{{SK}}:''Osteogenic fibroma of bone''; ''Giant osteoid osteoma''
{{SK}}Osteogenic fibroma of bone; giant osteoid osteoma
{{Infobox_Disease
{{Infobox_Disease
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==Overview==
==Overview==
'''Osteoblastoma''' is an uncommon primary [[neoplasm]] of the bone. It has [[clinical]] and [[histologic]] manifestations similar to those of osteoid osteoma; therefore, some consider the two [[tumors]] to be variants of the same disease, with osteoblastoma representing a giant [[osteoid osteoma]]. However, an aggressive type of osteoblastoma has been recognized, making the relationship less clear.
'''Osteoblastoma''' is a rare [[benign]] [[neoplasm]] of the [[bone]], which constitutes for almost 1% of all primary [[bone tumors]] and 3% of all [[benign tumors]] in the United States. One-third of patients have [[Lesion|lesions]] in the posterior elements of the [[spine]], most often the [[lumbar]] and [[Sacrum|sacral]] regions. In 1952, Lichtenstein first termed the lesion as osteogenic fibroma of [[bone]]. In 1956, Lichtenstein and Jaffe in their independent detailed studies of this [[neoplasm]] renamed the [[lesion]] as osteoblastoma. Osteoblastoma might be conventional [[benign]] or aggressive and [[malignant]]. The exact [[etiology]] of osteoblastoma is unknown. The osteoblastomas are more aggressive compared to the other [[benign tumors]] of the [[musculoskeletal system]]. [[Histologically]] osteoblastoma is similar to [[osteoid osteoma]] and is differentiated on the basis of its large size. Osteoblastoma is a [[benign tumor]] of the [[musculoskeletal system]] and is associated with little [[morbidity]]. The [[risk factors]] are not yet established and there is insufficient evidence to recommend routine screening for osteoblastoma. If not treated, it may [[Growth|grow]] and damage the [[bone]] and adjacent structures. If the untreated osteoblastoma invades the [[spinal canal]] or neural foramina, it may lead to progressive [[Neurological|neurologic]] deficits. Once the [[tumor]] expands outside the [[bone]], the recurrence rate of osteoblastoma reaches to nearly 20%. [[Biopsy]] is the [[diagnostic study of choice]] for the [[diagnosis]] of osteoblastoma which shows similar features to that of [[osteoid osteoma]]. The majority of [[Patient|patients]] with osteoblastoma have a positive [[History and Physical examination|history]] of [[pain]] which is dull and achy in nature, and the [[pain]] is not relieved by [[salicylates]]. There are no diagnostic [[laboratory]], [[The electrocardiogram|ECG]], [[echocardiography]] or [[ultrasound]] findings associated with osteoblastoma. [[X-rays|X-ray]] is a useful diagnostic tool in the [[diagnosis]] of osteoblastoma and may reveal a well circumscribed radiolucent [[lesion]] in the bony cortex. [[Computed tomography|CT scan]] may be helpful in the [[Diagnosis-related group|diagnosis]] and management of osteoblastoma and may provide the size and extent of osteoblastoma. [[Magnetic resonance imaging|MRI]] may be helpful in determining the extent of osteoblastoma that has invaded the surrounding [[Soft tissue|soft tissues]], [[bone marrow]], and [[Spinal cord|spine]]. The most sensitive [[radiographic]] examination for the evaluation of osteoblastoma is [[bone scan]]. The [[angiography]] is performed if the information about the adjacent major [[Blood vessel|ve sel]] locations or its involvement is needed. [[Surgery]] is the mainstay of treatment for osteoblastoma and the treatment with [[chemotherapy]] and [[radiation therapy]] are still controversial.
