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1.  Osteoblastoma of the Lateral Skull Base: Work-Up, Surgical Management, and a Review of the Literature” 
Objectives To describe the work-up and surgical management of an osteoblastoma involving the lateral skull base. Typically occurring in the spine or long bones, osteoblastomas of the craniofacial skeleton are exceedingly rare and infrequently reported. A review of the current literature regarding temporal bone osteoblastoma, diagnosis, and treatment is described.
Methods This case report describes the clinical presentation, radiographic studies, surgical management, histology, and postoperative follow-up of a young man presenting to a tertiary care neurotology practice with osteoblastoma involving the lateral skull base. A review of the current literature regarding osteoblastoma of the skull base, work-up, and treatment is described.
Results A 15-year-old adolescent boy with a greater than 1-year history of right-sided retroauricular pain, a palpable postauricular mass, and chronic headaches presented for evaluation/management. Microscope examination of the ears, hearing, and cranial nerve function were normal. High-resolution temporal bone computed tomography and magnetic resonance imaging scans were obtained, which revealed an expansile mass involving the junction of the temporal and occipital bones. The patient underwent a combined retrosigmoid/retrolabyrinthine resection of this extradural tumor. Histology revealed a benign bone neoplasm consistent with osteoblastoma. Complete surgical resection was achieved, and the patient's symptoms fully resolved. Follow-up imaging studies found no evidence of recurrence. The scientific literature relevant to work-up and management of osteoblastoma is reviewed.
Discussion Osteoblastomas of the lateral skull base are rare, histologically benign tumors that can present with radiographic features suggestive of malignancy. An en bloc resection is important for both diagnosis and definitive treatment of these neoplasms. The differential diagnosis on imaging and histology is discussed.
PMCID: PMC3713558  PMID: 23943719
osteoblastoma; temporal bone; lateral skull base; retrosigmoid; retrolabyrinthine
2.  Diagnosis and treatment of a C2-osteoblastoma encompassing the vertebral artery 
European Spine Journal  2013;22(11):2504-2512.
Osteoblastoma is a rare, benign bone tumor that accounts for approximately 1 % of all primary bone tumors and 5 % of spinal tumors, mostly arising within the posterior elements of the spine within the second and third decades of life. Nonspecific initial symptoms mainly neck or back pain and stiffness of the spine remain often undiagnosed and the destructive nature of the expanding tumor can cause even neurological deficits. CT and MRI scans constitute the basic imaging modalities employed in diagnosis and preoperative planning with the former delineating the location and osseous involvement of the mass and the latter providing appreciation of the effect on soft tissues and neural elements.
Materials and methods
In our case a 23-year-old male presented with persisting head and neck pain, after being involved in a car collision a month ago. Although the initial diagnostic imaging, including plain X-rays and MRI scan failed to reveal any pathological findings, the persistence of the symptoms led to repeating imaging (CT and MRI) that showed the existence of a benign osseous tumor of the C2 lamina that was destructing the surrounding osseous structures and encompassing the right vertebral artery. The suspicion of an osteoblastoma was raised and the decision for surgical removal of the tumor was made for treating the persistent symptoms and preventing a possible neurological deficit or vascular lesion. A marginal tumor resection was performed through a posterior approach, followed by an anterior instrumented fusion. Histological examination confirmed the diagnosis of an osteoblastoma.
The recovery of the patient was uneventful and a significant symptom subsidence was reported following surgery. Eighteen months postoperatively the patient remains pain free without any indications for tumor recurrence.
This case delineates the difficulties in diagnosing this tumor, as well as the challenges and problems encountered in its surgical management, and also the favorable prognosis when adequately treated.
PMCID: PMC3886513  PMID: 23838701
Osteoblastoma; Cervical spine; Vertebral artery; Primary bone tumor
3.  Benign osteoblastoma of the mandible in a 12-year-old female: A case report 
Oncology Letters  2014;8(6):2691-2694.
