Imaging of huge lingual thyroid gland with goitre

One year after a nonspecific trauma and with a history of pain of four weeks only, an osteoid osteoma of the first phalanx of the left thumb was diagnosed in a 31-year-old man. The radiologic appearance as well as a bone scan were suggestive for an osteoid osteoma. The diagnosis was confirmed histologically after resection of the tumor. As indicated in the literature, osteoid osteoma of the hand is relatively rare. The symptoms and radiologic features (osteolytic nidus and sclerosis) of osteoid osteomas are independent of the tumor location. Surgery with resection of the nidus is the only known curative therapy. The etiological role of trauma is discussed and a review of the literature is done with 15 other cases of posttraumatic osteoid osteoma having been reported.     

Percutaneous laser photocoagulation of spinal osteoid osteomas under CT guidance

BACKGROUND AND PURPOSE: Spinal osteoid osteomas are rare; when they occur, they are usually treated by surgical or percutaneous excision. The aim of percutaneous interstitial laser photocoagulation (ILP) of osteoid osteomas under CT guidance is thermal destruction of the nidus using low-power laser energy, thus precluding bone resection and open surgery. METHODS: Three cases of spinal osteoid osteomas were treated with percutaneous ILP of the nidus. Under CT guidance, the needle was positioned in the center of the nidus, at least 8 mm from neurologic structures. Using a high-power semiconductor diode laser (805 nm) with a 400-microm optical fiber, we delivered 600 to 800 joules to the nidus, depending on its size. The procedure was performed with the patient under neuroleptanalgesia and required overnight hospitalization. RESULTS: Complete pain relief was obtained in all three patients within 24 hours of the procedure, and no major complications were incurred. Follow-up ranged from 20 months to 60 months. CONCLUSION: Percutaneous ILP of spinal osteoid osteoma is a promising, simple, precise, and minimally invasive technique and may be an alternative to traditional surgical and percutaneous ablations.     

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.     

Osteoid osteoma of the pubic bone. Report of a case

Osteoid osteoma involves the pubic bone in exceptional cases. In this case report, a 23 year-old male patient with osteoid osteoma of the pubic bone, was presented. He was complaining of right groin pain, occurring nocturnally and being relieved by rest and analgesics. Radiographic examination revealed a small lesion in the right pubic bone. The patient was treated surgically, and the nidus was excised. The result of the histopathological examination was "osteoid osteoma". At 1 year postoperatively, recurrence was not seen. It was concluded that, if osteoid osteoma was located in an unusual site, more detailed radiographic examination should be done for exact localization, before the operation.     

Osteoma of the long bones and the spine. A study of eleven patients and a review of the literature

The clinical features, radiographic and histopathological findings, treatment, and results are described for eleven patients who were managed for an extracranial osteoma at our medical center between 1980 and 1993. Ten of the patients were initially seen because of dull, aching bone pain that had been present for two weeks to thirty years. Radiographs demonstrated single or multiple homogeneous, well defined, radiodense foci with smooth round or lobulated margins. The histopathological features consistently included uniformly dense, compact, cortical-like, mature lamellar bone. The preoperative diagnosis was unclear for all patients, and osteoma was rarely considered in the differential diagnosis. For four patients, a tentative diagnosis of osteosarcoma was made, and a wide excision was carried out in two of these patients. Marginal excision with less than three millimeters of normal tissue around the lesion was performed in most patients. None of the osteomas recurred, and ten patients had relief of the pain. Awareness of the clinical, radiographic, and histopathological features of osteoma, as described, is valuable for making a differential diagnosis and for distinguishing osteomas from other lesions.     

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.     

Quantitation of porcine reproductive and respiratory syndrome virus RNA in semen by single-tube reverse transcription-nested polymerase chain reaction

The diagnosis of osteoid osteoma can be difficult. We present eight children where the diagnosis of osteoid osteoma was difficult, due to a clinical history suggesting an alternative diagnosis, misleading radiological findings, or where the osteoid osteoma was in an unusual site. In some cases, diagnosis was only reached after biopsy, despite radiological investigation and radioisotope studies. The diagnosis should be considered in a child with bony pain or bony swelling, especially where the history is a chronic one. We present a radiological algorithm for the investigation of patients suspected of having an osteoid osteoma.     