==Historical Perspective==
==Historical Perspective==
*In 1952, Lichtenstein first termed the leision as Osteogenic fibroma of bone.<ref>Lichtenstein L. Osteogenic Fibroma of Bone. In: Bone Tumors. St Louis, Mo: Mosby; 1952:82-87.</ref>
*In 1952, Lichtenstein was the first physician who termed the lesion as osteogenic fibroma of [[bone]].<ref>Lichtenstein L. Osteogenic Fibroma of Bone. In: Bone Tumors. St Louis, Mo: Mosby; 1952:82-87.</ref>
*In 1954, Dahlin and Johnson, called the tumor a giant osteoid osteoma for its histologic similarity to osteoid osteoma, they reported 11 aggressive but benign tumors that were commonly difficult for less experienced pathologists to differentiate from malignancy.<ref name="pmid13163088">{{cite journal |vauthors=DAHLIN DC, JOHNSON EW |title=Giant osteoid osteoma |journal=J Bone Joint Surg Am |volume=36-A |issue=3 |pages=559–72 |date=June 1954 |pmid=13163088 |doi= |url=}}</ref>
*<nowiki/>In 1954, Dahlin and Johnson, were able to identify 11 [[Tumor|tumors]] of bone origin that shared aggressive but nonetheless [[benign]] qualities. Therefore, this made these [[tumors]] notoriously difficult to [[Diagnosis|diagnose]] as [[benign]] or [[malignant]].<ref name="pmid13163088">{{cite journal |vauthors=DAHLIN DC, JOHNSON EW |title=Giant osteoid osteoma |journal=J Bone Joint Surg Am |volume=36-A |issue=3 |pages=559–72 |date=June 1954 |pmid=13163088 |doi= |url=}}</ref>
*In 1956, Lichtenstein and Jaffe in their independent detailed studies of the neoplasm termed the leision as Osteoblastoma.<ref>Jaffe HL. Osteoid-osteoma: a benign osteoblastic tumor composed of osteoid and atypical bone. Arch Surg. 1935;31:709–728.</ref><ref name="pmid13364889">{{cite journal |vauthors=LICHTENSTEIN L |title=Benign osteoblastoma; a category of osteoid-and bone-forming tumors other than classical osteoid osteoma, which may be mistaken for giant-cell tumor or osteogenic sarcoma |journal=Cancer |volume=9 |issue=5 |pages=1044–52 |date=1956 |pmid=13364889 |doi= |url=}}</ref>
*In 1954, Dahlin and Johnson, were the first to notice that an [[osteoid osteoma]] and osteoblastoma had many [[Histology|histological]] characteristics in common and they named it giant [[osteoid osteoma]]'''.'''
*In 1977, Jackson et al. published a review of 181 osteoblastomas from the literature and reported that spine is the location of 36% of the osteoblastomas.<ref name="pmid598169">{{cite journal |vauthors=Jackson RP, Reckling FW, Mants FA |title=Osteoid osteoma and osteoblastoma. Similar histologic lesions with different natural histories |journal=Clin. Orthop. Relat. Res. |volume= |issue=128 |pages=303–13 |date=October 1977 |pmid=598169 |doi= |url=}}</ref>
*In 1956, Lichtenstein and Jaffe in their independent detailed studies of the [[neoplasm]] termed the [[lesion]] as osteoblastoma'''.'''<ref>Jaffe HL. Osteoid-osteoma: a benign osteoblastic tumor composed of osteoid and atypical bone. Arch Surg. 1935;31:709–728.</ref><ref name="pmid13364889">{{cite journal |vauthors=LICHTENSTEIN L |title=Benign osteoblastoma; a category of osteoid-and bone-forming tumors other than classical osteoid osteoma, which may be mistaken for giant-cell tumor or osteogenic sarcoma |journal=Cancer |volume=9 |issue=5 |pages=1044–52 |date=1956 |pmid=13364889 |doi= |url=}}</ref>
*In 1977, Jackson published a review of 181 osteoblastomas from the literature and reported that [[Spinal cord|spine]] is the location of 36% of the osteoblastomas.<ref name="pmid598169">{{cite journal |vauthors=Jackson RP, Reckling FW, Mants FA |title=Osteoid osteoma and osteoblastoma. Similar histologic lesions with different natural histories |journal=Clin. Orthop. Relat. Res. |volume= |issue=128 |pages=303–13 |date=October 1977 |pmid=598169 |doi= |url=}}</ref>
*In 1984, Dorfman and Weiss reported on the aggressive osteoblastoma and termed it as a borderline osteoblastic [[Tumor cell|tumor]] entity.<ref name="pmid6600112">{{cite journal |vauthors=Dorfman HD, Weiss SW |title=Borderline osteoblastic tumors: problems in the differential diagnosis of aggressive osteoblastoma and low-grade osteosarcoma |journal=Semin Diagn Pathol |volume=1 |issue=3 |pages=215–34 |date=August 1984 |pmid=6600112 |doi= |url=}}</ref>
In regards to [[morbidity]] and [[mortality]], conventional osteoblastoma is a [[benign]] lesion with little associated morbidity. However, the tumor may be painful, and [[spinal]] lesions may be associated with [[scoliosis]] and neurologic manifestations. [[Metastases]] and even death have been reported with the controversial aggressive variant, which can behave in a fashion similar to that of osteosarcoma. This variant is also more likely to recur after surgery than is conventional osteoblastoma.
Osteoblastoma affects more males than it does females, with a ratio of 2-3:1 respectively. Osteoblastoma can occur in persons of any age, although the tumors predominantly affect the younger population (around 80% of these tumors occurs in persons under the age of 30). No racial predilection is recognized.
Approximately 40% of all osteoblastomas are located in the [[spine]]. The tumors usually involve the [[posterior]] elements, and 17% of spinal osteoblastomas are found in the [[sacrum]]. The long tubular bones are another common site of involvement, with a lower extremity preponderance. Osteoblastoma of the long tubular bones is often diaphyseal, and fewer are located in the metaphysis. Epiphyseal involvement is extremely rare. Although other sites are rarely affected, several bones in the abdomen and extremities have been reported as sites of osteoblastoma tumors.
