Osteoid osteoma: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
 
(70 intermediate revisions by 3 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
<br>'''For more information about osteoma that is not associated with osteoid osteoma, see [[osteoma]]'''  
<br>'''For more information about osteoma that is not associated with osteoid osteoma, see [[osteoma]]'''  
{{Osteoid osteoma}}
{{SI}}
{{CMG}} {{AE}} {{MV}}
{{CMG}}; {{AE}} {{Rohan}}


{{SK}} Osteoma osteoid; OO; Osteoid osteomas  
{{SK}} Osteoma osteoid; OO; Osteoid osteomas  


==Overview==
==Overview==
Osteoid osteoma is the third most common [[Benign tumor|benign bone tumor]]. Its incidence is 11% among the [[benign tumors]] and 3% among all primary [[bone]] [[Tumor|tumors]]. Adolescents and children are most affected by osteoid osteoma. Men are more commonly affected than women, with a 6:4 ratio. Osteoid osteoma is a benign osteoblastic [[tumor]] that was first described in 1930 by Bergstrand. Jaffe described it in 1935 and was the first to recognize it as a unique entity. Osteoid osteomas are usually smaller than 1.5-2 cm and characterized by an [[osteoid]]-rich nidus in a highly loose, [[vascular]] [[connective tissue]]. The nidus is well demarcated and may contain a variable amount of [[calcification]]. Surrounding the nidus is a zone of [[Sclerotic ring|sclerotic]] but otherwise normal [[bone]]. Osteoid osteoma can occur anywhere. Osteoid osteoma is usually occur in the [[cortex]] of the shafts of long [[bones]] more than 50% of the cases. It is seen in the [[metaphyseal]] regions of large [[bones]] of the [[femur]], [[tibia]], and [[humerus]]. About 20% percent of the [[lesions]] involve [[posterior]] element of the [[spine]]. The hallmark of osteoid osteoma is intense [[nocturnal]] [[Pain|limb pain]] which is relieved by low doses of [[salicylates]] and local [[tenderness]]. If left untreated, osteoid osteoma progression occurs slow and is then followed by restricted [[range of motion]], possible [[Fracture|pathologic fracture]], or spontaneous [[regression]]. The medical therapy for osteoid osteoma is [[Non-steroidal anti-inflammatory drug|NSAIDs]] and the mainstay of treatment is [[surgery]].


==Historical Perspective==
==Historical Perspective==
[Disease name] was first discovered by [name of scientist], a [nationality + occupation], in [year]/during/following [event].
*In 1930, Dr. Bergstrand, a German physician, first described osteoid osteoma in 1930.<ref name="pmid22669768">{{cite journal |vauthors=Karandikar S, Thakur G, Tijare M, Shreenivas K, Agrawal K |title=Osteoid osteoma of mandible |journal=BMJ Case Rep |volume=2011 |issue= |pages= |year=2011 |pmid=22669768 |pmc=3233922 |doi=10.1136/bcr.10.2011.4886 |url=}}</ref>
 
*In 1935, Dr.Henry Jaffe, an American pathologist first described osteoid osteoma as a [[benign]] [[Bone tumors|bone tumor]].<ref name="pmid3849059">{{cite journal |vauthors=Torg JS, Loughran T, Pavlov H, Schwamm H, Gregg J, Sherman M, Balduini FC |title=Osteoid osteoma. Distant, periarticular, and subarticular lesions as a cause of knee pain |journal=Sports Med |volume=2 |issue=4 |pages=296–304 |year=1985 |pmid=3849059 |doi= |url=}}</ref>
The association between [important risk factor/cause] and [disease name] was made in/during [year/event].
*In 1953, Dr. Jaffe coined the term nidus, which was described as the “core”, referring to the [[tumor]] itself and is composed of [[bone]] at various stages of maturity within a highly [[vascular]] [[connective tissue]] stroma.<ref name="pmid20462991">{{cite journal| author=Chai JW, Hong SH, Choi JY, Koh YH, Lee JW, Choi JA et al.| title=Radiologic diagnosis of osteoid osteoma: from simple to challenging findings. | journal=Radiographics | year= 2010 | volume= 30 | issue= 3 | pages= 737-49 | pmid=20462991 | doi=10.1148/rg.303095120 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20462991  }} </ref>
 
*In 1954, Dahlin and Johnson added the term giant osteoid osteomas.<ref name="pmid13163088">{{cite journal| author=DAHLIN DC, JOHNSON EW| title=Giant osteoid osteoma. | journal=J Bone Joint Surg Am | year= 1954 | volume= 36-A | issue= 3 | pages= 559-72 | pmid=13163088 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13163088  }} </ref>
In [year], [scientist] was the first to discover the association between [risk factor] and the development of [disease name].
*In 1966, Dr.Edeiken classified osteoid osteomas into three types.<ref name="pmid3849059">{{cite journal |vauthors=Torg JS, Loughran T, Pavlov H, Schwamm H, Gregg J, Sherman M, Balduini FC |title=Osteoid osteoma. Distant, periarticular, and subarticular lesions as a cause of knee pain |journal=Sports Med |volume=2 |issue=4 |pages=296–304 |year=1985 |pmid=3849059 |doi= |url=}}</ref>
 
In [year], [gene] mutations were first implicated in the pathogenesis of [disease name].
 
There have been several outbreaks of [disease name], including -----.
 
In [year], [diagnostic test/therapy] was developed by [scientist] to treat/diagnose [disease name].


==Classification==
==Classification==
There is no established system for the classification of [disease name].
*Osteoid Osteoma can be classified based on location and imaging findings.


OR
===Anatomical Classification===
*Based on Location:<ref name="pmid1116053">{{cite journal |vauthors=Morton KS, Vassar PS, Knickerbocker WJ |title=Osteoid osteoma and osteoblastoma: reclassification of 43 cases using Schajowicz's classification |journal=Can J Surg |volume=18 |issue=2 |pages=148–52 |year=1975 |pmid=1116053 |doi= |url=}}</ref><ref name="pmid26579486">{{cite journal |vauthors=Hakim DN, Pelly T, Kulendran M, Caris JA |title=Benign tumours of the bone: A review |journal=J Bone Oncol |volume=4 |issue=2 |pages=37–41 |year=2015 |pmid=26579486 |pmc=4620948 |doi=10.1016/j.jbo.2015.02.001 |url=}}</ref>


[Disease name] may be classified according to [classification method] into [number] subtypes/groups: [group1], [group2], [group3], and [group4].
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align="center"
| valign="top" |
|-
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Type of osteoid osteoma}}
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Characteristics}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Intracortical
| style="padding: 5px 5px; background: #F5F5F5;" | Dense [[sclerosis]] around the nidus
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Periosteal
| style="padding: 5px 5px; background: #F5F5F5;" | [[Periosteal reaction]]
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Cancellous (medullary)
| style="padding: 5px 5px; background: #F5F5F5;" | Produces very little reactive bone
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Subarticular
| style="padding: 5px 5px; background: #F5F5F5;" | Simulates [[arthritis]] as it produces [[Synovial|synovial reactions]]
|}


OR
===Enneking (MSTS) Staging System===
*The Enneking surgical staging system (also known as the MSTS system) for benign [[Musculoskeletal system|musculoskeletal]] [[Tumor|tumors]] based on [[radiographic]] characteristics of the [[tumor]] host margin.<ref name="pmid20333492">{{cite journal| author=Jawad MU, Scully SP| title=In brief: classifications in brief: enneking classification: benign and malignant tumors of the musculoskeletal system. | journal=Clin Orthop Relat Res | year= 2010 | volume= 468 | issue= 7 | pages= 2000-2 | pmid=20333492 | doi=10.1007/s11999-010-1315-7 | pmc=2882012 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20333492  }} </ref><ref name="pmid10472088">{{cite journal| author=Funovics M, Philipp M, Breitenseher M| title=[Staging of musculoskeletal tumors in diagnostic imaging]. | journal=Radiologe | year= 1999 | volume= 39 | issue= 7 | pages= 591-9 | pmid=10472088 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10472088  }}</ref><ref name="pmid7449206">{{cite journal| author=Enneking WF, Spanier SS, Goodman MA| title=A system for the surgical staging of musculoskeletal sarcoma. | journal=Clin Orthop Relat Res | year= 1980 | volume=  | issue= 153 | pages= 106-20 | pmid=7449206 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7449206  }}</ref><ref name="pmid3456859">{{cite journal| author=Enneking WF| title=A system of staging musculoskeletal neoplasms. | journal=Clin Orthop Relat Res | year= 1986 | volume=  | issue= 204 | pages= 9-24 | pmid=3456859 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3456859  }}</ref>
*It is widely accepted and routinely used classification.


