Figure - available from: BMC Musculoskeletal Disorders
This content is subject to copyright. Terms and conditions apply.
Osteoid osteoma, microscopic findings. a Overview. The cellular tumour (mid and lower left) shows irregular bone trabeculae partly consisting of osteoid and embedded in fibrous stroma. Cortical bone (upper left and upper and lower right) appears sclerotic. b Detail. The tumour tissue consists of woven bone trabeculae (1) covered by enlarged osteoblasts (2) and scattered multinucleated osteoclasts (3). The fibrous stroma contains dilated blood vessels (4). There is no evidence of tumour necrosis or cellular atypia. a Undecalcified preparation, staining method: toluidine blue, original magnification: 25×; b EDTA decalcification, staining method: haematoxylin and eosin, original magnification: 200 ×
Source publication
Background
The aim of this retrospective study was to investigate the frequency of intra-articular osteoid osteoma (iaOO) in a large study cohort and to demonstrate its clinical relevance as an important differential diagnosis of non-specific mono-articular joint pain. Methods
We searched the registry for bone tumours of the University Medical Cent...
Similar publications
The trapezium is rare site of osteoid osteoma development. The diagnostic challenge lies in its rare occurrence, and requires differentiation from various disease entities causing thumb basal joint pain. We report the case of a 29-year-old male who presented with severe thumb basal joint pain. He was initially treated for calcific periarthritis bec...
Citations
... Osteoid osteoma (OO) is a non-malignant, osteoblastic, and painful tumor-like lesion. It ranks as the third most prevalent benign bone lesion, with intra-articular cases comprising around 5% to 13% of occurrences [1][2][3]. Within the category of intra-articular OOs (IAOOs), sometimes referred to as "juxta-articular OOs," these are characterized by their development within synovial cavities, specifically in subsynovial or subchondral locations. Subchondral IAOOs stand out due to their proximity to and engagement with articular cartilage [2]. ...
... Subchondral IAOOs stand out due to their proximity to and engagement with articular cartilage [2]. Unlike their extra-articular counterparts located in the diaphysis, IAOOs often exhibit atypical radiographic and advanced imaging manifestations, contributing to delays in diagnosis, taking over two years on average, in contrast to 8.5 months for extra-articular cases [1,2,4,5]. ...
... IAOO is commonly observed in the hip joint, with a primary prevalence in the upper part of the femur. Nonetheless, occurrences of IAOO have been noted in different joints such as the knee, ankle, elbow, hand, subtalar, and metatarsophalangeal joints [1,2,10]. Regular X-rays often fail to promptly detect IAOO since the distinctive hardened border is usually absent in most cases [2,5]. ...
Osteoid osteomas (OOs) are non-malignant primary bone abnormalities marked by a central nidus surrounded by reactive sclerosis. They typically manifest as aggravated nocturnal pain that responds to non-steroidal anti-inflammatory drugs (NSAIDs). These growths are most frequently found within the intracortical bone and the diaphysis of elongated bones. Within the realm of uncommon conditions, intra-articular OOs (IAOOs) exhibit distinctive presentations, often leading to postponed or inaccurate diagnoses. We present a patient with OO at the distal femur, accessible through the knee joint, which was intraoperatively identified and localized using a needle pricking technique and treated by arthrotomy and mosaicplasty.
... Intra-articular osteoid osteoma is of rare occurrence, which accounts for 5.2% of all locations. 10 Radiographs of intra-articular osteoid osteoma are nonspecific, for example, joint effusion and bone marrow edema. Particularly, lack of the intense perifocal sclerotic margin tends to cause diagnostic difficulties. ...
Osteoid osteoma of the cuneiform bone is an exceedingly rare and easily missed cause of foot pain. The uncharacteristic and nonspecific radiographs of such intra-articular osteoid osteoma further increase difficulty in making the diagnosis. To date, there has been no description of intra-articular osteoid osteoma of the intermediate cuneiform bone causing articular degeneration in any published literatures. We present a case of intra-articular osteoid osteoma of the intermediate cuneiform bone causing articular degeneration, who underwent curettage, allograft bone graft, and navicular-cuneiform arthrodesis. The patient presented with radiographic bone union, full motor function recovery and pain-free at the 22-month follow-up. This report adds to the existing literature. Intra-articular osteoid osteoma of the intermediate cuneiform bone causing articular degeneration is an exceedingly rare and easily missed cause of foot pain. It proves a complicated and challenging task to identify intra-articular osteoid osteoma. Clinicians should be particularly careful not to exclude the possibility of arthritis and, thus, vigilant when choosing the surgical option.
