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To report a rare occurrence of osteoblastoma involving the L4 vertebra in an 8-year-old female child with histological features suggestive of osteoblastoma with secondary aneurysmal changes. The mean age incidence of osteoblastoma is 20.4 years. In our case, a rare presentation of osteoblastoma was seen in the first decade. The child was admitted with a 1-year history of increasing back pain and radiculopathy. The child was evaluated with X-rays, computed tomography scan and magnetic resonance imaging, which indicated involvement of the posterior elements of the 4th lumbar vertebrae. Decompression of the L5 nerve and resection of the tumor was performed. Osteoblastoma is a rare tumor with an incidence of 1% of all tumors and 30–40% of cases involving the spine. Osteoblastoma occurs most commonly in males (M:F, 2.5:1). The most common area of involvement is the cervical spine followed by the lumbar spine. Posterior elements of the vertebrae are commonly involved.

Osteoblastoma is a rare bone tumor which is mostly found in the vertebral column and long bone. We describe a 59-year-old woman with osteoblastoma in the right fifth posterior segment of the rib, whose presenting symptoms were right back pain for two years and awakened at night. Chest computer tomography (CT) and thoracic spine magnetic resonance (MR) imaging findings included an expansile lesion of the right fifth rib and an ossified matrix. Surgical resection of the lesion confirmed a benign osteoblastoma. 12 months follow-up revealed disappearance of right back pain. Rib osteoblastoma in plain film has been described previously; however, to our knowledge this is the only case report emphasized in CT and MR imaging.

Background. Osteoblastoma is a rare benign tumor. This tumor is characterized by osteoid and bone formation with the presence of numerous osteoblasts. The lesion is more frequently seen in long bones and rarely involves maxilla and mandible. Due to its clinical and histological similarity with other bone tumors such as osteoid osteoma and fibro-osseous lesions, osteoblastoma presents a diagnostic dilemma. Case Report. Very few cases of osteoblastomas involving maxillofacial region have been reported in the literature. This case report involves osteoblastoma involving right maxilla in an 18-year-old male patient. Following detailed clinical examination, radiological interpretation, and histopathological diagnosis, surgical excision was performed. The patient was followed up for a period of 3 years and was disease free. Summary and Conclusion. Benign osteoblastoma involving jaw bones is a rare tumor. There is a close resemblance of this tumor with other lesions such as fibro-osseous lesions and odontogenic tumors and thus faces a diagnostic challenge. Surgical excision with a long-term follow-up gives good prognosis to this lesion—Benign Osteoblastoma.

Osteoblastoma is a rare benign bone tumor that presents with back pain and occurs in the spine approximately 40% of the time. The time from onset of symptoms to diagnosis is typically several months because it is a rare entity and radiographic studies are often negative early in the course of the disease. These highly vascular and locally aggressive tumors require complete and precise resection. The patient presented is a 15-year-old boy with a 14-month history of right-sided neck and shoulder pain. Computerized tomography and magnetic resonance imaging demonstrated a lesion in the posterior elements of C7 which extended through the pedicle and into the body. Preoperative angiography confirmed a hypervascular lesion which was successfully embolized. He subsequently underwent piecemeal tumor resection and instrumented fusion. Immediate postoperative imaging demonstrated complete resection. At 18 months follow up the patient has maintained resolution of preoperative symptoms and demonstrates evidence of solid fusion on CT. This multidisciplinary approach markedly decreased blood loss and improved visualization to help achieve complete surgical resection and resolution of clinical symptoms.

