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Medicine Dec 2023Recently, cone-beam computed tomography (CBCT)-guided surgeries have been developed for bone and soft tissue tumors. The present study aimed to evaluate the efficacy of...
Recently, cone-beam computed tomography (CBCT)-guided surgeries have been developed for bone and soft tissue tumors. The present study aimed to evaluate the efficacy of CBCT-guided curettage for osteoid osteoma. Our study population included 13 patients who underwent primary curettage for osteoid osteoma using intraoperative CBCT in a hybrid operating room between April 2019 and November 2022. We collected the following data: sex, age, follow-up period, symptom onset to time of surgery, tumor size and location, length of skin incision, operating time, radiation dose, recurrence, postoperative complications, and visual analog scale for pain during the last follow-up. There were 10 male and 3 female patients, and the mean age was 25.0 years (range, 9-49 years). The mean follow-up period was 10.6 months (range, 0.4-24.0 months). The locations of the tumors were the proximal femur in 6 patients, the acetabular region in 2 patients, and the ilium, tibial shaft, calcaneus, cuboid, and talus in 1 patient each. The mean time of symptoms onset to surgery was 18.7 months (range, 2.3-69.9 months). The mean maximum diameter of the tumor was 5.9 mm (range, 3.5-10.0 mm). The mean length of the skin incision was 2.2 cm (range, 1.5-3.5 cm). The mean operating time was 96.9 minutes (range, 64-157 minutes). The mean dose of radiation was 193.2 mGy (range, 16.3-484.0 mGy). No recurrences, postoperative complications, and reoperation were observed in this study. All the patients reported 0 mm on the visual analogue scale for pain on the last follow-up. CBCT-guided curettage for osteoid osteoma was minimally invasive and reliable. This procedure can be effective for the treatment of lesions found in deep locations such as the pelvic bone and proximal femur or an invisible lesion that cannot be detected by regular fluoroscopy.
Topics: Humans; Male; Female; Adult; Osteoma, Osteoid; Tomography, X-Ray Computed; Radiography, Interventional; Bone Neoplasms; Cone-Beam Computed Tomography; Pain; Talus; Postoperative Complications; Calcaneus; Treatment Outcome
PubMed: 38134085
DOI: 10.1097/MD.0000000000036747 -
Current Opinion in Otolaryngology &... Apr 2024Benign bony lesions of the craniofacial complex are relatively common. However, their location close to critical neurovascular structures may render their treatment, if... (Review)
Review
PURPOSE OF REVIEW
Benign bony lesions of the craniofacial complex are relatively common. However, their location close to critical neurovascular structures may render their treatment, if required, highly challenging.This article reviews the current literature on their pathophysiology, diagnosis, natural course and treatment, with a focus on most recent findings.
RECENT FINDINGS
A new classification has been suggested concerning endoscopic resectability. The ratio of lateral frontal to interorbital distance can accurately and reliably predict the endoscopic reach to lateral frontal sinus, while orbital transposition can assist us in reaching lateral frontal sinus when anatomy is unfavorable. New and combined endoscopic transnasal and transorbital approaches are now in the surgical armamentarium. Prophylactic optic nerve decompression in fibrous dysplasia is absolutely contraindicated as it leads to worse visual outcomes. Radiotherapy of such lesions is of no benefit and may lead to a higher risk of malignant transformation. The presence of Guanine Nucleotide binding protein Alpha Stimulating (GNAS) mutation in chromosome 20 is universally present in fibrous dysplasia and can differentiate them from ossifying fibromas.
SUMMARY
Diagnosis and therapeutic management of benign craniofacial bone lesions remains challenging. If surgical treatment is contemplated, the morbidity of the intervention should always be weighed against the potential benefits. Evolution of extended endoscopic endonasal and transorbital surgery means that more lesions can be reached purely endoscopically with better oncological and cosmetic results.
Topics: Humans; Paranasal Sinuses; Skull Base; Fibroma, Ossifying; Endoscopy; Frontal Sinus; Osteoma
PubMed: 38116853
DOI: 10.1097/MOO.0000000000000955 -
Retinal Cases & Brief Reports Nov 2023To describe a case of a previously healthy middle-aged male with an atypical choroidal mass and fatigue.
PURPOSE
To describe a case of a previously healthy middle-aged male with an atypical choroidal mass and fatigue.
METHODS
Case report.