Benign osteoblastoma refers to a benign tumor of the bone. Osteoblastoma most commonly affects the vertebrae and long tubular bones, however, in rare cases is observed in the facial bones. The current study presents the case of a 12-year-old female patient with a tumor in the mandibular body. Radiological imaging revealed a lesion with regular contours. The lesion was radically resected and histological analysis of the specimen demonstrated features that are typical of a benign osteoblastoma. The consequential defects of the jaw were reconstructed using titanium implants and autologous bone transplantation. The patient remains disease free subsequent to a five-month follow-up period. The aim of the present report is to present a rare case of benign osteoblastoma of the mandible. This study demonstrated that correct diagnosis and complete surgical excision are important to reduce the risk of recurrence of a benign osteoblastoma.
PMCID: PMC4214441  PMID: 25364451
bone tumor; osteoblastoma; mandible
4.  Intraarticular osteoblastoma with subluxation of the hip joint 
Patient: Male, 5
Final Diagnosis: Osteoblastoma
Symptoms: —
Medication: —
Clinical Procedure: —
Specialty: Oncology
Rare disease
Osteoblastomas are relatively uncommon bone tumors that account for <1% of all bone tumors. They usually occur in the medullary region of the bone. As such, intraarticular osteoblastomas are quite rare.
Case Report:
In this report, we present the case of a 5-year-old boy who presented with vague pain and subluxation of the hip joint due to an intraarticular osteoblastoma. Radiological examinations showed an irregular calcified mass lesion in the hip joint. The final diagnosis of osteoblastoma was made by histological examination. The patient’s symptoms completely subsided following surgical removal of the tumor.
Osteoblastomas can occur in the intraarticular region. Although quite rare, osteoblastoma should be considered among the differential diagnoses for patients with pain and subluxation of the hip joint.
PMCID: PMC3726237  PMID: 23901353
intraarticular; diagnosis; bone neoplasms; osteoblastoma
5.  Recurrent osteoblastoma of the maxilla 
Dentomaxillofacial Radiology  2013;42(5):20100263.
Osteoblastoma is a benign neoplasm which commonly occurs in the vertebral column and long bones. The tumour grows slowly and rarely recurs after surgery. This report presents the clinicopathological and radiological findings of a case of recurrent osteoblastoma in the maxilla. A 7-year-old male patient visited our department with chief complaints of left facial swelling and pain. A panoramic radiograph showed a homogeneous radio-opaque expansile lesion in the left maxilla. The lesion was thought to be fibrous dysplasia and the patient underwent a surgical excision using the Caldwell–Luc procedure. Histopathological examination of the lesion confirmed it as benign osteoblastoma. The lesion recurred 6 months after the initial surgery. CT images revealed a large mass with multiple internal calcifications. Subsequently, the patient underwent mass excision with subtotal left maxillectomy. Follow-up CT scans at 1 year intervals showed no recurrence for 5 years.
PMCID: PMC3635770  PMID: 23604054
osteoblastoma; recurrence; X-ray computed tomography
6.  Benign Osteoblastoma Involving Maxilla: A Case Report and Review of the Literature 
Case Reports in Dentistry  2012;2012:351241.
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.
PMCID: PMC3347716  PMID: 22593831
7.  A rare occurrence of osteoblastoma in a child 
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.
PMCID: PMC3087998  PMID: 21559167
Benign tumors of spine; osteoblastoma; osteoblastoma in childhood
8.  Aggressive Osteoblastoma of the Maxilla: A Case Report and Review of the Literature 
Head and Neck Pathology  2010;5(2):165-170.
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.