'''Clinical Details:''' Patients with osteoblastoma usually present with pain of several months' duration. In contrast to the pain associated with osteoid osteoma, the pain of osteoblastoma usually is less intense, usually not worse at night, and not relieved readily with[[ salicylates]]( [[aspirin]] and related compounds). If the lesion is superficial, the patient may have localized swelling and tenderness. Spinal lesions can cause painful scoliosis, although this is less common with osteoblastoma than with osteoid osteoma. In addition, lesions may mechanically interfere with the [[spinal cord]] or [[nerve roots]], producing neurologic deficits.
When diagnosing osteoblastoma, the preliminary radiologic workup should consist of radiography of the site of the patient's pain. However, computed tomography (CT) is often necessary to support clinical and plain radiographic findings suggestive of osteoblastoma and to better define the margins of the lesion for potential surgery. CT scans are best used for the further characterization of the lesion with regard to the presence of a nidus and matrix mineralization. MRI aids in detection of nonspecific reactive marrow and soft tissue edema, and MRI best defines soft tissue extension, although this finding is not typical of osteoblastoma. Bone scintigraphy (bone scan) demonstrates abnormal [[radiotracer]] accumulation at the affected site, substantiating clinical suspicion, but this finding is not specific for osteoblastoma. In many patients, [[biopsy]] is necessary for confirmation.
==Classification==
==Classification==
There is no established system for the classification of [disease name].
*Osteoblastoma may be classified into two subtypes:<ref name="YinZhou2013">{{cite journal|last1=Yin|first1=Huabin|last2=Zhou|first2=Wang|last3=Yu|first3=Hongyu|last4=Li|first4=Binbin|last5=Zhang|first5=Dan|last6=Wu|first6=Zhipeng|last7=Liu|first7=Tielong|last8=Xiao|first8=Jianru|title=Clinical characteristics and treatment options for two types of osteoblastoma in the mobile spine: a retrospective study of 32 cases and outcomes|journal=European Spine Journal|volume=23|issue=2|year=2013|pages=411–416|issn=0940-6719|doi=10.1007/s00586-013-3049-1}}</ref>
**Conventional or [[benign]] osteoblastoma
OR
**Aggressive or [[malignant]] osteoblastoma
*A controversial aggressive [[tumor]] is reported which is [[malignant]] in nature as compared to the conventional or [[benign]] osteoblastomas.<ref name="pmid66001122">{{cite journal |vauthors=Dorfman HD, Weiss SW |title=Borderline osteoblastic tumors: problems in the differential diagnosis of aggressive osteoblastoma and low-grade osteosarcoma |journal=Semin Diagn Pathol |volume=1 |issue=3 |pages=215–34 |date=August 1984 |pmid=6600112 |doi= |url=}}</ref>
[Disease name] may be classified according to [classification method] into [number] subtypes/groups: [group1], [group2], [group3], and [group4].
OR
[Disease name] may be classified into [large number > 6] subtypes based on [classification method 1], [classification method 2], and [classification method 3].
[Disease name] may be classified into several subtypes based on [classification method 1], [classification method 2], and [classification method 3].
OR
Based on the duration of symptoms, [disease name] may be classified as either acute or chronic.
OR
If the staging system involves specific and characteristic findings and features:
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].
OR
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 etiology of osteoblastoma is unknown. Histologically, osteoblastomas are similar to osteoid osteomas, producing both osteoid and primitive woven bone amidst fibrovascular connective tissue. Although the tumor is usually considered [[benign]], a controversial aggressive variant has been described in the literature, with histologic features similar to those of malignant tumors such as an [[osteosarcoma]].
*The exact etiology of osteoblastoma is unknown.
*The exact etiology of osteoblastoma is unknown.
*The Osteoblastomas are composed of several osteoblasts that produce osteoid and woven bone regardless to their origin in the musculoskeletal system.<ref name="LucasKrishnan Unni1994">{{cite journal|last1=Lucas|first1=David R.|last2=Krishnan Unni|first2=K.|last3=McLeod|first3=Richard A.|last4=O'Connor|first4=Mary I.|last5=Sim|first5=Franklin H.|title=Osteoblastoma: Clinicopathologic study of 306 cases|journal=Human Pathology|volume=25|issue=2|year=1994|pages=117–134|issn=00468177|doi=10.1016/0046-8177(94)90267-4}}</ref>
*The osteoblastomas are composed of several [[Osteoblast|osteoblasts]] that produce [[osteoid]] and woven bone regardless to their origin in the [[musculoskeletal system]].<ref name="LucasKrishnan Unni1994">{{cite journal|last1=Lucas|first1=David R.|last2=Krishnan Unni|first2=K.|last3=McLeod|first3=Richard A.|last4=O'Connor|first4=Mary I.|last5=Sim|first5=Franklin H.|title=Osteoblastoma: Clinicopathologic study of 306 cases|journal=Human Pathology|volume=25|issue=2|year=1994|pages=117–134|issn=00468177|doi=10.1016/0046-8177(94)90267-4}}</ref>
*The expansion usually occurs when the primary site of Osteoblastoma is with in the cortical bone.
