Osteoid Osteoma: Difference between revisions
No edit summary |
No edit summary |
||
| Line 10: | Line 10: | ||
== Prevalence == | == Prevalence == | ||
Osteoid osteomas account for 1/8 to 1/10 of symptomatic bone tumors and 5% of all primary bone tumors.< | Osteoid osteomas account for 1/8 to 1/10 of symptomatic bone tumors and 5% of all primary bone tumors.<ref name="Lenke">Lenke LG, Sutherland CJ, Gilula LA. Osteoid osteoma of the proximal femur: CT-guided preoperative localization. Orthopedics. Mar 1994;17(3):289-92</ref> <br> | ||
Osteoid osteomas occur in children and young adults between the ages of 7 and 25. This type of bone tumor also occurs two to three times more often in males than in females.< | Osteoid osteomas occur in children and young adults between the ages of 7 and 25. This type of bone tumor also occurs two to three times more often in males than in females.<ref name="Goodman">Goodman, Snyder. ''Differential Diagnosis for Physical Therapists: Screening for Referral. ''St. Louis, Missouri: Saunders Elsevier; 2007. </ref> | ||
== Characteristics/Clinical Presentation<br> == | == Characteristics/Clinical Presentation<br> == | ||
This type of tumor is commonly found in the diaphysis of long bones (proximal femur), hands and feet, and posterior elements of the spine (lamina and spinouse processes).< | This type of tumor is commonly found in the diaphysis of long bones (proximal femur), hands and feet, and posterior elements of the spine (lamina and spinouse processes).<ref name="Goodman"> | ||
Clinical presentation is typically pain in the area of the tumor described as a dull ache, pain that is worse at night, increased skin temperature, sweating and tenderness to palpation of the localized area. Pain is relieved by salicylates or aspirin. <sup>6,7<br></sup> | Clinical presentation is typically pain in the area of the tumor described as a dull ache, pain that is worse at night, increased skin temperature, sweating and tenderness to palpation of the localized area. Pain is relieved by salicylates or aspirin. <sup>6,7<br></sup> | ||
{{#ev:youtube|ZVNw6P_kfac}} | {{#ev:youtube|ZVNw6P_kfac|200}} | ||
Ninety percent of cases occur in patients younger than 25 years so osteoid osteomas can easily be mis-diagnosed as a musculoskeletal disorder because when someone in their twenties reports pain, the vast majority of people assume the pain is musculoskeletal in nature.< | Ninety percent of cases occur in patients younger than 25 years so osteoid osteomas can easily be mis-diagnosed as a musculoskeletal disorder because when someone in their twenties reports pain, the vast majority of people assume the pain is musculoskeletal in nature.<ref name="Lenke"/> The true diagnosis is so easily overl ooked because epiphyseal lesions mimic intra-articular derangement and pain is typically localized to the site of the lesion, so the location of pain can be anywhere, and may coincide with common sites of musculoskeletal inflammation or strain.<ref name="Atar">Atar D, Lehman WB, Grant AD. Tips of the trade. Computerized tomography--guided excision of osteoid osteoma. Orthop Rev. Dec 1992;21(12):1457-8</ref>. Another reason diagnosis is easily misled is that pain usually occurs before the lesions are visible on radiographs and in the early stages can be easily missed on a radiograph.<ref name="Pettine">Pettine KA, Klassen RA. Osteoid-osteoma and osteoblastoma of the spine. J Bone Joint Surg Am. Mar 1986;68(3):354-61. </ref> Finally, these lesions may be associated with proliferative synovitis due to prostaglandin secretion that decreases range of motion, creates joint effusion, and can mimic inflammatory arthritis.<ref name="Frassica">Frassica FJ, Waltrip RL, Sponseller PD, et al. Clinicopathologic features and treatment of osteoid osteoma and osteoblastoma in children and adolescents. Orthop Clin North Am. Jul 1996;27(3):559-74. </ref> | ||
== Associated Comorbidities<br> == | == Associated Comorbidities<br> == | ||
| Line 30: | Line 30: | ||
== Medications == | == Medications == | ||
Pain caused by osteoid osteomas can be relieved with aspirin and NSAIDS, which inhibit the prostraglandins released by the tumor cells. Prostaglandins cause changes in vascular pressure, which stimulates sensory nerve endings locally, causing pain. Inhibition of these prostaglandins relieves pain.< | Pain caused by osteoid osteomas can be relieved with aspirin and NSAIDS, which inhibit the prostraglandins released by the tumor cells. Prostaglandins cause changes in vascular pressure, which stimulates sensory nerve endings locally, causing pain. Inhibition of these prostaglandins relieves pain.<ref name="Goodman">7</sup> | ||
