Osteoid Osteoma

DEFINITION AND PATHOGENESIS

• <2cm round nidus (nest) of benign abnormal bone
• Richly innervated and almost always painful
• Surrounded by reactive bone

IMPORTANCE

• Histology can be mistaken for osteosarcoma if radiologic features not taken into account
• 3-5% of 1° bone tumors; ~ 11% of benign tumors (2nd to OCE and NOF)
• Has been reported to be the most common benign neoplasm of the carpal bones

CLINICAL FEATURES

• Pain can be intense and nocturnal (? prostaglandins)
• Pain often relieved by aspirin and NSAIDs or exacerbated by alcohol (vasodilatation), may subside over time
• Pain has been misattributed to arthritis
• Reported to mimic DeQuervain's stenosing tenosynovitis in radial styloid location
• May be asymptomatic, esp in the hand (may be difficult to diagnose)
• Tenderness to palpation
• ± localized swelling and erythema
• Atrophy of surrounding muscles and sxs of weakness not uncommon
• Joint effusion can be present when periarticular
• Joint contracture may occur in periarticular locations
  • An average 38? flexion contracture reported of the elbow and capsular release is recommended to improve extension
  • Calcaneal location reported to be a cause of tibialis spastic varus foot
• Radicular or nonradicular leg pain may be present in spinal osteoid osteomas
• Scoliosis
• LLD or varus/valgus deformity
• Hypertrophy of the pulp and nail in distal phalanx location
• Occipital headache has been reported the major sx when lesion located in the atlas
• Most patients <20 years of age (rarely <5 or >40); 50% between 10-20 (mean 19), rarely <5 or >40 years
  • Dx in pts <5 difficult
    • Limp (LE lesions) and pain
• M:F = 2.3:1

RADIOLOGIC FEATURES

• Most common location is proximal femur, then tibia
• Other locations include humerus, spine (posterior elements), and talus (90-94% in neck)
• Unusual location: carpus (most commonly scaphoid)
• 10% occur in spine
  • ?27% in cervical spine
• Majority (>80%) occur in long bones in or near the cortex
  • Subcortical
  • Intracortical
  • Intraperiosteal/subperiosteal
  • Intramedullary
  • Subcondral
• Scoliosis (77.5%)
  • More common than in osteoblastoma
  • Lesion is typically on the concave side of the curve, off the midline, esp. T, L, lower cervical
  • Probably due to asymetric muscle spasm
• X-ray
  • Nidus can be lucent to dense, typically < 1cm (up to 2cm)
  • Elliptical nidi in long bones in very young patients due to growth
  • Radiolucent ring around nidus is a fibrovascular zone
• US
  • Has been used to detect osteoid osteoma in femoral neck
• Scintigraphy
  • Bone scan shows localized ? uptake
  • In111 labeled WBC imaging is -
  • Reported with uptake in I131 scan
• CT scanning (? IV contrast) usually reveals the nidus
  • Enhancement of the nidus more rapid than slower uptake of contrast in osteomyelitis with "dynamic contrast enhanced CT"
  • >40 Hownsfield units of enhancement with slow egress
• MRI
  • T1-weighted images: nidus has low-intermediate signal intensity; reactive sclerosis has low signal intensity
  • T2-weighted images: nidus demonstrates moderately ? signal intensity; reactive sclerosis has low signal intensity
  • STIR or fat-suppressed T2-weighted images: extensive marrow edema
    • ± ? vascularity directed toward the nidus

GROSS PATHOLOGY

• Highly vascular lesions are cherry red
• Mature lesions are less vascular and densely sclerotic surrounded by fibrovascular cuff
• Dense reactive bone around nidus

HISTOLOGIC FEATURES

• Osteoid, osteoclasts, vascular channels, osteoblastic rimming in nidus
• Reactive thickened host bone surrounds nidus, no permeation into surrounding bone is present
• Center of the lesion is often more mature and mineralized
• No cartilage is present, minimal fibroblasts and collagen
• Capillaries most often abundant
• Synovitis when periarticular
• Variable findings include:
  • Mature lesions may lack osteoblastic rimming and osteoclasts
  • Cellularity proportional to the amount of osteoid
  • Epiphyseal lesions lack sclerotic response because of lack of periosteum
  • Fibrovascular zone between nidus and sclerosis may not be present
  • Inflammatory lymphocytes or plasma cells may be present
• Nonmyelinated axons can be demonstrated with silver stains

DIFFERENTIAL CLINICOPATHOLOGIC DIAGNOSIS

• Intramedullary osteomyelits or intracortical abscess (permeative edges)
• Stress fracture (transverse fracture line)
• Metastasis (permeative or moth-eaten margins)
• Bone island (enostosis)
• Eosinophilic granuloma
• Osteoblastoma
• Osteosarcoma