*The expansion usually occurs when the primary site of osteoblastoma is within the [[cortical bone]].
*Typically the external rim of the Osteoblastoma is concealed by the covering of periosteum and a thin rim of reactive bone.
*Typically the external rim of the osteoblastoma is concealed by the covering of [[periosteum]] and a thin rim of reactive [[bone]].
*In a clinico pathologic study conducted at Mayo clinic, the reported sizes of Osteoblastomas ranged from 1 to 11 cm, with a mean of 3.2 cm.
*In a clinicopathologic study conducted at Mayo clinic, the reported sizes of osteoblastomas ranged from 1 to 11 cm, with a mean of 3.2 cm.
*The Osteoblastomas are more aggressive as compared to the other benign tumors of the musculoskeletal system.
*The osteoblastomas are more aggressive as compared to the other [[benign tumors]] of the [[musculoskeletal system]].
*Due to their aggresive nature the Osteoblastomas can sometimes mimic malignancy on radiographic studies.
*Due to their aggressive nature, the osteoblastomas may mimic [[Cancer|malignancy]] on [[radiographic]] studies.
As opposed to more their benign counterparts, aggressive osteoblastomas display aggressive destruction of the adjacent host bone cortex and extends into surrounding soft tissues.
==Causes==
==Causes==
Disease name] may be caused by [cause1], [cause2], or [cause3].
The [[Causes|cause]] of osteoblastoma has not been identified.
OR
Common causes of [disease] include [cause1], [cause2], and [cause3].
OR
The most common cause of [disease name] is [cause 1]. Less common causes of [disease name] include [cause 2], [cause 3], and [cause 4].
OR
The cause of [disease name] has not been identified. To review risk factors for the development of [disease name], click [[Pericarditis causes#Overview|here]].
==Differentiating ((Page name)) from Other Diseases==
==Differentiating Osteoblastoma 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].
*Osteoblastoma must be differentiated from following bone disorders:
| style="background:#F5F5F5;" align="center" + |[[Radiology]] and [[biopsy]]
|}
==Epidemiology and Demographics==
==Epidemiology and Demographics==
The incidence/prevalence of [disease name] is approximately [number range] per 100,000 individuals worldwide.
* In the United States, osteoblastoma constitutes for almost 1% of all primary [[bone tumors]] and 3% of all [[benign tumors]].<ref name="Greenspan1993">{{cite journal|last1=Greenspan|first1=Adam|title=Benign bone-forming lesions: osteoma, osteoid osteoma, and osteoblastoma|journal=Skeletal Radiology|volume=22|issue=7|year=1993|issn=0364-2348|doi=10.1007/BF00209095}}</ref><ref name="LucasKrishnan Unni19942">{{cite journal|last1=Lucas|first1=David R.|last2=Krishnan Unni|first2=K.|last3=McLeod|first3=Richard A.|last4=O'Connor|first4=Mary I.|last5=Sim|first5=Franklin H.|title=Osteoblastoma: Clinicopathologic study of 306 cases|journal=Human Pathology|volume=25|issue=2|year=1994|pages=117–134|issn=00468177|doi=10.1016/0046-8177(94)90267-4}}</ref><ref name="ArkaderDormans2008">{{cite journal|last1=Arkader|first1=Alexandre|last2=Dormans|first2=John P.|title=Osteoblastoma in the Skeletally Immature|journal=Journal of Pediatric Orthopaedics|volume=28|issue=5|year=2008|pages=555–560|issn=0271-6798|doi=10.1097/BPO.0b013e31817bb849}}</ref>
*[[Patients]] of all age groups may develop osteoblastoma.
OR
* The mean age reported in a literature study conducted by Lucas DR at the time of [[diagnosis]] is 20.4 years, but it may be seen at any age.
*[[Male|Males]] are more commonly affected by osteoblastoma than [[Female|females]].
In [year], the incidence/prevalence of [disease name] was estimated to be [number range] cases per 100,000 individuals worldwide.
* The [[male]] to [[female]] ratio is 2 to 1.<ref name="pmid1123354">{{cite journal |vauthors=Marsh BW, Bonfiglio M, Brady LP, Enneking WF |title=Benign osteoblastoma: range of manifestations |journal=J Bone Joint Surg Am |volume=57 |issue=1 |pages=1–9 |date=January 1975 |pmid=1123354 |doi= |url=}}</ref>
* One-third of [[Patient|patients]] have [[Lesion|lesions]] in the posterior elements of the [[spine]], most often the [[lumbar]] and [[Sacrum|sacral]] regions.<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
* Osteoblastoma is a [[benign tumor]] of the [[musculoskeletal system]] and is associated with little [[morbidity]].