Only eight cases of intraosseous schwannoma of the mobile spine have been reported in the English literature. We report herein a rare case of intraosseous schwannoma mimicking benign osteoblastoma originating from the posterior column of the thoracic spine. A 60-year-old man presented with a history of back pain for several months. The patient subsequently developed gait disturbance and numbness on bilateral lower limbs. Preoperative computed tomography and magnetic resonance imaging showed a neoplastic lesion occupying the posterior column of the ninth thoracic vertebra. The most likely preoperative diagnosis was osteoblastoma. The patient underwent tumor excision and posterior fusion with instrumentation. No nerve involvement of the tumor was identified intraoperatively. Histological diagnosis was schwannoma. To the best of our knowledge, this represents the first report of intraosseous schwannoma originating from the posterior column of the mobile spine.

INTRODUCTION

Osteoblastoma is a rare benign bone tumor commonly located at spine and long bones. However, rib involvement has been reported less frequently.

PRESENTATION OF CASE

In this report, we describe a young adult male presenting with left posterolateral chest wall pain. Chest computed tomography showed a calcified tumor in the left third posterior segment of the rib. Radical mass resection was performed and histopathology confirmed a benign osteoblastoma. At last follow-up, 10 months postoperatively, the patient has eventually relieved of the unbearable chest pain. Imaging evaluation revealed no evidence of recurrent tumor.

DISCUSSION

Osteoblastoma is an uncommon primary bone tumor accounting for only 1% of all bone tumors. Ribs are involved in less than 5% of patients. The disease has usually good prognosis with a tendency for local destruction and recurrence.

CONCLUSION

Radical surgery remains the treatment of choice to prevent recurrences and to provide a definite diagnosis differentiating it from osteoblastoma-like osteosarcoma.

Osteoblastoma is a benign bone-forming tumor that represents approximately 1% of all primary bone tumors. It occurs 40% of the time in the spine, most commonly in the posterior elements. The clinical presentation in this case is of chronic neck pain and stiffness. Although most lesions are well visualized on plain films, a bone scan or CT scan may be of better diagnostic value. Treatment is via surgical excision. In this report we present a case of cervical osteoblastoma mistaken for mechanical neck pain.

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Introduction: We present a case of an aggressive osteoblastoma involving the posterior acetabular column and the ischium, which is very rare location for the tumor.

Case presentation: A 21-year-old man presented with a persistent pain on the left buttock which extended on the rear surface of the thigh and the front surface of the left hip. A plain radiograph, a CT and MRI examinations were performed. The tumor was radically excised and histologically it proved to be an aggressive osteoblastoma.

Conclusions: Although aggressive osteoblastoma is a rare entity it should be considered in the differential diagnosis of bone tumors. Our purpose is to reveal the radiographic presentation of this rare tumor.

Osteoblastoma is a rare benign bone tumor that usually arises in the vertebral column and long bones of young adults. Craniofacial involvement is extremely rare. To date, osteoblastoma of the frontal sinus has not been reported in the English literature. We report an osteoblastoma of both frontal sinuses in a 23-year-old male who presented with headache and blurry vision in the left eye. Computed tomography (CT) demonstrated an expansile lesion involving both frontal sinuses with sclerotic and fibrous components, eroding into the roof of the left orbit. On magnetic resonance imaging (MRI) the dense portion of the lesion showed signal void on all sequences, while the fibrous matrix was isointense to grey matter on T1-weighted and T2-weighted images and showed avid enhancement following intravenous contrast administration. Surgical resection was performed and histology was consistent with osteoblastoma.

For osteoblastoma, with its predilection for the spinal column and appendicular skeleton, the skull is an unusual site, and paranasal sinus involvement is very rare. Herein, we report on a case in which the disease was located within the sphenoid bone. To the best of our knowledge, this is the 4th reported case of osteoblastoma with a sphenoid origin (1). We report an osteoblastoma of the sphenoid sinus in a 12-year-old girl who presented with exophthalmos. Computed tomography (CT) demonstrated an expansile lesion of the sphenoid which caused the orbital contents to be compressed and deviated to the right. In the magnetic resonance imaging scan, the lesion was found to invade the cranial base in the frontal and temporal region, approximating to the cavernous sinus and internal carotid artery on the right. Bilateral fronto-orbital craniotomy was performed. Histologically, the lesion was composed of proliferating osteoblasts along with vascular stroma. The tumor was described as an aggressive osteoblastoma. In the follow-up CT four months later, a pathological mass was observed in the area of the nasal septum, and a signal void was present on all sequences in the densely sclerotic areas. A second resection was performed. The patient has been disease-free for 61 months. Herein, we present the diagnosis and management of this unusual lesion. The histopathology and the imaging characteristics are shown.

