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Radiology Jun 2024A 15-year-old male patient presented with a 3-week history of inner left thigh pain provoked by activity and experienced occasionally at rest. The patient denied...
A 15-year-old male patient presented with a 3-week history of inner left thigh pain provoked by activity and experienced occasionally at rest. The patient denied nighttime pain, fever, or chills. Laboratory investigation revealed the following normal values: hemoglobin level of 15.6 g/dL (normal range, 13-16 g/dL), platelet count of 240 × 103/µL (normal range, 140-440 × 103/µL), and total leukocyte count of 7100 cells/µL (normal range, 4500-11 000 cells/µL). The percentage of neutrophils was considered low at 44% (normal range, 54%-62%), and the percentage of eosinophils was slightly high at 3.7% (normal range, 0%-3%). An anteroposterior radiograph of the left hip is shown. Physical therapy was initiated, with no improvement after 2 weeks of therapy. The patient was referred to an orthopedist for further evaluation. At physical examination, the patient endorsed marked left hip pain with hip flexion to 90°, limited internal and external rotation (5° and 15°, respectively), and antalgic gait favoring the left leg. Hip MRI and further serologic analysis were requested for further evaluation. Although the serologic testing was performed at an outside laboratory, the physician reported positive immunoglobulin-G Lyme titers, normal C-reactive protein level, and normal erythrocyte sedimentation rate. Pelvic CT was requested. The patient was prescribed a course of doxycycline (100 mg twice daily for 28 days), with reported resolution of symptoms 2 weeks after initiation of treatment. Three weeks later, the patient presented to our department with recurrent left hip pain, which was similar in severity compared with the initial presentation. A second MRI examination of the left hip was performed 4 months after the initial presentation.
Topics: Humans; Male; Adolescent; Osteoma, Osteoid; Magnetic Resonance Imaging; Diagnosis, Differential; Bone Neoplasms; Hip Joint
PubMed: 38916512
DOI: 10.1148/radiol.230629 -
Radiofrequency ablation of osteoid osteoma at the base of the coracoid process: Report of two cases.Clinical Case Reports Jul 2024If you encounter an unexplained case of bone marrow edema in a young patient, consider the possibility of osteoid osteoma (OO). Even in the presence of a nidus near...
If you encounter an unexplained case of bone marrow edema in a young patient, consider the possibility of osteoid osteoma (OO). Even in the presence of a nidus near vital structures, RFA can safely be used to treat OO.
PubMed: 38911920
DOI: 10.1002/ccr3.9098 -
Journal of Orthopaedic Case Reports Jun 2024Osteoblastoma is an uncommon benign bone tumor characterized by the formation of osteoid tissue, occurring more frequently in men than in women. It is often associated...
INTRODUCTION
Osteoblastoma is an uncommon benign bone tumor characterized by the formation of osteoid tissue, occurring more frequently in men than in women. It is often associated with osteoid osteoma and can be found at various locations in the skeleton, although it is rare in the sacrum. Typically, these lesions involve the posterior elements of the spine, including the pedicle and the lamina. We would like to present a case of sacral osteoblastoma, clinically presenting as lumbar radiculopathy, which was treated at our institute.
CASE REPORT
A 23-year-old male presented to us with left gluteal pain radiating to the left lower limb pain for 2 years. He had multiple consultations elsewhere and was being treated as a probable case of a lumbar disc lesion with left lower limb radiculopathy. X-rays appeared normal. Magnetic resonance imaging of the lumbar spine and pelvis revealed a T2 hyperintense lesion affecting the posterior elements of S3, compressing the nerve roots. Computed tomography (CT) was a better investigation modality for osteoblastoma. En bloc excision and curettage were performed, and the histopathological analysis confirmed the diagnosis of osteoblastoma. The patient had immediate relief of symptoms postoperatively with no complications. At 2-year follow-up, the patient had no evidence of recurrence on a follow-up CT scan.
CONCLUSION
Osteoblastomas predominantly occur in the spine, with rare instances in the sacrum. Treatment typically involves en bloc excision. Confusing clinical presentation may delay diagnosis, resulting in persistent morbidity.
