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| IMAGE QUIZ ARCHIVE | ||||||
| Image Quiz | ||
| Back Pain in an Adult (continued) | ||
| Answer: Osteoid osteoma of the spinous process of the L1 vertebra. | ||
| For larger view, click on image | ||
 Fig. 1 |
 Fig. 2 |
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| Fig. 1 Coronal T2-weighted magnetic resonance imaging scan showing the involved posterior elements and soft-tissue edema. Fig. 2 Computed tomographic image (osseous window) clearly demonstrating the nidus of the osteoid osteoma in the L1 vertebra. |
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| The lesion was excised with resection of the involved lamina. | ||
 Fig. 3 |
 Fig. 4 |
 Fig. 5 |
| Fig. 3 Morphology of the resected specimen with a round, sharply demarcated nidus surrounded by sclerotic bone. Fig. 4 Low-power photomicrograph of the nidus surrounded by sclerotic bone (hematoxylin and eosin, ×40). Fig. 5 Intermediate-power photomicrograph demonstrating the interlacing network of osseous trabeculae with varying levels of mineralization. The presence of dilated small vessels seen in the stroma is one of the characteristic histological features of osteoid osteoma (hematoxylin and eosin, ×100). |
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| The patient had immediate and complete relief of pain postoperatively. | ||
| Discussion | ||
| Osteoid osteoma, a benign tumor of the bone, was first recognized as a clinical entity by Jaffe in 1935. This neoplasm accounts for approximately 11% of benign bone tumors and 2% to 3% of all primary bone neoplasms1. The male-to-female ratio has been reported as approximately 3:12. | ||
| Patients with osteoid osteoma often present with a history of skeletal pain, often insidious in onset, that is characteristically worse at night and may be relieved substantially by aspirin and other nonsteroidal anti-inflammatory agents3. The duration of pain may vary from weeks to even months before the patient seeks medical attention. The lesion of osteoid osteoma typically consists of a nidus, round or oval in shape, usually <1 cm in diameter and variable in density, found either in the metaphysis or the diaphysis of the involved bone. These lesions are located most commonly in the long bones (frequently the femur, tibia, or humerus), spine (typically the posterior elements), and bones of the hands and feet2. | ||
| Approximately 10% to 15% of osteoid osteomas occur in the vertebral column and account for approximately 2% to 3% of primary tumors of the vertebral column4. With vertebral involvement, there is often an associated painful scoliosis. Some patients may have clinical symptoms of disc disease, a neurologic disorder, or both. Magnetic resonance imaging, computed tomography, or bone scans may help establish a diagnosis of osteoid osteoma. Some reports suggest that magnetic resonance imaging does not offer a definitive diagnosis of osteoid osteoma5,6. In contrast, computed tomographic scans have been reported to accurately demonstrate the location, nidus, and other characteristic diagnostic radiographic features of osteoid osteoma7,8. | ||
| Morphologically, the nidus tissue of an osteoid osteoma appears as a distinct oval or round, reddish area that can be easily separated from its bed. It varies in consistency from friable, soft, and granular to densely sclerotic. The nidus is usually surrounded by a large zone of dense sclerotic bone. Histologically, there is an interlacing network of osseous trabeculae with different levels of mineralization. Prominent osteoblasts rim the osseous trabeculae and are often accompanied by multinucleated giant cells. The heavily ossified central portion is usually less cellular as compared with the highly cellular peripheral zone. | ||
| Surgical en bloc resection, curettage, or radiofrequency ablation of the lesion are the preferred modalities of treatment. Radiofrequency ablation is usually avoided in lesions that involve the spine to prevent inadvertent injury to the neural elements. | ||
| Both osteoid osteoma and osteoblastoma are bone-forming, benign neoplastic lesions that occasionally involve the vertebral posterior elements in children and young adults. These neoplasms are histologically and radiologically similar, but they differ in lesion size and clinical presentation. Osteoid osteoma is a small lesion (no greater than 1.5 cm in diameter) while osteoblastoma can range from 2 to 10 cm in diameter. Secondary peripheral sclerosis may be minimal or absent in osteoblastoma. Clinically, patients with osteoblastoma present with pain that is not relieved by aspirin and that differs in severity from the pain that is characteristic of osteoid osteoma9. | ||
| *In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from Stryker and from Howmedica (H.S.H., C.M.O., R.D.L.). In addition, one of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity (Stryker and Howmedica [R.D.L.]). No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated. | ||
| References | ||
| 1. Mirra JM, Gold RH, Picci P. Osseous tumors of intramedullary origin. In: Mirra JM, editor. Bone tumors: clinical, radiologic, and pathologic correlations. Philadelphia: Lea and Febiger; 1989. p 143-438. |
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