Large Frontal Osteoid Osteoma with Orbital Extension

Abstract

Osteoid osteomas are benign bone tumors first described by Jaffe in 1935. They are usually located within the cortex of long bones in the lower extremities. These types of tumors are rare in the skull area, representing less than 1% of benign cases. We present a case of a large osteoid osteoma producing proptosis and requiring a frontal sinusotomy with excision of the mass.     

A distinctive patchy osteomalacia characterises Phospho1‐deficient mice

The phosphatase PHOSPHO1 is involved in the initiation of biomineralisation. Bones in Phospho1 knockout (KO) mice show histological osteomalacia with frequent bowing of long bones and spontaneous fractures: they contain less mineral, with smaller mineral crystals. However, the consequences of Phospho1 ablation on the microscale structure of bone are not yet fully elucidated. Tibias and femurs obtained from wild‐type and Phospho1 null (KO) mice (25–32 weeks old) were embedded in PMMA, cut and polished to produce near longitudinal sections. Block surfaces were studied using 20 kV backscattered‐electron (BSE) imaging, and again after iodine staining to reveal non‐mineralised matrix and cellular components. For 3D characterisation, we used X‐ray micro‐tomography. Bones opened with carbide milling tools to expose endosteal surfaces were macerated using an alkaline bacterial pronase enzyme detergent, 5% hydrogen peroxide and 7% sodium hypochlorite solutions to produce 3D surfaces for study with 3D BSE scanning electron microscopy (SEM). Extensive regions of both compact cortical and trabecular bone matrix in Phospho1 KO mice contained no significant mineral and/or showed arrested mineralisation fronts, characterised by a failure in the fusion of the calcospherite‐like, separately mineralising, individual micro‐volumes within bone. Osteoclastic resorption of the uncalcified matrix in Phospho1 KO mice was attenuated compared with surrounding normally mineralised bone. The extent and position of this aberrant biomineralisation varied considerably between animals, contralateral limbs and anatomical sites. The most frequent manifestation lay, however, in the nearly complete failure of mineralisation in the bone surrounding the numerous transverse blood vessel canals in the cortices. In conclusion, SEM disclosed defective mineralising fronts and extensive patchy osteomalacia, which has previously not been recognised. These data further confirm the role of this phosphatase in physiological skeletal mineralisation.     

股骨近端骨样骨瘤误诊原因分析

目的：分析骨样骨瘤的症状、体征及X线特点,减少该病的误诊误治率。方法：回顾分析经手术病理证实的骨样骨瘤9例。男7例,女2例。归纳所有病例的症状、体征、X线及CT检查特点。结果：全部9例患者均有患侧髋关节持续疼痛夜间加重的特点,及由此所致的跛行和患侧大腿肌肉萎缩的体征。骨样骨瘤的影像学表现为一圆形或卵圆形的透亮区,直径〈2cm,其周围有不同程度的骨质硬化。9例X线平片仅5例发现不规则密度减低区,9例CT均清楚显示病灶瘤巢;1例MRI也观察到类似瘤巢的改变。4例同位素检查均表现为病变区核素浓聚现象。结论：疼痛是骨样骨瘤的主要症状,瘤巢是确诊骨样骨瘤的关键,CT是发现瘤巢的最佳方法。误诊原因是缺乏对该病的认识。     

骨样骨瘤的影像学表现和诊断价值

目的:探讨骨样骨瘤的X线、CT与MR表现。方法:搜集2007年～2009年经手术病理证实的骨样骨瘤60例,其中男36例,女24例,年龄10～41岁,平均26岁。所有病例均行X线检查,其中行CT检查者18例,行MR检查者24例。分析上述3种影像检查对骨样骨瘤瘤巢的显示率。结果:在常规X线检查中60例病灶均是一个卵圆形亮区或者是一个圆形的亮区,直径>5～16mm,在病灶的周围出现骨质硬化现象,只是程度不同而已;其中48例可以看到瘤巢。显示率为80%;18例经CT薄层扫描均可清楚显示瘤巢,显示率为100%;24例行MR检查,其中18例可显示瘤巢,并可见瘤巢周围的软组织肿胀,瘤巢显示率为75%。结论:瘤巢能够确诊骨样骨瘤。对骨样骨瘤进行诊断一般首先选择常规的X射线,对瘤巢显示的方法中最可靠的是CT,其次是MR,虽然MR有某些缺陷,但却可以清楚的显示瘸巢周围的软组织肿胀情况。     

Magnetic resonance imaging findings of osteoid osteoma of the proximal femur

Osteoid osteoma (OO) is a benign bone tumor whose main radiological finding is nidus. OO of the proximal femur can also result in non-specific findings such as hip joint effusion, perinidal bone marrow edema and soft tissue mass. Since the nidus may be difficult to identify with MR, these non-specific findings can lead to erroneous diagnosis. Therefore, MR imaging technique should be optimized in order to identify nidus. Since MR imaging has assumed increasing importance in the evaluation of disorders of the hip, radiologists must be aware of the spectrum of findings of OO of the proximal femur. The aim of this pictorial review is to show the MR imaging findings of intra-articular and extra-articular OO of the proximal femur.     

