Intraoperative three-dimensional navigation for surgical treatment of osteoid osteoma in the foot and ankle – A series of 14 cases

BackgroundThe surgical treatment for osteoid osteoma (OO) in the foot and ankle is challenging. It is difficult to locate the lesion and the anatomy is crowded by sensitive structures. The purpose of this study was to describe the outcomes of navigated mini open-intralesional curettage (NMIC) or navigated minimally invasive radiofrequency ablation (NMRFA) in treating these lesions.MethodsAll patients who underwent surgery for OO in the foot and ankle between 2015 and 2020 were included. O-arm navigation was used in All procedures. The choice of NMIC versus NMRFA was made by the surgeon according to the location of the lesion and its proximity to sensitive anatomic structures.ResultsFourteen patients were included. Ten were operated by NMRFA and 4 by NMIC. All patients’ symptoms related to OO resolved following a single procedure. Average AOFAS score increased by 18.7 (P < .001). Three patients had the following complications: pathologic fracture, superficial infection and transient deep peroneal nerve sensory loss.ConclusionNavigated surgical treatment of OO in the foot and ankle is accurate, efficient and safe.     

骨样骨瘤诊断与治疗

目的：为了进一步了解骨样骨瘤的临床特点。方法：对１０例骨样骨瘤患者的诊断与治疗进行回顾分析。结果：１０例患者均行手术治疗并经病理证实为骨样骨瘤,术后经１～１０ａ随诊效果良好。结论：无论是骨干骨样骨瘤还是椎体骨样骨瘤,普通Ｘ光片往往不能显示出典型的瘤巢,ＣＴ、ＭＲＩ及同位素扫描方能显示出瘤巢,瘤巢所在的部位往往是反应骨最为隆起的部位,瘤巢的准确定位及彻底切除是获得良好效果的关键,术中在切除标本内找到     

眼眶骨瘤17例临床分析

目的 本文对我院1988～2003年的15年的17例眼眶骨瘤进行回顾性分析。方法 观察其临床表现，总结了眼眶骨瘤的影像诊断及治疗方法。结论 眼眶骨瘤多起源于副鼻窦，可以引起眼球突出、移位及视力障碍。X线和CT对其诊断有重要价值，较大的肿瘤可以采用手术切除，根据不同情况采取不同的手术方式可以减少手术并发症。     

Novel nonsense GNAS mutation in a 14‐month‐old boy with plate‐like osteoma cutis and medulloblastoma

Plate‐like osteoma cutis (PLOC) is a dermatological disorder characterized by superficial ossification and rarely occurs without any underlying tissue abnormalities or pre‐existing calcification. The hereditary form of PLOC is mainly due to inactivating mutation in the GNAS gene. Inactivating mutation of the GNAS gene is associated with several diseases, which commonly manifest heterotopic ossification and hormonal resistance; however, the development of malignant neoplasm has never been reported. Herein, we report a case of a patient with a novel nonsense mutation in the GNAS gene, who presented with concurrent PLOC and medulloblastoma.     

Review of spectral domain enhanced depth imaging optical coherence tomography of tumors of the choroid

Background:Spectral domain enhanced depth imaging optical coherence tomography (EDI-OCT) can provide anatomic localization of intraocular tumors.Aims:The aim was to identify topographical and intrinsic patterns of choroidal tumors on EDI-OCT.Results:Using EDI-OCT, choroidal nevus displayed a smooth, dome-shaped topography with overlying retinal pigment epithelium alterations, drusen, and occasional subretinal cleft demonstrating photoreceptor loss. Small choroidal melanoma showed smooth, moderately dome-shaped topography, commonly with overlying shallow subretinal fluid that often depicted “shaggy” photoreceptors. Choroidal metastasis showed a minimally “lumpy, bumpy” surface topography and with overlying subretinal fluid and shaggy photoreceptors. Choroidal hemangioma showed a smooth, dome-shaped topography, with expansion of the affected small, medium, and large choroidal vessels. Choroidal lymphoma showed varying topography with increasing tumor thickness as “flat, rippled, or undulating (seasick)” surface. Choroidal osteoma displayed a smooth undulating surface with visible intralesional horizontal lines suggestive of bone lamellae and occasional horizontal and vertical tubules with intralesional “spongy” flecks. Choroidal melanocytosis appeared as uniformly thickened choroid with increased stromal density surrounding the normal choroidal vascular structures.Conclusions:Enhanced depth imaging-OCT can depict characteristic patterns that are suggestive of various choroidal tumors.     

Osteogenic tumors of bone

In this paper we provide an overview of benign and malignant osteogenic bone tumors. We describe the diagnostic features, radiographic findings, and pertinent ancillary studies needed to diagnose these bone-forming lesions. We begin with osteoid osteoma and osteoblastoma, which are histologically bland and eminently benign with rare possible exceptions. On the other end of the behavioral spectrum is osteosarcoma, which encompasses many subtypes ranging from high-grade osteogenic osteosarcoma to less overtly osteogenic lesions such as telangiectatic and small cell osteosarcoma. While classic osteogenic osteosarcoma can be easily recognized by its high grade morphology and formation of extracellular lace-like osteoid, its variants may pose diagnostic dilemmas as their differential diagnoses can include benign, fibrous, and vascular lesions, among others. Recognition of these variants is essential to avoid diagnostic pitfalls. In equivocal cases, some forms of osteosarcoma have shown molecular alterations that may prove diagnostically useful.     

下颌骨喙突骨瘤1例报告及文献复习

<正>骨瘤是一种骨源性良性肿瘤,由分化良好的成熟骨组织构成,通常发生在颌面骨,在体积缓慢增大的过程中多没有症状,直到引起容貌改变和(或)直接影响发病部位的正常功能时才被发现。下颌骨骨瘤以下颌角、髁突多见,其次为磨牙区及下颌升支,发生在喙突部位的较罕见。现报告1例。     

Factors Associated with Osteoid Osteoma Recurrence after CT-Guided Radiofrequency Ablation

PurposeTo identify clinical and imaging variables associated with symptomatic recurrence of osteoid osteomas (OOs) treated with computerized tomography (CT)–guided radiofrequency (RF) ablation.Materials and MethodsSeventy-one patients treated with the use of CT-guided RF ablation for OO at a single institution from July 2005 to May 2018 were included in this retrospective cohort analysis. Clinical data, including patient age, sex, race, and clinical outcomes, were collected from institutional electronic health records and telephone follow-up. Imaging variables regarding tumor characteristics were gathered from imaging reports and a blinded review of preprocedural images by an experienced musculoskeletal radiologist. Logistic regression, Cox proportional hazards, and Kaplan-Meier analyses were used to identify variables that are significantly associated with symptomatic recurrence, which was defined as pain occurring > 2 weeks after RF ablation.ResultsTen patients (14.1%) experienced symptomatic recurrence at a median of 21.5 months after RF ablation. Univariable logistic regression classified young age (≤ 13 years), female sex, maximum tumor length, and “eccentricity index” (EI) ≥ 3 as predictive variables significantly associated with symptomatic recurrence. Multivariable logistic regression identified female sex and EI ≥ 3 to be significant predictors for symptomatic recurrence. A multivariable proportional hazards Cox regression of time to recurrence revealed EI ≥ 3 to be the only significant predictor of symptomatic recurrence.ConclusionsFemale patients with OOs with an EI ≥ 3 have a greater risk of symptomatic recurrence following RF ablation. The EI is a useful tool to identify OOs with elongated 3-dimensional morphology, which may warrant more extensive ablation.