[Disease name] may be classified into [large number > 6] subtypes based on [classification method 1], [classification method 2], and [classification method 3].
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align="center"
[Disease name] may be classified into several subtypes based on [classification method 1], [classification method 2], and [classification method 3].
| valign="top" |
 
|-
OR
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Stages}}
 
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Description}}
Based on the duration of symptoms, [disease name] may be classified as either acute or chronic.
|-
 
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |1
OR
| style="padding: 5px 5px; background: #F5F5F5;" | Latent: Well demarcated borders
 
|-
If the staging system involves specific and characteristic findings and features:
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |2
According to the [staging system + reference], there are [number] stages of [malignancy name] based on the [finding1], [finding2], and [finding3]. Each stage is assigned a [letter/number1] and a [letter/number2] that designate the [feature1] and [feature2].
| style="padding: 5px 5px; background: #F5F5F5;" | Active: Indistinct borders
 
|-
OR
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |3
 
| style="padding: 5px 5px; background: #F5F5F5;" | Aggressive: Indistinct borders
The staging of [malignancy name] is based on the [staging system].
|}
 
OR
 
There is no established system for the staging of [malignancy name].


==Pathophysiology==
==Pathophysiology==
The exact pathogenesis of [disease name] is not fully understood.
*The exact [[etiology]] of osteoid osteoma is unknown.<ref name="pmid24830123">{{cite journal |vauthors=Athwal P, Stock H |title=Osteoid osteoma: a pictorial review |journal=Conn Med |volume=78 |issue=4 |pages=233–5 |year=2014 |pmid=24830123 |doi= |url=}}</ref>
*Osteoid osteoma arises from the [[Osteoblast|osteoblasts]].
*Osteoid osteoma consists of radially oriented [[Trabecula|trabeculae]] of surrounding reactive [[bone]], indicating an increased pressure in the [[vascular]] nidus.
*This arrangement of the bony [[Trabecula|trabeculae]] is due to the stresses placed on them.
*This increased pressure is due to [[vasodilatation]] and [[edema]] is which stimulate [[Interossei|interosseous]] nerve endings, generating [[pain]].<ref name="pmid9504688">{{cite journal |vauthors=O'Connell JX, Nanthakumar SS, Nielsen GP, Rosenberg AE |title=Osteoid osteoma: the uniquely innervated bone tumor |journal=Mod. Pathol. |volume=11 |issue=2 |pages=175–80 |year=1998 |pmid=9504688 |doi= |url=}}</ref>
*In addition, the [[pain]] is also attributed to increased local concentration of [[Prostaglandin E2 receptor|prostaglandin E2]], [[Cyclooxygenase|COX1 & 2]] expression; and increased number and size of unmyelinated [[nerve fibers]] within the nidus.
*Osteoid osteomas are usually [[Cortical area|cortical]] [[lesions]] but they can occur anywhere within the [[bone]] including [[medullary]], [[Periosteum|subperiosteal]] (most common in [[Talus bone|talus]]), and intracapsular area.
*More than 50 percent of osteoid osteomas occur in [[lower extremity]] of [[Long bone|long bones]].<ref name="pmid3849059">{{cite journal |vauthors=Torg JS, Loughran T, Pavlov H, Schwamm H, Gregg J, Sherman M, Balduini FC |title=Osteoid osteoma. Distant, periarticular, and subarticular lesions as a cause of knee pain |journal=Sports Med |volume=2 |issue=4 |pages=296–304 |year=1985 |pmid=3849059 |doi= |url=}}</ref><ref>{{cite book | last = Peabody | first = Terrance | title = Orthopaedic oncology : primary and metastatic tumors of the skeletal system | publisher = Springer | location = Cham | year = 2014 | isbn = 9783319073224 }}</ref>
*It most commonly affects  the metadiaphysis of the [[femur]] and [[tibia]].
*About 20 percent of osteoid osteomas occur in the [[posterior]] elements of the [[Vertebral column|spine]].


OR
==Genetics==
 
*The structural [[Chromosome|chromosomal]] alterations involving [[22q13 deletion syndrome|22q13]].1 in osteoid osteoma may affect critical [[genes]] involved in the regulation of [[cell proliferation]], such as the [[YWHAH]] [[gene]].<ref name="pmid11172903">{{cite journal| author=Baruffi MR, Volpon JB, Neto JB, Casartelli C| title=Osteoid osteomas with chromosome alterations involving 22q. | journal=Cancer Genet Cytogenet | year= 2001 | volume= 124 | issue= 2 | pages= 127-31 | pmid=11172903 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11172903  }} </ref>
It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].
*[[YWHAH]] [[gene]] codes for a 14-3-3 family members of [[dimeric]] [[phosphoserine]]-binding [[proteins]] that participate in signal [[transduction]] and checkpoint control pathways.
 
*Their primary function is to [[Inhibition|inhibit]] [[apoptosis]].
OR
*Another [[gene]] mapped in this region is [[PDGFB gene|PDGFB]] that codes for a [[platelet-derived growth factor]], a beta [[polypeptide]] ([[simian]] [[sarcoma]] [[viral]] [v-sis] [[oncogene]] [[homolog]]), a potent [[mitogen]] for [[Cell (biology)|cells]] of [[mesenchymal]] origin and involved in the [[transformation]] process.
 
[Pathogen name] is usually transmitted via the [transmission route] route to the human host.
 
OR
 
Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.
 
OR
 
 
[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].
 
OR
 
The progression to [disease name] usually involves the [molecular pathway].
 
OR
 
The pathophysiology of [disease/malignancy] depends on the histological subtype.


==Causes==
==Causes==
Disease name] may be caused by [cause1], [cause2], or [cause3].
*The [[Causes|cause]] of osteoid osteoma has not been identified.<ref>{{cite book | last = Peabody | first = Terrance | title = Orthopaedic oncology : primary and metastatic tumors of the skeletal system | publisher = Springer | location = Cham | year = 2014 | isbn = 9783319073224 }}</ref>
 
OR
 
Common causes of [disease] include [cause1], [cause2], and [cause3].