RESULTS
A 56-year-old Caucasian male presented with decreased vision in the right eye (OD) and a choroidal amelanotic mass OD with subretinal fluid. He received bevacizumab (1.25 mg/0.05 mL) injections by multiple providers without improvement in vision and with tumor progression. Visual acuity was 20/400 OD and 20/25 left eye (OS). The anterior segment was unremarkable in both eyes (OU). He was referred with suspected diagnosis of choroidal melanoma, metastasis, or osteoma. On examination, a choroidal amelanotic tumor with vermiform margins measuring 12 mm in base and 1.8 mm in thickness was seen OD. Smaller satellite lesions were noted inferiorly. Fundus OS was normal. Infectious evaluation was unrevealing and angiotensin-converting enzyme, lysozyme, and chest x-ray were normal. Fine-needle aspiration biopsy was declined by the patient. Given the clinical suspicion of choroidal sarcoidosis with characteristic tumor color, vermiform margins, and presence of satellite lesions, oral corticosteroids 60 mg/day for 2 months were started, followed by sub-Tenons triamcinolone acetonide (40mg/1 mL) injection three months later and urgent rheumatologic evaluation. He self-discontinued the oral corticosteroids and the tumor progressed by the next follow-up. Oral corticosteroids were restarted at 80mg/day. 16 months after his presentation to us, he experienced fatigue with electrocardiogram findings of third-degree heart block from sarcoidosis. He received an intracardiac defibrillator and 80 mg/day of corticosteroids with plans to initiate methotrexate for stronger immunosuppression.
CONCLUSION
Understanding the numerous manifestations of ocular and systemic sarcoidosis is crucial. Choroidal sarcoidosis characteristically exhibits vermiform margins. Close follow-up and systemic monitoring is necessary in patients presenting with ocular signs of sarcoidosis.
PRECIS
The diagnosis of choroidal sarcoidosis can be challenging. Features including vermiform tumor margins, satellite lesions, and choroidal infiltration on OCT are suggestive of choroidal sarcoidosis. All patients with ocular sarcoidosis should be monitored for systemic involvement. In this case, the ocular manifestation guided the diagnosis and eventually the treatment of cardiac sarcoidosis.
PubMed: 38113278
DOI: 10.1097/ICB.0000000000001507 -
Cureus Nov 2023Osteoid osteoma is the most common benign osteogenic bone neoplasm. Osteoid osteomas are typically located in the metaphysis and diaphysis of long bones, especially the...
Osteoid osteoma is the most common benign osteogenic bone neoplasm. Osteoid osteomas are typically located in the metaphysis and diaphysis of long bones, especially the tibia and femur. However, less common sites of the skeleton can be affected as well, including carpal bones. Among carpal bones, the scaphoid and the capitate are the most affected. Osteoid osteoma of the trapezium is an extremely rare entity, with only seven cases reported in recent literature. We present a case of a 29-year-old male with persistent left wrist pain who was diagnosed with an osteoid osteoma of the trapezium bone. The diagnosis was based on the patient's history, clinical examination and findings from the CT scan, MRI, and plain radiographs. The patient was treated with an excision biopsy with no additional bone grafting. After a follow-up period of 12 months, no pain or signs of recurrence were present. We conducted a literature review to elucidate the clinical presentation as well as the proper diagnostic tools and therapeutic methods for this rare occurrence.
PubMed: 38106747
DOI: 10.7759/cureus.48889 -
European Review For Medical and... Dec 2023Visfatin is currently a cytokine that is extensively researched in the field of bone diseases. In this prospective study, we aimed to investigate the potential of serum...
OBJECTIVE
Visfatin is currently a cytokine that is extensively researched in the field of bone diseases. In this prospective study, we aimed to investigate the potential of serum visfatin levels as a biomarker for the diagnosis of osteoid osteoma.
PATIENTS AND METHODS
This study included a cohort of 20 patients diagnosed with osteoid osteoma (Group 1) and 30 healthy individuals (Group 2). The age, gender, cyst sizes, and visfatin values of all participants were documented and analyzed.
RESULTS
There was a significant difference in visfatin levels between the two groups. The median visfatin level in Group 1 was 6.13 ng/ml (IQR: 4.21-8.08), while in Group 2, it was 15.83 ng/ml (IQR: 11.11-20.6). The difference was statistically significant (p<0.000). The optimal cut-off value for visfatin was found to be 7.74 ng/ml, which had a 93% sensitivity and 78% specificity. An area under the curve of receiver operating characteristic (ROC) analysis of 0.85 indicates good diagnostic performance.
CONCLUSIONS
Our study revealed a significant decrease in visfatin levels among patients diagnosed with osteoid osteomas in comparison to the healthy control group. The ROC analysis revealed that visfatin exhibited a commendable diagnostic capacity, indicating its potential utility as a biomarker for osteoid osteoma.