Aggressive osteoblastoma is a rare primary bone neoplasm with the potential for local invasion and recurrence. While the vertebrae or long bones are most commonly affected, few well-documented cases have been reported in the jaws. A 25-year-old man presented with a palatal mass of several months’ duration. He reported the lesion had undergone gradual enlargement and, while generally asymptomatic, had recently become increasingly painful. An incisional biopsy was interpreted as “osteoblastic neoplasm” most suggestive of osteoblastoma. However, final diagnosis was deferred until the resection specimen could be evaluated. Following partial maxillectomy, histopathologic examination revealed a proliferation of large epithelioid cells with eccentric nuclei and prominent nucleoli associated with broad, irregular deposits of osteoid and trabeculae of bone. The lesional cells exhibited minimal pleomorphism with infrequent, normal-appearing mitotic figures and numerous osteoclast-like giant cells were observed within an associated loose fibrovascular stroma. Transformation of “blue bone” to more organized eosinophilic trabeculae of woven bone was noted at the periphery of the lesion and there was no evidence of invasion. A diagnosis of aggressive osteoblastoma was made. Previous reports of gnathic aggressive osteoblastoma are reviewed and the features that distinguish this process from conventional osteoblastoma or osteoblastoma-like osteosarcoma are presented.

OBJECTIVES—To characterise the pattern of and risk factors for degenerative changes of the cervical spine in patients with spasmodic torticollis and to assess whether these changes affect outcome after selective peripheral denervation.
METHODS—Preoperative CT of the upper cervical spine of 34 patients with spasmodic torticollis referred for surgery were reviewed by two radiologists blinded to the clinical findings. Degenerative changes were assessed for each joint separately and rated as absent, minimal, moderate, or severe. Patients were clinically assessed before surgery and 3 months postoperatively by an independent examiner using standardised clinical rating scales. For comparison of means a t test was carried out. To determine whether an association exists between the side of degenerative changes and type of spasmodic torticollis a χ2 test was used. Changes in severity, disability, and pain before and after surgery were calculated using a Wilcoxon matched pairs signed ranks test.
RESULTS—Fourteen out of 34 patients had moderate or severe degenerative changes. They were predominantly found at the C2/C3 and C3/C4 level and were significantly more likely to occur on the side of the main direction of the spasmodic torticollis (p=0.015). There was no significant difference in age, sex, duration of torticollis, overall severity, degree of disability, or pain between the group with either no or minimal changes and the group with moderate or severe changes. However, in the second group the duration of inadequate treatment was longer (10.1 v 4.8 years; p=0.009), head mobility was more restricted (p=0.015), and head tremor was more severe (p=0.01). At 3 months postoperatively, patients with no or minimal degenerative changes showed a significant improvement in pain and severity whereas no difference was found in those with moderate or severe changes.
CONCLUSIONS—Patients with spasmodic torticollis have an increased risk of developing premature degenerative changes of the upper cervical spine that tend to be on the side towards which the head is turned or tilted and compromise outcome after surgery. Effective early treatment of spasmodic torticollis with botulinum toxin seems to have a protective effect. Patients with spasmodic torticollis and restricted head mobility who do not adequately respond to treatment should undergo imaging of the upper cervical spine. Patients with imaging evidence of moderate or severe degenerative changes seem to respond poorly to selective peripheral denervation.