OR
==Differentiating Osteoid osteoma from Other Diseases==
*Osteoid osteoma must be differentiated from other [[Disease|diseases]] that cause night-pain, soft tissue [[swelling]], and bowing deformity such as other [[Osteogenic Sarcoma|osteogenic]] [[tumors]],  [[osteoblastoma]], [[bone]] [[abscess]] ([[Brodie abscess]]), [[osteosarcoma]], and [[enostosis]].<ref name="pmid23329939">{{cite journal |vauthors=Hashemi J, Gharahdaghi M, Ansaripour E, Jedi F, Hashemi S |title=Radiological features of osteoid osteoma: pictorial review |journal=Iran J Radiol |volume=8 |issue=3 |pages=182–9 |year=2011 |pmid=23329939 |pmc=3522328 |doi=10.5812/kmp.iranjradiol.17351065.3392 |url=}}</ref><ref name="pmid22052644">{{cite journal |vauthors=Atesok KI, Alman BA, Schemitsch EH, Peyser A, Mankin H |title=Osteoid osteoma and osteoblastoma |journal=J Am Acad Orthop Surg |volume=19 |issue=11 |pages=678–89 |year=2011 |pmid=22052644 |doi= |url=}}</ref><ref name="pmid23089877">{{cite journal| author=Laurence N, Epelman M, Markowitz RI, Jaimes C, Jaramillo D, Chauvin NA| title=Osteoid osteomas: a pain in the night diagnosis. | journal=Pediatr Radiol | year= 2012 | volume= 42 | issue= 12 | pages= 1490-501; quiz 1540-2 | pmid=23089877 | doi=10.1007/s00247-012-2495-y | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23089877  }}</ref><ref name="pmid20462991" />


The most common cause of [disease name] is [cause 1]. Less common causes of [disease name] include [cause 2], [cause 3], and [cause 4].
{| style="border: 0px; font-size: 85%; margin: 3px; width: 1000px" align="center"
 
| valign="top" |
OR
|+
 
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Differential Diagnosis}}
The cause of [disease name] has not been identified. To review risk factors for the development of [disease name], click [[Pericarditis causes#Overview|here]].
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Similar Features}}
 
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Differentiating Features}}
==Differentiating ((Page name)) from Other Diseases==
|-
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | [[Osteoblastoma]]
 
| style="padding: 5px 5px; background: #F5F5F5;" |
OR
*[[Benign]], male predilection, and also present in [[long bones]]
 
| style="padding: 5px 5px; background: #F5F5F5;" |
[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
*In [[osteoblastoma]], differentiating features include uncommon [[tumor]],  affect the [[axial skeleton]] more frequently, [[lesions]] are typically larger than 2 cm, but more importantly, osteoid osteoma can only be distinguished from [[osteoblastoma]] by imaging features
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | [[Brodie abscess]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*Present in children, [[limb pain]], and occasionally affects [[long bones]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*In [[Brodie abscess]], differentiating features include: fever, [[subacute]] onset, and the location usually affects the [[metaphysis]] of [[Tubular|tubular bones]]
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | [[Osteosarcoma]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*Affects the same group of population (children and [[Adolescent|adolescents]]), patients usually present with [[bone pain]], and the location is usually [[Long bone|long bones]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*In [[osteosarcoma]], differentiating features include: [[malignancy]], [[Infiltration (medical)|infiltration]] to surrounding tissue, and elevation of serum [[alkaline phosphatase]] ([[ALP]])
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | [[Enostosis]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*Affects the same group of population (children and [[Adolescent|adolescents]]), small size, and the location is usually long [[bones]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*In [[enostosis]], differentiating features, include: [[Pathognomonic]] [[radiological]] appearance and incidental finding
|}


==Epidemiology and Demographics==
==Epidemiology and Demographics==
The incidence/prevalence of [disease name] is approximately [number range] per 100,000 individuals worldwide.
*Osteoid osteoma is the third most common [[benign]] [[Bone tumors|bone tumor]].<ref name="pmid16932114">{{cite journal| author=Lee EH, Shafi M, Hui JH| title=Osteoid osteoma: a current review. | journal=J Pediatr Orthop | year= 2006 | volume= 26 | issue= 5 | pages= 695-700 | pmid=16932114 | doi=10.1097/01.bpo.0000233807.80046.7c | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16932114  }} </ref><ref name="pmid12802523">{{cite journal| author=Kalil RK, Antunes JS| title=Familial occurrence of osteoid osteoma. | journal=Skeletal Radiol | year= 2003 | volume= 32 | issue= 7 | pages= 416-9 | pmid=12802523 | doi=10.1007/s00256-003-0660-y | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12802523  }} </ref>
 
*Its [[incidence]] is 11% among the [[Tumor|benign tumors]] and 3% among all [[Bone tumors|primary bone tumors]].<ref>{{cite book | last = Peabody | first = Terrance | title = Orthopaedic oncology : primary and metastatic tumors of the skeletal system | publisher = Springer | location = Cham | year = 2014 | isbn = 9783319073224 }}</ref>
OR
*[[Adolescent|Adolescents]] and children are most affected by osteoid osteoma.
 
*The age distribution of osteoid osteoma is between 5-22 years.<ref name="pmid23814261">{{cite journal| author=Barlow E, Davies AM, Cool WP, Barlow D, Mangham DC| title=Osteoid osteoma and osteoblastoma: novel histological and immunohistochemical observations as evidence for a single entity. | journal=J Clin Pathol | year= 2013 | volume= 66 | issue= 9 | pages= 768-74 | pmid=23814261 | doi=10.1136/jclinpath-2013-201492 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23814261  }} </ref>
In [year], the incidence/prevalence of [disease name] was estimated to be [number range] cases per 100,000 individuals worldwide.
*The mean age of the patients with osteoid osteoma is 12 years.<ref name="pmid23814261">{{cite journal| author=Barlow E, Davies AM, Cool WP, Barlow D, Mangham DC| title=Osteoid osteoma and osteoblastoma: novel histological and immunohistochemical observations as evidence for a single entity. | journal=J Clin Pathol | year= 2013 | volume= 66 | issue= 9 | pages= 768-74 | pmid=23814261 | doi=10.1136/jclinpath-2013-201492 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23814261  }} </ref>
 
*Men are more commonly affected than women, with a 6:4 ratio.<ref name="pmid23814261">{{cite journal| author=Barlow E, Davies AM, Cool WP, Barlow D, Mangham DC| title=Osteoid osteoma and osteoblastoma: novel histological and immunohistochemical observations as evidence for a single entity. | journal=J Clin Pathol | year= 2013 | volume= 66 | issue= 9 | pages= 768-74 | pmid=23814261 | doi=10.1136/jclinpath-2013-201492 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23814261  }} </ref>
OR
*There is no [[racial]] predilection to osteoid osteoma.
 
In [year], the incidence of [disease name] is approximately [number range] per 100,000 individuals with a case-fatality rate of [number range]%.
 
 
 
Patients of all age groups may develop [disease name].
 
OR
 
The incidence of [disease name] increases with age; the median age at diagnosis is [#] years.
 
OR
 
[Disease name] commonly affects individuals younger than/older than [number of years] years of age.
 
OR
 
[Chronic disease name] is usually first diagnosed among [age group].
 
OR
 
[Acute disease name] commonly affects [age group].
 
 
 
There is no racial predilection to [disease name].
 
OR
 
[Disease name] usually affects individuals of the [race 1] race. [Race 2] individuals are less likely to develop [disease name].
 
 
 
[Disease name] affects men and women equally.
 
OR
 
[Gender 1] are more commonly affected by [disease name] than [gender 2]. The [gender 1] to [gender 2] ratio is approximately [number > 1] to 1.
 
 
 
The majority of [disease name] cases are reported in [geographical region].
 
OR
 
[Disease name] is a common/rare disease that tends to affect [patient population 1] and [patient population 2].


==Risk Factors==
==Risk Factors==
There are no established risk factors for [disease name].
OR


The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].
* There are no established risk factors for osteoid osteoma.<ref>{{cite book | last = Peabody | first = Terrance | title = Orthopaedic oncology : primary and metastatic tumors of the skeletal system | publisher = Springer | location = Cham | year = 2014 | isbn = 9783319073224 }}</ref>
 
OR
 
Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].
 
OR
 
Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.


==Screening==
==Screening==
There is insufficient evidence to recommend routine screening for [disease/malignancy].
*There is insufficient evidence to recommend routine [[Screening (medicine)|screening]] for osteoid osteoma.
 
OR
 
According to the [guideline name], screening for [disease name] is not recommended.
 
OR
 
According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].


