Percutaneous therapy of osteoid osteoma

Osteoid osteomas are tumors with intense clinical symptoms and extensive reactive bone changes far exceeding the volume of the lesion itself. Because of their small size they can be approached by minimally invasive surgical procedures. We treated ten symptomatic patients with osteoid osteomas (n 6 hip point, n 1 iliac bone, n 1 femoral diaphysis, n 2 tibial diaphysis) by excision of the nidus with a 3-mm Harlow-Wood needle using a percutaneous CT-guided approach. Seven patients with residual tumor were treated with either thermocautery (n 2) or sclerosis with 1 ml of 96% ethanol (n 5). Six patients had instant and constant relief (3 years' observation) of their pain. In two patients a second transcutaneous intervention was successful. Only two patients needed open resection. Compared with the invasive open resection of the tumors, sometimes even putting the stability of the femoral neck at risk, transcutaneous CT-guided enucleation of the nidus of the osteoid osteoma with additional sclerotherapy is a good alternative method, especially in the region of the femoral neck.     

MRI in the diagnosis of osteoid osteoma

INTRODUCTION: Osteoid osteoma (OO) is a frequently encountered benign bone tumor, seen in young adults with male predominance. MATERIALS AND METHODS: Nine patients complaining of nonspecific extremity pain underwent MRI examination. The sequences obtained were T1 and T2 weighted spin-echo and T2 weighted gradient echo. A CT scan examination followed in all cases, exploring the region of the abnormal signal seen on MRI. The results of both examinations were compared. RESULTS: In six of the nine patients (66.6%) MRI showed evidence suggestive of osteoid osteoma, comparable that seen on CT scan. In three patients (33.3%), MRI showed a nonspecific and ill-defined bone marrow signal abnormality. CT cuts focused on those areas of signal abnormality showed the nidus. DISCUSSION: MRI is more sensitive than CT scan in detecting soft tissue and bone marrow abnormalities adjacent to an osteoid osteoma. This may produce a misleading aggressive appearance on MR images. CT scanning is more specific than MRI, by showing the nidus. In three patients studied, the nidus was only seen by CT, the other six osteoid osteomas were equally seen by CT and by MRI. In our study, MRI revealed abnormalities in all the cases. It was also highly specific for osteoid osteoma in 66.6%. CONCLUSION: MRI is very sensitive in detecting bone marrow and soft tissue abnormalities, and can suggest the diagnosis of OO in a good number of patients. In the remainder cases MRI guides the CT-scan. CT is more accurate and remains the definite examination for the diagnosis of OO, by showing the nidus.     

Angiographic demonstration of vertebral osteoid osteoma

A case of osteoid osteoma in the left lamina of the T-8 vertebra is reported. The roentgenograms of the thoracic spine showed a hyperostotic round mass with associated scoliotic changes and the myelograms revealed complete obstruction of the spinal subarachnoid space. By selective spinal angiography a peculiar ring-like vascular stain was visualized in the area of hyperostosis which may be characteristic of an osteoid osteoma.     

Discrete synchronous multifocal osteoid osteoma of the humerus

A 24-year-old patient is described who had a 4-year history of pain in the right upper arm, with distinct night pain, that responded to salicylates. From the findings on conventional radiography, bone scintigraphy and MRI a multifocal osteoid osteoma was suspected, with one focus in the cancellous region of the greater tuberosity and a second cortical focus at the proximal humeral diaphysis. The resection "en bloc" of both tumors and histological examination confirmed the diagnosis. The patient was painfree after the curative resection of the two osteoid osteomas. Osteoid osteoma is a frequently found benign bone tumor, accounting for approximately 11% of cases. In rare cases a multicentric occurrence has been described. A possible occurrence of more than one osteoid osteoma in a single bone, not verified histologically, has been reported only three times in the literature. In patients with scintigraphic and radiographic findings of two foci, discrete synchronous multifocal osteoid osteomas should be suspected.     