PubMed: 38910997
DOI: 10.13107/jocr.2024.v14.i06.4520 -
Ear, Nose, & Throat Journal Jun 2024To analyze the etiology, diagnosis, and treatment of unexplained conductive hearing loss (UCHL) with intact tympanic membrane. A systematic review was conducted based... (Review)
Review
To analyze the etiology, diagnosis, and treatment of unexplained conductive hearing loss (UCHL) with intact tympanic membrane. A systematic review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 642 articles were retrieved from databases such as PubMed, Embase, Web of Science, and Cochrane. Fifty-four research articles and 21 case reports were screened out according to the inclusion and exclusion criteria for analysis of the etiology of UCHL. Seven research articles with UCHL who underwent exploratory tympanotomy were selected for data extraction and analysis of clinical characteristics. UCHL is a common manifestation of various diseases, including congenital ossicular anomalies (COA), otosclerosis (OTS), congenital middle ear cholesteatoma (CMEC), oval window atresia, superior semicircular-canal dehiscence, congenital stapedial footplate fixation, middle ear osteoma or adenoma, congenital ossification of stapedial tendon, and so on. A total of 522 patients were included in the 7 articles; among whom OTS showed a tendency to increase with age. The main symptoms were hearing loss, followed by tinnitus, dizziness, ear fullness, ear pain, facial paralysis. A total of 87.5% to 93.0% patients with COA manifested as nonprogressive deafness that occurred since childhood, with tinnitus incidence of 15.6% to 30.2%, and 86.4% to 96.4% patients with OTS presented with progressive hearing loss, with tinnitus incidence of 60.1% to 90.9%. The diagnosis positive rate of high-resolution computed tomography (HRCT) was 33.8% to 87.1%, and CMEC was higher than that of COA (83.3%-100% vs 28.6%-64%). All the articles reported good hearing recovery. The most common surgical complications included taste abnormalities, tinnitus, and dizziness. UCHL presents with similar clinical manifestations and poses challenges in preoperative diagnosis. Exploratory tympanotomy is the primary method for diagnosis and treatment, with good prognosis after removing the lesion and reconstructing hearing during the operation. Children can also safely undergo the surgery.
PubMed: 38895947
DOI: 10.1177/01455613241262129 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Jun 2024To investigate the criteria for selecting surgical approaches for frontal and ethmoid sinus osteomas of different locations and sizes on CT imaging. Using sagittal and...
To investigate the criteria for selecting surgical approaches for frontal and ethmoid sinus osteomas of different locations and sizes on CT imaging. Using sagittal and coronal CT images, the following lines were delineated: the F-line(a horizontal line passing nasofrontal beak), the M-line(a vertical line passing paries medialis orbitae), and the P-line(a vertical line passing the center of the pupil). Classification of frontal and ethmoid sinus osteomas was based on their relationship with these lines. Appropriate surgical approaches were selected, including pure endoscopic approaches, endoscopic combined with eyebrow incision approach, and endoscopic combined with coronal incision approach. This method was applied to a single center at the Third Affiliated Hospital of Sun Yat-sen University for endoscopic resection of frontal and ethmoid sinus osteoma. Case Data: Sixteen cases of ethmoid sinus osteomas were treated from January 2020 to September 2023. Among these cases, there were 9 males and 7 females, with ages ranging from 18 to 69 years, and a median age of 48 years. Thirteen cases underwent pure endoscopic resection of the osteoma, while in three cases, a combined approach was utilized. Among the combined approach cases, two exceeded both the M-line and the F-line but did not cross the P-line; therefore, they underwent endoscopic combined with eyebrow incision approach. One case exceeded all three lines and thus underwent endoscopic combined with coronal incision. In all cases, complete resection of the osteoma was achieved as per preoperative planning, and none of the patients experienced significant postoperative complications. For frontal and ethmoid sinus osteomas, it is advisable to perform a thorough preoperative radiological assessment. Based on the size of the osteoma and its relationship to the three lines, an appropriate surgical approach should be chosen to optimize the diagnostic and treatment plan.
Topics: Humans; Osteoma; Male; Female; Middle Aged; Adult; Aged; Frontal Sinus; Ethmoid Sinus; Adolescent; Tomography, X-Ray Computed; Paranasal Sinus Neoplasms; Endoscopy; Young Adult
PubMed: 38858119
DOI: 10.13201/j.issn.2096-7993.2024.06.013 -
SAGE Open Medical Case Reports 2024Lingual osteoma, a rare, benign bone tumor that primarily affects the posterior tongue, can be difficult to diagnose. This study aims to report a case of osteoma...
