Osteoma Osteoid, “Benign Bone Tumor", Atypical Behavior on the Subject of a Case
Robaina Ruíz Lázaro1* and Robaina Machado Alan2
1Specialist of 2nd degree in Traumatology and Orthopedics, Head of the Traumatology and Orthopedics Service of the Specialty Hospital of Guayaquil, USA
2Specialist of 1st degree in Comprehensive General Medicine, Zaragoza, Spain
Submission: April 27, 2017; Published: June 02, 2017
*Corresponding author: Robaina Ruíz Lázaro, Specialist of 2nd degree in Traumatology and Orthopedics, Head of the Traumatology and Orthopedics Service of the Specialty Hospital of Guayaquil, USA, Email: lazaro_robaina@yahoo.es
How to cite this article: Robaina R L, Robaina M A. Osteoma Osteoid, “Benign Bone Tumor”, Atypical Behavior on the Subject of a Case. Ortho & Rheum Open Access 2017; 7(3): 555712. DOI: 10.19080/OROAJ.2017.07.555712
Abstract
We present a patient (M.J.P.R) of 70 years of age, white race, normal line, married, attended in consultation of Traumatology and Orthopedics of the hospital, who consultation for pain and swelling in the carpus and right hand of 9 months of evolution. It denies traumatic antecedents. It refers to spontaneous pain, deaf and persists all day, more intense at night, which makes it difficult to sleep, initially relented with NSAID, later the pain increased to become severe, causing insomnia in the last weeks before the query.
About a Case
We present a patient (M.J.P.R) of 70 years of age, white race, normal line, married, attended in consultation of Traumatology and Orthopedics of the hospital, who consultation for pain and swelling in the carpus and right hand of 9 months of evolution. It denies traumatic antecedents. APP of Essential Hypertension controlled with drugs and diet. It refers to spontaneous pain, deaf and persists all day, more intense at night, which makes it difficult to sleep, initially relented with NSAID, later the pain increased to become severe, causing insomnia in the last weeks before the query.
Physical examination shows ill-defined swelling on the dorsal aspect of the carpus and right hand, more specific on the third metacarpal, very painful on pressure, associated with redness and increased volume in the central dorsal region. The mobility of the wrist and fingers was preserved, although painful for dorsal and palmar flexion of the carpus (Figure 1).
On the simple radiograph, a dense sclerotic lucid radius of bone is present, with bone hypertrophy that completely includes the third metacarpal and invades large bone (Figure 2). Axial tomography shows a dense sclerotic image throughout the perimeter of the third metacarpal (anteroposterior, transverse and caudal skull diameters), associated with large bone edema and its connections with trapezoids and ganchous (Figure 3). In the three-phase bone scan with technetium 99 shows an intense focus of hypercaptation in the carpal and third metacarpal regions (Figure 4). The study by pathological anatomy concludes diagnosis of Osteoid Osteoma (Figure 5).
Discussion
An osteoid osteoma is a benign bone tumor that arises from osteoblasts and was originally thought to be a smaller version of an osteoblastoma, characterized by being less than 1.5 cm in diameter, it can be in any bone of the body, although more common in the long bones, like femur and tibia, and less common in the jaw and cranofacial bones. They represent 10 to 12 percent of all benign bone tumors, can occur at any age, and are more common between the ages of 4 and 25 years, are affected three times more men than women (Man / Female: 3 - 1) [1].
They cause a dull ache, it is not radiant, if it is persistent over 24 hours, which increases considerably at night [2] and tends to alleviate with NSAIDs like ibuprofen [3]. X-rays on the osteoid osteoma typically show a round light, which contains a dense sclerotic central nest (the lesion characteristic of this type of tumor), surrounded by sclerotic bone [4-7]. The nidus is rarely larger than 1.5 cm. Osteoid osteoma shares, in on radiographs the osteoid osteoma typically shows a round light, which contains a dense sclerotic central nest addition to clinical similarities, histological features with osteoblastoma [8-13]. Both benign bone tumors are characterized by the formation of osteoid tissue surrounded by vascular fibrous stroma and perilesional sclerosis [14-18]. In the osteoid osteoma, the production of osteoid and vascular connective tissue is less abundant than in the osteoblastoma [19-21].
Macroscopically, the osteoid osteoma is smaller (1-1.5 cm) than the osteoblastoma, which in its usual size is greater than 2 cm in diameter [2,22]. The most important difference in osteoid osteoma is that it lacks growth potential compared to osteoblastoma, which may be locally aggressive [6,13], with high cellularity atypical cells [23,24], which can lead to local destruction, early recurrence and even Tumor malignancies [9,20,23,25]. The osteoid osteoma with clinical and radiological characteristics of a benign tumor allows a wide differential diagnosis, prior to the biopsy of other tumors, including giant cell, aneurysmal bone cyst, enchondroma, chondrosarcoma and osteosarcoma [6,13].