DISEASE COURSE AND TREATMENT

• Cessation of pain with complete resection of nidus
• Recurrence (9% with operative tx) can be a problem since lesion can be extremely small within the surrounding reactive host bone and can be left unresected
  • May actually represent an osteoblastoma
• Finding nidus can be like finding a "needle in a haystack" and can be assisted by:
  • CT guidance
    • Just prior to surgery (most accurate), dissecting down the wire
    • Finding a drill hole made just over the lesion
    • Using a trephine over a wire with CT control
    • Percutaneous excision reported with excellent results using a power-drill bx trocar
  • Fluoroscopy or bone scan intraoperatively (for removal and complete removal documentation)
  • TCN labeling and UV light (Wood's light) observance of fluorescing nidus
    • 250mg TID PO X3 days prior to surgery
    • Can obscure C/S results if infection high on the ddx
  • Frozen section analysis
  • Small changes on the cortical surface seen with magnification or palpation
  • Removing all (not generally needed) the reactive bone as well, bone grafting ± IF/EF
• High speed burring can be done to remove only enough bone to encounter and scoop out the nidus after gradual "planing off" reactive bone
  • A 6-8mm bone bx trephine (guided over a wire with fluoroscopic or CT guidance) can be used to remove a cylinder of bone
  • CT guided trephine particulary useful in acetabular locations
• CT guided percutaneous radiofrequency electrodes (16-gauge 200, 250, or 300 length) to ablate a presumptive osteoid osteoma (anesthetic required since the procedure is painful)
  • 90?C X4min with a "second pass" for lesions with a larger nidus
  • Tissue may not be available for histologic dx in some techniques
    • If LR is again txd with radiofrequency ablation, tissue dx is imperative
  • 12% LR at 3.4 yr average (9% LR with surgeery at 9 yr average)
  • Radiofrequency generator also commonly used in neurosurgery (model 3DRG, Radionics, Burlington, MA)
  • Cool-tip Tyco probe (Valleylab, Boulder, CO) with larger heating distance reported
• CT guided percutaneous laser photocoagulation (Diomed, Cambridge, UK)
  • Energy needed to coagulate tumor calculated from the size of the nidus
  • Iced saline lavage in subcutaneous locations to avoid skin damage
    • Nail loss reported in a distal phalangeal location
• Non-surgical (medical) tx with NSAIDS until burnout (unpredictable)
  • Reports of spontaneous resolution of sxs (2-15 yrs)
  • Cyclooxygenase-2 inhibitor (rofecoxib) reported to alleviate sxs more effectively than aspirin
• Difficult locations
  • Acetabular location has been appoached through the inner wall and via an intra-articular approach
  • Base of the coracoid process has been appoached from posteriorly (Swafford/Lichtman approach)
  • Thoracic spine at the entry site of the artery of Adamkjewicz
• Hospital stay average for operative tx 4.7/5.1 days (primary/recurrence) and 0.2 days for percutaneous radiofrequency coagulation

SPECIAL CONSIDERATIONS

• PERIOSTEAL OSTEOID OSTEOMA
  • Has been reported to be multicentric
  • Femoral, then tibial locations most common
  • Subungual location reported
• MULTIFOCAL (MULTICENTRIC) OSTEOID OSTEOMA
  • So-called "beaded" osteoid osteoma may be a transition lesion between the solitary and multifocal lesions
  • Progression of a single nidus to a multicentric nidus over time has been reported
• FAMILIAL OSTEOID OSTEOMA

Osteoid Osteoma (PORTNotes)

Osteoid osteoma (Orthopaedia Main)