Lingual osteoma, a rare, benign bone tumor that primarily affects the posterior tongue, can be difficult to diagnose. This study aims to report a case of osteoma affecting the tongue in a 17-year-old female. The patient had a foreign body sensation and a progressively growing lesion for 3 years and underwent clinical examination and diagnostic procedures. A well-defined, smooth-surfaced, white mass was discovered in the posterior third of the tongue. The 1.5 × 1 × 0.4 cm mass was completely excised under local anesthesia and histopathologically confirmed as a benign lingual osteoma. The 2-month post-operative outcome was uneventful. The rarity of lingual osteoma, as well as the fact that it is often asymptomatic, makes diagnosis difficult. The diagnosis entails a proper clinical examination, imaging studies, and histopathological analysis. Surgical intervention, primarily aimed at complete excision while preserving tongue function, remains the primary treatment option. Successful excision entails educating healthcare professionals about this rare benign bony tumor to ensure the best possible patient outcomes.
PubMed: 38854676
DOI: 10.1177/2050313X241260177 -
Radiographics : a Review Publication of... Jul 2024Osteoid osteoma (OO) is the third most prevalent benign bone neoplasm in children. Although it predominantly affects the diaphysis of long bones, OO can assume an... (Review)
Review
Osteoid osteoma (OO) is the third most prevalent benign bone neoplasm in children. Although it predominantly affects the diaphysis of long bones, OO can assume an intra-articular location in the epiphysis or the intracapsular portions of bones. The most common location of intra-articular OO is the hip joint. The presentation of intra-articular OOs often poses a diagnostic enigma, both from clinical and radiologic perspectives. Initial symptoms are often vague and nonspecific, characterized by joint pain, stiffness, and limited range of motion, which frequently contributes to a delayed diagnosis. Radiographic findings range from normal to a subtle sclerotic focus, which may or may not have a lucent nidus. In contrast to their extra-articular counterparts, intra-articular lesions have distinct features at MRI, including synovitis, joint effusion, and bone marrow edema-like signal intensity. While CT remains the standard for identifying the nidus, even CT may be inadequate in visualizing it in some cases, necessitating the use of bone scintigraphy or fluorine 18-labeled sodium fluoride PET/CT for definitive diagnosis. Radiologists frequently play a pivotal role in suggesting this diagnosis. However, familiarity with the unique imaging attributes of intra-articular OO is key to this endeavor. Awareness of these distinctive imaging findings of intra-articular OO is crucial for avoiding diagnostic delay, ensuring timely intervention, and preventing unnecessary procedures or surgeries resulting from a misdiagnosis. The authors highlight and illustrate the different manifestations of intra-articular OO as compared with the more common extra-articular lesions with respect to clinical presentation and imaging findings. RSNA, 2024 Supplemental material is available for this article.
Topics: Humans; Osteoma, Osteoid; Bone Neoplasms; Diagnosis, Differential; Child; Magnetic Resonance Imaging; Hip Joint; Tomography, X-Ray Computed
PubMed: 38843097
DOI: 10.1148/rg.230208 -
Cureus May 2024A choroidal osteoma (CO) is a relatively rare, benign tumor with ossification that develops in the choroid and undergoes enlargement and decalcification in its natural...
A choroidal osteoma (CO) is a relatively rare, benign tumor with ossification that develops in the choroid and undergoes enlargement and decalcification in its natural course. Photodynamic therapy (PDT) is used to induce decalcification, but there are few reports on individual cases treated with PDT. A 47-year-old Japanese man who had reduced decimal visual acuity (VA) of the right eye to 0.7 due to a CO away from the fovea was treated with PDT. The PDT resulted in a partial decalcification of CO, and the visual acuity improved to 1.0. However, the tumor slowly expanded, eventually reaching the central fovea. Decalcification and focal choroidal excavation occurred during this natural course of the disease. Although his metamorphopsia worsened, his VA was maintained at 1.0. This case highlights that a CO partially decalcified after PDT can still enlarge and decalcify over several years. These findings indicate the need for careful and continuous monitoring of eyes with a CO.
PubMed: 38826936
DOI: 10.7759/cureus.59581 -
Pathology Oncology Research : POR 2024Gardner syndrome is a rare genetic cancer predisposition disorder characterized by intestinal polyposis, multiple osteomas, and soft and hard tissue tumors. Dental...