PMCID: PMC3098324  PMID: 21181315
Aggressive osteoblastoma; Gnathic; Maxilla; Osteoblastoma-like osteosarcoma
9.  Destructive osteoblastoma with secondary aneurysmal bone cyst of cervical vertebra in an 11-year-old boy: case report 
Study Design: A case report and review of previous literature are presented. Objective and Background: The objective of this manuscript was to report a case of destructive osteoblastoma with secondary aneurysmal bone cyst of cervical vertebra in a child, and discuss the pathogenesis of this disease. The combination of osteoblastoma and aneurysmal bone cyst in the cervical spine is rare in primary bone neoplasm. To the authors’ knowledge, only one case in a child has been reported. Method: Plain X-rays, technetium bone scanning, CT scan and MRI indicated an expansile, partially sclerotic lesion of the C4 involving the body of vertebra and appendix. The lesion was excised through anterior and posterior approach. Results: After operation the tumor was removed completely. There has been no sign of tumor recurrence or clinical or radiologic sign of instability in the follow-up investigations. Conclusions: We report a rare case of destructive osteoblastoma with Secondary aneurysmal bone cyst of cervical vertebra in a child, a full investigation indicated that complete resection of the tumor can prevent recurrence and malignant transformation. Long-term follow-up is needed to declare a lifelong cure of the disease.
PMCID: PMC3902271  PMID: 24482719
Osteoblastoma; aneurysmal bone cyst; cervical vertebra; child
10.  Osteoblastoma of the rib: A rare benign tumor with an unusual location 
Osteoblastoma is a rare benign bone tumor commonly located at spine and long bones. However, rib involvement has been reported less frequently.
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.
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.
Radical surgery remains the treatment of choice to prevent recurrences and to provide a definite diagnosis differentiating it from osteoblastoma-like osteosarcoma.
PMCID: PMC3540225  PMID: 23274849
Bone tumor; Rib; Osteoblastoma
11.  Osteoblastoma of the rib with CT and MR imaging: a case report and literature review 
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.
PMCID: PMC3320550  PMID: 22397553
Bone neoplasm; Osteoblastoma; Computer Tomography (CT); Magnetic Resonance (MR)
12.  Aggressive osteoblastoma of the sphenoid bone 
Oncology Letters  2010;1(2):367-371.
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.
PMCID: PMC3436399  PMID: 22966310
sphenoid bone; osteoblastoma
13.  Treatment of osteoblastoma at C7: a multidisciplinary approach. A case report and review of the literature 
European Spine Journal  2008;18(Suppl 2):196-200.
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.
PMCID: PMC2899567  PMID: 18839223
Osteoblastoma; Embolization; Spinal fusion; Spinal tumor; CT; Bone scan
14.  A case report of osteoblastoma on the distal phalanx of the ring finger successfully treated with curettage and polymethylmethacrylate filling 
•This is the first report of osteoblastoma on the distal phalanx. The finger was monitored closely for two years; sequential films showed a radiopaque interface and no evidence of local recurrence.
Osteoblastoma is an aggressive benign tumor whose presentation varies with location and size. This rare bone tumor is thus difficult to diagnose particularly when it occurs outside its most common location – the vertebral column and long bones.
We report a case of osteoblastoma of the fourth distal phalanx of the left hand in an 18-year-old male, presented with pain and swelling and treated with curettage and polymethylmethacrylate filling followed by immobilization by a cast, which was opened 10 days later to start physical therapy. Patient was pain-free, recovered full function of his finger, and remained without pain at one month post-surgery. The finger was monitored closely for two years; sequential films showed a radiopaque interface and no evidence of local recurrence.
This is the first report of osteoblastoma on the distal phalanx. The possibility of osteoblastoma should be considered in cases of pain and swelling of phalanx, and if diagnosed, curettage and polymethylmethacrylate filling may be the treatment of choice.
PMCID: PMC4486407  PMID: 26072004
Bone tumors; Osteoblastoma; Phalanges
15.  Extraosseous Thoracic Foraminal Osteoblastoma: Diagnostic Dilemma and Management with 3 Year Follow-Up 
Asian Spine Journal  2014;8(5):689-694.