REFERENCES

Abe E, Sato K, Okada K, Mizutani Y, Ishizawa N, Suzuki T: Selective en bloc resection of osteoid osteoma of the superior articular process of sacral spine. A case report. Spine 8:2336-9,1993.
Adam G, Neuerburg J, Vorwerk D, Forst J, Gunther RW: Percutaneous treatment of osteoid osteomas: combination of drill biopsy and subsequent ethanol injection. Semin Musculoskelet Radiol 1:281-4,1997.
Aisen AM, Glazer GM: Diagnosis of osteoid osteoma using computed tomography. J Comput Tomogr 8:175-8,1984.
Allen SD, Saifuddin A: Imaging of intra-articular osteoid osteoma. Clin Radiol 58:845-52,2003.
Allieu Y, Lussiez B, Benichou M, Cenac P: A double nidus osteoid osteoma in a finger. J Hand Surg 14A:538-41,1989.
Arora J, McLauchlan J, Munro N: Recurrent osteoid osteoma of the lunate: a case report and review of the literature. Hand Surg 8:239-42,2003.
Assoun J, Railhac JJ, Bonnevialle P, Poey C, Salles de Gauzy J, Baunin C, Cahuzac JP, Clement JL, Coustets B, Railhac N: Osteoid osteoma: percutaneous resection with CT guidance. Radiology 188:541-7,1993.
Assoun J, Richardi G, Railhac JJ, Baunin C, Fajadet P, Giron J, Maquin P, Haddad J, Bonnevialle P: Osteoid osteoma: MR imaging versus CT. Radiology 191:217-23,1994.
Atar D, Lehman WB, Grant AD: Computerized tomography-guided excision of osteoid osteoma. Orthop Rev 21:1457-8,1992.
Atar D, Lehman WB, Grant AD: CT-guided excision of osteoid osteoma: AJR 160:211,1993.
Athwal GS, Pichora DR, Ellis RE, Rudan JF: A computer-assisted guidance technique for the localization and excision of osteoid osteoma. Orthopedics 27:195-7,2004.
Ayala AG, Murray JA, Erling MA, Raymond AK: Osteoid osteoma: intraoperative tetracycline-fluorescence demonstration of the nidus. J Bone Joint Surg 68A:747-51,1986.
Aydinli U, Ozturk C, Ersozlu S, Filiz G: Results of surgical treatment of osteoid osteoma of the spine. Acta Orthop Belg 69:350-4,2003.
Barca F, Acciaro AL, Recchioni MD: Osteoid osteoma of the phalanx: enlargement of the toe: two case reports. Foot Ankle Int 19:388-93,1998.
Barei DP, Moreau G, Scarborough MT: Percutaneous radiofrequency thermal ablation of osteoid osteoma. In Fu FH, Scully SP (eds) Opertive Techniques in Orthopaedics 9(2):72-8,1999.
Barei DP, Moreau G, Scarborough MT, Neel MD: Percutaneous radiofrequency ablation of osteoid osteoma. Clin Orthop 373:115-24,2000.
Bartolozzi P, Floris G: Osteoid osteoma of the body of the first sacral vertebra. Case report. Ital J Orthop Traumatol 14:527-8,1988.
Bednar MS, Maywood IL, McCormack RR, Glasser D, Weiland AJ: Osteoid osteoma of the upper extremity. J Hand Surg 18A:1019-25,1993.
Bednar MS, McCormack RR Jr, Glasser D, Weiland AJ: Osteoid osteoma of the upper extremity. J Hand Surg 18A:1019-25,1993.
Biagini R, Orsini U, Demitri S, Bibiloni J, Ruggieri P, Mercuri M, Capanna R, Majorana B, Bertoni F, Pacchini P, Briccoli A: Osteoid osteoma and osteoblastoma of the sacrum. Orthopedics 24:1061-4,2001.
Birdsall PD: Case report. Osteoid osteoma: an unusual cause of foot pain. Orthopedics 24:173-4,2001.
Blankstein A, Morag B, Apter S, Engel J: Diagnosis of osteoid osteoma using computerized tomography. J Hand Surg 10B:407-8,1985.
Bojanic I, Orlic D, Ivkovic A: Arthroscopic removal of a juxtaarticular osteoid osteoma of the talar neck. J Foot Ankle Surg 42:359-62,2003.
Boretz RS, Lonner BS: Atypical presentation of an osteoid osteoma in a child. Am J Orthop 31:347-8,2002.
Bottner F, Roedl R, Wortler K, Grethen C, Winkelmann W, Lindner N: Cyclooxygenase-2 inhibitor for pain management in osteoid osteoma. Clin Orthop 393:258-63,2001.
Bowen CVA, Dzus AK, Hardy DA: Osteoid osteomata of the distal phalanx. J Hand Surg 12B:387-90,1987.
Bowen CVA, Dzus AK, Hardy DA: Osteoid osteomata of the distal phalanx. J Hand Surg 12B:387-90,1987.
Bulas RV, Hayes CW, Conway WF, Loughran T: Case report 738: Osteoid osteoma of the patella. Skeletal Radiol 21:326-9,1992.
Byers PD: Solitary benign osteoblastic lesions of bone. Osteoid osteoma and benign osteoblastoma. Cancer 22:43-57,1968.
Cameron BM, Friend LF: Osteoid osteoma of the sacrum; report of a case. J Bone Joint Surg 36A:876-7,1954.
Campanacci M, Ruggieri P, Gasbarrini A, Ferrara A, Campanacci L: Osteoid osteoma: direct visul identification and intralesional excision of the nidus with minimal removal of bone. J Bone Joint Surg 81B:814-820,1999.
Cantwell CP, Obyme J, Eustace S: Current trends in treatment of osteoid osteoma with an emphasis on radiofrequency ablation. Eur Radiol 14:607-17,2004.
Capanna R, Ayala A, Bertoni F, Picci P, Calderoni P, Gherlinzoni F, Bettelli G, Campanacci M: Sacral osteoid osteoma and osteoblastoma: a report of 13 cases. Arch Orthop Trauma Surg 105:205-10,1986.
Capanna R, Van Horn J, Ayala A, Picci P, Betelli G: Osteoid osteoma and osteoblastoma of the talus. A report of 40 cases. Skeletal Radiol 15:360-4,1986.