==Natural History, Complications, and Prognosis==
==Natural History, Complications, and Prognosis==
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
*The natural history of untreated osteoid osteoma is toward spontaneous [[regression]], it is taken an average of 6 years.<ref name="pmid7130236">{{cite journal| author=Rand JA, Sim FH, Unni KK| title=Two osteoid-osteomas in one patient. A case report. | journal=J Bone Joint Surg Am | year= 1982 | volume= 64 | issue= 8 | pages= 1243 | pmid=7130236 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7130236  }} </ref>
 
*During this period, the nidus gradually begins to calcify; afterwards, ossify, and, finally, blends into [[Sclerotic ring|sclerotic]] surrounding [[bone]].
OR
*The local [[pain]] gradually diminishes over time.  
 
*Common [[complications]] of osteoid osteoma includes [[pathological]] [[Bone fracture|fracture]], [[stress fracture]], and [[muscle atrophy]].
Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
*[[Prognosis]] is generally excellent after [[surgery]].
 
* Local [[Recurrence quantification analysis|recurrence]] is rare but may occur 6 months after [[surgery]].
OR
 
Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.


==Diagnosis==
==Diagnosis==
===Diagnostic Study of Choice===
===Diagnostic Study of Choice===
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
*[[Computed tomography|CT scan]] is the diagnostic study of choice for the [[diagnosis]] of osteoid osteoma.
 
*[[Computed tomography|CT scan]] findings include:<ref>{{cite book | last = Peabody | first = Terrance | title = Orthopaedic oncology : primary and metastatic tumors of the skeletal system | publisher = Springer | location = Cham | year = 2014 | isbn = 9783319073224 }}</ref><ref name="pmid26622638">{{cite journal| author=Park JH, Pahk K, Kim S, Lee SH, Song SH, Choe JG| title=Radionuclide imaging in the diagnosis of osteoid osteoma. | journal=Oncol Lett | year= 2015 | volume= 10 | issue= 2 | pages= 1131-1134 | pmid=26622638 | doi=10.3892/ol.2015.3258 | pmc=4509085 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26622638  }}</ref>
OR
**Sharp round [[lesion]] which is less than 2 cm in diameter.
 
**Osteoid osteoma has a [[homogeneous]] dense center.
The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
**[[Sclerotic ring|Sclerotic reactive bone]] surrounding the nidus is seen.
 
**A 1.5 mm peripheral radiolucent zone is seen.
OR
**Furthermore, a central [[Sclerotic ring|sclerotic]] is noted.
 
The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
There are no established criteria for the diagnosis of [disease name].


===History and Symptoms===
===History and Symptoms===
The majority of patients with [disease name] are asymptomatic.
*The majority of patients with osteoid osteoma have localized [[pain]] that worsens at night.<ref>{{cite book | last = Peabody | first = Terrance | title = Orthopaedic oncology : primary and metastatic tumors of the skeletal system | publisher = Springer | location = Cham | year = 2014 | isbn = 9783319073224 }}</ref>
 
*The pain is relieved by [[salicylates]].
OR
*[[Swelling]]
 
*Intra-articular [[Lesion|lesions]] present with:
The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].
**[[Deformity|Limb deformity]]  
**Abnormal [[Gait (human)|gait]]
*[[Lesions]] involving [[spine]] present as [[back pain]].


===Physical Examination===
===Physical Examination===
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
*Patients with osteoid osteoma usually appears well.
 
*Common [[physical examination]] findings of osteoid osteoma include:<ref name="pmid8272884">{{cite journal |vauthors=Greenspan A |title=Benign bone-forming lesions: osteoma, osteoid osteoma, and osteoblastoma. Clinical, imaging, pathologic, and differential considerations |journal=Skeletal Radiol. |volume=22 |issue=7 |pages=485–500 |year=1993 |pmid=8272884 |doi= |url=}}</ref>
OR
**Palpable [[Deformity|bone deformity]]
 
**[[Swelling]]
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
**[[Erythema]]
 
**[[Tenderness]]
OR
*If the [[lesion]] is in proximity to a [[joint]], findings include:
 
**Effusion
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
**[[Contracture]]
 
**Abnormal [[gait]]  
OR
**[[Muscle atrophy]]
 
*If the lesion involves spine, findings include:
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
**Postural [[scoliosis]]  
**Paravertebral [[muscle spasm]]


===Laboratory Findings===
===Laboratory Findings===
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].
*There are no [[diagnostic]] laboratory findings associated with osteoid osteoma.
 
{| align="right"
OR
|
 
[[File:Osteoid-osteoma-10.JPG|200px|thumb| X-ray of osteoid osteoma: A well circumscribed lucent region with a central sclerotic dot.[https://radiopaedia.org/articles/osteoid-osteoma Source: Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 28806]]]
Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
|}
 
OR
 
[Test] is usually normal among patients with [disease name].
 
OR
 
Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].
 
OR
 
There are no diagnostic laboratory findings associated with [disease name].
 
===Electrocardiogram===
===Electrocardiogram===
There are no ECG findings associated with [disease name].
* There are no [[The electrocardiogram|ECG]] findings associated with osteoid osteoma.
 
OR
 
An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].


===X-ray===
===X-ray===
There are no x-ray findings associated with [disease name].
*Three views of affected [[bone]] or [[joint]] are recommended.<ref>{{cite book | last = Peabody | first = Terrance | title = Orthopaedic oncology : primary and metastatic tumors of the skeletal system | publisher = Springer | location = Cham | year = 2014 | isbn = 9783319073224 }}</ref>
 
*[[Radiological]] findings for osteoid osteoma include:
OR
**Intensely reactive [[bone]]
 
**Radiolucent nidus
An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===Echocardiography or Ultrasound===
===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound  findings associated with [disease name].


OR
* [[Ultrasound]] findings associated with osteoid osteoma, include:<ref>{{cite book | last = Peabody | first = Terrance | title = Orthopaedic oncology : primary and metastatic tumors of the skeletal system | publisher = Springer | location = Cham | year = 2014 | isbn = 9783319073224 }}</ref>
 
** Focal [[Cortical area|cortical]] irregularity
Echocardiography/ultrasound  may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
** Adjacent hypoechoic [[synovitis]]
 
**Hypoechogenicity with posterior acoustic enhancement
OR
**On [[Doppler ultrasound]], osteoid osteoma may appear as a hypervascular nidus.
 
There are no echocardiography/ultrasound  findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===CT scan===
===CT scan===
There are no CT scan findings associated with [disease name].
{| align="right"
 
|
OR
[[File:Osteoid-osteoma-1.jpg|200px|thumb|none| CT scan of osteoid osteoma showing a lucent nidus on proximal femur.[https://radiopaedia.org/articles/osteoid-osteoma Source: Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 28806]]]
 
|}
[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
*[[Computed tomography|CT scan]] is the study of choice for the [[diagnosis]] of osteoid osteoma.<ref name="pmid17580548">{{cite journal| author=Zerjavic NL, Potocki K, Prutki M, Curković B, Babić-Naglić D, Soldo-Juresa D| title=[Late diagnosis of intraarticular osteoid osteoma treated as hip osteoarthritis--case report and review of the literature]. | journal=Reumatizam | year= 2006 | volume= 53 | issue= 1 | pages= 33-6 | pmid=17580548 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17580548  }}</ref>
 
*[[Computed tomography|CT]] findings include:<ref>{{cite book | last = Peabody | first = Terrance | title = Orthopaedic oncology : primary and metastatic tumors of the skeletal system | publisher = Springer | location = Cham | year = 2014 | isbn = 9783319073224 }}</ref><ref name="pmid11120413">{{cite journal| author=Spouge AR, Thain LM| title=Osteoid osteoma: MR imaging revisited. | journal=Clin Imaging | year= 2000 | volume= 24 | issue= 1 | pages= 19-27 | pmid=11120413 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11120413  }}</ref>
OR
**Sharp round [[lesion]] which is less than 2 cm in diameter.
 
**Osteoid osteoma has a [[homogeneous]] dense center.
There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
**[[Sclerotic ring|Sclerotic]] reactive bone surrounding the nidus is seen.
**A 1.5 mm peripheral radiolucent zone is seen.
**Furthermore, a central [[Sclerotic ring|sclerotic]] is noted.