== Diagnostic Tests/Lab Tests/Lab Values == | == Diagnostic Tests/Lab Tests/Lab Values == | ||
| Line 38: | Line 38: | ||
[http://www.uhrad.com/msiarc/msi084.htm www.uhrad.com/msiarc/msi084.htm] | [http://www.uhrad.com/msiarc/msi084.htm www.uhrad.com/msiarc/msi084.htm] | ||
An osteoid osteoma can also be detected with bone scan, or scintigraphy, which will show a focal uptake of the radiotracer by the tumor.<sup></sup>Scintigraphy is often used to detect an osteoid osteoma that is not easily seen on a radiograph, such as a vertebral tumor.< | An osteoid osteoma can also be detected with bone scan, or scintigraphy, which will show a focal uptake of the radiotracer by the tumor.<sup></sup>Scintigraphy is often used to detect an osteoid osteoma that is not easily seen on a radiograph, such as a vertebral tumor.<ref name="Goodman"> | ||
Osteoid osteomas can be detected on an MRI and CT scan, which are often used to identify the location of the nidus when the tumor is intra-articular. A CT scan will reveal the nidius as a small area of low attenuation surrounded by reactive bone formation, seen as a larger area of higher attenuation.< | Osteoid osteomas can be detected on an MRI and CT scan, which are often used to identify the location of the nidus when the tumor is intra-articular. A CT scan will reveal the nidius as a small area of low attenuation surrounded by reactive bone formation, seen as a larger area of higher attenuation.<ref name="Goodman and Fuller"> | ||
== Causes | == Causes / == | ||
An ostoid osteoma is a vascular lesion consisting of an area of immature bone surrounded by osteoblasts and osteoclasts. The tumor starts with the nidus, or nest of vascular osteoid tissue in the center of the tumor. The nidus then becomes surrounded by reactive bone sclerosis. After the removal of the nidus, the secondary bone sclerosis generally disappears gradually.< | An ostoid osteoma is a vascular lesion consisting of an area of immature bone surrounded by osteoblasts and osteoclasts. The tumor starts with the nidus, or nest of vascular osteoid tissue in the center of the tumor. The nidus then becomes surrounded by reactive bone sclerosis. After the removal of the nidus, the secondary bone sclerosis generally disappears gradually.<ref name="Goodman and Fuller">Goodman CG, Fuller KS. ''Pathology: Implications for the Physical Thearpist, 3rd Edition.'' St. Louis, Missouri: Saunders Elsevier; 2009. | ||
== Systemic Involvement == | == Systemic Involvement == | ||
Systemic involvement is uncommon with an osteoid osteoma.< | Systemic involvement is uncommon with an osteoid osteoma.<ref name="Goodman and Fuller" /> | ||
== Medical Management (current best evidence) == | == Medical Management (current best evidence) == | ||
| Line 72: | Line 72: | ||
1) Lenke LG, Sutherland CJ, Gilula LA. Osteoid osteoma of the proximal femur: CT-guided preoperative localization. Orthopedics. Mar 1994;17(3):289-92 | 1) Lenke LG, Sutherland CJ, Gilula LA. Osteoid osteoma of the proximal femur: CT-guided preoperative localization. Orthopedics. Mar 1994;17(3):289-92 | ||
2) | 2) | ||
3) | |||
3) | |||
4) Frassica FJ, Waltrip RL, Sponseller PD, et al. Clinicopathologic features and treatment of osteoid osteoma and osteoblastoma in children and adolescents. Orthop Clin North Am. Jul 1996;27(3):559-74. | 4) Frassica FJ, Waltrip RL, Sponseller PD, et al. Clinicopathologic features and treatment of osteoid osteoma and osteoblastoma in children and adolescents. Orthop Clin North Am. Jul 1996;27(3):559-74. | ||
5) | 5) - | ||
<br>[http://emedicine.medscape.com/article/392850-media emedicine.medscape.com/article/392850-media] | <br>[http://emedicine.medscape.com/article/392850-media emedicine.medscape.com/article/392850-media] | ||
| Line 84: | Line 83: | ||
6) Goodman, Snyder. ''Differential Diagnosis for Physical Therapists: Screening for Referral. ''St. Louis, Missouri: Saunders Elsevier; 2007. | 6) Goodman, Snyder. ''Differential Diagnosis for Physical Therapists: Screening for Referral. ''St. Louis, Missouri: Saunders Elsevier; 2007. | ||
7) | 7) | ||
[[Category:Articles]] [[Category:Condition]] [[Category:Oncology]] [[Category:Bellarmine_Student_Project]] [[Category:Videos]] | [[Category:Articles]] [[Category:Condition]] [[Category:Oncology]] [[Category:Bellarmine_Student_Project]] [[Category:Videos]] | ||
Revision as of 10:42, 27 August 2010
Original Editors - Michelle Quill from Bellarmine University's Pathophysiology of Complex Patient Problems project.
Lead Editors - Your name will be added here if you are a lead editor on this page. Read more.