Carroll RE: Osteoid osteoma in the hand. J Bone Joint Surg 35A:888-93,1953.
Cerase A, Priolo F: Skeletal benign bone-forming lesions. Eur J Radiol 27(suppl 1):91-7,1998.
Chamberlain BC, Mosher JF, Levinsohn EM, Greenberg JA: Subperiosteal osteoid osteoma of the hamate: a case report. J Hand SUrg 17A:462-5,1992.
Chen SC, Caplan H: An unusual site of osteoid osteoma in the proximal phalanx of a finger. J Hand Surg 14B:341-4,1989.
Chiou YY, Rosenthal DI, Rosenberg AE: "Beaded" osteoid osteoma: a possible transition between solitary and multicentric tumor. Skeletal Radiol 32:412-5,2003.
Ciabattoni G, Tamburrelli F, Greco F: Increased prostacyclin biosynthesis in patients with osteoid osteoma. Eicosanoids 3:165-7,1991.
Cioni R, Armillotta N, Bargellini I, Zampa V, Cappelli C, Vagli P, Boni G, Marchetti S, Consoli V, Bartolozzi C: CT-guided radiofrequency ablation of osteoid osteoma: long-term results. Eur Radiol 2004.
Cohen LJ, Van Brown D: Osteoid osteoma; a case report. Surg 28:751-4,1950.
Colton CL, Hardy JG: Evaluation of a sterilizable radiation probe as an aid to the surgical treatment of osteoid-osteoma. J Bone Joint Surg 65A:1019-22,1983.
Dahlin DC, Johnson EW Jr: Giant osteoid osteoma. J Bone Joint Surg 36A:559-72,1954.
de Berg JC, Pattynama PM, Obermnann WR,Bode PJ, Vielvoye GJ, Taminiau AH: Percutaneous computed-tomography-guided thermocoagulation for osteoid osteomas. Lancet 246:3590-1,1995.
De Boeck H, Casteleyn PM, Obermnann WR, Bode PJ, Vielvoye GJ, Taminiau AH: Percutaneous computed-tomography-guided thermocoagulation for osteoid osteomas. Lancet 246:3590-1,1995.
DePraeter MP, Dua GF, Seynaeve PC, Vermeersch DG, Klaes RL: Occipital pain in osteoid osteoma of the atlas: a report of two cases. Spine 24:912-4,1999.
D'Erme M, Del Popolo P, Diotallevi R, Pasquali-Lasagni M: CT-guided percutaneous treatment of osteoid osteoma. Radiol Med (Torino) 90:84-7,1995.
De Smet L: Osteoid osteoma of the wrist and hand. J Am Soc Surg Hand 1:267-74,2001.
Destian S, Henanz-Schulman M, Raskin K, Genieser N, Becker M, Crider R, Crece MA: Case report 468. Epiphyseal osteoid osteoma distal end of femur. Skeletal Radiol 23:565-8,1994.
Dockerty MB, Ghormley RK, Jackson AE: Osteoid osteoma; a clinocopathologic study of 20 cases. Ann Surg 133:77-89,1951.
Donahue F, Ahmad A, Mnaymneh W, Pevsner NH: Osteoid osteoma: computed tomography guided percutaneous excision. Clin Orthop 366:191-6,1999.
Doyle T, King K: Percutaneous removal of osteoid osteomas using CT control. CLin Radiol 40:514-7,1989.
el-Mowafi H, Refaat H, Kotb S: Percutaneous destruction and alcoholisation for the management of osteoid osteoma. Acta Orthop Belg 69:447-51,2003.
Esquerdo J, Fernandez CF, Gomar F: Pain in osteoid osteoma: histological facts Acta Orthop Scand 47:520-4,1976.
Fagerberg S, Rudstrom P: Osteoid osteoma of a vertebral arch; a case report. Acta Radiol 40:383-6,1953.
Fenton RL, Hoffman BP: Osteoid osteoma and non-ossifying fibromas coexisting in one femur: case report. Bull Hosp Joint Dis 14:217-20,1953.
Fehring TK, Green NE: Negative radionuclide scan in osteoid osteoma: a case report. Clin Orthop 185:245-9,1984.
Fielding JW, Keim HA, Hawkins RJ, Gabrielian JZ: Osteoid osteoma of the cervical spine. Clin Orthop 128:163-4,1977.
Firooznia H, Rafii M, Golimbu C: Computed tomography of osteoid osteoma. J Comput Tomogr 9:265-8,1985.
Francis WR Jr, Einhorn T, Fielding JW: Ostoeoid osteoma of the thoracic spine: report of a case. Clin Orthop 149:175-6,1980.
Frassica FJ, Waltrip RL, Sponseller PD, Ma LD, McCarthy EF: Clinicopathologic features and treatment of osteoid osteoma and osteoblastoma in children and adolescents. Orthop Clin North Am 27:559-74,1996.
Freiberger RH, Loitman BS, Halpern M, Thompson TC: Osteoid osteoma: a report on 80 cases. AJR 82:194-205,1959.
Fromm B, Martini A, Schmidt E: Osteoid osteoma of the radial styloid mimcking stenosing tenosynovitis. J Hand Surg 17B:236-8,1992.
Gaeta M, Minutoli F, Pandolfo I, Vinci S, D'Andrea L, Blandino A: Magnetic resonance imaging findings of osteoid osteoma of the proximal femur. Eur Radiol 2004.
Gangi A, Dietemann JL, Guth S, Vinclair L, Sibilia J, Mortazavi R, Steib JP, Roy C: Interstitial laser phocoagulation of osteoid osteomas with use of CT guidance. Radiology 203:843-8,1997.
Gangi A, Dietemann JL, Gasser B, Mortazavi R, Brunner P, Mourou MY, Dosch JC, Durckel J, Marescaux J, Roy C: Percutaneous laser photocoagulation of spinal osteoid osteomas under CT guidance. AJNR 19:1955-8,1998.
Garg V, Kapoor SK: Osteoid osteoma of scaphoid. J South Orthop Assoc 12:141-2,2003.
Ghanem I, Collet LM, Kharrat K, Samaha E, Deramon H, Mertl P, Dagher F: Percutaneous radiofrequency coagulation of osteoid osteoma in children and adolescents. J Pediatr Orthop B 12:244-52,2003.