ABSTRACT

Benign osteoblastoma is an uncommon primary tumor of the bone. Any area of the skeleton may be affected by this tumor, but its occurrence in the temporal bone and middle ear is extremely rare. Clinical symptoms are nonspecific, even in the middle ear, and the diagnosis is often difficult in spite a complete physical and radiological examination. A biopsy is usually necessary for definitive diagnosis. Because of its potential for recurrence, local invasion, and, rarely, malignant transformation, a complete surgical excision remains the treatment of choice for osteoblastoma. We report a case of benign osteoblastoma involving the temporal bone and the middle ear and a review of the literature.

We present a case of a 35-year-old active rugby player presenting with a history of recurrent burner syndrome thought secondary to an osteoblastoma involving the posterior arch of the atlas. Radiographically, the lesion had features typical for a large osteoid osteoma or osteoblastoma, including osseous expansion, peripheral sclerosis and bony hypertrophy, internal lucency, and even suggestion of a central nidus. The patient subsequently underwent an en bloc resection of the posterior atlas via a standard posterior approach. The surgery revealed very good clinical results.

In this report, we will discuss in detail, the presentation, treatment, and return to play recommendations involving this patient.

Benign osteoblastoma is an uncommon primary bone tumor, extremely rare in calvarium. We present a case of a 25-year-old female with an osteoblastoma of parietal bone which was totally resected. The authors discussed the clinical presentation, radiographic finding, differential diagnosis and management of the benign calvarial osteoblastoma with a review of the literature.

The clinical facts and radiologic findings are very important in the diagnostic evaluation of jaw swellings, and must be considered along with histologic findings. Osteoblastoma, an uncommon primary lesion of the bone that occasionally arises in the jaws, is one such lesion causing a localized jaw swelling. Clinically, osteoblastoma can be symptomatic or even remain symptom-free, and may be diagnosed only on routine radiographic examination. Histologically and clinically, differential diagnosis for osteoblastoma ranges from a variety of benign and malignant tumors that poses a diagnostic dilemma. Stressing the importance of the correct diagnosis of such lesions, this report discusses a case of aggressive osteoblastoma of the mandible posing as a diagnostic dilemma.

Torticollis is a term that describes abnormal posturing of the head secondary to the contraction of the neck musculature. Spasmodic torticollis is a rare form of this disorder that has been attributed to disturbances in the extrapyramidal system. It is a form of focal dystonia that primarily affects women in their forties and usually progresses slowly, leading to severe disability. Although the torticollis may be painful, the patient’s main preoccupation is usually with the deformity itself. The diagnosis is often delayed because of the unusual clinical presentation and these patients are frequently labelled as neurotic. The following report illustrates a case of torticollis and thoracolumbar scoliosis secondary to dystonia.

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Ten patients with spasmodic torticollis were treated by injection of a total dose of 30 ng of botulinum toxin type A into the affected sternomastoid and posterior cervical muscles. Nine patients reported improvement in head position and control, which was confirmed in seven cases by clinical assessment and "blind" videotape ratings before and 6 weeks after injection. Five patients who had pain reported relief. Seven patients had mild transient dysphagia after injection; two who were given a more concentrated solution of the toxin developed more severe dysphagia, but this also recovered. Other minor transient side effects included weakness of the voice and local pain. The beneficial effects of botulinum toxin injections lasted some 2 to 3 months. A slight reduction in the total dose of toxin injected avoided the main side effects, and this method of treatment appears to offer successful control of head position and pain in the majority of patients with torticollis.

ABSTRACT

Osteoblastoma is an uncommon benign bone tumor that accounts for 1% of all primary bone tumors. Well documented in the spine and long bones, it is rarely found in the skull, namely in the sphenoid bone, with only five cases reported in the literature. We report a case of an 11-year-old girl with a histologically confirmed benign osteoblastoma in an unusual location and an atypical aspect on the imaging studies.