In the present case, we see an injury with nonspecific clinical and radiological features for an osteoid osteoma, suggesting a non-benign lesion with a high osteogenic activity by bone scintigraphy. For this reason, in this case, we think of proposing a more aggressive behavior with surgery, although it is mandatory to perform a previous bone biopsy. The pathological anatomy report histologically confirms osteoid osteoma.
References
- Healey JH, Ghelman B (1986) Osteoid osteoma and osteoblastoma. Current concepts and recent advances. Clin Orthop Relat Res 204: 7685.
- Menon J, Rankin D, Jacobson C (1988) Recurrent osteoblastoma of the carpal hamate. Orthopedics 11(4): 609- 611.
- Mungo DV, Zhang X, O'Keefe RJ, Rosier RN, Puzas JE, et al. (2002) COX-1 and COX-2 expression in osteoid osteomas. J Orthop Res 20(1): 159162.
- Atesok KI, Alman BA, Schemitsch EH, Peyser A, Mankin H (2011) Osteoid osteoma and osteoblastoma. J Am Acad Orthop Surg 19(11): 678-689.
- Sforzo CR, Scarborough MT, Wright TW (2004) Bone-forming tumors of the upper extremity and Ewing's sarcoma. Hand Clin 20(3): 303315.
- Bone and Soft Tissue Tumors: Benign Tumors. Dana-Farber Cancer Institute.
- Singh Arun Pal. Osteoid Osteoma-Diagnosis and Treatment.
- Osteoid Osteoma Imaging at medicine. Osteoid Osteoma. Knol.
- Lateur L, Baert AL (1977) Localisation and diagnosis of osteoid osteoma of the carpal area by angiography. Skeletal Radiology 2(2): 75-79.
- http://www.bonetumor.org/tumors-bone/osteoid-osteoma
- Sim FH, Dahlin CD, Beabout JW (1975) Osteoid-osteoma: diagnostic problems. J Bone Joint Surg Am 57(2): 154-159.
- Rosenthal DI, Alexander A, Rosenberg AE, Springfield D (1992) Ablation of osteoid osteomas with a percutaneously placed electrode: a new procedure. Radiology 183(1): 29-33.
- Weber MA, Sprengel SD, Omlor GW, Lehner B, Wiedenhöfer B, et al. (2015-04-25) Clinical long-term outcome, technical success, and cost analysis of radiofrequency ablation for the treatment of osteoblastomas and spinal osteoid osteomas in comparison to open surgical resection. Skeletal Radiol 44(7): 981-993.
- Rosenthal DI, Hornicek FJ, Torriani M, Gebhardt MC, Mankin HJ (2003) Osteoid Osteoma: Percutaneous Treatment with Radiofrequency Energy. Radiology 229(1): 171-175.
- Rimondi E, Mavrogenis AF, Rossi G, Ciminari R, Malaguti C, et al. (2011) Radiofrequency ablation for non-spinal osteoid osteomas in 557 patients. European Radiol 22(1): 181-188.
- Rosenthal DI, Hornicek FJ, Wolfe MW, Jennings LC, Gebhardt MC, et al. (1998) Percutaneous Radiofrequency Coagulation of Osteoid Osteoma Compared with Operative Treatment. J Bone Joint Surg Am 80(6): 815821.
- Focused Ultrasound Foundation (2014) Bone tumor destroyed using incisionless surgery: First in North American child. Science Daily, USA.
- Satish Karandikar, Gagan Thakur, Manisha Tijare, Shreenivas K, Kavita Agarwal (2011)0steoid osteoma of mandible. BMJ Case Report, London, UK.
- Mangini U (1967) Tumors of the skeleton of the hand. Bull Hosp Joint Dis 28(2): 61-103.
- Van Dijk M, Winters HA, Wuisman PI (1999) Recurrent osteoblastoma of the hamate bone. A two-stage reconstruction with a free vascularised iliac crest flap. J Hand Surg Br 24(4): 501-505.
- Muñoz J, De las Heras J, Rojo JM, Narbona J, Parra J, et al. (2009) Osteoblastoma del hueso ganchoso. A propósito de un caso. Rev Iberoam Cir Mano 37: 133-137.
- Atesok K, Alman BA, Schemitsch EH, Peyser A, Mankin H (2011) Osteoid osteoma and osteoblastoma. J Am Acad Orthop Surg 19(11): 678-689.
- Oliveira CR, Mendonfa BB, Camargo OP, Pinto EM, Nascimento SA, et al. (2007) Classical osteoblastoma, atypical osteoblastoma, and osteosarcoma: a comparative study based on clinical, histological, and biological parameters. Clinics (Sao Paulo) 62(2): 167-174.
- Dorfman HD, Weiss SW (1984) Bordeline osteoblastic tumors: problems in the differential diagnosis of agressive osteoblsatoma and low-grade osteosarcoma. Semin Diagn Pathol 1(3): 215-234.
- Jackson RP (1978) Recurrent osteoblastoma: a review. Clin Orthop Relat Res 131: 229-233.