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].
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].
There are no established [[Risk factor|risk factors]] for osteoblastoma.
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].
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]] for osteoblastoma.
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].
*If left untreated, osteoblastoma may progress to grow and it may damage the [[bone]] and adjacent structures.<ref name="pmid1563167">{{cite journal |vauthors=Boriani S, Capanna R, Donati D, Levine A, Picci P, Savini R |title=Osteoblastoma of the spine |journal=Clin. Orthop. Relat. Res. |volume= |issue=278 |pages=37–45 |date=May 1992 |pmid=1563167 |doi= |url=}}</ref><ref name="ElhawiDe La Roza2013">{{cite journal|last1=Elhawi|first1=Mohamed E.|last2=De La Roza|first2=Gustavo L.|last3=Damron|first3=Timothy A.|title=Natural History of Untreated Osteoblastoma|journal=JBJS Case Connector|volume=3|issue=4|year=2013|pages=e110|issn=2160-3251|doi=10.2106/JBJS.CC.M.00130}}</ref>
*If the untreated osteoblastoma invades the [[spinal canal]] or [[Nervous system|neural]] foramina, it may lead to progressive [[Neurological|neurologic]] deficits.
OR
*If the [[lesion]] expands outside the [[bone]], the recurrence rate of osteoblastoma is nearly 20%.<ref name="pmid11505926">{{cite journal |vauthors=Aboulafia AJ, Kennon RE, Jelinek JS |title=Begnign bone tumors of childhood |journal=J Am Acad Orthop Surg |volume=7 |issue=6 |pages=377–88 |date=1999 |pmid=11505926 |doi= |url=}}</ref>
*Secondary [[aneurysmal bone cyst]] (ABC) occurs in approximately 15 % of lesions. <ref name=":0">{{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>
Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
*Recurring [[osteoid osteoma]] can rarely evolve to osteoblastoma.<ref name="pmid2000498">{{cite journal| author=Bettelli G, Tigani D, Picci P| title=Recurring osteoblastoma initially presenting as a typical osteoid osteoma. Report of two cases. | journal=Skeletal Radiol | year= 1991 | volume= 20 | issue= 1 | pages= 1-4 | pmid=2000498 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2000498 }} </ref><ref name="pmid16235709">{{cite journal| author=Bruneau M, Polivka M, Cornelius JF, George B| title=Progression of an osteoid osteoma to an osteoblastoma. Case report. | journal=J Neurosurg Spine | year= 2005 | volume= 3 | issue= 3 | pages= 238-41 | pmid=16235709 | doi=10.3171/spi.2005.3.3.0238 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16235709 }} </ref>
*Since osteoblastoma is a [[benign tumor]], the [[prognosis]] is generally good.<ref name="YinZhou20132">{{cite journal|last1=Yin|first1=Huabin|last2=Zhou|first2=Wang|last3=Yu|first3=Hongyu|last4=Li|first4=Binbin|last5=Zhang|first5=Dan|last6=Wu|first6=Zhipeng|last7=Liu|first7=Tielong|last8=Xiao|first8=Jianru|title=Clinical characteristics and treatment options for two types of osteoblastoma in the mobile spine: a retrospective study of 32 cases and outcomes|journal=European Spine Journal|volume=23|issue=2|year=2013|pages=411–416|issn=0940-6719|doi=10.1007/s00586-013-3049-1}}</ref>
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 Criteria===
===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].
{| align="right"
|
OR
[[File:Osteoblastoma Histology.jpg|200px|thumb|Osteblastoma histology.[https://commons.wikimedia.org/wiki/Category:Histopathology_of_osteoblastoma#/media/File:Osteoblastoma_-_high_mag.jpg 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]]]
|}
The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
*[[Biopsy]] is the [[diagnostic study of choice]] for the [[diagnosis]] of osteoblastoma.
OR
*[[Biopsy]] features of the osteoblastoma are similar to [[osteoid osteoma]]. Osteoblastoma [[Lesion|lesions]] are larger than [[osteoid osteoma]].
*[[Biopsy]] demonstrates the following features:
The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
** Nidus
** Network of interconnecting [[bone]], widened [[Blood vessel|vessels]], [[Osteoblast|osteoblasts]], and [[Osteon|bone matrix]]
OR
** Fibrinoid margin with areas of [[angiogenesis]]
** Adjacent [[sclerosis]]
* On [[Histology|histological]] examination the aggressive or [[malignant]] osteoblastomas contain:<ref name=":0" />
**An [[osteoid]] nidus with rimming [[Epithelioid sarcoma|epitheloid]] [[Osteoblast|osteoblasts]] surrounded by a fibrovascular [[stroma]] with [[Osteoclast|osteoclasts]].
