-
Skeletal Radiology Apr 2024Papillary intralymphatic angioendothelioma (PILA) is an exceptionally rare metastasizing soft tissue tumor. It tends to arise in the subcutaneous tissues of distal...
INTRODUCTION
Papillary intralymphatic angioendothelioma (PILA) is an exceptionally rare metastasizing soft tissue tumor. It tends to arise in the subcutaneous tissues of distal extremities in children. Only four intraosseous PILA cases have been reported until now in English language literature.
CASE REPORT
We present a case of PILA arising in the distal femoral epiphysis of a 50-year-old female patient. It started as a relentless pain in her left knee. A plain radiography revealed a radiolucent area in the left internal femoral condyle. Computerized tomography revealed a 1-cm lytic lesion with a sclerotic rim. Magnetic resonance images showed a significant bone marrow edema signal focused on a 1-cm subchondral lesion suggestive of an intraarticular osteoid osteoma. Histologically, the tumor contained vascular channels covered by a single endothelial layer with intraluminal papillary endothelial structures lined with hobnail cells. Immunohistochemically, the cells were positive for ERG, CD31, and D2-40. The tumor underwent cryoablation and 6 months later, after local recurrence or tumor persistence, a wide tumor resection was referred. After 7 years of follow-up, the patient displayed neither local recurrence nor distant metastases.
CONCLUSION
Primary intraosseous PILAs are exceedingly rare tumors that should be considered in the differential diagnosis of vascular bone tumors.
PubMed: 38619614
DOI: 10.1007/s00256-024-04674-8 -
Journal of the American Podiatric... Apr 2024Osteoid osteoma is a benign tumor of the bone which tends to occur in diaphysis or metaphysis of the long bones. The lesion is generally intraosseous with vague clinical...
Osteoid osteoma is a benign tumor of the bone which tends to occur in diaphysis or metaphysis of the long bones. The lesion is generally intraosseous with vague clinical symptoms, hence given the name "great mimicker". When located subperiosteally and juxtaarticulary, atypical clinical presentation and radiological may lead to a delayed or missed diagnosis. Performing surgery with a misdiagnosis carries the risk of incomplete resection of the lesion and recurrence. We report the case of a 15-year-old male with a subperiosteal osteoid osteoma of the talus, who was misdiagnosed with pigmented villonodular synovitis and operated through anterior ankle arthrotomy. A nodular lesion 1 cm in diameter with hard rubber consistency was removed from the dorsal aspect of the talar neck. The pathological specimens were consistent with subperiosteal osteoid osteoma. The patient's symptoms resolved rapidly in the early postoperative period. The patient remained asymptomatic at the 20th-month follow-up and the control MRI revealed no signs of recurrence. Atypical radiological and clinical presentation of juxtaarticular subperiosteal osteoid osteomas cause misdiagnosis, delay in diagnosis, incomplete resection and recurrence. It is important to keep in mind "juxtaarticular subperiosteal osteoid osteoma" in the differential diagnosis of cases with suspected Pigmented Villonodular Synovitis.
PubMed: 38573837
DOI: 10.7547/23-006 -
BMJ Case Reports Apr 2024Osteoid osteoma is a benign osteoblastic tumour with a predilection for the lower extremity that rarely affects the forearm. It is commonly seen in adolescents and young...
Osteoid osteoma is a benign osteoblastic tumour with a predilection for the lower extremity that rarely affects the forearm. It is commonly seen in adolescents and young adults, and is seldom diagnosed in the paediatric age group. We report a boy in his early childhood who presented with a swelling over the distal forearm, which was incidentally noted by the mother 3 months ago. Plain radiographs showed diffuse sclerosis of the dorsal cortex of the distal radius. CT scan showed a central lucent nidus in the intramedullary region and surrounding sclerosis in the radial metaphysis, confirming the diagnosis of osteoid osteoma. The patient was successfully treated by surgical en bloc resection of the nidus and was asymptomatic at 1-year follow-up. Non-specific symptoms at presentation make it a challenge to diagnose osteoid osteoma in children and it needs to be considered in the differential diagnosis when radiographs show lytic lesions in the bone.
Topics: Male; Young Adult; Adolescent; Humans; Child, Preschool; Child; Osteoma, Osteoid; Radius; Sclerosis; Bone Neoplasms; Ulna
PubMed: 38569739
DOI: 10.1136/bcr-2024-259712 -
Orthopaedic Surgery May 2024Percutaneous CT-guided radiofrequency ablation (CT-RFA) is a widely accepted procedure for treatment of osteoid osteomas. However, the application of CT-RFA was...
OBJECTIVE
Percutaneous CT-guided radiofrequency ablation (CT-RFA) is a widely accepted procedure for treatment of osteoid osteomas. However, the application of CT-RFA was restricted as a result of some drawbacks, such as radiation exposure, and inconvenience in general anesthesia. The primary aim of this study is to evaluate the safety and efficacy of intra-operative TiRobot-assisted percutaneous RFA of osteoid osteomas.