High-frequency radio-wave ablation of osteoid osteoma in the lumbar spine

This report describes a presumed choroidal granuloma with vitreous hemorrhage resembling choroidal melanoma. A healthy 31-year-old man, who had progressive vision loss in the right eye during 1 month, was found to have a yellow-white juxtapapillary choroidal mass. Fluorescein angiography demonstrated a choroidal neovascular membrane over the lesion. There was focal persistent hypofluorescence in the late phase of fluorescein angiography. The thickness of the lesion increased from 3.0 mm to 7.1 mm during 1 month. Subretinal and vitreous hemorrhage developed. The patient was suspected to have a choroidal granuloma and choroidal neovascular membrane, and was treated with oral steroids. Ten months later, the vitreous blood cleared completely with an attached retina. Control of inflammation may have a role in the treatment of idiopathic choroidal granulomas and some choroidal neovascular membranes secondary to ocular inflammation.     

Painless osteoid osteoma of the rib in an adult. A case report and a review of the literature

BACKGROUND: An asymptomatic rib lesion was discovered by means of a bone scan obtained during the clinical evaluation of an adult man with biopsy proven prostate adenocarcinoma. Clinically and radiologically considered to be a metastatic focus, on resection it proved to be an osteoid osteoma (OO). METHODS: A review of the English medical literature on OO was conducted with emphasis on the occurrence in older patients, costal location, and the absence of pain. RESULTS: OO in patients older than age 50 years is rare (1% - 2% of cases). Only 18 cases of painless OO were found. Of these, 8 (44%) occurred in the phalanges, and 3 (17%) in the cranial-facial bones, both uncommon sites for OO; only 7 (39%) arose in the long bones, the most common site for conventional OO. A disproportionate number of these patients (44%) were younger than age five years, a rarity for OO. Fourteen reported examples of costal OO were found, all of which were associated with pain. The possible mechanisms involved in the production of pain, including analysis of the effect of its site of origin and the presence of nerve fibers, is reviewed. CONCLUSIONS: Costal OO is distinguished from osteoblastoma and from what has been described as painless fibro-osseous lesion of the rib. The infrequency of metastases as a cause of solitary rib lesion is emphasized.     

Rapid development of severe osteoarthritis associated with osteoid osteoma in a young girl

A 52-year-old woman with a seven-year history of rheumatoid arthritis (RA) was transferred to our department with chronic renal failure to undergo hemodialysis. She had been treated with prednisolone for a long time, and had renal amyloidosis secondary to RA. During her hospitalization, a left pleural effusion developed. Pleural fluid cultured positive for Cryptococcus neoformans (CN), and the CN antigen was detected in both pleural fluid and serum. Chest computerized tomography revealed an infiltrate shadow in the left lower lung field suggestive of CN infection. This was successfully treated with anti-fungal agents. Pleural effusion is an unusual manifestation of pulmonary cryptococcosis. We should consider a diagnosis of CN infection when pleural effusion is observed in compromised patients such as those receiving a long-term corticosteroid treatment.     

Treatment of osteoid osteoma by CT-controlled percutaneous drill resection. Apropos of 27 cases

PURPOSE OF THE STUDY: Osteoid osteoma is a benign tumor requiring excision due to pain, usually severe and invalidating. Surgical "en bloc" resection is not always easy. Complete resection of the nidus is required to prevent recurrence while at the same time a limited resection should also be used to avoid a pathological fracture or a growth plate injury in children. In order to achieve these 2 goals, we have developed an alternative method: CT guided drill resection. This method is reported with special reference to its technical aspects. MATERIAL AND METHODS: Twenty seven patients (16 children and 11 young adults) were treated during a seven year period (June 87 through June 94) and observed clinically and radiologically with an average two-year follow-up (range one to three years). Osteoid osteoma was localized mainly in the lower limb: Femoral neck (or head): 10 cases, 3 in the acetabulum; Femoral shaft: 6 cases; Tibial shaft: 4 cases. Diagnosis was based on clinical features and imaging: radioisotope bone scan and computed tomography in all cases--angiography in 3 patients to assess the diagnosis more accurately. The procedure was performed under general anesthesia (a short hospitalization is needed). The nidus was first localized by Computed Tomography, then approached and resected through a small percutaneous incision. A special device has been manufactured in order to remove a bone cylinder containing the nidus. It was thus possible to perform histological studies of the specimen and confirm the diagnosis. Histological confirmation was possible in 50 per cent of the cases. No complication (except a case of transient extensor hallucis palsy) was observed in this series, 24 patients healed completely; pain disappeared immediately, and the control CT scan returned to normal after a one-year follow-up. In 3 patients, because of a technical error, the nidus was not totally removed. These patients underwent a second procedure, which was effective. DISCUSSION: This method is a good alternative to the direct surgical approach because of its technical advantages: precision in nidus localization and minimal bone resection; consequently, one should underline the practical benefits for the patient: short hospitalization, immediate full weight bearing, quick return to socio-economic activities. Furthermore, some localizations of the nidus which are difficult to reach (for instance the acetabulum) represent a good indication for the method. Accurate pre-operative diagnosis has now become possible with recent advances in imaging techniques but still remains "uncertain". The resection of the specimen allows confirmation of the diagnosis is most of cases. This procedure should ideally be performed by a team (orthopedic surgeon and a radiologist): collaboration instead of competition is in fact the best way to progress in this field of "interventionnal radiology".     