... In some cases, complementary symptoms such as swelling and deformities (nail hypertrophy, nail and bone deformity) can be observed [12][13][14]. A previous evaluation of 367 OO revealed a frequency of 8.4% in the bones of the hand [15]. It is known that patients with OO of the hand often must endure a long period of discomfort until final diagnosis [16]. ...
... All patients were male, with an average age of 27.3 (range 22-37). In the available literature, men are more frequently affected, with a ratio of 2:1 and an increased occurrence in the second and third decades of life [15,22]. ...
... Nevertheless, percutaneous procedures such as radiofrequency ablation (RFA) show successful results in treating OO in the bones of the hand and have the advantage of low trauma [34][35][36]. A central CT-guided puncture of the nidus is necessary, whereby the close relationship to nerves, tendons, and vessels with the risk of unintentional damage should be considered [15,37]. The advantage of surgical removal consists of the subsequent histopathological confirmation of the tumor. ...
Osteoid osteoma (OO) is a benign bone tumor that rarely occurs in the bones of the hand. Due to the comparatively non-specific symptoms when occurring in the hand, OO is often misdiagnosed at first presentation, posing a diagnostic challenge. In the present case study, six cases of phalangeal and carpal OO, treated surgically at our department between 2006 and 2020, were retrospectively reviewed. We compared all cases regarding demographic data, clinical presentation, imaging findings, time to diagnosis, surgical treatment, and clinical outcome in follow-up examinations. When OO occurs in the bones of the hand, it can lead to swelling and deformities, such as enlargement of the affected bone and nail hypertrophy. Initial misdiagnoses such as primary bone tumors other than OO, tendinitis, osteomyelitis, or arthritis are common. Most of the presented cases showed a prolonged time until diagnosis, whereby the primarily performed imaging modality was often not sensitive. CT proved to be the most sensitive sectional imaging modality for diagnosing OO. With adequate surgical treatment, complications and recurrence are rare.
... Osteoid osteoma (OO), first reported by Jaffe 1935, is a benign bone tumor which is mostly present in the tibia, femur and other long bones, but may also occur at atypical locations [17,30]. Its typical characteristic in imaging such as radiography, MRI (magnetic resonance imaging) and CT is a central nidus that contains high amounts of osteoid and is surrounded by sclerotic osseous tissue [10,20]. ...
... A frequent occurrence of OO in male patients could also be confirmed in our review [10,34]. Together, these epidemiologic data are consistent with the literature, although this review shows that relatively more women may be affected and the mean age is slightly higher (female 38.5%, male 71.1%) [30]. When examining the most affected bones, there is an increased incidence in the proximal phalanges. ...
... It leads to good outcomes and a low morbidity [39]. When used for lesions in the hand and feet RFA must be used with caution as there is a risk of subsequent osteonecrosis or thermal damage to adjacent neurovascular structures [22,30,32]. When treating OO by RFA, it is important to reach inside the nidus to eliminate the lesion entirely [39]. ...
Introduction
Osteoid osteoma (OO) is a common benign bone tumor. OO is observed most frequently in the long bones, especially in the tibia and femur. When occurring in the bones of the hand, OO can be a diagnostic and therapeutic challenge. The aim of this study was to provide a systematic review of occurrence, symptoms, diagnosis and treatment options regarding OO in hand bones.
Materials and methods
We performed a systematic review of the literature. All studies from the online databases PubMed and SpringerLink, which reported cases of osteoid osteomas in the bones of the hand, were included. By summarizing the literature, we evaluated the localization within the hand as well as diagnostic and therapeutic options.
Results
We included 133 studies reporting 401 cases. OO was mostly common in the phalanges. The diagnosis was mostly made by CT (computed tomography) scan. Most of the OO were treated surgically by open curettage or en bloc resection.
Conclusions
Osteoid osteomas in the bones of the hand are rare and a delayed diagnosis is common. In cases of pain combined with particular symptoms such as nail hypertrophy and swelling OO should be considered. Of the most used imaging methods, CT scans have the highest sensitivity.
... It may be multifocal, meaning there are several tumours in a single bone, in exceedingly rare cases. Its incidence in the craniofacial bones has been reported in only a few 5 cases . The current report describes a very unusual instance of multifocal osteoid osteoma in the jaw that presented bilaterally, with extensive clinical and radiological data. ...
