251/454. MR imaging of osteoid osteoma of the talus. Magnetic resonance (MR) imaging of the painful ankle of a 15-year-old boy revealed the nidus of a subarticular osteoid osteoma of the talus along with markedly abnormal signal intensity in the neighboring bone marrow. This MR appearance correlated with alterations in the neighboring bone marrow documented by histopathologic examination. ( info) |
| The average age of 19 patients with osteoid osteoma of the hand or wrist was 23 years (range, 8 to 70 years). Nine lesions were in the proximal phalanx, four in the distal phalanx, one in a middle phalanx, and one in a metacarpal. Two lesions were in the capitate, one of the hamate, and one in the triquetrum. The average time from onset of symptoms to successful treatment was 16 months. Fifteen of the 19 patients had had treatment elsewhere; 14 had had unsuccessful operative procedures, usually related to incorrect diagnoses. Sixteen patients had a minimum follow-up of 5 months (range, 5 months to 31 years; mean, 11 years) after operation. Surgical failure occurred in four patients with phalangeal lesions (two proximal and two distal). Three of the four patients subsequently were cured by reoperation, and the other patient obtained further treatment elsewhere. ( info) |
| Osteoid osteoma is a benign bone tumor, first reported 50 years ago. Various characteristics of this bone tumor have remained consistent throughout the years. A discussion of the previous literature on osteoid osteoma and its characteristics are presented in this article, with a case report. ( info) |
254/454. Metastatic and pseudomalignant osteoblastoma: a report of two unusual cases. Two unusual cases of osteoblastoma with different responses to radiation therapy are reported. A 15-year-old boy with an aggressive osteoblastoma of the ilium was treated initially with curettage and subsequently with radiation and systemic chemotherapy. The patient died 35 months after his initial presentation with distant metastases which were verified at autopsy. A 12-year-old girl developed a lesion of the femur with clinical and histologic features of aggressive osteoblastoma. amputation was recommended at the time of recurrence, but the patient declined and radiation therapy was given. The patient was alive and well 14 years after her initial presentation. These cases highlight the biologic diversity of osteoblastoma-like lesions and illustrate the difficulties which may be encountered in attempting to differentiate between benign and malignant forms of this tumor. ( info) |
255/454. An osteoid osteoma in an open distal femoral epiphysis. A case report. An osteoid osteoma occurred in the distal femoral epiphysis of an 11-year-old boy. Only eight other cases of this tumor in an open epiphysis have been reported. An image intensifier was used to place the tip of a wire in the center lesion. Removal through a small incision with a bone trephine placed over a guiding Kirschner wire was curative. Bone peripheral to the lesion was replaced, allowing early mobilization without support. ( info) |
| Osteoid osteoma is rarely located in the hamate. Only five similar cases have appeared in the international literature, and none have appeared in the Spanish literature. In a 15-year-old girl, the lesion was excised en bloc, and the defect was filled with a bone graft. Two and one-half years after the operation the patient was asymptomatic with normal mobility of the affected wrist. ( info) |
257/454. Pediatric orthopedic pain of unknown origin. Thirty-eight cases of musculoskeletal pain in a pediatric population that defied diagnosis are reviewed. The time between the onset of symptoms and the final diagnosis averaged 11.4 months, but in many cases was greater than 1 year. The most common diagnoses included reflex sympathetic dystrophy, osteoid osteoma, osteomyelitis, intraarticular hemangiomata, slipped epiphyses, and rheumatoid variants. There were several uncommon causes of pain, such as soft tissue hemangiomata, dystonia, and addison disease. The pitfalls and causes of error are reviewed. ( info) |
258/454. Osteoid osteoma of the cervical spine. Osteoid osteoma is a benign tumor of bone that occurs in children and adolescents, particularly in the femur and tibia. Osteoid osteoma of the spine accounts for approximately 10% of these lesions. There frequently is a delay in diagnosis because of its difficult visual appearance. Pain in the spine occurring at night that is relieved by aspirin, or painful scoliosis, should alert the physician to the possibility of its presence. Bone scan and tomograms are essential in making the diagnosis. Complete surgical excision of the lesion is the procedure of choice for immediate, lasting pain relief. ( info) |
259/454. Subperiosteal osteoid osteoma of the talus. We report three patients with subperiosteal osteoid osteoma of the talus. All showed an erosion of the dorsal surface of the talus with medullary bone sclerosis. Adjacent paraosseous soft tissue calcification was seen in two lesions. Computed tomography demonstrated the nidus of the osteoid osteoma in two cases. ( info) |
260/454. Intraoperative radioactive localization of osteoid osteomas: four case reports. We have excised four osteoid osteomas in four children, aided by intraoperative radioactive localization. Here we report these cases and describe the equipment used. Exact detection and elective excision are the two advantages of this technique. ( info) |