Arthroscopic removal of a .44 caliber bullet from the hip

Hip arthroscopy is far less invasive than standard open arthrotomy and offers unparalleled visualization of the acetabulum and femoral head. Diagnostic arthroscopy is becoming increasingly accepted as therapeutic options are still evolving. We report the case of the arthroscopic removal of a .44 caliber bullet from the femoral head of a 45-year-old man. The procedure afforded the opportunity to thoroughly irrigate the joint, debride the articular surface, and remove several loose bodies.     

Benign osteoblastic neoplasias of bone: clinical and anatomoradiological correlations between osteoid osteoma and osteoblastoma (author''s transl)

Ornithine decarboxylase (L-ornithine carboxylase; EC 4.1.1.17) (ODC) activity falls to approximately 30% of the control value in diabetic rat kidney 4 weeks after induction of diabetes with alloxan. The extent of this fall was related to the severity of diabetes based on parameters such as body weight, blood glucose and adipose tissue weight. The diabetic rat kidney did not attain the same high level of activity of ODC as did that of the control group 24 h after unilateral nephrectomy, however, the percentage stimulation in the two groups was essentially similar.     

Implant reconstruction following removal of tumors of the head and neck

Functional maxillofacial rehabilitation following tumor ablation depends on many variables. These include the magnitude of hard or soft tissue defects, the use of adjunctive chemotherapy or radiation therapy, and the presence of underlying systemic disease. The physiologic effects of tumor ablation and radiation therapy on local tissues and grafted bone are discussed in this article in relation to the ultimate use of implant supported prostheses. Cases are presented to illustrate a variety of clinical situations.     

Osteoid osteoma of the hand

Toothbrush swallowing is an uncommon occurrence. Unlike most cases of foreign-body ingestion, there have been no cases of spontaneous passage reported. Consequently, prompt removal is recommended before complications develop. We report a case of toothbrush ingestion which failed attempted endoscopic removal. This patient was managed successfully with laparoscopic assisted removal via gastrotomy. We recommend this approach for the removal of any ingested foreign bodies when surgical intervention is indicated.     

Osteoid osteoma of the petrous bone

We present a case of osteoid osteoma of the petrous bone presenting with progressive sensorineural hearing loss. CT showed a dense homogeneous mass at the promontory surrounded by a thin bony border. On MRI this lesion gave intermediate signal intensity on T1- and T2-weighted spin-echo images and enhanced intensely with gadolinium. Surgical removal and pathological study proved the diagnosis.     

Pneumocephalus complicating osteoma of the frontal sinus

Osteomas of the paranasal sinuses are benign, often asymptomatic, tumors which progress very slowly. Endocranial development of an osteoma can breach the dura mata, allowing air to enter the cranium producing pneumocephalia which leads to severe neurological deficiencies. Pneumocephalia is an exceptional complication of osteoma. We found 40 cases reported in the literature. Brain CT scan easily gives the diagnosis. Surgical exeresis with closure of the breach gave very satisfactory results in our 2 cases.