**More aggressive [[Lesion|lesions]] tend to have large [[Epithelioid sarcoma|epitheloid]]-like [[Osteoblast|osteoblasts]] that are [[Mitotic|mitotically]] active.
There are no established criteria for the diagnosis of [disease name].
===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 cell|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>
*It is widely accepted and routinely used classification.
The majority of patients with [disease name] are asymptomatic.
*The majority of [[Patient|patients]] with osteoblastoma have a positive [[History and Physical examination|history]] of [[pain]] which is dull and achy in nature.<ref name="LucasKrishnan Unni19942" />
*The [[pain]] is not relieved by [[Salicylic acid|salicylates]].
OR
*[[Neurological]] conditions occur often due to compression of either the [[spinal cord]] or [[nerve]] roots, and lead to:<ref name="pmid6693472">{{cite journal |vauthors=Kirwan EO, Hutton PA, Pozo JL, Ransford AO |title=Osteoid osteoma and benign osteoblastoma of the spine. Clinical presentation and treatment |journal=J Bone Joint Surg Br |volume=66 |issue=1 |pages=21–6 |date=January 1984 |pmid=6693472 |doi= |url=}}</ref>
**[[Paralysis]]
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].
**[[Stiffness|Spinal stiffness]]
===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].
*Common [[physical examination]] findings of osteoblastoma include:
**[[Scoliosis]]
OR
**[[Torticollis]]
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===
===Laboratory Findings===
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].
Some [[patients]] with osteoblastoma may have elevated concentration of [[Paraneoplastic syndrome|para-neoplastic]] [[beta-human chorionic gonadotropin]] (β-hCG) , which is usually suggestive of aggressive osteoblastoma.<ref name="pmid28396962">{{cite journal| author=Morris CD, Hameed MR, Agaram NP, Hwang S| title=Elevated β-hCG associated with aggressive Osteoblastoma. | journal=Skeletal Radiol | year= 2017 | volume= 46 | issue= 9 | pages= 1187-1192 | pmid=28396962 | doi=10.1007/s00256-017-2647-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28396962 }} </ref>
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===
===Electrocardiogram===
There are no ECG findings associated with [disease name].
There are no [[The electrocardiogram|ECG]] findings associated with osteoblastoma.[[image:Osteoblastoma.jpg|thumb|Osteoblastoma causing a marked scoliosis in a 7 year old boy. Case courtesy of Dr Angela Byrne, via Radiopedia.org<ref><"https://radiopaedia.org/">Radiopaedia.org. From the case <"https://radiopaedia.org/cases/7593">rID: 7593</ref>]]
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].
*An [[X-rays|x-ray]] may be helpful in the [[diagnosis]] of osteoblastoma.
*Findings on an [[X-rays|x-ray]] suggestive of osteoblastoma include:<ref name="Saccomanni2009">{{cite journal|last1=Saccomanni|first1=Bernardino|title=RETRACTED ARTICLE: Osteoid osteoma and osteoblastoma of the spine: a review of the literature|journal=Current Reviews in Musculoskeletal Medicine|volume=2|issue=1|year=2009|pages=65–67|issn=1935-973X|doi=10.1007/s12178-009-9047-6}}</ref><ref name="pmid2343130">{{cite journal |vauthors=Kroon HM, Schurmans J |title=Osteoblastoma: clinical and radiologic findings in 98 new cases |journal=Radiology |volume=175 |issue=3 |pages=783–90 |date=June 1990 |pmid=2343130 |doi=10.1148/radiology.175.3.2343130 |url=}}</ref><ref>Resnick D. Tumors and tumor-like lesions of bone: imaging and pathology of specific lesions. In: Diagnosis of Bone and Joint Disorders.</ref>
OR
**A well-circumscribed radiolucent [[lesion]] in the [[Bone|bony]] cortex
**A thin shell of peripheral new [[bone]] separating the [[tumor]] from the surrounding soft tissue
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].
**Typically > 2.0 cm in diameter
** No reactive zone surrounding the lesion
*[[Cortical bone]] [[lesions]] often present with reactive [[Bone cell|bone]] formation, more so than those [[lesions]] in the spongy bone of the [[spine]], [[Ilium (bone)|ilium]], or [[Talus bone|talus]].
* Osteoblastoma may have features similar to those of [[malignancy]], such as:
**[[image:Pelvic-osteoblastoma.jpg|thumb|Left acetabular fossa pubic bone expansile predominantly lytic lesion with a rim of reactive sclerosis. Case courtesy of Dr Amr Farouk, <ref><"https://radiopaedia.org/">Radiopaedia.org. From the case <href="https://radiopaedia.org/cases/41171">rID: 41171</ref>]]Associated [[Aneurysm|aneurysmal]] [[Simple bone cyst|bone cyst]] component
* The usual sites of osteoblastoma and their plain [[radiographic]] features are described below:
* A well-defined destructive process within the [[cortical bone]]
OR
* Involvement of:
** [[Cortex]]
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].
