Indian Journal of Radiology and Imaging Indian Journal of Radiology and Imaging

CASE REPORT
Year
: 2006  |  Volume : 16  |  Issue : 2  |  Page : 275-

Osteoid Osteoma


DS Shah, G Tomar, P Kiran, C Patel 
 India

Correspondence Address:
D S Shah
India




How to cite this article:
Shah D S, Tomar G, Kiran P, Patel C. Osteoid Osteoma.Indian J Radiol Imaging 2006;16:275-275


How to cite this URL:
Shah D S, Tomar G, Kiran P, Patel C. Osteoid Osteoma. Indian J Radiol Imaging [serial online] 2006 [cited 2020 Jul 2 ];16:275-275
Available from: http://www.ijri.org/text.asp?2006/16/2/275/29109


Full Text

This is a benign osteoblastic tissue consisting of a central core of vascular osteoid tissue and peripheral zone of sclerotic bone. This tumor usually occurs before 25 years of age [ 2-3 decade][1] and with male predominance[2.5:1]. Pain is the hallmark of the lesion which is more at the night and relieved by salicylates. Long bones are usually involved , femur being the commonest, followed by tibia [2],[3]. Intramedullary intracapsular lesions , usually located in the proximal femur at the medial aspect of femoral neck, may cause growth deformities and overgrowth with limb length discrepancy, muscle atrophy and associated early osteoarthrits [4]. Diaphysis is ithe usual site of involvement but it may extend to meta- or diaphysis. Any of the cortical cancellous or subperiosteal region may be involved. Vertebral osteoid osteomas are also seen involving posterior elements.

 HISTORY



A 8 month old child presented with history of trauma (due to fall from walker) followed by inability to keep his right leg on the ground. Radiograph of right femur with knee joint and tibia/fibula [Figure 1] was taken which showed radiolucent area with central calcified area and surrounding sclerosis on the medial aspect of upper one-third of right tibia. Diagnosis of aoteoid osteoma was put and CT Scan [Figure 2] was performed which showed hypodense area with hyperdensity and peripheral sclerosis involving medial cortex of upper tibia. The lucent area showed enancement on post-contrast study. The diagnosis of osteoid osteoma was put.

 Imaging



The radiographic appearance of centrally located oval or round lucent lesion surrounded by zone of sclerosis is diagnostic. The central lucent zone is called nidus which may show varible calcification. It is usually less than one cm in size which differentiates it from osteoblastoma [1]. Solid or lamellated periosteal reaction is seen in 60% patients. Scintigraphy [5],[6] shows double density sign consisting of intense activity centrally in the region of the nidus and less intense activity in peripheral sclerotic area. CT scan is particularly useful in cases of spine [7], pelvis and femoral neck. MR imaging may be misleading showing marrow and tissue edema, the findings simulating malignent tumor or infection. Histologically osteoid osteoma and osteoblastoma [1] are similar.

Treatment is by resection of nidus either surgically, by CT guided trephine biopsy or by intralesional electrode Vplaced percutaneously , thermoablation or radiofrequency ablation.

 Conclusion



Osteoid osteoma usually presents in second or third decade and is rare in first few years of life.X ray is diagnostic but CT scan may be required for visualisation of nidus.

References

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2O'mara RE, Weber DA 1984 The Osseous system (eds) Freeman and Johnson's clinical radionucleide imaging, vol-2 Grune Stratton, Orlardo, p1179
3Kayser F, Resnick D, Praviz H et al 1988 Evidence of subperiosteal origin of osteoid osteoma in tubular bones. Analysis by CT and MRI. Am J Roentgen 170 ; 609-614.
4Goldman AB, Schneider R, Pavlov H 1993. Osteoid osteoma of the femoral neck ; report of four cases evaluated with isotopic bone scanning CT and MR imaging radiology 186; 227-231
5Delbeke d , Habibiar MR 1988 non inflammatory entities and the differential diagnosis of positive three phase with bone scintigraphy. Clinical med B ; 844-851
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7Harche HT , Conway JJ, Tachdijar MO 1985 Scintigraphic localization of bone lesions during surgery. Skel rowdiol 13;211.