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.
Benign tumors of spine; osteoblastoma; osteoblastoma in childhood
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.
Bone neoplasm; Osteoblastoma; Computer Tomography (CT); Magnetic Resonance (MR)
Patient: Male, 5
Final Diagnosis: Osteoblastoma
Clinical Procedure: —
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.
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.
intraarticular; diagnosis; bone neoplasms; osteoblastoma
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.
Osteoblastoma; Embolization; Spinal fusion; Spinal tumor; CT; Bone scan
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.
Magnetic resonance imaging; Intraosseous schwannoma; Osteoblastoma; Thoracic spine
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.
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.
Bone tumor; Rib; Osteoblastoma
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.
osteoblastoma; cervical spine; neck pain
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.
osteoblastoma; temporal bone; lateral skull base; retrosigmoid; retrolabyrinthine
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.
aggressive osteoblastoma; ischium; bone tumors; MRI
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.
Key words Osteoblastoma; Vertebral body; Painful scoliosis
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.
Frontal sinus; exophthalmos; 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.
sphenoid bone; osteoblastoma
Osteoblastoma is a rare benign tumor of the calvarium. We present the case of a 20-year-old female with occipital osteoblastoma and discussion of imaging modalities of calvarial osteoblastoma. To our knowledge, this is the ninth reported case of occipital osteoblastoma. Imaging characterization of osteoblastoma may vary. Plain radiograph, CT, MRI, and CT angiography establish osteoblastoma characterization and vascular supply prior to surgical resection.
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.
Aggressive osteoblastoma; Gnathic; Maxilla; Osteoblastoma-like osteosarcoma
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.
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.
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
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.
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.
Osteoblastoma; temporal bone; tinnitus; hearing loss
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.
Osteoblastoma; Parietal bone
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.
aggressive; mandible; osteoblastoma
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.
spasmodic torticollis; scoliosis; dystonia; chiropractic
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.
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.
Benign osteoblastoma; child; sphenoid bone; radical resection
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.
The case of a 22-year-old woman presenting with progressive low back pain as a result of a recurrent osteoblastoma of the body of L3, is reported. Total spondylectomy together with anterior and posterior fusion was carried out in a two-stage procedure. We highlight the rarity of the site of occurrence of osteoblastoma, the difficulty in diagnosis and the fact that a radical treatment needs to be performed.
Key words Osteoblastoma; Spine