Topics: Humans; Biomarkers; Bone Neoplasms; Cytokines; Nicotinamide Phosphoribosyltransferase; Osteoma, Osteoid; Prospective Studies
PubMed: 38095401
DOI: 10.26355/eurrev_202312_34592 -
Retinal Cases & Brief Reports Dec 2023To describe a case of choroidal osteoma with macular involvement in an infant that was treated with transpupillary thermotherapy.
PURPOSE
To describe a case of choroidal osteoma with macular involvement in an infant that was treated with transpupillary thermotherapy.
METHODS
A case report.
RESULTS
An 11-month-old infant presented for retinopathy of prematurity follow up examination and was found to have a three disc-diameter round, orange, subretinal, slightly elevated lesion with well-defined margins in the superior macula of the left eye. B-scan ultrasonography showed a slightly elevated, highly reflective choroidal mass with acoustic shadowing. A diagnosis of choroidal osteoma was made. Six months later, repeat examination under anesthesia (EUA) showed the lesion to be increasing in size and encroaching on the fovea. Given demonstrated growth and the risk of central vision loss, the patient was treated with transpupillary thermotherapy (TTT). Subsequent EUAs, over a period of four months, have shown complete decalcification with no subsequent growth.
CONCLUSION
Choroidal osteomas are benign lesions that can be sight threatening if located in the macula. TTT in this case resulted in complete regression of a sight threatening extrafoveal choroidal osteoma at four month follow up.
PubMed: 38091609
DOI: 10.1097/ICB.0000000000001526 -
World Journal of Clinical Cases Nov 2023Forehead osteoma is a commonly encountered benign facial bone tumor. Endoscopic excision of benign forehead masses is widely performed. Here, we report a rare case of...
BACKGROUND
Forehead osteoma is a commonly encountered benign facial bone tumor. Endoscopic excision of benign forehead masses is widely performed. Here, we report a rare case of recurrent forehead osteoma that disseminated after a previous osteoma excision.
CASE SUMMARY
A 54-year-old female patient had previously undergone endoscopic removal of a single forehead osteoma at 30 years of age. However, she had a recurrent osteoma around the same site and underwent another endoscopic resection at 40 years of age. During her first visit to our outpatient clinic, she presented with a cobblestone-like irregular surface on the forehead and a 3D facial bone computed tomography scan revealed a widely ragged surface of the inoculated osteoma on the outer table of the frontal bone. Under general anesthesia, we performed a radical complete excision of the disseminated osteoma through a bicoronal incision using an osteotome, chisel, mallet, and rasping. We hypothesized that the recurrence may have been caused by the inoculation of residual osteoma remnants from the previous procedure. Craniofacial surgeons should be cautious when removing osteoma particles, particularly when using an endoscopic approach.
CONCLUSION
To prevent recurrence, it is essential to conduct additional meticulous burring and a thorough inspection of the surface after copious irrigation.
PubMed: 38078123
DOI: 10.12998/wjcc.v11.i31.7684 -
Journal of Family Medicine and Primary... Oct 2023We report a very rare case of 35-year-old female with a giant mandibular osteoma in the angle of the mandible. We highlight the importance of CT in diagnosing as well as...
We report a very rare case of 35-year-old female with a giant mandibular osteoma in the angle of the mandible. We highlight the importance of CT in diagnosing as well as defining the extent of this rare case so that proper management can be undertaken. We also showcase the importance of angiography to show relationship of this mass with the surrounding vessels.
PubMed: 38074223
DOI: 10.4103/jfmpc.jfmpc_2343_21 -
Cureus Nov 2023Osteoid osteoma (OO) is a common benign tumor that tends to affect children and young adults. Patients typically present with nocturnal pain that is relieved with...
Osteoid osteoma (OO) is a common benign tumor that tends to affect children and young adults. Patients typically present with nocturnal pain that is relieved with non-steroidal anti-inflammatory drugs (NSAIDs) and a unique round or oval radiolucent area with surrounding sclerotic bone on X-ray. The cortex of the diaphysis or metaphysis of long bones is the usual anatomical location, with only 4% of cases localizing to the foot and ankle. Treatment options include medical management, surgical excision, and less invasive techniques such as radiofrequency ablation (RFA). We present a case report of a 21-year-old female with an osteoid osteoma of the calcaneus, a rare presentation for this type of tumor. She was successfully treated with RFA and had an excellent functional outcome.
PubMed: 38074005
DOI: 10.7759/cureus.48521 -
Annals of Dermatology Nov 2023
PubMed: 38061755
DOI: 10.5021/ad.22.120