** [[Medullary canal]]
|-
| style="background:#DCDCDC;" |
* [[Vertebral column]]
| style="background:#DCDCDC;" |
* A well-defined destructive process within the [[cortical bone]]
* Tumor is visualized in the posterior elements
* May bulge into the surrounding soft [[tissues]] and [[spinal column]]
|-
| style="background:#DCDCDC;" |
* [[Long bone|Long bones]]
| style="background:#DCDCDC;" |
* Rounded or oval, lucent [[tumor]] arising within the [[diaphysis]]
|}
===Echocardiography or Ultrasound===
===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound findings associated with [disease name].
There are no [[echocardiography]] or [[ultrasound]] findings associated with osteoblastoma.
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===
===CT scan===
There are no CT scan findings associated with [disease name].
*[[Computed tomography|CT scan]] may be helpful in the [[diagnosis]] and management of osteoblastoma.<ref name="YinZhou20133">{{cite journal|last1=Yin|first1=Huabin|last2=Zhou|first2=Wang|last3=Yu|first3=Hongyu|last4=Li|first4=Binbin|last5=Zhang|first5=Dan|last6=Wu|first6=Zhipeng|last7=Liu|first7=Tielong|last8=Xiao|first8=Jianru|title=Clinical characteristics and treatment options for two types of osteoblastoma in the mobile spine: a retrospective study of 32 cases and outcomes|journal=European Spine Journal|volume=23|issue=2|year=2013|pages=411–416|issn=0940-6719|doi=10.1007/s00586-013-3049-1}}</ref><ref name="KroonSchurmans1990">{{cite journal|last1=Kroon|first1=H M|last2=Schurmans|first2=J|title=Osteoblastoma: clinical and radiologic findings in 98 new cases.|journal=Radiology|volume=175|issue=3|year=1990|pages=783–790|issn=0033-8419|doi=10.1148/radiology.175.3.2343130}}</ref>
*[[Computed tomography|CT scan]] may provide information during the [[Pre-operative clearance|preoperative evaluation]] of osteoblastoma in [[cortical bone]], such as:
OR
**Size of the [[tumor]]
**Extent of the [[tumor]]
[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 best beneficial for the [[vertebral column]] [[Lesion|lesions]], which are hard to clearly localize on plain radiographs.
*[[Computed tomography|CT scan]] generally results in smaller and more precise [[surgical resection]]<nowiki/>s.
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===
===MRI===
There are no MRI findings associated with [disease name].
*[[Magnetic resonance imaging|MRI]] may be helpful in determining the extent of osteoblastoma that has invaded the surrounding [[Soft tissue|soft tissues]], [[bone marrow]], and [[Spinal cord|spine]].<ref name="KroonSchurmans19902">{{cite journal|last1=Kroon|first1=H M|last2=Schurmans|first2=J|title=Osteoblastoma: clinical and radiologic findings in 98 new cases.|journal=Radiology|volume=175|issue=3|year=1990|pages=783–790|issn=0033-8419|doi=10.1148/radiology.175.3.2343130}}</ref>
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===
===Other Imaging Findings===
There are no other imaging findings associated with [disease name].
*The most sensitive radiographic examination for the evaluation of osteoblastoma is [[bone scan]].<ref name="pmid27476846">{{cite journal |vauthors=Galgano MA, Goulart CR, Iwenofu H, Chin LS, Lavelle W, Mendel E |title=Osteoblastomas of the spine: a comprehensive review |journal=Neurosurg Focus |volume=41 |issue=2 |pages=E4 |date=August 2016 |pmid=27476846 |doi=10.3171/2016.5.FOCUS16122 |url=}}</ref>
*The typical appearance of an osteoblastoma on a technetium [[bone scan]] is:<ref name="pmid66934722">{{cite journal |vauthors=Kirwan EO, Hutton PA, Pozo JL, Ransford AO |title=Osteoid osteoma and benign osteoblastoma of the spine. Clinical presentation and treatment |journal=J Bone Joint Surg Br |volume=66 |issue=1 |pages=21–6 |date=January 1984 |pmid=6693472 |doi= |url=}}</ref>
OR
**A hot spot
[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===
===Other Diagnostic Studies===
There are no other diagnostic studies associated with [disease name].
*[[Angiogram|Angiography]] is performed if the information about the adjacent major [[Blood vessel|vessels]] locations or its involvement is needed.
