Osteosarcomas of the larynx

OBJECTIVES/HYPOTHESIS: The objective was to review the etiology, presentation, treatment, and prognosis in patients with osteosarcoma of the larynx using an illustrative case example. STUDY DESIGN: Case report and literature review. METHODS: A case is reported, and a review of all available published cases of osteosarcoma of the larynx is presented. RESULTS: Osteosarcoma of the larynx may be a difficult clinical diagnosis. To be able to reach the correct diagnosis, a high index of suspicion and due diligence in obtaining deep biopsy specimens are important. Treatment is primarily surgical. Outcomes for this disease are generally poor, with most patients dying of the disease as a result of pulmonary metastasis. CONCLUSION: Osteosarcoma of the larynx is a rare entity, with only 14 cases reported to date. Pathological confirmation of osteoid is required for diagnosis. It is likely that aggressive surgical intervention directed at complete tumor extirpation is the treatment of choice, although long-term prognosis is poor.     

The diagnostic and therapeutic challenge of femoral head osteoid osteoma presenting as thigh pain: a case report

Osteoid osteoma, an infrequent but important cause of musculoskeletal pain, is often difficult to diagnose. We present a case of a 31-year-old man who, for 2 years, had left groin pain radiating to the thigh. Symptoms began 1 month after a motorcycle crash in which he sustained only shin abrasions. Initial spine and hip radiographs were negative. Treatment with naproxen provided significant relief, but the symptoms gradually worsened over 6 months. An electromyogram and lumbar magnetic resonance imaging (MRI) of the left lower leg were unremarkable. Hip MRI revealed edema without fracture. Prophylactic femoral pinning for impending stress fracture provided no relief. Rheumatologic evaluation revealed normal serologies and synovial fluid. Cyclobenzaprine and sulfasalazine were started and provided mild relief. At presentation to our institution, he was in significant discomfort, but could ride a bicycle for exercise and was completing a home exercise program. He had antalgic gait and globally restricted hip motion with end-range pain. A neurologic examination showed no abnormalities. Hip and pelvis computed tomography scan revealed increased sclerosis of the femoral head, with a central lucency suggestive of osteoid osteoma. This was confirmed by biopsy. Radiofrequency ablation provided significant symptom relief.     

病理性骨化的X线形态及诊断价值

目的 分析病理性骨化的X线形态，探讨其在X线诊断中的价值。方法 对243例X线上表现有骨化的病例进行X线形态的回顾性分析，根据其表现特点进行分类研究。结果 243例病理性骨化中，单表现骨化者231例，伴有钙化者12例；其中反应性骨化183例、肿瘤性骨样基质骨化51例、非肿瘤性骨样基质骨化13例、特异性骨化1例。各种骨化都有其独特的X线表现特点。结论 X线上病理性骨化代表着独特的组织学属性。其X线形态的不同对其疾病的X线诊断有着重要价值。     

Osteoid Osteoma of the Calcaneus: Percutaneous Radiofrequency Ablation

Osteoid osteoma of the foot can pose particular problems in diagnosis, especially when positioned in a juxta-articular location. It can cause reactive synovitis and simulate arthritis without periostitis. An atypical presentation may delay diagnosis and thus delay treatment. Different modes of treatment have been described including medical management with nonsteroidal, antiinflammatory drugs, and open surgical resection with intralesional, marginal, or wide surgical margins. In recent years, several computed tomography-guided percutaneous techniques have been used to achieve ablation of the nidus with minimal tissue invasion. We report a case of a 39-year-old man with an 8-month history of persistent foot pain who underwent percutaneous radiofrequency ablation of an osteoid osteoma involving the calcaneus. The patient related an immediate relief of pain and had no recurrence of symptoms or the lesion at 3-year follow-up.     