Ghiam GF, Bora FW Jr: Osteoid osteoma of the carpal bones. J Hand Surg 3:280-3,1978.
Giannikas A, Papachristou G, Tiniakos G, Chrysafidis G, Hartofilakidis-Garofalidis G: Osteoid osteoma of the terminal phalanges. Hand 9:295-300,1977.
Gisselback M, Kirchoff R, Jorgensen U: Osteoid osteoma as a cause of hip pain in a young athlete. Scand J Med Sci Sports 8:50-1,1998.
Gitelis S, Schajowicz F: Osteoid osteoma and osteoblastoma. Orthop Clin North Am 20:313-7,1989.
Glass RB, Poznanski AK, Fisher MR, Shkolnik A, Dias L: MR imaging of osteoid osteoma. J Comput Assist Tomogr 10:1065-7,1986.
Glynn JJ, Lichtenstein L: Osteoid-osteoma with multicentric nidus. J Bone Joint Surg 55:855-8,1973.
Golding JSR: The natural history of osteoid osteoma with a report of twenty cases. J Bone Joint Surg 36B:218-29,1954.
Gonzalez G, Abril JC, Mediero IG, Epeldegui T: Osteoid osteoma with a multicentric nidus. Int Orthop 20:61-3,1996.
Graham HK, Laverick MD, Cosgrave AP, Crone MD: Minimally invasive surgery for osteoid osteoma of the proximal femur. J Bone Joint Surg 75B:115-8,1993.
Greco F, Tamburelli F, Ciabattoni G: Prostaglandins in osteoid osteoma. Int Orthop 15:35-7,1991.
Greenspan A: Benign bone-forming lesions: steoma, osteoid osteoma, and osteoblastoma: clinical, imaging, pathologic and differential considerations. Skeletal Radiol 22:485-500,1993.
Grob D: Osteoblastoma of cervical spine. Case report. Arch Orthop Trauma Surg 108:179-81,1989.
Habermann ET, Stern RE: Osteoid-osteoma of the tibia in an eight-month-old boy. A case report. J Bone Joint Surg 56A:633-6,1974.
Hadjipavlou AG, Lander PH, Marchesi D, Katonis PG, Gaitanis IN: Minimally invasive surgery for ablation of osteoid osteoma of the spine. Spine 28:E472-7,2003.
Halperin N, Gadoth N, Reif R, Axer A: Osteoid osteoma of the proximal femur simulating spinal root compression. Clin Orthop 162:191-4,1982.
Harcke HT, Conway JJ, Tachdjian MO, Dias LS, Noble HB, MacEwen GD, Weiss S: Scintigraphic localization of bone lesions during surgery. Skeletal Radiol 13:211-6,1985.
Hasegawa T, Hirose T, Sakamoto R, Seki K, Ikata T, Hizawa K: Mechanism of pain in osteoid osteomas: an immunohistochemical study. Histopathology 22:487-91,1993.
Healey JH: Osteoid osteoma and osteoblastoma. Current concepts and recent advances. Clin Orthop 204:76-85,1986.
Heiman ML, Cooley CJ, Bradford DS: Osteoid osteoma of a vertebral body. Report of a case with extension across the intervertebral disk. Clin Orthop 118:159- ,1976.
Helms CA: Osteoid osteoma. The double density sign. Clin Orthop 222:167-73,1987.
Helms CA, Hattner RS, Vogler JB III: Osteoid osteoma: radionuclide diagnosis. Radiology 151:779- ,1984.
Herndon JH, Eaton RG, Littler JW: Carpal-tunnel syndrome. An unusual presentation of osteoid-osteoma of the capitate. J Bone Joint Surg 56A:1715- ,1974.
Herrlin K, Ekelund L, Lovdahl R, Persson B: Computed tomography in suspected osteoid osteomas of tubular bones. Skeletal Radiol 9:92-7,1982.
Hershman E: Osteoid osteoma in a cervical pedicle. Resection via transpillar approach. Clin Orthop 213:115-7,1986.
Hoeffel C, Hoeffel JC, Galloy MA, Gucher H: Localization of osteoid osteoma. Can Assoc Radiol J 47:300,1996.
Holmes WS, Pope TL, de Lange E, Fechner RE, McDowel CL, Deats TE: Case report 413. Skeletal Radiol 16:163-5,1987.
Inoue G, Inagaki H: Osteoid osteoma of the distal phalanx. Orthopedics 22:1093-4,1999.
Jackson IJ: Osteoid osteoma of the lamina and its treatment. Am Surg 19:17-23,1953.
Jackson RP, Reckling FW, Mantz FA: Osteoid osteoma and osteoblastoma: similar histologic lesions with different natural histories. Clin Orthop 128:303-13,1977.
Jaffe HL: Osteoid osteoma. Proc R Soc Med 46:1007-12,1953.
Jaffe HL: Osteoid osteoma: a benign osteoblastic tumor composed of osteoid and atypical bone. Arch Surg 31:709,1935.
Jones DA: Osteoid osteoma of the atlas. J Bone Joint Surg 69A:149,1987.
Kaempffe FA: Osteoid osteoma of the coracoid process. Excision by posterior approach. A case report. Clin Orthop 301:260-2,1994.
Kalil RK, Antunes JS: Familial occurrence of osteoid osteoma. Skletal Radiol 32:416-9,2003.
Kayser M, Muhr G: Eighteen-year anamnesis of osteoid osteoma--a diagnostic problem? Arch Orthop Traum Surg 107:27-30,1988.
Kenan S, Abdelwahab IF, Klein MJ, Hermann G, Lewis MM: Case report 864. Elliptical multicentric periosteal osteoid osteoma. Skeletal Radiol 23:565-8,1994.
Kernoham J, Beacon JP, Dakin PK, Helal B: Ostoid osteoma of the pisiform. J Hand Surg 10B:411-4,1985.
Kettunen JS, Makela EA, Kauppinen TA: Gamma probe localization in the surgical treatment of osteoid osteoma. Scand J Surg 92:224-6,2003.
Kirwan EO, Hutton PA, Pozo JL, Ransford AO: Osteoid osteoma and benign osteoblastoma of the spine: clinical presentation and treatment. J Bone Joint Surg 66B:21-6,1984.
Klein MH, Shankman S: Osteoid osteoma: radiologic and pathologic correlation. Skeletal Radiol 21:23-31,1992.