Osteoblastomas are bone forming lesions arising mainly from posterior elements of the vertebra. They are commonly encountered in the cervical and lumbar regions. We present a case of a thoracic osteoblastoma which is extra osseous and is not communicating with any part of the vertebra present intraforaminally. This is a rare presentation of an osteoblastoma. Imaging studies do not accurately diagnose the osteiod lesion. The size of the lesion and cortical erosion seen on the computed tomography scan help in differentiating the osteoid osteoma and osteoblastoma, but they are less sensitive and specific. Thus a histopathology is the investigation of choice to diagnose the osteoblastoma. Early and adequate removal of mass prevents malignant transformation, metastasis, and recurrence. In our case we excised the pars interarticularis unilaterally, removed the osteoid mass intact, and performed unilateral instrumented fusion. There was no recurrence and solid fusion was seen at 3 years follow up.
PMCID: PMC4206822  PMID: 25346825
Thoracic osteoblastoma; Intraforaminal; Extra osseous; Unilateral fusion
16.  Aggressive middle turbinate osteoblastoma with intracranial extension: a case report 
Osteoblastoma is an uncommon benign bone tumor that accounts for 1 percent of all primary bone tumors. About 30 to 40 percent of all osteoblastoma cases involve the spine. Osteoblastoma involving the nasal cavity is rare, with only 11 reported cases in the English-language literature, while only four cases of turbinate osteoblastoma have been described.
Case presentation
We report an unusual case of middle turbinate osteoblastoma associated with right-sided nasal obstruction and severe headache in a 14-year-old Caucasian girl. The tumor involved the right middle turbinate, complete anterior and incomplete posterior ethmoidal cells, and the frontal sinus ostium. Cribriform lamina was, in the most part, consumed by the tumor growth, while the skull base was mostly of normal bone structure.
To the best of our knowledge, this is the first case of middle turbinate osteoblastoma with intracranial spread. Surgical treatment is the only therapeutic option for osteoblastoma.
PMCID: PMC4096441  PMID: 24884831
Osteoblastoma; Middle turbinate; Nasal obstruction
17.  A Rare Case of Rib Osteoblastoma: Imaging Features and Review of Literature 
Iranian Journal of Radiology  2013;10(3):152-155.
Osteoblastoma is a rare benign, but locally aggressive bone tumor with rare malignant transformation. It mostly affects the vertebral column and long bones. Radiographically, it is seen as an expansile, oval, sclerotic or lytic mass-like lesion with well-defined borders, although sometimes it may mimic a malignant tumor such as osteogenic sarcoma by its irregular borders. Herein, we report a case of osteoblastoma in a 22 year-old man with a long history of back and neck pain accompanied with neck stiffness. On the routine chest X-ray, the salient lesion appeared as an expansile, oval, sclerotic mass with well-defined borders and speckled calcification without any internal lucency and periosteal reaction, involving the posterolateral aspect of the first left thoracic rib, a rare anatomical site. Despite the unusual location, osteoblastoma should be considered in the differential diagnosis of a solitary rib lesion.
PMCID: PMC3857978  PMID: 24348601
Ribs; Osteoblastoma; Bone Neoplasms; Osteoma, Osteoid
18.  Clinical Features and Surgical Management of Spinal Osteoblastoma: A Retrospective Study in 18 Cases 
PLoS ONE  2013;8(9):e74635.
To investigate the clinical manifestation and surgical outcome of spinal osteoblastoma.
From June 2006 to July 2011, 18 patients with spinal osteoblastoma treated surgically were analyzed retrospectively. There were 11 males and 7 females with an average age of 27.5 years(range, 16-38 years). The tumors were located at C5 in 7, C6 in 6, C7 in 3, C6-T1 1 in 1 and T11 in 1. Based on WBB classification, 16 were 1-3 or 10-12 and 2 were 4-9 and 1-3. 18 operations had been performed with en bloc resection. A posterior approach was used for 16 patients, and a combined posterior and anterior approach was used for 2 patients. Reconstruction using instrumentation and fusion was performed using spinal instrumentation in 13 patients. We used visual analogue scales (VAS) to evaluate the change of pain before and after the operation, and the McCormick System to assess functional status of the spine. Imaging test was used to review the stability and recurrence rate of spine cord, and the confluence of graft bones.