Gardner syndrome is a rare genetic cancer predisposition disorder characterized by intestinal polyposis, multiple osteomas, and soft and hard tissue tumors. Dental anomalies are present in approximately 30%-70% of patients with Gardner syndrome and can be discovered during routine dental examinations. However, sometimes the diagnosis is challenging due to the high clinical variability and incomplete clinical picture. Herein, we report a family with various dental and bone anomalies, in which the definitive diagnosis was established with the help of a comprehensive genetic analysis based on state-of-the-art next-generation sequencing technology. A 17-year-old female index patient presented with dental (caries, impacted, retained and anteriorly located teeth) and atypical bone anomalies not resembling Gardner syndrome. She was first referred to our Genetic Counselling Unit at the age of 11 due to an atypical bone abnormality identified by a panoramic X-ray. Tooth 3.6 was surgically removed and the histopathology report revealed a Paget's disease-like bone metabolic disorder with mixed osteoblastic and osteoclastic activity of the mandible. A small lumbar subcutaneous tumor was discovered by physical examination. Ultrasound examination of the tumor raised the possibility of a soft tissue propagation of chondromatosis. Her sister, 2 years younger at the age of 14, had some benign tumors (multiple exostoses, odontomas, epidermoid cysts) and impacted teeth. Their mother had also skeletal symptoms. Her lower teeth did not develop, the 9th-10th ribs were fused, and she complained of intermittent jaw pain. A cranial CT scan showed fibrous dysplasia on the cranial bones. Whole exome sequencing identified a heterozygous pathogenic nonsense mutation (c.4700C>G; p.Ser1567*) in the gene in the index patient's DNA. Targeted sequencing revealed the same variant in the DNA of the other affected family members (the sister and the mother). Early diagnosis of this rare, genetically determined syndrome is very important, because of the potentially high malignant transformation of intestinal polyps. Dentists should be familiar with the typical maxillofacial features of this disorder, to be able to refer patients to genetic counseling. Dental anomalies often precede the intestinal polyposis and facilitate the early diagnosis, thereby increasing the patients' chances of survival. Genetic analysis may be necessary in patients with atypical phenotypic signs.
Topics: Humans; Gardner Syndrome; Female; Adolescent; Genetic Testing; Tooth Abnormalities; Early Diagnosis; Pedigree
PubMed: 38807857
DOI: 10.3389/pore.2024.1611768 -
International Journal of Surgery Case... Jun 2024Osteoid osteoma is a benign primary bone tumor with a predilection for the long bones and vertebrae, presenting a unique challenge when occurring in rare locations such...
INTRODUCTION AND IMPORTANCE
Osteoid osteoma is a benign primary bone tumor with a predilection for the long bones and vertebrae, presenting a unique challenge when occurring in rare locations such as the talus, accounting for 5 to 8 % of cases. Early imaging struggles to detect its nidus, leading to diagnostic delays, especially when atypical symptoms and previous trauma complicate clinical presentations. This case report illustrates the diagnostic challenges and emphasizes the importance of targeted computed tomography (CT) guided by scintigraphy in diagnosing osteoid osteoma of the talus.
CASE PRESENTATION
A 23-year-old male presented with chronic left ankle pain spanning three years, with a history of previous trauma. Initial evaluations including standard radiology and magnetic resonance imaging (MRI) suggested algodystrophy of the talus and tenosynovitis, but failed to identify the osteoma. Persistent pain led to further investigation with bone scintigraphy, revealing hyperfixation indicative of partial algodystrophy. Targeted CT scans focused on the scintigraphy-identified area ultimately revealed an osteoid osteoma's nidus, enabling successful surgical intervention and symptomatic relief.
DISCUSSION
The diagnosis of osteoid osteoma in the talus is frequently delayed due to its atypical presentation and rare occurrence. Traditional imaging techniques may overlook the tumor's nidus, underscoring the necessity for targeted diagnostic approaches. This case demonstrates the value of integrating scintigraphy with targeted CT to enhance early diagnosis and treatment planning, contrasting with the limited diagnostic yield of MRI and underscoring CT's superiority for nidus detection.
CONCLUSION
Osteoid osteoma of the talus poses significant diagnostic challenges. This case report highlights the utility of scintigraphy-guided targeted CT in identifying the nidus and facilitating prompt surgical management, advocating for a multidisciplinary approach to atypical ankle pain, especially in patients with a history of trauma.
PubMed: 38735215
DOI: 10.1016/j.ijscr.2024.109745