METHODS
We retrospectively reviewed 21 medical files of patients who were treated with percutaneous RFA of osteoid osteomas guided by the TiRobot system in our institution between March 2021 and April 2022. The three-dimensional images obtained by a 3D C-arm intra-operatively were sent to the TiRobot system. The puncture point and trajectory were designed. Then the guide pin was positioned to the lesion with the assistance of TiRobot and the biopsy sheath was inserted into the lesion through the guide pin. The tumor was biopsied for pathological examination. Then the RFA needle was inserted into the nidus through the biopsy sheath for thermal ablation. Data were extracted on the associated complications, the reduction in pain at 1 month and 1 year postoperatively assessed by the visual analogue scale (VAS). A paired t-test was used to compare the pre-operative and post-operative VAS scores.
RESULTS
The patients included 17 males and four females with a mean age of 19.5 ± 10.4 years (range 3-45 years). Lesions were located on the femur in nine cases, on the tibia in nine cases, on the humerus in one case, on the calcaneus in one case, and on the acetabulum in one case. TiRobot-assisted percutaneous RFA was successfully performed on all 21 patients. There was no intra-operative or post-operative complications observed. Pathological diagnosis of osteoid osteoma was obtained in 11 patients, but the other 10 cases were not pathologically diagnosed. The mean follow-up time was 18.8 months (range: 12-26 months).Post-operative VAS scores were reduced significantly in all cases. The mean VAS score decreased from 6.5 pre-operatively to 0.5 at 1 month post-operatively and to 0.1 at 1 year post-operatively.
CONCLUSION
As a reliable technique for localizing and resection of nidus, TiRobot-assisted percutaneous RFA is a safe and effective option for the treatment of osteoid osteomas.
Topics: Humans; Osteoma, Osteoid; Male; Retrospective Studies; Radiofrequency Ablation; Female; Adolescent; Bone Neoplasms; Robotic Surgical Procedures; Child; Young Adult; Adult; Tomography, X-Ray Computed; Pain Measurement; Middle Aged; Surgery, Computer-Assisted
PubMed: 38556479
DOI: 10.1111/os.14043 -
Indian Journal of Surgical Oncology Mar 2024In this narrative review, we aim to describe the clinical features, diagnosis, and management of common primary osseous tumors affecting the posterior elements of the... (Review)
Review
In this narrative review, we aim to describe the clinical features, diagnosis, and management of common primary osseous tumors affecting the posterior elements of the spine in children. We searched PubMed, Mendeley, and Google Scholar using the terms primary osseous tumors of the spine in children, tumors of the posterior elements of the spine, and names of individual tumors. The clinical features, investigations, and treatment modalities were analyzed, and a narrative review of the topic was prepared. We have included 54 studies published in the last 20 years. The majority are isolated reports or case series. Tumors of the posterior elements of the spine are rare. They are common in children and the majority of them are benign. Pain and deformity are common presentations. It is better to perform thorough investigations of children complaining of back pain to rule out primary tumors of the posterior elements of the spine.
PubMed: 38545585
DOI: 10.1007/s13193-023-01729-5 -
Insights Into Imaging Mar 2024We aim to evaluate the efficacy of CT-guided percutaneous radiofrequency ablation (RFA) and surgical treatment in osteoid osteoma (OO) treated at the Medical University...
A comparative study assessing the efficacy and safety of radiofrequency ablation versus surgical treatment for osteoid osteoma: retrospective analysis in a single institution.
OBJECTIVE
We aim to evaluate the efficacy of CT-guided percutaneous radiofrequency ablation (RFA) and surgical treatment in osteoid osteoma (OO) treated at the Medical University of Graz.
MATERIALS AND METHODS
In a single-institution study, we analysed data from January 2005 to January 2021 of patients with histological/radiological diagnosis of OO. CT and MRI scans were reviewed for typical findings. Means (with SD) and medians (with IQR) were reported for normally and non-normally distributed variables. Differences between groups were assessed using chi-squared tests and t-tests.
RESULTS
One hundred nineteen patients (mean age: 21.6 ± 10.9 years; 63.9% males) with confirmed OO were retrospectively evaluated. 73 and 43 patients underwent RFA and surgery, respectively. In three cases, RFA combined with surgery was performed. Pre-intervention, 103 patients (88.8%) had undergone CT, and 101 had an MRI (87.1%). The nidus was confirmed in 82.5% of cases with CTs (85/103) and 63.4% with MRIs (64/101). The majority of nidi were located cortically (n = 96; 82.8%), most frequently in the femur (38 patients, 33.3%) with a median size of 8.0 mm (IQR: 5.0-12.0 mm). Median symptom duration before treatment was 6.0 (IQR: 4.0-13.0) months. The complication rate was 12.1% (14/116; 15.1% RFA vs. 7.0% surgery; p = 0.196). In total, 11.2% of patients had persistent symptoms after one week with clinical success rates of RFA and surgery, 86.3% and 90.7% (p = 0.647), respectively.
