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Year : 2006  |  Volume : 16  |  Issue : 1  |  Page : 53-54
Multifocal osteoid osteoma - a case report


From the Chandak Nursing home, Nagpur, India

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Keywords: Osteoid osteoma

How to cite this article:
Chandak R M, Phatak S V, Jain L, Kolwadkar P K. Multifocal osteoid osteoma - a case report. Indian J Radiol Imaging 2006;16:53-4

How to cite this URL:
Chandak R M, Phatak S V, Jain L, Kolwadkar P K. Multifocal osteoid osteoma - a case report. Indian J Radiol Imaging [serial online] 2006 [cited 2019 Sep 20];16:53-4. Available from: http://www.ijri.org/text.asp?2006/16/1/53/29046

   Introduction Top


Osteoid osteoma is a common benign lesion consisting of small (upto 2 cms.) nidus of highly vascularized osteoid tissue surrounded by peripheral zone of sclerosis. Only rarely they multifocal. Very few cases have been reported in the literature of multifocal osteiod osteomas [2],[3],[4]. The authors present a case of multifocal osteoid osteoma with two nidi involving the lower shaft of Humerus.


   Case report Top


A twenty four old man presented with complaints of pain localized to lower third of left arm since one year. He responded well to analgesics but the pain used to recur after a few days. Physical examination and laboratory studies reealed no abnormalities.

A Radiograph of the left arm shows an area of localized periosteal new bone formation in the lower shaft of humerus along is lateral border. Two lucent areas were noted in this region indicative of nidi. Minimal endosteal thickening was also observed, rest of the humeral shaft appeared normal. Surgical resection of the involved area of the humerus was performed. Two nidi were seen. Microscopic view showed a well developed nidus comprising of thick network of trabeculae of woven bone, partly calcified centrally. Osteoblasts were plump, active and forming prominent rimming of woven bone. Between the woven bone, vascular stroma was present with a few osteoclastic giant cells. Surrounding the nidus sclerotic normal lamellar bone was seen quite abruptly without an interface.


   Discussion Top


The nidus : The nidus is best seen in the diaphysis where it usually presents as a small lucency or frequently as a mere chink in the bone. The long diameter varies from 0.3 to 2 cms, but rarely it is more than 1 cms. When an osteoid osteoma shows a nidus that measures 2-4 cms in diameter and retains the other attributes of the condition it is a large osteoid osteoma. Whereas if the nidus measures over 4 cms, in diameter it is regarded as a giant sized osteoid osteoma [1].

The core of the nidus is eccentrically placed in respect to long axis of thebone. It does not invade the soft tissue. Approximately half of the nidi are lucent and other contain different patterns of tumor matrix mineralization. If the osteoid tissue is more abundant in central portion of nidus it creates a translucent image, if the reticular calcified bony tissue predominates the image is denser than normal bone. A partly calcified nidus is represented by more distinct flecks of larger masses of increased density creating a 'stippled pattern' when central osteoid area alternates with a reticular one; followed towards periphery by another osteoid area the appearance simulates an annular sequestrum. Occasionally the nidus is completely calcified in which case a uniformly dense center is surrounded by a narrow halo of radiolucency. The ndus may be intramedullary, subcortical, intracortical or subperiosteal. Rarely it has been seen lying close to the edge of an articular surface in the epiphysis [1]. Commonly only one nidus forms but in rare instances an osteoid osteoma may be multifocal. Sherman (1947) found double nidi in neck of femur. Flaherty et al (1956) described one case with three distinct but closely-grouped nidi. Each was identified roentgenologically and histologically. Greenspan et al (1974) reported a case of multifocal osteoid osteoma with three nidi involving distal tibia. Schajowicz and Lemos (1970) in their large series observed one case showing two small nidi adjacent to one another [1].

Kenan S et al [3] also described a case of elliptical multicentric periosteal osteoid osteoma in 1994. G Gonzales et al described a case of osteoid osteoma with multicentric nidus in 1996 [4].


   Peripheral sclerosis Top


The degree and extent of sclerosis seems to vary with location of nidus and age of patient. An intramedullary nidus in shaft of a bone may produce only a narrow ring of sclerosis and little if any changes in contour of bone. As is more often the case a diaphyseal osteoid osteoma incites an abundant sclerotic reaction about most of the circumference of nidus and will exend for several millimeters beyond it. The reactive bone is often symmetrical in respect to both the long axis of the shaft and location of the nidus so that the nidus may be located towards the edge of the sclerosis and not within the center. When the nidus is in the uncommon subperiosteal location it produces a localized periosteal bulge in contour of bone. In children under the age of five the reactive sclerosis is quite marked irrespective of location of nidus. Extensive and dense reactive new new bone formation can obscure the nidus requiring over penetrated or tomography to demonstrate it [1].

Occasional case of osteoid osteoma may present with atypical manifestations. These are subperiosteal nidus - the nidus extending in soft tissues raising the periosteum, juxta articular location, accelerated growth, spontaneous regression, occurrence without characteristic pain or appearance as double lesion - widely separated lesions in same bone.

 
   References Top

1.Daniel Wilner Osteoid osteoma in radiology of bone tumors and allied disorders First edition WB Saunders and Company totonto 1982 Volume 1, firstedition: 144-216  Back to cited text no. 1    
2.Adam Greenspan, Alberto Elguezabel, David BRYK Multifocal osteoid osteomas a case report and review of literature Am. J. of Roentgenology 1974;121:103-106.  Back to cited text no. 2    
3.G. Gonzalez, JC Abril, IG Medirio, Tepeldegui osteoid osteoma with multicentric nidus international Orthopedics 1996; volume 20 issue 1:61-63.  Back to cited text no. 3    
4.Kenan S, Abdelwahab I, Klein MJ, Hermann G, Lewis MM Elliptical multicentric periosteal osteoid osteoma Skeletal Radiol 1994;Oct 23 (7): 565-8.  Back to cited text no. 4    

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Correspondence Address:
R M Chandak
M.S. (Orthopaedic Surgery), Chandok Nursing Home, 1st floor, Super Market, Sitabuldi, Nagpur-12
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-3026.29046

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    Figures

[Figure - 1], [Figure - 2], [Figure - 3]

This article has been cited by
1 Atypical osteoid osteomas
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European Journal of Orthopaedic Surgery & Traumatology. 2013;
[Pubmed] | [DOI]



 

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    Introduction
    Case report
    Discussion
    Peripheral sclerosis
    References
    Article Figures

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