matched that had identical values of BMD in the nondominant forearm at a location representing mainly cortical bone (SPA). The product of ulna length and frequency of resonance in the ulna in the younger women was found to be 61.4±5.8 m/second, and in the middle-aged women 55.7±4.5 m/second. The difference was highly significant with P<0.005. Our results confirm recent findings indicating a deterioration of bone material quality independent of BMD with increasing age. As shown by comparing ulna width at the site of measurement of bone mineral density between both groups of women, the deterioration of bone material quality in ulnar cortical bone with increasing age might at least in part be functionally compensated by an increase of the moment of inertia due to greater bone width [8, 10].     

Osteoid osteoma of the cervical spine depicted as dumbbell tumor by MRI

We report a case of 14-year-old male patient with osteoid osteoma of the cervical spine. Magnetic resonance imaging (MRI) revealed a large dumbbell-shaped paravertebral tumor in the region of the exiting left C6 nerve. A computed tomographic (CT) scan after myelography showed a much smaller bony defect in the medial aspect of the left C6 pedicle with central calcification and extensive bone sclerosis around the defect, typical of osteoid osteoma. The diagnosis was confirmed postoperatively. The resected specimen exhibited extensive vascularization of the osteoid tissue. The case is presented because MRI did not allow a specific diagnosis of osteoid osteoma, and suggested the tumor was larger than in reality it was, by also depicting the reactive inflammation around the tumor as if it were part of the tumor. Received: 12 October 1999/Revised: 7 February 2000/Accepted: 23 February 2000     

Posttraumatisches Osteoidosteom Fallbericht und Literaturübersicht

Osteoid osteoma is a painful benign bone neoplasm that is rarely described after trauma but should be suspected. A case of osteoid osteoma 19 years after a tibial fracture is presented. The patient had pain in the tibia for 6 years before the osteoid osteoma was confirmed. He had been operated on twice for suspected osteomyelitis although the clinical symptoms suggested an osteoid osteoma. The radiographic appearance as well as a bone scan confirmed the diagnosis. Removal of the nidus resulted in immediate pain relief. A precise preoperative diagnosis of the lesion based on clinical findings, standard radiographs, high-resolution CT, and bone scan is mandatory. It is important to recognize this uncommon entity to avoid morbidity associated with a prolonged delay in diagnosis.     

Tendon Graft—Ulna Fixation in Distal Radio-Ulnar Joint Stabilisation; Biomechanical Comparison of Three Graft-Bone Fixation Methods

A common distal radio-ulnar joint (DRUJ) stabilisation procedure uses a tendon graft running from the lip of the radial sigmoid notch to the ulnar fovea and through a bony tunnel to the ulnar shaft, before being wrapped round the distal ulna and sutured to itself. Such graft fixation can be challenging and requires a considerable tendon length. The graft length could be reduced by fixing the graft to the ulna using a bone anchor or interference screw. The aim of this study was to compare the strength of three distal ulna graft fixation methods (tendon wrapping and suturing, bone anchor and interference screw). Four human cadaveric ulnae were used. A tendon strip was run through a tunnel in the distal ulna and secured by: (1) wrapping round the shaft and suturing it to itself, (2) a bone anchor and (3) an interference screw in the bone tunnel. Load to failure was determined using a custom-made apparatus and an Instron machine. Maximum failure load was highest for the bone anchor fixation (99.3 ± 23.7 N) followed by the suturing (96.2 ± 12.1 N), and the interference screw fixation (46.9 ± 5.6 N). There was no significant difference between the tendon suturing and bone anchor methods, but the tendon suturing was statistically significantly higher compared to the interference screw (P = 0.028). In performing anatomical stabilisation of the DRUJ fixation of the tendon graft to the distal ulna with a bone anchor provides the most secure fixation. This may make the stabilisation technique less demanding and require a smaller tendon graft.     

Gamma probe localization of cranial bone lesions: technical note

BACKGROUND: Intraoperative localization of cranial bone lesions may be challenging especially when the lesion is not well demonstrated on computed tomography (CT) scan but solely on a radio-isotope bone scan. We hereby demonstrate a technique for localizing such lesions using an intraoperative gamma probe reader and summarize the relevant literature. METHODS: A case report of a temporal osteoid osteoma causing local pain and unresponsive to conservative treatment is presented. The lesion was demonstrated preoperatively solely on a bone scan, and was intra-operatively localized by a gamma probe reader. RESULTS: The lesion was totally excised with normal background readings after lesion removal. Six months after total removal of the osteoid osteoma, the patient is asymptomatic. CONCLUSION: Intraoperative gamma probe reader is a simple, effective, and safe method for intra-operative localization of bone lesions, which are positive on bone scans. It is especially useful for skull lesions that are not demonstrated by other imaging methods.     

Osteoid osteoma of the sesamoid bone: An unusual localization

Osteoid osteoma is the most common benign bone tumor because it accounts for 10–12% of all these tumors. Localized most often with long bones (75% of cases), especially in the tibia and femur, osteoid osteoma can evoke other etiologies, especially when it is juxta-articular. We report the case of an osteoid osteoma of the sesamoid in a 23-year-old patient with no particular history who presented pain at the root of his hallux evolving for 6 months. The clinical examination was without abnormalities. Standard X-rays found no lesions. The tomodensitometry of the foot showed an image "cockade" with a peripheral sclera ring. The patient underwent surgical excision with simple operative follow-up and disappearance of pain at one year of follow-up. The histopathological study confirmed the diagnosis. The osteoid osteoma of the sesamoid bone is exceptional. The diagnosis may be delayed due to misleading "articular" symptomatology.     