===MRI===
===MRI===
There are no MRI findings associated with [disease name].


OR
* [[Magnetic resonance imaging|MRI]] is usually not recommended as it can mimic aggressive [[Lesion|lesions]].<ref name="pmid9537182">{{cite journal| author=Hachem K, Haddad S, Aoun N, Tamraz J, Attalah N| title=[MRI in the diagnosis of osteoid osteoma]. | journal=J Radiol | year= 1997 | volume= 78 | issue= 9 | pages= 635-41 | pmid=9537182 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9537182  }}</ref>
 
*[[Magnetic resonance imaging|MRI]] is more sensitive than [[Computed tomography|CT scan]] for detection of reactive changes in osteoid osteoma patients.
[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
*[[Magnetic resonance imaging|MRI]] may be helpful in the visualizing the nidus especially in the [[cortex]] and [[Medulla|medullary]] zone of the [[bone]].
 
*Visualizing nidus depends on the [[mineralization]] and its vascularity of the lesion and it can be hypointense in appearance.
OR
*The reactive changes in osteoid osteoma patients on [[Magnetic resonance imaging|MRI]] can look like half-moon sign.<ref name="CarraChen2016">{{cite journal|last1=Carra|first1=Bradley J.|last2=Chen|first2=Dillon C|last3=Bui-Mansfield|first3=Liem T.|title=The Half-Moon Sign of the Femoral Neck Is Nonspecific for the Diagnosis of Osteoid Osteoma.|journal=American Journal of Roentgenology|volume=206|issue=3|year=2016|pages=W54–W54|issn=0361-803X|doi=10.2214/AJR.15.15610}}</ref>
 
*The presence of half-moon sign in [[femoral]] neck is an indication and highly specific for osteoid osteoma.<ref name="pmid26204287">{{cite journal| author=Klontzas ME, Zibis AH, Karantanas AH| title=Osteoid Osteoma of the Femoral Neck: Use of the Half-Moon Sign in MRI Diagnosis. | journal=AJR Am J Roentgenol | year= 2015 | volume= 205 | issue= 2 | pages= 353-7 | pmid=26204287 | doi=10.2214/AJR.14.13689 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26204287  }}</ref>
There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===Other Imaging Findings===
===Other Imaging Findings===
There are no other imaging findings associated with [disease name].
OR


[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
===Radionuclide Scanning===
*[[Bone scan|Radionuclide scans]] are reliable tools when [[Radiography|radiographic]] findings are not [[diagnostic]].<ref name="pmid6224390">{{cite journal| author=Meire E, Hoogmartens M, De Roo M, Mortelmans L, Nicolai D| title=The peroperative use of the mobile gamma camera for the localization of spinal osteoid osteoma. | journal=Acta Orthop Belg | year= 1983 | volume= 49 | issue= 3 | pages= 384-90 | pmid=6224390 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6224390  }} </ref><ref name="pmid7351408">{{cite journal| author=Rinsky LA, Goris M, Bleck EE, Halpern A, Hirshman P| title=Intraoperative skeletal scintigraphy for localization of osteoid-osteoma in the spine. Case report. | journal=J Bone Joint Surg Am | year= 1980 | volume= 62 | issue= 1 | pages= 143-4 | pmid=7351408 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7351408  }} </ref><ref name="pmid758639">{{cite journal| author=Swee RG, McLeod RA, Beabout JW| title=Osteoid osteoma. Detection, diagnosis, and localization. | journal=Radiology | year= 1979 | volume= 130 | issue= 1 | pages= 117-23 | pmid=758639 | doi=10.1148/130.1.117 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=758639  }} </ref>
*[[Bone scan]] findings include:
**Intense hot area of focal uptake at the nidus.
**Low uptake in [[reactive zone]] known as the double-density sign.


===Other Diagnostic Studies===
===Other Diagnostic Studies===
There are no other diagnostic studies associated with [disease name].
{| align="right"
 
|
OR
[[File:Osteoid-osteoma-gross-pathology.jpg|200px|thumb|Osteoid Osteoma Gross Appearnace.[https://radiopaedia.org/articles/osteoid-osteoma Source: Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 28806]]]
 
|
[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
[[File:Osteoidosteoma micrograph.jpeg|200px|thumb|Osteoid Osteoma histology.[Source: By No machine-readable author provided. Nephron assumed (based on copyright claims). - No machine-readable source provided. Own work assumed (based on copyright claims)., CC BY-SA 3.0]]]
 
|}
OR
===Biopsy===


Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].
*[[Biopsy]] may be helpful in the [[diagnosis]] of osteoid osteoma.
*[[Biopsy]] demonstrates the following features:
**Nidus usually about 1.5-2 cms, brownish-red, [[Mottling|mottled]], and gritty lesion that is distinct from the surrounding [[bone]].
**Network of interconnecting [[bone]], widened [[vessels]], [[Osteoblast|osteoblasts]], and [[bone matrix]]
**[[Fibrinoid necrosis|Fibrinoid]] margin with areas of [[angiogenesis]]
**Adjacent [[sclerosis]]
*On histological examination:
**[[Osteoid]] and woven [[bone]] lined with [[Osteoblast|osteoblasts]] and richly innervated with surrounding hypervascular [[connective tissue]] with [[Osteoclast|osteoclasts]] is seen.
*Osteoid osteoma do not [[Malignant|malignantly]] transform.


==Treatment==
==Treatment==
===Medical Therapy===
===Medical Therapy===
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
*[[Clinical]] observation and [[Non-steroidal anti-inflammatory drug|NSAID]] administration.<ref name="pmid26579486">{{cite journal |vauthors=Hakim DN, Pelly T, Kulendran M, Caris JA |title=Benign tumours of the bone: A review |journal=J Bone Oncol |volume=4 |issue=2 |pages=37–41 |year=2015 |pmid=26579486 |pmc=4620948 |doi=10.1016/j.jbo.2015.02.001 |url=}}</ref><ref>Gangi A. [The treatment of osteoid osteoma: a multitude of choice: surgery, percutaneous resection, alcohol injection or thermocoagulation]. J Radiol 1999; 80:419-420</ref>
**[[Non-steroidal anti-inflammatory drug|NSAIDs]] are 1st line and will lead to a dramatic decrease in [[symptoms]].
**About 50%  of the [[patients]] can be treated with [[Non-steroidal anti-inflammatory drug|NSAIDs]] alone.
**[[Non-steroidal anti-inflammatory drug|NSAIDs]] are also indicated for painful [[spine]] [[lesions]] without [[Scoliosis|scoliosis.]]
**The natural course of osteoid osteomas is spontaneous [[regression]]. However, [[Non-steroidal anti-inflammatory drug|NSAIDs]] may accelerate this process.<ref name="pmid22528893">{{cite journal |vauthors=Iyer RS, Chapman T, Chew FS |title=Pediatric bone imaging: diagnostic imaging of osteoid osteoma |journal=AJR Am J Roentgenol |volume=198 |issue=5 |pages=1039–52 |year=2012 |pmid=22528893 |doi=10.2214/AJR.10.7313 |url=}}</ref><ref name="pmid20737157">{{cite journal |vauthors=Goto T, Shinoda Y, Okuma T, Ogura K, Tsuda Y, Yamakawa K, Hozumi T |title=Administration of nonsteroidal anti-inflammatory drugs accelerates spontaneous healing of osteoid osteoma |journal=Arch Orthop Trauma Surg |volume=131 |issue=5 |pages=619–25 |year=2011 |pmid=20737157 |doi=10.1007/s00402-010-1179-z |url=}}</ref><ref name="pmid22528893">{{cite journal |vauthors=Iyer RS, Chapman T, Chew FS |title=Pediatric bone imaging: diagnostic imaging of osteoid osteoma |journal=AJR Am J Roentgenol |volume=198 |issue=5 |pages=1039–52 |year=2012 |pmid=22528893 |doi=10.2214/AJR.10.7313 |url=}}</ref>
**Fingertip [[lesions]] (distal [[phalanx]]) may not respond to [[Non-steroidal anti-inflammatory drug|NSAIDs]].