Osteoid osteoma and osteoblastoma are rare primary bone tumors that usually do not arise in the spine. Histologically, osteoid osteoma and osteoblastoma are similar, containing osteoblasts that produce osteoid and woven bone. Osteoblastoma, however, is larger, tends to be more aggressive, and can undergo malignant transformation, whereas osteoid osteoma is small, benign, and self-limited. With the help of modern imaging modalities that aid in diagnosis and surgical planning, a complete removal and cure may be achieved for most of these rare tumors. We document a brief review of the literature.

We reviewed the efficacy and adverse effects of repeated botulinum toxin injections into hyperactive neck muscles of 107 successive patients with spasmodic torticollis. They received 510 injection treatments over a median period of 15 months (range 3-42 months). One patient failed to benefit at all, but 101 (95%) patients reported considerable (moderate or excellent) benefit from at least one treatment. On a global subjective response rating, 93% of 429 treatments resulted in some improvement and 76% in moderate or excellent improvement. Pain reduction followed 89% of 190 treatments with moderate or excellent reduction after 66%. Median duration of benefit was 9 weeks. All torticollis types responded equally well and injections into two (or more) involved neck muscles were more effective than injection into a single muscle. The most frequent adverse effect was dysphagia, occurring after 44% of all treatments, but this was severe after only 2%. Antibodies to botulinum toxin were detected in the serum of three out of the five patients in whom loss of treatment efficacy occurred. We conclude that botulinum toxin treatment is the most effective available therapy for spasmodic torticollis and practical advice is provided for anyone wishing to set up the technique.

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Botulinum toxin A was administered to 19 patients in a double-blind placebo controlled trial. Toxin was more effective than placebo for improving both head position and pain which was measured by an objective rating scale and videofilm assessments. Following the controlled trial, treatment with botulinum toxin was continued in an open fashion. A total of 60 patients with torticollis received toxin in a total of 117 treatment periods. The mean follow up period was 8.4 months. In 39 patients with pain there was benefit in 77% of treatment periods. Some improvement in neck posture occurred in 83% of the treatment periods with a mean duration of 12 weeks. Side effects were frequent with dysphagia being the most common (28% of treatment periods). Botulinum toxin is an effective treatment for toticollis but treatment should be initiated with doses at the lower end of the range used in this study (400-600 mouse units).

Spasmodic torticollis, once thought to be psychogenic, is now recognized as an extrapyramidal movement disorder. A patient with onset of classical torticollis after closed head injury and intracranial hypertension is described. The patient had no clinical or radiologic evidence of brain stem dysfunction, but brain stem auditory evoked potentials suggested pontomesencephalic conduction disturbance ipsilateral to head and neck movements. This finding accords with some previous clinical and experimental evidence that pontomesencephalic structures ipsilateral to the movements may be involved in torticollis. The observation suggests that spasmodic torticollis may develop as a sequel to trauma in head-injured patients and should be differentiated from posttraumatic seizures.

Botulinum toxin has been successfully used to treat spasmodic torticollis. The optimum dosage is not clear and the recommended doses in the United Kingdom are 20-25 ng. We have used much lower doses (average 13 ng) without loss of efficacy and accompanied by a reduction in side effects. We treated 12 patients (eight women and four men) with a mean duration of torticollis of 4 years. Eleven of the 12 patients (91%) showed an improvement in total scores for pain and degree of head movement. The benefits appeared a week after treatment and lasted for 3 months. Side effects were minimal and transient. Our experience suggests low doses of the toxin may be equally efficacious.

Three cases of osteoid osteoma and one of benign osteoblastoma in children are described. The main complaint was severe pain which was worse at night; it was relieved by aspirin or other analgesics. The diagnosis was made on clinical and radiological grounds and was confirmed on histological examination of the central nidus removed at operation. The pain was relieved in the patients with osteoid osteoma, and it was very much less after operative removal of the benign osteoblastoma. Both conditions are probably variations of the same disease process, depending on the anatomical site and the type of bone affected.

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