Osteoid osteoma of the dens axis

An osteoid osteoma of the dens axis was diagnosed by computed tomography and bone scintigraphy in a 14-year-old girl with a 1.5-year history of pain. No case of an osteoid osteoma of the dens axis has been published in the literature yet. Regarding its clinical and radiological appearance, this osteoid osteoma was essentially similar to osteoid osteomas in other locations, i.e., it had an osteolytic nidus surrounded by sclerosis, associated with nocturnal pain and a positive aspirin test.

     

Recurrence of juxtacortical chondrosarcoma arising on the rib

Juxtacortical chondrosarcoma developing on the surface of a bone is quite rare. We report a case of juxtacortical chondrosarcoma arising on the fourth rib of a 76-year-old man. Intraregional tumor resection was performed, but local recurrence was detected after 6 months. The patient underwent wide resection including the ribs, and reconstruction of the thoracic wall. He was released with a good prognosis after a year. This case emphasizes the importance of biopsy analysis before surgery to carefully evaluate tumor spread in the cartilage and performing wide resection even if the tumor is easily separated from the bone.     

Multifocal intradiploic cavernous hemangioma of the skull associated with nasal osteoma

Summary.  Objective: To present a 42-year-old female patient with multifocal cavernous hemangioma of the skull associated with nasal osteoma.  Design: A case report.  Intervention methods: X-rays, computerized tomography, magnetic resonance imaging, and histopathology were used to achieve the diagnosis of this rare entity. The multiple cavernous hemangiomas were resected en-bloc and a curettage biopsy was obtained from the nasal osteoma.  Results: The patient healed well after the operation. No recurrences of the cavernous hemangiomas were observed after one-year follow-up.  Conclusion: Multifocal cavernous hemangiomas are rare benign lesions of the calvarium, arising from the intrinsic vasculature of the bone. Although they are benign, radiological findings are not always characteristic and their multiple presentation may easily make surgeons consider the other malignancies of the skull in the differential diagnosis. Histopathologic confirmation of the tumor is the definitive method for diagnosis. The treatment of choice is early en bloc resection of the tumour where it is possible. Published online April 28, 2003  Correspondence: Kayhan Kuzeylı˙, M.D., Karadeniz Teknik U¨niversitesi, Farabi Hastanesi N?roşirurji AbD, 61080 Trabzon, Türkiye.     

皮质旁软骨瘤的CT、MRI与病理分析

目的分析皮质旁软骨瘤的CT、MRI表现及病理学特点。方法分析8例经手术病理证实的皮质旁软骨瘤影像学和病理学表现。8例均接受X线平片检查,3例接受CT检查,7例接受MR检查。结果位于肱骨6例、股骨1例、指骨1例。肿瘤最大径2~6cm。7例X线表现为骨皮质旁钙化性或骨化性肿块,其中5例邻近骨皮质增生,6例骨皮质凹陷,4例呈"火山口"样外观,2例肿块表面绕有不完整骨壳;另1例X线表现为骨皮质浅碟形凹陷,未见钙化或骨化。3例CT表现类似X线平片。6例伴钙化或骨化性的肿瘤T2WI呈明显高信号伴数量不等低信号;另1例无钙化或骨化的肿瘤T2WI呈明显高信号。增强扫描肿瘤不均匀强化,邻近骨髓腔未见受累。8例术后病理学表现为分化良好的软骨组织,掺杂钙化或骨化灶。结论皮质旁软骨瘤好发于长骨的皮质旁,影像学表现具有一定特征。     

A pathologic fracture of an intracortical chondroma masking as an osteoid osteoma

The differential diagnosis of a tibial intracortical diaphyseal lesion includes osteoid osteoma, periosteal chondroma, nonossifying fibroma, osteofibrous dysplasia, and adamantinoma. While osteoid osteomas represent 5% of all primary bone tumors, little is understood about intracortical chondromas. Intracortical chondroma was first described in 1990 and 7 reported cases have since been published. This article presents the first reported case of a pathologic fracture of an intracortical lesion in a child that shared radiographic and clinical features similar to those of osteoid osteoma, but on histopathologic examination revealed an intracortical chondroma. Our patient exhibited radiographic features of a poorly circumscribed cortical bone sclerosis, a centralized radiolucent nidus on computed tomography, and a hot bone scan of a lesion <1 cm in size that was consistent with an osteoid osteoma. An excision of the bone lesion was performed. The histopathology of the lesion revealed nodules of benign hyaline cartilage in cortical bone, consistent with an intracortical chondroma. Demarcated by cortical bone with mature Haversian systems rather than periosteum or cancellous bone, intracortical chondroma differs from the other 2 chondroma variants, periosteal chondroma and enchondroma, by its relationship to the surrounding bone. Enchondromas are characteristically understood to be asymptomatic. Intracortical chondromas along with periosteal chondromas have been found to present as painful lesions. The similarities with osteoid osteoma and intracortical chondroma in our patient make it circumspect in regards to ablating lesions (ie, needle radiofrequency ablation) without acquiring a biopsy in pediatric patients that both clinically and radiographically are presumably an osteoid osteoma.