... Newer techniques have shown promising results in the imaging of intra-articular OO. Single photon emission computed tomography and MRI gadolinium enhanced imaging have also been proven to be efficient in the detection of the nidus in intra-articular lesions [18]. Especially around the knee joint, the diagnosis of osteoid osteoma can be delayed for many months [11]. ...
... Especially around the knee joint, the diagnosis of osteoid osteoma can be delayed for many months [11]. The average delay for diagnosis of intra-articular OO has been reported by Szendroi et al. at 26.6 months and by Rolvien et al. at 20.7 months [13,18]. In our case, the time interval between the onset of symptoms and the diagnosis was approximately one year. ...
Giriş: Osteoid Osteoma (OO) belirgin bir nidus ve onu çevreleyen sklerotik reaktif zon ile karakterize küçük selim bir kemik tümörüdür. Genellikle uzun kemiklerde yerleşmekle birlikte nadiren patellada da görülebilmektedir.Vaka Sunumu: Sekiz yaşında kız çocuğu ön diz ağrısı şikayetiyle polikliniğimize başvurdu. Hastanın ağrı şikayetleri yaklaşık bir yıldır mevcuttu. Hastada Patellar Osteoid Osteoma tespit edildi. Lezyon kürete edildi ve cerrahi sonrası ilk gün hastanın ağrıları tamamen geçti.Sonuç: Her ne kadar Patellar OO nadir gözükse de çocuk ve genç erişkinlerdeki uzun süreli diz ağrısının ayırıcı tanısında düşünülmesi gerekir.Anahtar Kelimeler: Osteoid Osteoma, patella, diz ağrısı, küretaj, gecikmiş tanı, kemik neoplazmı
... Juxta-articular and intra-articular OO have been reported accounting for almost 10% of the tumor. 3,4 In intra-articular OO, diagnosis might be difficult and prolonged due to diffuse joint pain, mimicking more common differential diagnoses, including inflammatory arthritis or osteochondritis dissecans. 5 The time to diagnosis in intra-articular OO is almost three times more than extraarticular tumor. ...
... Arrow shows the lesion, which is very hard to be found intra-articular OO compared to the diaphyseal lesions. [7][8][9][10] In addition, nocturnal pain is also less prominent in intraarticular OO. 3 These findings, which lead to delay in diagnosis, were also present in our patient. ...
... 12,13 Imaging properties of juxta-and intra-articular OOs are also unremarkable. 3 Plain radiographs may show decalcification and joint narrowing. This will suggest arthritis or degenerative joint disease or even osteomyelitis. ...
Here, we describe the first case of intra‐articular osteoid osteoma of the capitulum, which is presented as elbow pain, extension lack, and sensation of click in joint flexion. Surgical treatment either arthroscopic or open is more in use in this location of the tumor than cortical osteoid osteoma. We describe the first case of intra‐articular osteoid osteoma of the capitulum presented as elbow pain, extension lack, and sensation of click in joint flexion. Surgical treatment either arthroscopic or open is more in use in tumor location than cortical osteoid osteoma. Radiofrequency ablation should be used with extreme caution.
... Combining CT scan and high suspicion should lead to an early OO diagnosis (Fig. 3) [2, 5-7, 44, 59-65]. Therefore, histological diagnosis confirmation of the OO appears even more important [2,16,48,66]. Arthroscopy allows reliable lesion sampling before the ablation. ...
Background
Today, intra-articular and juxta-articular osteoid osteomas are treated with arthroscopy and radiofrequency thermal ablation. However, for the case of an elbow joint, arguments are made for the use of a minimally invasive technique to be the optimal choice. This study aims to analyse our experiences of arthroscopically treated elbow osteoid osteomas and to compare it with the published results of both techniques.
Methods
The retrospective study analyses the patients who underwent elbow arthroscopy ablation of an elbow osteoid osteoma at a single institution from January 2014 until March 2020. Clinical and diagnostic features, success and treatment failure rates, complications and tumour recurrence rates were all compared to 13 studies of intra-articular elbow osteoid osteoma arthroscopic ablation and 15 studies involving radiofrequency thermal ablation of intra-articular osteoid osteoma within different joints.
Results
Four males and two females, with a mean age of 19.3 years, were encompassed. All the patients had immediate postoperative pain relief and improved range of motion. No tumour recurrences were observed during a median of 21.7 months. The literature review yielded 86.4% success rate, 68.2% successful biopsies, one minor complication and no recurrences following the arthroscopic ablation of an elbow osteoid osteoma; while radiofrequency thermal ablation of an intra-articular elbow osteoid osteoma yielded 96.3% success rate, 33.3% successful biopsies, no complications and 3.7% recurrence rate.