Kneisl JS, Simon MA: Medical management compared with operative treatment for osteoid osteoma. J Bone Joint Surg 74A:174-85,1992.
Kransdorf MJ, Stull MA, Gilkey FW, Moser RP Jr: Osteoid osteoma. Radiographics 11:671-96,1991.
Kumar R, Chandrashekhar N, Dasan JB, Ashok S, Rastogi S, Gupta V, Hadi M, Choudhury S: Recurrent osteoid osteoma: a case report with imaging features. Clin Imaging 27:269-72,2003.
Labbe JL, Clement JL, Dupare B, Poey C, Railhac JJ: Percutaneous extraction of vertebral osteoid osteoma under computed tomography guidance. Eur Spine J 4:368-71,1995.
Larsen LJ, Mall JC, Ichtertz DF: Metachronous osteoid-osteomas. Report of a case. J Bone Joint Surg 73A:612-4,1991.
Lee DH, Malawer MM: Staging and treatment of primary and persistent (recurrent) osteoid osteoma. Clin Orthop 281:229-38,1992.
Lenke LG, Sutherland CJ, Gilula LA: Osteoid osteoma of the proximal femur: CT-guided preoperative localization. Orthopaedics 17:289-92,1994.
Letson GD, McEwen GD, Choy JY: A technique for excision of an osteoid osteoma. Orthopedics 20:266-8,1997.
Liu Pt, Chivers FS, Roberts CC, Schultz CJ, Beauchamp CP: Imaging of osteoid osteoma with dynamic gadolinium-enhanced MR imaging. Radiology 227:691-700,2003.
Lofgren L: Osteoid-osteoma. Acta Chir Scand 104:383-404,1953.
Marck KW, Dhar BK, Spauwen PHM: A cryptic cause of monarthritis in the hand: the juxta-articular osteoid osteoma. J Hand Surg 13B:221-3,1988.
Marcove RC, Heelan RT, Huvos AG, Healey J, Lindeque BG: Osteoid osteoma. Diagnosis, localization and treatment. Clin Orthop 267:197-201,1991.
Marinelli A, Giacomini S, Bianchi G, Pellacani A, Bertoni F, Mercuri M: Osteoid osteoma simulating an osteocartilaginous exostosis. Skeletal Radiol 2004.
Martorano D, Verna V, Mancini A, Mastrantuono D, Faletti C, Gino G, Albertini U, Mellano D, Piana R, Marone S, Brach del Prever E, Linari A, Forni M: CT evaluation pre- and post-percutaneous ablation by radiofrequency of osteoid osteoma. Preliminary experience. Chir Organi Mov 88:233-40,2003.
Mastrokalos DS, Passler HH, Tibesku CO, Wrazidlo W: Computed tomography-guided endoscopic removal of an osteoid osteoma from the femur. Arthroscopy 17:62-6,2001.
Mayer L: The surgery of osteoid osteoma. Bull Hosp Joint Dis 12:174-201,1951.
Mazoyer JF, Kohler R, Bossard D: Osteoid osteoma: CT-guided percutaneous treatment. Radilogy 181:269-71,1991.
McGrath BE, Bush CH, Nelson TE, Scarborough MT: Evaluation of suspected osteoid osteoma. Clin Orthop 327:247-52,1996.
Mirra JM, Gold RH: Osseous tumors of intramedullary origin. In Mirra JM (ed): Bone Tumors: Clinical, Radiologic, and Pathologic Correlations. Phliadelphia, Lea & Febiger, 1989, pp 389-430.
Moberg E: The natural course of osteoid osteoma. J Bone Joint Surg 33A:166-70,1951.
Morton KS, McGraw RW: Osteoid osteoma. Report of a case in a sixty-seven-year-old man. J Bone Joint Surg 69:449-51,1987.
Morton KS, Quenville NF, Beauchamp CP: Aggressive osteoblastoma. J Bone Joint Surg 71B:428-31,1989.
Morton KS, Vassar PS, Knickerbocker WJ: Osteoid osteoma and osteoblastoma: reclassification of 43 cases using Schajowicz's classification. Can J Surg 18:148-52,1975.
Moses RP, Kransdorf MJ, Brower AC, : Osteoid osteoma of the elbow: a review of six cases. Skeletal Radiol 19:181-6,1990.
Muscolo DL, Velan O, Acero GP, Ayerza MA, Calabrese ME, Santini Araujo E: Osteoid osteoma of the hip: percutaneous resection by computed tomography. Clin Orthop 310:170-5,1995.
Nakamichi K, Tachibana S: Osteoid osteoma of the radial diaphysis. J Hand Surg 21B:688-9,1996.
Nascimento RJ, Varney TE, Kasparyan NG, Warhold LG: Intracortical osteoid osteoma of the scaphoid. Orthopedics 30:573-4,2007.
Nelson MC, Lack EE, Freedman MT: Case report 856: Multifocal osteoid osteoma in a 2.5-year-old child. Skeletal Radiol 23:465-7,1994.
Norman A: Persistence or recurrence of pain: a sign of surgical failure in osteoid osteoma. Clin Orthop 130:263-6,1978.
Norman A, Dorfman HD: Osteoid-osteoma inducing pronounced overgrowth and deformity of bone. Clin Orthop 110:233-8,1975.
Osebold WR, Lester EL, Hurley JH, Vincent RL: Intraoperative use of the mobile gamma camera in localizing and excising osteoid osteomas of the spine. Spine 18:1816-28,1993.
Okuda R, Kinoshita M, Morikawa J, Jotoku T, Shima H, Abe M: Tibalis spastic varus foot caused by osteoid osteoma of the calcaneus. Clin Orthop 412:149-52,2003.
Palamarchuk HJ, Ahalt RG, Clements JR: Osteoid osteoma in a 20-year-old soccer player. J Am Podiatr Med Assoc 93:344-6,2003.
Parlier-Cuau C, Nizard R, Champsaur P, Hamze B, Quillard A, Laredo J-D: Osteoid osteoma of the acetabulum: three cases treated by percutaneous resection. Clin Orthop 365:167-74,1999.
Pettine KA: Osteoid-osteoma and osteoblastoma of the spine. J Bone Joint Surg 68A:354-61,1986.