All cases were followed up for 24-80 months (average, 38.4 months). The average surgical time was 120.8 minutes (range, 80-220 minutes), with the average intraoperative blood loss of 520 ml (range, 300-1200 ml). During the follow-up period, the VAS grade reduced from 6.46±1.32 to 2.26±1.05 (P <0.05). 15 patients had neurological function improved and 3 remained no change which was evaluated by McCormick scale for spinal function status at final follow-up.
Spinal osteoblastoma has its own specific radiographic features. There is some recurrence in simple curettage of tumor lesion. The thoroughly en bloc resection of tumor or spondylectomy, bone fusion and strong in Ter fixation are the key points for successful surgical treatment.
PMCID: PMC3776745  PMID: 24058612
19.  Osteoblastoma of the Frontal Sinuses Presenting with Headache and Blurred Vision: Case Report and Review of the Literature 
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.
PMCID: PMC3303412  PMID: 22470734
Frontal sinus; exophthalmos; osteoblastoma
20.  A Large Multifocal Aggressive Osteoblastoma of Mandible: an Immunohistochemistry Case Study Report 
Aggressive osteoblastoma (AO) is a benign osteoblastic tumor which is rare in the head and neck region. Clinical and histo-logical features are therefore overlap with other benign and low-grade malignant tumors. The aim of this article is to report and discuss the differential diagnosis of an aggressive osteoblastoma in the mandible. A 25-year-old male patient reported with pain and asymmetry on the left side of the face since 8 months previously. Radiographic evaluation showed a mixed lesion extending from approximately the lower left premolar to the third molar region. After incisional biopsy, resection with continuity defect was carried out. Microscopic findings showed woven bone and bony trabeculae with varied degrees of mineralization along with sheets of osteoblast cells. Immunohistochemistry showed that p53 and cytokeratin (CK) were negative and ki-67 index was 7%. Postoperative follow-up for 15 months showed no evidence of recurrence.
PMCID: PMC4091700  PMID: 25024840
Aggressive osteoblastoma; cytokeratin; immunohistochemistry; mandible; p53
21.  Intraosseous schwannoma originating from the posterior column of the thoracic spine 
European Spine Journal  2010;20(Suppl 2):153-156.
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.
PMCID: PMC3111510  PMID: 20496036
Magnetic resonance imaging; Intraosseous schwannoma; Osteoblastoma; Thoracic spine
22.  Aggressive osteoblastoma involving the craniovertebral junction: A case report and review of literature 
Osteoblastoma (OB) is a rare bony neoplasm constituting around 1% of all primary bone tumors. Although the vertebrae and long bones are the most common sites affected by OB, skull remains a relatively uncommon site of occurrence. Aggressive variant of OB is histologically intermediate between an indolent conventional OB and a malignant osteosarcoma. To the best of our knowledge, aggressive osteoblastoma (AO) affecting the craniovertebral junction has not been previously described in the literature. In this report, we present a 34-year-old gentleman who presented with a mass involving the left side of the neck and oral cavity along with ipsilateral lower cranial nerve paresis. Computed tomography and magnetic resonance imaging scans of the craniovertebral junction revealed a heterogeneously enhancing expansile lesion with areas of destruction involving the clivus, left sided jugular foramen and left side of first two cervical vertebras. Angiography showed distortion of the V3 segment of the left vertebral artery and shift of the ipsilateral internal carotid artery. The tumor was maximally excised through far lateral approach. Histopathologic examination revealed a diagnosis of AO. The patient was referred for radiotherapy for the residual tumor and was doing well at 5 months follow-up.
PMCID: PMC3980559  PMID: 24744565
Aggressive; epithelioid; osteoblastoma; pathology; skull base; surgery
23.  Oral and Maxillofacial Sclerosing Epithelioid Fibroscarcoma: Report of Five Cases 
Head and Neck Pathology  2007;1(1):13-20.
