Osteoid osteoma

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For more information about osteoma that is not associated with osteoid osteoma, see osteoma Template:Osteoid osteoma Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

Synonyms and keywords: Osteoma osteoid; OO; Osteoid osteomas


Overview

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 classifed 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

  • The Enneking surgical staging system (also known as the MSTS system) for benign musculoskeletal tumors based on radiographic characteristics of the tumor host margin.[7]
  • It is widely accepted and routinely used classification.
Stages Description
1 Latent: Well demarcated borders
2 Active: Indistinct borders
3 Aggressive: Indistinct borders

Pathophysiology

  • The exact etiology of osteoid osteoma is unknown.[8]
  • Osteoid osteoma arises from the osteoblasts.
  • Osteoid osteoma consists of radially oriented trabeculae of surrounding reactive bone, indicating an increased pressure in the vascular nidus.
  • This arrangement of the bony trabeculae is due to the stresses placed on them.
  • This increased pressure is due to vasodilatation and edema is which stimulate intraosseous nerve endings, generating pain.[9]
  • In addiition, the pain is also attributed to increased local concentration of prostaglandin E2, COX1 & 2 expression; and increased number and size of unmyelinated nerve fibers within the nidus.
  • Osteoid osteomas are usually cortical lesions but they can occur anywhere within the bone including medullary, subperiosteal (most common in talus), and intracapsular area.
  • More than 50 percent of osteoid osteomas occur in lower extremity of long bones.[2][10]
  • It most commonly affects the metadiaphysis of the femur and tibia.
  • About 20 percent of osteoid osteomas occur in the posterior elements of the spine.

Genetics

  • The structural chromosomal alterations involving 22q13.1 in osteoid osteoma may affect critical genes involved in the regulation of cell proliferation, such as the YWHAH gene.[11]
  • 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 inhibit apoptosis.
  • Another gene mapped in this region is PDGFB that codes for a platelet-derived growth factor, a beta polypeptide (simian sarcoma viral [v-sis] oncogene homolog), a potent mitogen for cells of mesenchymal origin and involved in the transformation process.

Causes

  • The cause of osteoid osteoma has not been identified.[12]

Differentiating ((Page name)) from Other Diseases
Differential Diagnosis Similar Features Differentiating Features
Osteoblastoma
  • Benign, male predilection, and also present in long bones
  • 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
Brodie abscess
  • Present in children, limb pain, and ocassionaly affects long bones
  • In Brodie abscess, differentiating features include: fever, subacute onset, and location is usually affects the metaphysis of tubular bones
Osteosarcoma
  • Affects same group of population (children and adolescents), patients usually present with bone pain, and the location is usually long bones
  • In osteosarcoma, differentiating features include: malignancy, infiltration to surrounding tissue, and elevation of serum alkaline phosphatase (ALP)
Enostosis
  • Affects same group of population (children and adolescents), small size, and the location is usually long bones
  • In enostosis, differentiating features,include: pathognomonic radiological appearance and incidental finding

Epidemiology and Demographics

  • Osteoid osteoma is the third most common benign bone tumor.[15][16]
  • Its incidence is 11% among the benign tumors and 3% among all primary bone tumors.[17]
  • Adolescents and children are most affected by osteoid osteoma.
  • The age distribution of osteoid osteoma is between 5-22 years.[18]
  • The mean age of the patients with osteoid osteoma is 12 years (range, 8-35 years).[18]
  • Men are more commonly affected than women, with a 6:4 ratio.[18]
  • There is no racial predilection to osteoid osteoma.

Risk Factors

There are no established risk factors for osteoid osteoma.[19]

Screening

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

Natural History, Complications, and Prognosis

If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].

OR

Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].

OR

Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.

Diagnosis

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].

OR

The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].

OR

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

The majority of patients with [disease name] are asymptomatic.

OR

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].

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].

OR

Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

Laboratory Findings

An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].

OR

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

There are no ECG findings associated with [disease name].

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

There are no x-ray findings associated with [disease name].

OR

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

There are no echocardiography/ultrasound findings associated with [disease name].

OR

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].

OR

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

There are no CT scan findings associated with [disease name].

OR

[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].

OR

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].

MRI

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

OR

[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].

OR

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

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].

Other Diagnostic Studies

There are no other diagnostic studies associated with [disease name].

OR

[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].

OR

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].

Treatment

Medical Therapy

There is no treatment for [disease name]; the mainstay of therapy is supportive care.

OR

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].

Surgery

Surgical intervention is not recommended for the management of [disease name].

OR

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]

OR

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].

OR

The feasibility of surgery depends on the stage of [malignancy] at diagnosis.

OR

Surgery is the mainstay of treatment for [disease or malignancy].

Primary Prevention

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

OR

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

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].

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. ↑ 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. ↑ 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. ↑ Athwal P, Stock H (2014). "Osteoid osteoma: a pictorial review". Conn Med. 78 (4): 233–5. PMID 24830123.
  9. ↑ 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.
  10. ↑ Peabody, Terrance (2014). Orthopaedic oncology : primary and metastatic tumors of the skeletal system. Cham: Springer. ISBN 9783319073224.
  11. ↑ 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.
  12. ↑ Peabody, Terrance (2014). Orthopaedic oncology : primary and metastatic tumors of the skeletal system. Cham: Springer. ISBN 9783319073224.
  13. ↑ 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.
  14. ↑ 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.
  15. ↑ 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.
  16. ↑ 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.
  17. ↑ Peabody, Terrance (2014). Orthopaedic oncology : primary and metastatic tumors of the skeletal system. Cham: Springer. ISBN 9783319073224.
  18. ↑ 18.0 18.1 18.2 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.
  19. ↑ Peabody, Terrance (2014). Orthopaedic oncology : primary and metastatic tumors of the skeletal system. Cham: Springer. ISBN 9783319073224.


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