Bone tumors of the coracoid process of the scapula

Bone tumors of the coracoid process of the scapula are rare, and diagnosis and treatment often are delayed. The records of 18 patients with bone tumors of the coracoid process were reviewed. Histologic types included eight cases of ordinary chondrosarcoma, three cases of dedifferentiated chondrosarcoma, two cases of osteoid osteoma, and one case each of osteosarcoma, plasmacytoma, lymphoma, giant cell tumor, and aneurysmal bone cyst. All 18 patients had shoulder pain, and eight of them had been treated with steroid injections for nonneoplastic conditions. Radiologically, chondrosarcoma did not always show clear cortical destruction, and one giant cell tumor had features mimicking those of chondrosarcoma. Five patients (three with dedifferentiated chondrosarcoma, one with chondrosarcoma, one with plasmacytoma) died of disease. The coracoid process was the site with a markedly high proportion of chondrosarcomas. Bone tumors of the coracoid process may be difficult to detect on plain radiographs. In the patient with persistent shoulder pain unresponsive to the selected treatment, additional imaging studies should be considered to eliminate the possibility of a bone lesion.     

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.     

Pain in osteoid osteoma: histological facts

Six cases of osteoid osteoma were studied histologically using the Gross technique. When the nidus is located centrally, it is reached by amyelinic fibers accompanying the vessel branches or as independent fibers. The pain is generally considered to reflect changes in vessel pressure and it could also be due to direct irritation of the nerve fibers included in or near the calcification focus.     

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".     

Osteoid osteoma in a three-year-old child--a case report

Osteoid osteoma is an uncommon tumour in the very young. We present a case of osteoid osteoma in a three-year-old boy, who was treated as a case of sclerosing osteomyelitis of the femur. Because of persistent pain and lack of response to treatment, further radiological investigation confirmed the diagnosis to be that of an osteoid osteoma.     

When to use bone scintigraphy. It can reveal things other studies cannot

Despite advances in nuclear medicine, bone scintigraphy remains an important imaging technique. It is sensitive in detecting stress fractures and bone metastases and can assess suspected injury that is difficult to see on plain films (e.g., rib fracture). Scintigraphy is useful in evaluating new symptoms, response to therapy, and prognosis in patients with known malignant tumor. In patients with low back pain, the technique can determine the age of fractures to help identify osteoporosis and can uncover other causes of the pain (e.g., spondylolysis, arthritis). When Paget's disease is suggested by unexplained bone pain or an elevated serum alkaline phosphatase level, bone scintigraphy is a useful screening test. Combined with other appropriate nuclear medicine studies, it helps in early identification and localization of osteomyelitis. Scintigraphic scans can provide a general indicator of malignant versus benign disease (according to the amount of lesion activity seen) and may produce characteristic findings in certain primary tumors (e.g., osteoid osteoma) that are difficult to evaluate with other methods.     

Diagnosis of vasa previa with endovaginal color Doppler and power Doppler sonography: report of two cases

Craniofacial osteomas are benign tumors of the skull base, often involving the paranasal sinuses. The frontal sinus is the most common site of involvement, followed by the ethmoid, maxillary, and sphenoid sinuses, respectively. The growth rate is very slow, and it may take many years for osteomas to become clinically apparent. The origin of these tumors has been ascribed to embryologic tissue maldevelopment, trauma, or infection. The tumors are hard and lobulated with an ivory-like appearance, often mixed with a coarse granular component. The bone is compact or cancellous, with vascular or connective tissue components. The complications of osteoma growth are obstruction of sinus ostia, extension into adjacent bones and the intracranial cavity, and displacement of anatomic structures. Management of uncomplicated sinus osteomas is controversial, since surgery involves serious potential risks. When surgery is performed, these tumors can be successfully managed via endoscopic, open, or combined techniques. This article reviews the clinical findings, diagnostic studies, and treatment of 16 patients with paranasal osteomas. The indications for surgical intervention are discussed.     