Sclerosing epithelioid fibrosarcoma (SEF) has distinctive morphology and occurs mainly in deep soft tissue of adult extremities. Approximately 59 cases of SEF have been reported, with only 12 previously described in head and neck locations. Lesions involving the oral and maxillofacial region (OMFR) and intraosseous examples are rare. We present five cases of OMFRSEF. The OMF Pathology Department Registry was searched for cases coded from 1990 to the present as “SEF,” “fibrosarcoma not otherwise specified” or “neoplasm of uncertain histiogenesis.” Inclusion required OMFR location, an abundantly sclerotic sarcoma with epithelioid features, and lack of other phenotype by immunohistochemistry. Five cases of SEF included 3 males and 2 females. The age of the patients were: 19, 22, 35, 47 and 47 years. Tumor location included the infra-temporal fossa, buccal mucosa (recurrence extending into bone), anterior mandible (intraosseous primary, focally extending into soft tissue), and left parotid and submandibular gland (with metaplastic bone) regions. Tumor sizes ranged from 1.0 to 5.7 cm, median 3.5 cm. Histologically, the tumors were well delineated and multinodular, separated by fibrous septae. The spindled to primarily epithelioid tumor cells formed moderately cellular sheets and cords of irregularly contoured medium to large, round to oval, occasionally overlapping nuclei, indistinct nucleoli, wispy eosinophilic (retracting) cytoplasm, and distinctive cytoplasmic borders, embedded in osteoid-like stroma. Hemangiopericytoid (HPC-like) vessels were observed. Despite numerous apoptotic cells, mitoses were generally low; necrosis was present in two cases. Three tumors were graded as 2/3 and two 1/3. Immunohistochemically, the tumor cells were positive for vimentin, 1 case focally for CD34, whereas all cases were negative for S100 protein, keratins, EMA, desmin, and SMA. Wide or radical excision was performed with no adjuvant therapy. Follow-up revealed that 4 cases recurred at a range of 12–120 months. One case had no recurrent/residual disease at 3 months. Metastatic disease was present in 2 cases, to chest wall and lumbar/thoracic spine at 12 and 21 months, respectively. One patient died of disease complications at 15 months. OMFRSEF occur in adults in various locations, but with a common propensity to involve bone; there is recurrent potential and morbidity with higher grade lesions. The differential diagnosis for these tumors in this site includes sclerosing carcinoma, Ewing/PNET, osteosarcoma, osteoblastoma, and benign and malignant myoepithelial salivary gland tumors. The collagen, focal spindle cell features, HPC-like vasculature, and weak focal CD34 reactivity in one case might have raised a possible relationship between OMFRSEF and low grade malignant solitary fibrous tumor, but the intraosseous propensity, epithelioid features and relative lack of CD34 make this a distinctive entity.
PMCID: PMC2807507  PMID: 20614275
Sclerosing epithelioid fibrosarcoma; Sarcoma; Oral; Maxillofacial
24.  Cervical spine osteoblastoma presenting as mechanical neck pain: a case report 
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.
PMCID: PMC2485103
osteoblastoma; cervical spine; neck pain
25.  Painful scoliosis secondary to osteoblastoma of the vertebral body 
European Spine Journal  1998;7(3):246-248.
A 19-year-old boy with a painful thoracolumbar scoliosis was found to have an osteoblastoma of the body of T12. Excision of the tumour was carried out through a left thoracotomy approach and strut bone grafting was performed. Complete excision of the tumour was facilitated by intraoperative radiographs of the removed vertebra. Following surgery the patient’s pain resolved completely and the deformity was partially corrected. Osteoblastoma of the vertebral body in the thoracolumbar region has not previously been reported. Diagnosis may be difficult unless the significance of the association between pain and the scoliosis is appreciated. The tumour is often not readily apparent on plain radiographs. Therefore, further radiological investigation in the form of a bone and CT scan is necessary to establish the diagnosis. Early excision of the tumour is essential to prevent a permanent structural scoliosis from developing.
PMCID: PMC3611248  PMID: 9684960
Key words Osteoblastoma; Vertebral body; Painful scoliosis

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