Osteoid osteoma in the differential diagnosis of persistent joint pain

We report 20 cases (13 male and 7 female), mean age 21 years) of juxta-articular osteoid osteoma. The distribution of affected joints was as follows: hip joint (7 cases), knee joint (2 cases), ankle joint (2 cases); iliosacral joint (2 cases), lumbar spine (2 cases), carpus (2 cases), shoulder (1 case), second metacarpal (MCP; 1 case) and first metatarsal (MTP; 1 case). The duration between the onset of symptoms and diagnosis varied from 8 months to approximately 4 years. In juxta-articular osteoid osteoma, the clinical picture and the radiographic findings are often atypical, and this may lead to misdiagnosis and delayed definitive treatment. In young patients with persistent undiagnosed pain, the possibility of an osteoid osteoma should be considered. When the clinical picture is suggestive but radiological findings are negative, we must proceed to further investigation with bone scintigraphy and computed tomography. These examinations should be repeated 1 year after the onset of symptoms because initially negative findings may become positive at a later date. When the diagnosis of an osteoid osteoma is confirmed, surgical excision leads to complete relief of the symptoms.     

350例骨肿瘤及瘤样病变病理分析

本文对350例骨肿瘤及瘤样病变进行统计分析。其中良性瘤229例(65. 4%),恶性瘤70例(20. 0%),瘤样病变51例(14. 6%)。各组肿瘤患者年龄均以11～30岁较多见;男性多于女性;发生于股骨者较多见。良性瘤以软骨瘤最多,后依次为骨巨细胞瘤、骨瘤及骨软骨瘤。恶性瘤以骨肉瘤多见,依次为软骨肉瘤、恶性骨巨细胞瘤。骨的瘤样病变包括骨纤维结构不良、孤立性骨囊肿、动脉瘤性骨囊肿及骨嗜酸性肉芽肿。     

Osteoma Cutis and Calcinosis Cutis: “Similar but Different”

The development of calcium salt deposits in the skin can occur in the presence or absence of membranous ossification and are categorized into osteoma cutis (i.e., cutaneous osteoma) and calcinosis cutis. For the former, distinction into primary or secondary osteoma cutis is mainly based on clinical and histopathological parameters, as primary osteoma cutis originates without any underlying intradermal inflammatory or neoplastic process, as opposed to a far greater number of secondary osteoma cutis that occur on the grounds of inflammation or tumors. Genetic disorders might predispose a person to the formation of these overall rare tumors. However, some patients develop primary osteoma cutis in the absence of any genetic background. In pre-menopausal women with fair skin, the condition of multiple miliary osteoma cutis is a relevant differential diagnosis for solid subcutaneous facial nodules. While pathogenesis remains unclear, most affected individuals have suffered from acne vulgaris at some point. Excision might be a viable option for disturbing lesions, as are ablative lasers. Here, we discuss and review relevant causes of calcium salt deposits in the skin based on a notable case of multiple primary osteoma cutis of the face in an otherwise healthy woman.     

骨样骨瘤CT导引下经皮瘤巢毁损治疗(附17例报告)

目的:探讨骨样骨瘤CT导引下经皮瘤巢毁损治疗的适应证,并判断其疗效。材料与方法:17例骨样骨瘤,其中男10例,女7例,年龄8～31岁。病人取仰卧位或俯卧位,局部浸润麻醉,应用骨钻针切除病变。17例在钻切处注入无水酒精5ml。结果:17例病人术后疼痛症状全部消失,17例全部准确穿刺到位,疗效肯定,均未发生任何并发症。结论:骨样骨瘤CT导引下经皮瘤巢毁损治疗是一种微创、安全、简单有效的治疗方法。     

骨样骨瘤的影像学表现及诊断价值分析

目的:分析骨样骨瘤的X线、CT、MRI及SPECT-CT融合图像的表现,总结其影像学特征。方法:对我院经手术或穿刺病理证实的28例骨样骨瘤的影像学表现进行回顾性分析。25例行X线检查,20例行CT检查,7例行MRI检查,9例行SPECT-CT图像融合。结果:28例均出现大小不一的圆形或椭圆形瘤巢,直径为2.3~19.5mm,瘤巢周围伴有不同程度的骨质硬化。X线对瘤巢显示率为48%(12/25),4例瘤巢中心出现钙化;CT对瘤巢显示率为95%(19/20),出现钙化者16例,2例显示"血管沟征";SPECT-CT融合图像,9例瘤巢均有显像剂团状异常浓聚,呈"太阳征";MRI对瘤巢显示率为57%(4/7),7例均显示不同程度骨髓水肿。结论:瘤巢是确诊骨样骨瘤的关键,CT是发现瘤巢的较好方法,SPECT有利于发现隐匿性病变,SPECT-CT融合图像可以明确病变及其累及的范围。