Pneumocystis carinii pneumonia in HIV primary infection]

We report a case of osteoid osteoma as a cause of hip pain in a young athlete. Excision of the lesion resulted in complete relief of the symptoms.     

Long-term outcome after frontal sinus obliteration with an ionomer bone substitute in the cat. I: Histological results

BACKGROUND: Osteoplastic frontal sinus surgery in combination with sinus obliteration may occasionally be performed for indications such as severe sinus inflammations, extensive wall fractures involving the nasofrontal duct, or osteomas. The material most frequently used for this obliteration is autogenous adipose tissue. Autografts such as muscle, cartilage, and bone chips have been also recommended for this purpose. In order to avoid the surgical procedure required for harvesting an autograft from other body sites, alloplastic materials have been suggested for frontal sinus obliteration. METHODS: In an animal study using cats, the mucous lining of the frontal sinus was removed, the nasofrontal duct sealed with semifluid ionomer cement, and the cavity filled up with a solid and porous ionomer-based microimplant. RESULTS: Histological investigations were performed up to two years after surgery. Increasing obliteration of the sinus cavity by bone regeneration, starting from the sinus wall, as well as formation of connective tissue between the cement grains was detected as early as one month after implantation. Osteoblasts lining the osteoid layer were considered to be an indication of active bone regeneration. Osteogenesis inside the sinus cavity continuously progressed during the following months. Two years after implantation, osteoid and newly mineralized bone encircled the microimplants leading to an almost complete obliteration. There was no evidence for mucosal regeneration or foreign body reaction. CONCLUSIONS: Because of its osteoconductive effect, biocompatibility, and biostability the ionomer-based microimplant is a suitable alloplastic material for frontal sinus obliteration.     

Project for the development of an ambulatory and semi-ambulatory community center for the third age

A case of osteoid osteoma of the scaphoid was discovered, in the absence of radiological (conventional and CT-scan) alterations. MRI findings were not conclusive.     

Radiologic and histologic analysis of morselized allograft in revision total knee replacement

Morselized cancellous allograft was used to fill large femoral and/or tibial defects in 63 patients (63 knees) who had revision surgery for failed arthroplasty between September 1988 and January 1993. Firm seating of the components on a rim of viable bone and rigid fixation with a medullary stem were achieved in all cases. One patient was lost to followup, leaving 62 patients with standard radiographic evaluation at 1 month, 3 months, and yearly intervals postoperatively. Fourteen patients required reoperation between 3 weeks and 37 months after revision surgery for loosening (two patients), wound avulsion (one patient), wound hematoma (two patients), painful wires (four patients), patellar tendon avulsion from the tibial tubercle (two patients), patellar subluxation (one patient), or late onset instability (two patients). A biopsy specimen was taken from the central portion of the allograft in each case. Evidence of healing, bone maturation, and formation of trabeculae was seen in all allografted areas visible on radiograph at 1 year after surgery. No sign of significant bone graft loss had occurred in any case. Likewise, all biopsy specimens, including the 3-week specimen, showed evidence of active new bone formation in the allografted area. Active bone formation was found in and around the allograft pieces, and new osteoid formed directly on dead allograft trabeculae. Vascular stroma was present between the bone fragments deep in the allograft mass. Older biopsy specimens evidenced progressive maturation, and evidence of active osteoclastic activity was absent by 18 months after surgery. All patients but one had significant improvement in their pain score as compared with their preoperative status. Although the complication rate was high (22%), all but one patient achieved lasting fixation to bone, adequate ligament balancing, good range of motion, and minimal to mild pain. Two patients required revision surgery. Both had greatly improved bone stock so that new implants could be applied with minor additional grafting. This method of bone stock reconstitution appears to be reliable when used in conjunction with firm rim seating and rigid intramedullary stem fixation.     

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.     

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.