Definition/Description[edit | edit source]
Benign osteoblastic tumor consisting of vascular osteoid tissue centrally and sclerotic bone peripherally. This type of tumor is commonly found in the diaphysis of long bones such as the femur (more than 50% of cases). This type of tumor can also occur more rarely in the bones of the hands, feet, and posterior spine.6,7
Prevalence[edit | edit source]
Osteoid osteomas account for 1/8 to 1/10 of symptomatic bone tumors and 5% of all primary bone tumors.[1]
Osteoid osteomas occur in children and young adults between the ages of 7 and 25. This type of bone tumor also occurs two to three times more often in males than in females.[2]
Characteristics/Clinical Presentation
[edit | edit source]
This type of tumor is commonly found in the diaphysis of long bones (proximal femur), hands and feet, and posterior elements of the spine (lamina and spinouse processes).Cite error: Closing </ref> missing for <ref> tag. Another reason diagnosis is easily misled is that pain usually occurs before the lesions are visible on radiographs and in the early stages can be easily missed on a radiograph.[3] Finally, these lesions may be associated with proliferative synovitis due to prostaglandin secretion that decreases range of motion, creates joint effusion, and can mimic inflammatory arthritis.[4]
Associated Comorbidities
[edit | edit source]
None
Medications[edit | edit source]
Pain caused by osteoid osteomas can be relieved with aspirin and NSAIDS, which inhibit the prostraglandins released by the tumor cells. Prostaglandins cause changes in vascular pressure, which stimulates sensory nerve endings locally, causing pain. Inhibition of these prostaglandins relieves pain.<ref name="Goodman">7
Diagnostic Tests/Lab Tests/Lab Values[edit | edit source]
Radiograph reveals a well demarcated area of translucency (nidus) inside the bone, often times with a central calcified dot. This is surrounded by bony sclerosis. Usually less than 1 cm in size.5
www.uhrad.com/msiarc/msi084.htm
An osteoid osteoma can also be detected with bone scan, or scintigraphy, which will show a focal uptake of the radiotracer by the tumor.Scintigraphy is often used to detect an osteoid osteoma that is not easily seen on a radiograph, such as a vertebral tumor.<ref name="Goodman">
Osteoid osteomas can be detected on an MRI and CT scan, which are often used to identify the location of the nidus when the tumor is intra-articular. A CT scan will reveal the nidius as a small area of low attenuation surrounded by reactive bone formation, seen as a larger area of higher attenuation.<ref name="Goodman and Fuller">
Causes /[edit | edit source]
An ostoid osteoma is a vascular lesion consisting of an area of immature bone surrounded by osteoblasts and osteoclasts. The tumor starts with the nidus, or nest of vascular osteoid tissue in the center of the tumor. The nidus then becomes surrounded by reactive bone sclerosis. After the removal of the nidus, the secondary bone sclerosis generally disappears gradually.<ref name="Goodman and Fuller">Goodman CG, Fuller KS. Pathology: Implications for the Physical Thearpist, 3rd Edition. St. Louis, Missouri: Saunders Elsevier; 2009.
Systemic Involvement[edit | edit source]
Systemic involvement is uncommon with an osteoid osteoma.[5]
Medical Management (current best evidence)[edit | edit source]
Treatment options include medical management with NSAIDs, surgical excision (wide/enbloc excision or curetting), or the use of CT- or MRI-guided minimally invasive procedures including core drill excision, laser photocoagulation, or radiofrequency ablation. For many years, complete surgical excision was the classic treatment of osteomas, usually performed in patients with pain despite medical management.
Physical Therapy Management (current best evidence)[edit | edit source]
None
Alternative or Holistic Management (current best evidence)[edit | edit source]
None
Case Reports[edit | edit source]
www.uhrad.com/msiarc/msi084.htm
Resources
[edit | edit source]
1) Lenke LG, Sutherland CJ, Gilula LA. Osteoid osteoma of the proximal femur: CT-guided preoperative localization. Orthopedics. Mar 1994;17(3):289-92
2) 3)
4) Frassica FJ, Waltrip RL, Sponseller PD, et al. Clinicopathologic features and treatment of osteoid osteoma and osteoblastoma in children and adolescents. Orthop Clin North Am. Jul 1996;27(3):559-74.
5) -
emedicine.medscape.com/article/392850-media
6) Goodman, Snyder. Differential Diagnosis for Physical Therapists: Screening for Referral. St. Louis, Missouri: Saunders Elsevier; 2007.
7)
- ↑ Lenke LG, Sutherland CJ, Gilula LA. Osteoid osteoma of the proximal femur: CT-guided preoperative localization. Orthopedics. Mar 1994;17(3):289-92
- ↑ Goodman, Snyder. Differential Diagnosis for Physical Therapists: Screening for Referral. St. Louis, Missouri: Saunders Elsevier; 2007.
- ↑ Pettine KA, Klassen RA. Osteoid-osteoma and osteoblastoma of the spine. J Bone Joint Surg Am. Mar 1986;68(3):354-61.
- ↑ Frassica FJ, Waltrip RL, Sponseller PD, et al. Clinicopathologic features and treatment of osteoid osteoma and osteoblastoma in children and adolescents. Orthop Clin North Am. Jul 1996;27(3):559-74.
- ↑ Cite error: Invalid
<ref>tag; no text was provided for refs namedGoodman and Fuller