OR
===Surgery===
 
[[Surgery]] is the mainstay of treatment for osteoid osteoma.<ref name="pmid26579486">{{cite journal |vauthors=Hakim DN, Pelly T, Kulendran M, Caris JA |title=Benign tumours of the bone: A review |journal=J Bone Oncol |volume=4 |issue=2 |pages=37–41 |year=2015 |pmid=26579486 |pmc=4620948 |doi=10.1016/j.jbo.2015.02.001 |url=}}</ref><ref>Gangi A. [The treatment of osteoid osteoma: a multitude of choice: surgery, percutaneous resection, alcohol injection or thermocoagulation]. J Radiol 1999; 80:419-420</ref><ref name="pmid26579486">{{cite journal |vauthors=Hakim DN, Pelly T, Kulendran M, Caris JA |title=Benign tumours of the bone: A review |journal=J Bone Oncol |volume=4 |issue=2 |pages=37–41 |year=2015 |pmid=26579486 |pmc=4620948 |doi=10.1016/j.jbo.2015.02.001 |url=}}</ref><ref name="pmid22528893">{{cite journal |vauthors=Iyer RS, Chapman T, Chew FS |title=Pediatric bone imaging: diagnostic imaging of osteoid osteoma |journal=AJR Am J Roentgenol |volume=198 |issue=5 |pages=1039–52 |year=2012 |pmid=22528893 |doi=10.2214/AJR.10.7313 |url=}}</ref>
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
 
OR
 
The majority of cases of [disease name] are self-limited and require only supportive care.
 
OR
 
[Disease name] is a medical emergency and requires prompt treatment.
 
OR
 
The mainstay of treatment for [disease name] is [therapy].
 
OR
 
The optimal therapy for [malignancy name] depends on the stage at diagnosis.
 
OR
 
[Therapy] is recommended among all patients who develop [disease name].
 
OR
 
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
 
OR
 
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
 
OR
 
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
 
OR


Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
===Percutaneous Radiofrequency Ablation (RFA)===     


===Surgery===
'''Indications'''
Surgical intervention is not recommended for the management of [disease name].
*Failure of [[Medical management company|medical management]]
*Periarticular [[Lesion|lesions]] which increase the risk of [[cartilage]] injury and premature [[Degenerative diseases|degenerative disease]]
*Spinal [[lesions]] depending on the location of the [[Lesions|lesion]] and proximity to neural elements


OR
'''Contraindications'''
*[[Lesions]] close to [[spinal cord]] or [[nerve roots]]


Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]
'''Technique'''
*It is done under [[CT-scans|CT]] guidance
*Probing is done at 80-90 degree C for 6 minutes to produce a 1cm zone of [[necrosis]]


OR
'''Outcomes'''
*90% of patients are successfully treated with 1-2 sessions of [[radiofrequency ablation]] ([[Radiofrequency ablation|RFA]]).
*10-15% recurrence rate.


The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].
===Surgical Resection with Curettage===
'''Indications'''<ref name="pmid2662110">{{cite journal| author=Gitelis S, Schajowicz F| title=Osteoid osteoma and osteoblastoma. | journal=Orthop Clin North Am | year= 1989 | volume= 20 | issue= 3 | pages= 313-25 | pmid=2662110 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2662110  }}</ref>


OR
*When location of [[Lesions|lesion]] is not amenable to [[Computed tomography|CT]] guided percutaneous [[radiofrequency ablation]] such as close to [[skin]] or [[nerve]].
*[[Spine]] [[lesion]] associated with painful [[scoliosis]].
*Digital [[lesions]] because [[Radiofrequency ablation|RFA]] carries risk of thermal skin [[necrosis]] and injury to digital [[Neurovascular bundle|neurovascular]] bundle.


The feasibility of surgery depends on the stage of [malignancy] at diagnosis.
'''Technique'''
*Successful treatment depends on complete marginal [[resection]] of nidus.
*Sclerotic [[bone]] is normal and can be left behind.
*It can be done by:
**[[Percutaneous]] approach
**Open approach


OR
'''Outcomes'''
 
*94% success with local [[excision]].
Surgery is the mainstay of treatment for [disease or malignancy].


===Primary Prevention===
===Primary Prevention===
There are no established measures for the primary prevention of [disease name].


OR
* There are no established measures for the [[primary prevention]] of osteoid osteoma.
 
There are no available vaccines against [disease name].
 
OR
 
Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
 
OR
 
[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].


===Secondary Prevention===
===Secondary Prevention===
There are no established measures for the secondary prevention of [disease name].
OR


Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].
* There are no established measures for the [[secondary prevention]] of osteoid osteoma.


==References==
==References==

Latest revision as of 20:58, 8 October 2019


For patient information click here
For more information about osteoma that is not associated with osteoid osteoma, see osteoma

WikiDoc Resources for Osteoid osteoma

Articles

Most recent articles on Osteoid osteoma

Most cited articles on Osteoid osteoma

Review articles on Osteoid osteoma

Articles on Osteoid osteoma in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Osteoid osteoma

Images of Osteoid osteoma

Photos of Osteoid osteoma

Podcasts & MP3s on Osteoid osteoma

Videos on Osteoid osteoma

Evidence Based Medicine

Cochrane Collaboration on Osteoid osteoma

Bandolier on Osteoid osteoma

TRIP on Osteoid osteoma

Clinical Trials

Ongoing Trials on Osteoid osteoma at Clinical Trials.gov

Trial results on Osteoid osteoma

Clinical Trials on Osteoid osteoma at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Osteoid osteoma

NICE Guidance on Osteoid osteoma

NHS PRODIGY Guidance

FDA on Osteoid osteoma

CDC on Osteoid osteoma

Books

Books on Osteoid osteoma

News

Osteoid osteoma in the news

Be alerted to news on Osteoid osteoma

News trends on Osteoid osteoma

Commentary

Blogs on Osteoid osteoma

Definitions

Definitions of Osteoid osteoma

Patient Resources / Community

Patient resources on Osteoid osteoma

Discussion groups on Osteoid osteoma

Patient Handouts on Osteoid osteoma

Directions to Hospitals Treating Osteoid osteoma

Risk calculators and risk factors for Osteoid osteoma

Healthcare Provider Resources

Symptoms of Osteoid osteoma

Causes & Risk Factors for Osteoid osteoma

Diagnostic studies for Osteoid osteoma

Treatment of Osteoid osteoma

Continuing Medical Education (CME)

CME Programs on Osteoid osteoma

International

Osteoid osteoma en Espanol

Osteoid osteoma en Francais

Business

Osteoid osteoma in the Marketplace

Patents on Osteoid osteoma

Experimental / Informatics

List of terms related to Osteoid osteoma

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rohan A. Bhimani, M.B.B.S., D.N.B., M.Ch.[2]

Synonyms and keywords: Osteoma osteoid; OO; Osteoid osteomas

Overview

Osteoid osteoma is the third most common benign bone tumor. Its incidence is 11% among the benign tumors and 3% among all primary bone tumors. Adolescents and children are most affected by osteoid osteoma. Men are more commonly affected than women, with a 6:4 ratio. Osteoid osteoma is a benign osteoblastic tumor that was first described in 1930 by Bergstrand. Jaffe described it in 1935 and was the first to recognize it as a unique entity. Osteoid osteomas are usually smaller than 1.5-2 cm and characterized by an osteoid-rich nidus in a highly loose, vascular connective tissue. The nidus is well demarcated and may contain a variable amount of calcification. Surrounding the nidus is a zone of sclerotic but otherwise normal bone. Osteoid osteoma can occur anywhere. Osteoid osteoma is usually occur in the cortex of the shafts of long bones more than 50% of the cases. It is seen in the metaphyseal regions of large bones of the femur, tibia, and humerus. About 20% percent of the lesions involve posterior element of the spine. The hallmark of osteoid osteoma is intense nocturnal limb pain which is relieved by low doses of salicylates and local tenderness. If left untreated, osteoid osteoma progression occurs slow and is then followed by restricted range of motion, possible pathologic fracture, or spontaneous regression. The medical therapy for osteoid osteoma is NSAIDs and the mainstay of treatment is surgery.