Peyser A, Applbaum Y, Simanovsky N, Safran O, Lamdan R: CT-guided radiofrequency ablation of pediatric osteoid osteoma utilizing a water-cooled tip. Ann Surg Oncol. 2009 Oct;16(10):2856-61.
Phalen GS, Patch DW: Pain in the hip caused by osteoid osteoma. Clin Orthop 4:154-9,1954.
Pogliacomi F, Vaienti E: Misdiagnosed juxta-articular osteoid osteoma of the calcaneus following an injury. Acta Biomed Ateneo Parmense 74:144-50,2003.
Purcell HM, Mills SD, Lipscomb PR: Osteoid osteoma in childhood. Pediatrics 9:295-303,1952.
Rachinsky I, Shelef I, Agranovich S, Lantsberg S: Is osteoid osteoma an iodophilic lesion?: pathologically proved osteoid osteoma of nasal bone first seen on whole-body iodine-131 scan. Clin Nucl Med 28:696-8,2003.
Rand JA, Sim FH, Unni KK: Two osteoid-osteomas in one patient. A case report. J Bone Joint Surg 64:1243,1982.
Ransford AO, Pozo JL, Hutton PAN, Kirwan EO: The behaviour pattern of the scoliosis associated with osteoid osteoma or osteoblastoma of the spine. J Bone Joint Surg 66B:16-20,1984.
Regan MW, Galey JP, Oakeshott RD: Recurrent osteoid osteoma: case report with a ten year asymptomatic interval. Clin Orthop 253:221-4,1990.
Resnick RB, Jarolem KL, Sheskier SC, Desai P, Cisa J: Arthroscopic removal of an osteoid osteoma of the talus: a case report. Foot Ankle Int 16:212-5,1995.
Rex C, Jacobs L, Nur Z: Painless osteoid osteoma of the middle phalanx. J Hand Surg 22B:798-800,1997.
Roger B, Bellin MF, Wioland M, Grenier P: Osteoid osteoma: CT-guided percutaneous excision confirmed with immediate follow-up scintigraphy in 16 outpatients. Radiology 201:239-42,1996.
Rosenthal DI, Alexander A, Rosenberg AE, Springfield D: Ablation of osteoid osteomas with a percutaneously placed electrode: a new procedure. Radiology 183:29-33,1992.
Rosenthal DI, Hornicek FJ, Torriani M, Gebhardt MC, Mankin HJ: Osteoid osteoma: percutaneous treatment with radiofrequency energy. Radiolog 229:171-5,2003.
Rosenthal DI, Hornicek FJ, Wolfe MW, Jennings LC, Gebhardt MC, Mankin HJ: Decreasing length of hospital stay in treatment of osteoid osteoma. Clin Orthop 361:186-91,1999.
Rosenthal DI, Hornicek FJ, Wolfe MW, Jennings LC, Gebhardt MC, Mankin HJ: Percutaneous radiofrequency coagulation of osteoid osteoma compared with operative treatment. J Bone Joint Surg 80A:815-21,1998.
Rosenthal DI, Springfield DS, Gebhardt MC, Rosenberg AE, Mankin HJ: Osteoid osteoma: percutaneous radio-frequency ablation. Radiology 197:451-4,1995.
Rushton JG, Mulder DW, Lipscomb PR: Neurologic symptoms with osteoid osteoma. Neurology 5:794-7,1955.
Sacks S: Osteoid osteoma; report of a case with pain in the arm for ten years. S Afr Med J 28:766-8,1954.
Saifuddin A, White J, Sherazi Z, Shaikh MI, Natali C, Ransford AO: Osteoid osteoma and osteoblastoma of the spine: Factors associated with the presence of scoliosis. Spine 23:47-53,1998.
Sankaran B: Osteoid osteoma. Surg Gynecol Obstet 92:193-8,1954.
Sans N, Galy-Fourcade D, Assouon J, Jarlaud T, Chiarassa H, Bonnevialle P, Railhac N, Giron J, Morera-Moupome H, Railhac JJ: Osteoid osteoma: CT-guided percutaneous resection and follow-up in 38 patients. Radiology 212:687-92,1999.
Schaefer MP, Smith J: The diagnostic and therapeutic challenge of femoral head osteoid osteoma presenting as thigh pain: a case report. Arch Phys Med Rehabil 84:904-5,2003.
Schai P, Fiederich N, Kruger A, Jundt G, Herbe E, Buess P: Discrete synchronous multifocal osteoid osteoma of the humerus. Skeletal Radiol 25:667-70,1996.
Schajowicz F, Lemos C: Osteoid osteoma and osteoblastoma. Closely related entites of osteoblastic derivation. Acta Orthop Scand 41:272-91,1970.
Sevitt S, Horn JS: A painless and calcified osteoid osteoma of the little finger. J Pathol Bacteriol 67:571-4,1954.
Sherman M: The differential diagnosis of osteoid osteoma. J La State Med Soc 105:469-74,1953.
Sherman MS, Caldwell GA: Osteoid osteoma. Clin Orthop 2:203-10,1953.
Sim FH, Dahlin DC, Beabout JW: Osteoid-osteoma: diagnostic problems. J Bone Joint Surg 57A: 154-9,1975.
Simon SD, Silver CM: Osteoid osteoma. R I Med J 37:23-9,1954.
Sinha S, Housden P: Discrete synchronous multifocal osteoid osteoma of the femur. Pediatr Radiol 34:280,2004.