Conclusions
Our results are consistent with the published literature proving that arthroscopic ablation is an efficient method with low treatment failure rates and no recurrences in treating intra- and juxta-articular elbow osteoid osteomas. Advantages of arthroscopic ablation stem from the ability to visualise and safely deal with the lesion and the joint’s reactive changes resulting in high biopsy rates, no recurrences and better postoperative elbow’s range of motion. Still, the technique selection should be personalised considering the medical expertise of every institution.
... Osteoid osteomas once present, are usually found in the diaphysis of the extra-articular long bones such as the femur and the tibia [3]. Intra-articular osteoid osteoma within or near a joint is very rarely present, and is hence considered as a distinct entity [2][3][4]. Furthermore, occurrence in the distal humerus and elbow joint is uncommon and is observed in only up to 5-12% of all diagnosed osteoid osteomas [4][5][6][7]. Once these lesions present in the elbow, it manifests with atypical clinical features and radiological findings that are completely different from lesions presented in the extra-articular portions [2]. ...
... Intra-articular osteoid osteoma within or near a joint is very rarely present, and is hence considered as a distinct entity [2][3][4]. Furthermore, occurrence in the distal humerus and elbow joint is uncommon and is observed in only up to 5-12% of all diagnosed osteoid osteomas [4][5][6][7]. Once these lesions present in the elbow, it manifests with atypical clinical features and radiological findings that are completely different from lesions presented in the extra-articular portions [2]. ...
... Classically, patients complaining of nocturnal pain usually respond to non-steroidal anti-inflammatory drugs, especially salicylates [4][5][6]. In contrast, intra-articular lesions show minimal reactive cortical thickening or sclerosis which results in difficulty to determine imaging findings accurately, which causes a delay in the diagnosis [8]. ...
Osteoid osteoma (OO) of the elbow is a very rare entity as it typically occurrs in the lower extremity of extra-articular long bones. Hereby, we report a case for a 28-year-old female patient has been diagnosed with a unique presentation of sub-periosteal osteoid osteoma in the intra-articular portion of distal humerus. She underwent arthroscopic excision for the lesion which is considered a reliable minimally invasive management modality. In addition to this, findings of a 1-year follow-up after excision is reported.
... Prinzipiell können Osteoidosteome am gesamten Skelett auftreten. Mit über 50 % der Fälle sind allerdings die häufigste Prädilektionsstellen die langen Röhrenknochen des Femurs oder der Tibia [14,29]. Der Fuß und das Sprunggelenk sind mit 2-10 % der Fälle eine seltene Lokalität, hier ist vor allem der Talus betroffen Der Orthopäde [14,17]. ...
Zusammenfassung
Hintergrund
Osteoidosteome zählen zu den benignen ossären Neoplasien und können am gesamten Skelett auftreten. Die verlängerte Diagnosestellung eines Osteoidosteoms der Großzehe veranlasste uns, einen Fallbericht mit Review der Literatur zu verfassen, um mögliche Fehlerquellen zu identifizieren und einen Beitrag zur zügigeren Diagnosefindung und Therapie zu leisten.
Literatur
In der deutschen Literatur sind aktuell nur zwei Fallberichte zu Osteoidosteomen der Zehen bekannt. International wurde allerdings eine Vielzahl an Fällen beschrieben, die in der Zusammenschau ein homogenes Bild ergeben. Eine sehr deutliche Häufung von Osteoidosteomen am Endglied der Großzehe lassen eine posttraumatische Ätiologie möglich erscheinen. Der typische NSAR-sensible Nachtschmerz ist klinisch eindeutig und sollte an jeder Lokalität des Körpers an ein Osteoidosteom denken lassen. Auffällig ist das an den Zehen einzigartige Symptom der Makrodaktylie, was ein dankbarer Hinweis zur Diagnosefindung sein kann. Die mittlere Zeit vom Symptombeginn bis zur korrekten Diagnosestellung betrug 12 Monate. Häufig wurden Fehldiagnosen und Fehltherapien unter einer anderen Verdachtsdiagnose beschrieben. Eine mögliche Ursache ist die häufig atypische und uneindeutige Bildgebung. Die operative Therapie stellt bei Osteoidosteomen der Zehen die Methode der Wahl dar und sollte stets durch eine histopathologische Untersuchung ergänzt werden.