Historical Perspective

  • In 1930, Dr. Bergstrand, a German physician, first described osteoid osteoma in 1930.[1]
  • In 1935, Dr.Henry Jaffe, an American pathologist first described osteoid osteoma as a benign bone tumor.[2]
  • In 1953, Dr. Jaffe coined the term nidus, which was described as the “core”, referring to the tumor itself and is composed of bone at various stages of maturity within a highly vascular connective tissue stroma.[3]
  • In 1954, Dahlin and Johnson added the term giant osteoid osteomas.[4]
  • In 1966, Dr.Edeiken classified osteoid osteomas into three types.[2]

Classification

  • Osteoid Osteoma can be classified based on location and imaging findings.

Anatomical Classification

Type of osteoid osteoma Characteristics
Intracortical Dense sclerosis around the nidus
Periosteal Periosteal reaction
Cancellous (medullary) Produces very little reactive bone
Subarticular Simulates arthritis as it produces synovial reactions

Enneking (MSTS) Staging System

Stages Description
1 Latent: Well demarcated borders
2 Active: Indistinct borders
3 Aggressive: Indistinct borders

Pathophysiology

Genetics

Causes

  • The cause of osteoid osteoma has not been identified.[15]

Differentiating Osteoid osteoma from Other Diseases
Differential Diagnosis Similar Features Differentiating Features
Osteoblastoma
Brodie abscess
Osteosarcoma
Enostosis
  • Affects the same group of population (children and adolescents), small size, and the location is usually long bones

Epidemiology and Demographics

Risk Factors

  • There are no established risk factors for osteoid osteoma.[23]

Screening

  • There is insufficient evidence to recommend routine screening for osteoid osteoma.

Natural History, Complications, and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

  • There are no diagnostic laboratory findings associated with osteoid osteoma.
X-ray of osteoid osteoma: A well circumscribed lucent region with a central sclerotic dot.Source: Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 28806

Electrocardiogram

  • There are no ECG findings associated with osteoid osteoma.

X-ray

  • Three views of affected bone or joint are recommended.[29]
  • Radiological findings for osteoid osteoma include:
    • Intensely reactive bone
    • Radiolucent nidus

Echocardiography or Ultrasound

  • Ultrasound findings associated with osteoid osteoma, include:[30]
    • Focal cortical irregularity
    • Adjacent hypoechoic synovitis
    • Hypoechogenicity with posterior acoustic enhancement
    • On Doppler ultrasound, osteoid osteoma may appear as a hypervascular nidus.

CT scan

CT scan of osteoid osteoma showing a lucent nidus on proximal femur.Source: Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 28806
  • CT scan is the study of choice for the diagnosis of osteoid osteoma.[31]
  • CT findings include:[32][33]
    • Sharp round lesion which is less than 2 cm in diameter.
    • Osteoid osteoma has a homogeneous dense center.
    • Sclerotic reactive bone surrounding the nidus is seen.
    • A 1.5 mm peripheral radiolucent zone is seen.
    • Furthermore, a central sclerotic is noted.

MRI

  • MRI is usually not recommended as it can mimic aggressive lesions.[34]
  • MRI is more sensitive than CT scan for detection of reactive changes in osteoid osteoma patients.
  • MRI may be helpful in the visualizing the nidus especially in the cortex and medullary zone of the bone.
  • Visualizing nidus depends on the mineralization and its vascularity of the lesion and it can be hypointense in appearance.
  • The reactive changes in osteoid osteoma patients on MRI can look like half-moon sign.[35]
  • The presence of half-moon sign in femoral neck is an indication and highly specific for osteoid osteoma.[36]

Other Imaging Findings

Radionuclide Scanning

Other Diagnostic Studies

Osteoid Osteoma Gross Appearnace.Source: Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 28806
Osteoid Osteoma histology.[Source: By No machine-readable author provided. Nephron assumed (based on copyright claims). - No machine-readable source provided. Own work assumed (based on copyright claims)., CC BY-SA 3.0]

Biopsy

Treatment

Medical Therapy

Surgery

Surgery is the mainstay of treatment for osteoid osteoma.[6][43][6][41]

Percutaneous Radiofrequency Ablation (RFA)

Indications

Contraindications

Technique

  • It is done under CT guidance
  • Probing is done at 80-90 degree C for 6 minutes to produce a 1cm zone of necrosis

Outcomes

Surgical Resection with Curettage

Indications[44]

Technique

  • Successful treatment depends on complete marginal resection of nidus.
  • Sclerotic bone is normal and can be left behind.
  • It can be done by:

Outcomes

Primary Prevention

Secondary Prevention

References

  1. ↑ Karandikar S, Thakur G, Tijare M, Shreenivas K, Agrawal K (2011). "Osteoid osteoma of mandible". BMJ Case Rep. 2011. doi:10.1136/bcr.10.2011.4886. PMC 3233922. PMID 22669768.
  2. ↑ 2.0 2.1 2.2 Torg JS, Loughran T, Pavlov H, Schwamm H, Gregg J, Sherman M, Balduini FC (1985). "Osteoid osteoma. Distant, periarticular, and subarticular lesions as a cause of knee pain". Sports Med. 2 (4): 296–304. PMID 3849059.
  3. ↑ 3.0 3.1 Chai JW, Hong SH, Choi JY, Koh YH, Lee JW, Choi JA; et al. (2010). "Radiologic diagnosis of osteoid osteoma: from simple to challenging findings". Radiographics. 30 (3): 737–49. doi:10.1148/rg.303095120. PMID 20462991.
  4. ↑ DAHLIN DC, JOHNSON EW (1954). "Giant osteoid osteoma". J Bone Joint Surg Am. 36-A (3): 559–72. PMID 13163088.
  5. ↑ Morton KS, Vassar PS, Knickerbocker WJ (1975). "Osteoid osteoma and osteoblastoma: reclassification of 43 cases using Schajowicz's classification". Can J Surg. 18 (2): 148–52. PMID 1116053.
  6. ↑ 6.0 6.1 6.2 6.3 Hakim DN, Pelly T, Kulendran M, Caris JA (2015). "Benign tumours of the bone: A review". J Bone Oncol. 4 (2): 37–41. doi:10.1016/j.jbo.2015.02.001. PMC 4620948. PMID 26579486.
  7. ↑ Jawad MU, Scully SP (2010). "In brief: classifications in brief: enneking classification: benign and malignant tumors of the musculoskeletal system". Clin Orthop Relat Res. 468 (7): 2000–2. doi:10.1007/s11999-010-1315-7. PMC 2882012. PMID 20333492.
  8. ↑ Funovics M, Philipp M, Breitenseher M (1999). "[Staging of musculoskeletal tumors in diagnostic imaging]". Radiologe. 39 (7): 591–9. PMID 10472088.
  9. ↑ Enneking WF, Spanier SS, Goodman MA (1980). "A system for the surgical staging of musculoskeletal sarcoma". Clin Orthop Relat Res (153): 106–20. PMID 7449206.
  10. ↑ Enneking WF (1986). "A system of staging musculoskeletal neoplasms". Clin Orthop Relat Res (204): 9–24. PMID 3456859.
  11. ↑ Athwal P, Stock H (2014). "Osteoid osteoma: a pictorial review". Conn Med. 78 (4): 233–5. PMID 24830123.
  12. ↑ O'Connell JX, Nanthakumar SS, Nielsen GP, Rosenberg AE (1998). "Osteoid osteoma: the uniquely innervated bone tumor". Mod. Pathol. 11 (2): 175–80. PMID 9504688.
  13. ↑ Peabody, Terrance (2014). Orthopaedic oncology : primary and metastatic tumors of the skeletal system. Cham: Springer. ISBN 9783319073224.
  14. ↑ Baruffi MR, Volpon JB, Neto JB, Casartelli C (2001). "Osteoid osteomas with chromosome alterations involving 22q". Cancer Genet Cytogenet. 124 (2): 127–31. PMID 11172903.
  15. ↑ Peabody, Terrance (2014). Orthopaedic oncology : primary and metastatic tumors of the skeletal system. Cham: Springer. ISBN 9783319073224.
  16. ↑ Hashemi J, Gharahdaghi M, Ansaripour E, Jedi F, Hashemi S (2011). "Radiological features of osteoid osteoma: pictorial review". Iran J Radiol. 8 (3): 182–9. doi:10.5812/kmp.iranjradiol.17351065.3392. PMC 3522328. PMID 23329939.
  17. ↑ Atesok KI, Alman BA, Schemitsch EH, Peyser A, Mankin H (2011). "Osteoid osteoma and osteoblastoma". J Am Acad Orthop Surg. 19 (11): 678–89. PMID 22052644.
  18. ↑ Laurence N, Epelman M, Markowitz RI, Jaimes C, Jaramillo D, Chauvin NA (2012). "Osteoid osteomas: a pain in the night diagnosis". Pediatr Radiol. 42 (12): 1490–501, quiz 1540-2. doi:10.1007/s00247-012-2495-y. PMID 23089877.
  19. ↑ Lee EH, Shafi M, Hui JH (2006). "Osteoid osteoma: a current review". J Pediatr Orthop. 26 (5): 695–700. doi:10.1097/01.bpo.0000233807.80046.7c. PMID 16932114.
  20. ↑ Kalil RK, Antunes JS (2003). "Familial occurrence of osteoid osteoma". Skeletal Radiol. 32 (7): 416–9. doi:10.1007/s00256-003-0660-y. PMID 12802523.
  21. ↑ Peabody, Terrance (2014). Orthopaedic oncology : primary and metastatic tumors of the skeletal system. Cham: Springer. ISBN 9783319073224.
  22. ↑ 22.0 22.1 22.2 Barlow E, Davies AM, Cool WP, Barlow D, Mangham DC (2013). "Osteoid osteoma and osteoblastoma: novel histological and immunohistochemical observations as evidence for a single entity". J Clin Pathol. 66 (9): 768–74. doi:10.1136/jclinpath-2013-201492. PMID 23814261.
  23. ↑ Peabody, Terrance (2014). Orthopaedic oncology : primary and metastatic tumors of the skeletal system. Cham: Springer. ISBN 9783319073224.
  24. ↑ Rand JA, Sim FH, Unni KK (1982). "Two osteoid-osteomas in one patient. A case report". J Bone Joint Surg Am. 64 (8): 1243. PMID 7130236.
  25. ↑ Peabody, Terrance (2014). Orthopaedic oncology : primary and metastatic tumors of the skeletal system. Cham: Springer. ISBN 9783319073224.
  26. ↑ Park JH, Pahk K, Kim S, Lee SH, Song SH, Choe JG (2015). "Radionuclide imaging in the diagnosis of osteoid osteoma". Oncol Lett. 10 (2): 1131–1134. doi:10.3892/ol.2015.3258. PMC 4509085. PMID 26622638.
  27. ↑ Peabody, Terrance (2014). Orthopaedic oncology : primary and metastatic tumors of the skeletal system. Cham: Springer. ISBN 9783319073224.
  28. ↑ Greenspan A (1993). "Benign bone-forming lesions: osteoma, osteoid osteoma, and osteoblastoma. Clinical, imaging, pathologic, and differential considerations". Skeletal Radiol. 22 (7): 485–500. PMID 8272884.
  29. ↑ Peabody, Terrance (2014). Orthopaedic oncology : primary and metastatic tumors of the skeletal system. Cham: Springer. ISBN 9783319073224.
  30. ↑ Peabody, Terrance (2014). Orthopaedic oncology : primary and metastatic tumors of the skeletal system. Cham: Springer. ISBN 9783319073224.
  31. ↑ Zerjavic NL, Potocki K, Prutki M, Curković B, Babić-Naglić D, Soldo-Juresa D (2006). "[Late diagnosis of intraarticular osteoid osteoma treated as hip osteoarthritis--case report and review of the literature]". Reumatizam. 53 (1): 33–6. PMID 17580548.
  32. ↑ Peabody, Terrance (2014). Orthopaedic oncology : primary and metastatic tumors of the skeletal system. Cham: Springer. ISBN 9783319073224.
  33. ↑ Spouge AR, Thain LM (2000). "Osteoid osteoma: MR imaging revisited". Clin Imaging. 24 (1): 19–27. PMID 11120413.
  34. ↑ Hachem K, Haddad S, Aoun N, Tamraz J, Attalah N (1997). "[MRI in the diagnosis of osteoid osteoma]". J Radiol. 78 (9): 635–41. PMID 9537182.
  35. ↑ Carra, Bradley J.; Chen, Dillon C; Bui-Mansfield, Liem T. (2016). "The Half-Moon Sign of the Femoral Neck Is Nonspecific for the Diagnosis of Osteoid Osteoma". American Journal of Roentgenology. 206 (3): W54–W54. doi:10.2214/AJR.15.15610. ISSN 0361-803X.
  36. ↑ Klontzas ME, Zibis AH, Karantanas AH (2015). "Osteoid Osteoma of the Femoral Neck: Use of the Half-Moon Sign in MRI Diagnosis". AJR Am J Roentgenol. 205 (2): 353–7. doi:10.2214/AJR.14.13689. PMID 26204287.
  37. ↑ Meire E, Hoogmartens M, De Roo M, Mortelmans L, Nicolai D (1983). "The peroperative use of the mobile gamma camera for the localization of spinal osteoid osteoma". Acta Orthop Belg. 49 (3): 384–90. PMID 6224390.
  38. ↑ Rinsky LA, Goris M, Bleck EE, Halpern A, Hirshman P (1980). "Intraoperative skeletal scintigraphy for localization of osteoid-osteoma in the spine. Case report". J Bone Joint Surg Am. 62 (1): 143–4. PMID 7351408.
  39. ↑ Swee RG, McLeod RA, Beabout JW (1979). "Osteoid osteoma. Detection, diagnosis, and localization". Radiology. 130 (1): 117–23. doi:10.1148/130.1.117. PMID 758639.
  40. ↑ Gangi A. [The treatment of osteoid osteoma: a multitude of choice: surgery, percutaneous resection, alcohol injection or thermocoagulation]. J Radiol 1999; 80:419-420
  41. ↑ 41.0 41.1 41.2 Iyer RS, Chapman T, Chew FS (2012). "Pediatric bone imaging: diagnostic imaging of osteoid osteoma". AJR Am J Roentgenol. 198 (5): 1039–52. doi:10.2214/AJR.10.7313. PMID 22528893.
  42. ↑ Goto T, Shinoda Y, Okuma T, Ogura K, Tsuda Y, Yamakawa K, Hozumi T (2011). "Administration of nonsteroidal anti-inflammatory drugs accelerates spontaneous healing of osteoid osteoma". Arch Orthop Trauma Surg. 131 (5): 619–25. doi:10.1007/s00402-010-1179-z. PMID 20737157.
  43. ↑ Gangi A. [The treatment of osteoid osteoma: a multitude of choice: surgery, percutaneous resection, alcohol injection or thermocoagulation]. J Radiol 1999; 80:419-420
  44. ↑ Gitelis S, Schajowicz F (1989). "Osteoid osteoma and osteoblastoma". Orthop Clin North Am. 20 (3): 313–25. PMID 2662110.


Template:WikiDoc Sources

Retrieved from "https://www.wikidoc.org/index.php?title=Osteoid_osteoma&oldid=1583700"