Authors : Harish Hosalkar
IntroductionOsteoblastoma is sometimes called "giant osteoid osteoma" because it is histologically identical to osteoid osteoma, but larger. Osteoblastoma is less common than osteoid osteoma, accounting for less than 1% of the primary bone tumors. Clinical FindingsApproximately 30-40% of osteoblastomas are found in the spine, where they most often affect the posterior elements, including spinous and tranverse processes, lamina, and pedicles. All areas of the spine may be involved, from the upper cervical region to the sacrum. The diaphysis of long bones, particularly the femur and tibia, is also a common site. Spinal involvement may present with myelopathic or radicular symptoms, progressive painful scoliosis, or torticollis if the lesion is in cervical spine. In nonvertebral locations, pain is usually the prominent complaint. The pain is less localized than the pain of osteoid osteomas and much less likely to be relieved by salicylates. Osteoblastomas are tender, and direct palpation often localizes a lesion, even when it cannot be seen on a plain radiograph. Radiographic and Histologic FeaturesTable 1 presents the typical radiographic and histologic features of osteoblastoma while comparing it to features of osteoid osteoma. Hosalkar et al have reported (Clin Orthop Relat Res. 2005 Jul;(436):286) that CT imaging is more diagnostically accurate in suspected cases of osteoid osteoma as MRI tends to present a more aggressive picture and can lead to diagnostic inaccuracy. Table 1. Typical radiographic and histologic features of osteoid osteoma as compared to an osteoblastoma.
Fig. 1. Typical location in the posterior elements of the spine. Radiodense, expansile, bone producing neoplasm.
Fig. 2. Radiodense bone producing tumor. DDx Osteosarcoma (classic, parosteal), osteoblastoma, osteoma.
Fig. 3. Typical gross appearance, dense cancellous cortical bone. TreatmentOsteoblastoma is a benign, but locally aggressive lesion. The tumor should be excised surgically, otherwise it continues to enlarge and damage the bone and adjacent structures.
Osteoblastomas located in sites inaccessible to surgical excision have been reported to respond to radiation therapy or chemotherapy. Figures |
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Harish Hosalkar . Orthopaedia Main - Osteoblastoma. In: Orthopaedia - Collaborative Orthopaedic Knowledgebase. Created Sep 06, 2008 07:44 by Harish Hosalkar , Last modified May 22, 2009 15:04 ver.16. Retrieved 2010-09-03, from http://www.orthopaedia.com/x/KoG0.
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