CONCLUSION
Compared to surgical treatment, CT-guided percutaneous RFA is a safe, minimally invasive, reliable, and efficient treatment option for OO.
CRITICAL RELEVANCE STATEMENT
This article critically assesses the diagnosis and treatment of osteoid osteoma, emphasising accurate imaging, and detailing a non-invasive option for effective management.
KEY POINTS
• This study analyses 116 cases of OO at one institution, focusing on symptom persistence, recurrence in short-term follow-up, and complications in two study groups. • Surgery showed higher, though not statistically significant, success despite comparable symptom persistence; CT displayed typical OO features more than MRI, regardless of the intramedullary, cortical and subperiosteal location as well as the site of the affected bone. • CT-guided RFA is an effective therapeutic alternative for OO compared to surgical intervention. In case of atypical OO appearance, RFA is not the first-line treatment.
PubMed: 38517657
DOI: 10.1186/s13244-024-01656-1 -
Academic Radiology Mar 2024The aim of the current study was to evaluate the feasibility and effectiveness of CT-guided microwave ablation (MWA) in the treatment of osteoid osteomas (OO).
RATIONALE AND OBJECTIVES
The aim of the current study was to evaluate the feasibility and effectiveness of CT-guided microwave ablation (MWA) in the treatment of osteoid osteomas (OO).
MATERIALS AND METHODS
Data from 59 consecutive patients who underwent percutaneous CT-MWA for OO treatment were examined in the current retrospective study. The period of this study spanned from January 2021 to May 2023 at a single institution. The study involved an evaluation of clinical and radiological characteristics, procedural data, Visual Analog Scale (VAS) pain scores, complication incidences, as well as clinical and technical success rates. Statistical analyses were performed by using the Wilcoxon test with Bonferroni correction, Friedman, Spearman, Mann-Whitney U test.
RESULTS
59 patients with an average age of 17.31 ± 8.53 years underwent CT-guided MWA for the treatment of OO. The procedure demonstrated a high success rate, with 96.6% of cases achieving both technical and clinical success. However, recurrence was observed in two patients (3.4%) at the three-month follow-up. These cases were successfully managed with a second MWA procedure. The median VAS pain scores reported by the patients was significantly improved post-procedure: from 8.64 ± 1.14 before treatment to 0.63 ± 0.98 in the first month, 0.41 ± 1.02 in the third month, and 0.15 ± 0.45 in the sixth month. Only one patient (1.7%) experienced a minor complication; no major complications were recorded in this study.
CONCLUSION
CT-guided percutaneous MWA is a minimally invasive and a highly effective and safe approach for the treatment of OO.
PubMed: 38490842
DOI: 10.1016/j.acra.2024.02.025 -
BMJ Case Reports Mar 2024A young male in his mid-teen years presented with severe back pain for 3 months and was subsequently diagnosed with osteoid osteoma in the left superior articular...
A young male in his mid-teen years presented with severe back pain for 3 months and was subsequently diagnosed with osteoid osteoma in the left superior articular process of the L4 vertebra. Initial treatment with non-steroidal anti-inflammatory drugs provided temporary relief. Due to concerns about scoliosis progression along with unrelieved pain, a multidisciplinary team recommended endoscopic excision of the osteoid osteoma. The procedure resulted in complete pain relief and an improvement in the scoliosis curve from 22° of Cobb's angle to 12 degrees at the 8-month follow-up.
Topics: Adolescent; Humans; Male; Osteoma, Osteoid; Scoliosis; Tomography, X-Ray Computed; Pain; Bone Neoplasms
PubMed: 38453226
DOI: 10.1136/bcr-2023-258346 -
Oral and Maxillofacial Surgery Clinics... Aug 2024This article provides a comprehensive overview of benign non-odontogenic pathologies. Bone-derived lesions like osteoma, osteoid osteoma, osteoblastoma, and... (Review)
Review
This article provides a comprehensive overview of benign non-odontogenic pathologies. Bone-derived lesions like osteoma, osteoid osteoma, osteoblastoma, and osteochondroma are discussed in detail, emphasizing their radiographic features, locations, and treatment strategies. Cartilage-derived lesions such as chondroma, chondroblastoma, and chondromyxoid fibroma are also examined, noting their typical presentation and management approaches. The article then delves into fibroconnective tissue lesions. Mesenchymal and vascular lesions are detailed regarding their clinical and radiographic characteristics and treatment options. Lastly, nerve-derived lesions like schwannoma and neurofibroma are covered, providing insights into their association with diseases like neurofibromatosis and preferred management strategies.
Topics: Humans; Child; Bone Neoplasms
PubMed: 38402139
DOI: 10.1016/j.coms.2024.01.007 -
Diagnostic and Interventional Imaging Apr 2024
Topics: Humans; Sarcoma; Soft Tissue Neoplasms; Hemangioma; Hemangioendothelioma; Biomarkers, Tumor
PubMed: 38388250
DOI: 10.1016/j.diii.2024.02.008