Soller JM Piza G, Aliaga F: Special characteristics of osteoid osteoma in the proximal phalanx. J Hand Surg 22B:793-7,1997.
Spadea S: Osteoid osteoma of the astragalus. R I Med J 33:464-5,1950.
Sproule JA, Khan F, Fogarty EE: Osteoid osteoma: painful enlargement of the second toe. Arch Orthop Trauma Surg 2004.
Strach EH: Osteoid osteoma. Br Med J 1(4818):1031,1953.
Szendroi M, Kollo K, Antal I, Lakatos J, Szoke G: Intraarticular osteoid osteoma: clinical features, imaging results, and comparison with extraarticular localizztion. J Rheumatol 31:957-64,2004.
Tacke J, Mahnken A, Roggan A, Gunther RW: Multipolar radiofrequency ablation: first clinical results. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 176:324-9,2004.
Takeda A, Kikuchi S, Tajino T, Yamada H, Sato K: Basic and clinical studies of percutaneous radiofrequency ablation of osteoid osteoma using a standard electrosurgical generator. J Orthop Sci 8:301-5,2003.
Tanaka C, Fujiwara Y, Yomamuro T, Nakashima Y, Harbura H: Intraperiosteal osteoid osteoma. A case report. Clin Orthop 175:190-2,1983.
Thompson GH, Wong K, Konsens RM, Vibhakers S: Magnetic resonance imaging of an osteoid osteoma of the proximal femur: a potentially confusing appearance. J Pediatr Orthop 10:800-4,1990.
Tillotson CL, Rosenberg AE, Rosenthal DI: Controlled thermal injury of bone: report of a percutaneous technique using radiofrequency electrode and generator. Investigative Radiol 24:888-92,1989.
Toni A, Calderoni P: Intracapsular metaphyseal osteoid osteoma of the femoral neck. Ital J Orthop Traumatol 9:501-6,1983.
Tse WL, Hung LK, Law B, Ho PC: Enhanced localization of osteoid osteoma with radiolabeling and intraoperative gamma counter guidance: a case report. J Hand Surg 28:699-703,2003.
Vaughan WW, Johnston GB, Bugg EI: Osteoid osteoma of bone. A clinical study with the report of two cases. N C Med J 11:660-6,1950.
Vaughan-Jackson OJ: Osteoid osteoma with unusual symptoms; case report. J Bone Joint Surg 32B:368-9,1950.
Voto SJ, Cook AJ, Weiner DS, Ewing JW, Arrington LE: Treatment of osteoid osteoma by computed tomography guided excision in the pediatric patient. J Pediatr Orthop 10:510-3,1990.
Ward WG, Eckardt JJ, Shayestehfar S, Mirra J, Grogan T, Oppeheim W: Osteoid osteoma diagnosis and management with low morbidity. Clin Orthop 291:229-35,1993.
Wasserlauf B, Gossett J, Rosenthal DI, Levine WN: Osteoid osteoma of the glenoid: minimally invasive treatment. Am J Orthop 32:405-7,2003.
Weber KL, Morrey BF: Osteoid osteoma of the elbow: a diagnostic challenge. J Bone Joint Surg 81A:1111-9,1999.
Wedge JH, Tehang S, MacFadyen DJ: Computed tomography in localization of spinal osteoid osteoma. Spine 6:423-7,1981.
Wilson Y, Fogelman I, Evans DM: Detection of an elusive osteoid osteoma using a registration bone scan. J Hand Surg 22B:801-4,1997.
Witt JD, Hall-Craggs MA, Ripley P, Cobb JP, Bown SG: Interstitial laser photocoagulation for the treatment of osteoid osteoma. J Bone Joint Surg 82B:1125-8,2000.
Woods ER, Martel W, Mandell SH, Crabbe JP: Reactive soft-tissue mass associated with osteoid osteoma: correlation of MR imaging features with pathologic findings. Radiology 186:221-5,1993.
Yamamura S, Sato K, Sugiura H, Asano M, Takahashi M, Iwata H: Magnetic resonance imaging of inflammatory reaction in osteoid osteoma. Arch Orthop Trauma Surg 114:8-13,1994.
Yamamura S, Sato K, Sugiura H, Katagiri H, Ando Y, Fukatsu H, Iwata H: Prostaglandin levels of primary bone tumor tissues correlate with peritumoral edema demonstrated by magnetic resonance imaging. Cancer 79:255-61,1997.
Yercan HS, Okcu G, Ozalp T, Osic U: Arthroscopic removal of the osteoid osteoma on the neck of the talus. Knee Surg Sports Traumatol Arthrosc 2003.
Zambelli P-Y, Lechevallier J, Bracq H, Carlioz H: Osteoid osteoma or osteoblastoma of the cervical spine in relation to the vertebral artery. J Ped Orthop 14:788-92,1994.
Ziegler DN, Scheid DK: A method for location of an osteoid-osteoma of the femur at operation. J Bone Joint Surg 74A:1549-52,1992.
Zmurko MG, Mott MP, Lucas DR, Hamre MR, Miller PR: Multicentric osteoid osteoma. Orthopedics 27:1294-6,2004.

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