股骨头颈部肿瘤及瘤样病变的手术治疗

目的探讨股骨头颈部肿瘤及瘤样病变的手术治疗效果.方法对19例股骨头颈部瘤样病变及良性肿瘤患者行病灶刮除＋自体髂骨植骨术.结果 19例均获随访,时间1年3个月～4年,平均2.7年.患者术后6～9个月植骨融合,无股骨头坏死或塌陷,肿瘤无复发征象.结论对股骨头颈部良性肿瘤及瘤样病变采用病灶清除＋植骨可取得良好效果.     

Difference in label length between demethylchlortetracycline and oxytetracycline: Implications for the interpretation of bone histomorphometric data

Summary We measured the individual lengths of fluorescent labels on the three subdivisions of the endosteal envelope in iliac bone biopsy specimens produced by the administration of both oxytetracycline and demethylchlortetracycline. Fifty-one healthy subjects and 53 patients with postmenopausal osteoporosis were labeled in the stated order, and 8 osteopenic patients were labeled in the reverse order. Whatever the order of administration, the demethylchlortetracycline label was longer than the oxytetracycline label. We conclude: (1) the difference in label lengths reflects a difference between the two compounds in some intrinsic property, whether physical, chemical, or pharmacokinetic. (2) If the calculation of extent of mineralizing surface is based on the mean length of the two labels, a suitable correction should be applied to the shorter label; alternatively, the length of the longer label alone should be used. (3) Unlabeled osteoid not due to label escape probably results from slow terminal mineralization after cessation of matrix synthesis during which too few tetracycline molecules are incorporated to exceed the threshold for visible fluorescence, rather than from the temporary interruption of mineralization followed by its resumption.     

骨样骨瘤的影像学诊断

目的分析骨样骨瘤的X线、CT及MRI表现,探讨其影像学特征。方法搜集经临床及病理证实的骨样骨瘤23例,男19例,女4例。所有病例均行X线检查,其中同时行CT检查者19例,行MR检查者7例,3种检查都进行者6例。分析骨样骨瘤的X线、CT和MRI表现,及其对瘤巢和瘤巢周围改变的显示能力,总结其特征性的影像学表现。结果23例病灶均显示一直径0.2～2.1cm大小不等的圆形或椭圆形瘤巢,边界清楚,边缘骨质不同程度硬化,骨膜反应,骨髓腔及软组织水肿或关节腔积液。24例X线平片17例显示瘤巢,19例行CT检查者均清晰显示瘤巢,7例行MR检查者5例可显示瘤巢,2例需结合X线及CT检查方能肯定诊断。X线、CT及MR对瘤巢的显示率分别为73.9%(17/23)、100%(19/19)及71.4%(5/7)。结论瘤巢是骨样骨瘤的特征性表现,CT检查是诊断骨样骨瘤最准确的方法,X线检查是诊断骨样骨瘤的重要方法,MR检查对显示瘤巢周围骨髓、软组织及关节腔情况非常敏感,仅凭X线或MR的表现易造成误诊、漏诊。     

CT引导下经皮关节周围骨样骨瘤旋切术11例临床报告

目的探讨在CT引导下经皮旋切关节周围骨样骨瘤的治疗方法。方法2003年2月至12月,共收治11例关节周围小病灶（直径6～11mm,平均8.7mm）;其中男性7例,女性4例;年龄14～32岁,平均19.3岁。其中股骨近端6例、髋臼区4例,肱骨头内1例。首先对整个瘤巢采用2mm薄层扫描,选择穿过瘤巢中心的层面,以克氏针钻入,定位瘤巢中心,在套筒保护下用环钻沿导引针将整个瘤巢切除。CT扫描复查确定是否已将整个瘤巢切除,并将所取出组织送病理检查。结果其中9例取出的病变组织经病理证实为骨样骨瘤,1例为纤维组织,1例为结核。被病理证实的9例骨样骨瘤患者手术后次日症状缓解,无明显手术并发症发生。随访8-18个月（平均15.2个月）,患者症状完全缓解,无1例复发。结论CT引导下,经皮旋切关节周围骨样骨瘤的治疗方法,简便、安全、恢复快。