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==
==Treatment==
The first route of treatment in Osteoblastoma is via medical means. Although necessary, radiation therapy (or chemotherapy) is controversial in the treatment of osteoblastoma. Cases of postirradiation [[sarcoma]] have been reported after use of these modalities. However, it is possible that the original histologic diagnosis was incorrect and the initial lesion was an [[osteosarcoma]], since histologic differentiation of these two entities can be very difficult.
The alternative means of treatment consists of surgical therapy. The treatment goal is complete surgical excision of the lesion. The type of excision depends on the location of the tumor. For stage 1 and 2 lesions, the recommended treatment is extensive intralesional excision, using a high-speed burr. Extensive intralesional resections ideally consist of removal of gross and microscopic tumor and a margin of normal tissue. For stage 3 lesions, wide resection is recommended because of the need to remove all tumor-bearing tissue. Wide excision is defined here as the excision of tumor and a circumferential cuff of normal tissue around the entity. This type of complete excision is usually curative for osteoblastoma.
In most patients, [[radiographic]] findings are not diagnostic of osteoblastoma; therefore, further imaging is warranted. [[CT]] examination performed with the intravenous administration of contrast agent poses a risk of an [[allergic reaction]] to contrast material.
The lengthy duration of an [[MRI]] examination and a history of [[claustrophobia]] in some patients are limiting the use of MRI. Although osteoblastoma demonstrates increased radiotracer accumulation, its appearance is nonspecific, and differentiating these lesions from those due to other etiologies involving increased radiotracer accumulation in the bone is difficult. Therefore, bone scans are useful only in conjunction with other radiologic studies and are not best used alone.
===Medical Therapy===
===Medical Therapy===
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
*The treatment of osteoblastoma with [[chemotherapy]] and [[radiation therapy]] is controversial.<ref name="YinZhou2013">{{cite journal|last1=Yin|first1=Huabin|last2=Zhou|first2=Wang|last3=Yu|first3=Hongyu|last4=Li|first4=Binbin|last5=Zhang|first5=Dan|last6=Wu|first6=Zhipeng|last7=Liu|first7=Tielong|last8=Xiao|first8=Jianru|title=Clinical characteristics and treatment options for two types of osteoblastoma in the mobile spine: a retrospective study of 32 cases and outcomes|journal=European Spine Journal|volume=23|issue=2|year=2013|pages=411–416|issn=0940-6719|doi=10.1007/s00586-013-3049-1}}</ref><ref name="pmid11233542">{{cite journal |vauthors=Marsh BW, Bonfiglio M, Brady LP, Enneking WF |title=Benign osteoblastoma: range of manifestations |journal=J Bone Joint Surg Am |volume=57 |issue=1 |pages=1–9 |date=January 1975 |pmid=1123354 |doi= |url=}}</ref>
*The [[radiation therapy]] may lead to post-irradiation [[sarcoma]].
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===
===Surgery===
Surgical intervention is not recommended for the management of [disease name].
*[[Surgery]] is the mainstay of treatment for osteoblastoma.<ref>de Andrea CE, Bridge JA, Schiller A (2013) Osteoblastoma. In: Fletcher CDM, Bridge JA, Hogendoorn PCW, Mertens F, editors. WHO classification of tumours of soft tissue and bone. Lyon: International Agency for Research on Cancer; pp. 279-280</ref>
*The total removal of the [[tumor]] is the treatment of goal in osteoblastoma.
OR
*Extensive intra-[[Lesion|lesional]] excision with a use of a high-speed burr is the recommended treatment for enneking stage 1 and 2 [[lesions]].
*Wide [[resection]] for the removal of all [[tumor]]-bearing [[Tissue (biology)|tissue]] is the recommended treatment for enneking stage 3 lesions, which is considered curative for osteoblastoma.
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
===Recurrence===
*The recurrence risk is related to the adequacy of [[resection]] and is about at 10–24 %.<ref name=":0" />
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===
===Primary Prevention===
There are no established measures for the primary prevention of [disease name].
There are no established measures for the [[primary prevention]] of osteoblastoma.
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===
===Secondary Prevention===
There are no established measures for the secondary prevention of [disease name].
There are no established measures for the [[secondary prevention]] of osteoblastoma.
OR
Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].
Osteoblastoma is a rare benignneoplasm of the bone, which constitutes for almost 1% of all primary bone tumors and 3% of all benign tumors in the United States. One-third of patients have lesions in the posterior elements of the spine, most often the lumbar and sacral regions. In 1952, Lichtenstein first termed the lesion as osteogenic fibroma of bone. In 1956, Lichtenstein and Jaffe in their independent detailed studies of this neoplasm renamed the lesion as osteoblastoma. Osteoblastoma might be conventional benign or aggressive and malignant. The exact etiology of osteoblastoma is unknown. The osteoblastomas are more aggressive compared to the other benign tumors of the musculoskeletal system. Histologically osteoblastoma is similar to osteoid osteoma and is differentiated on the basis of its large size. Osteoblastoma is a benign tumor of the musculoskeletal system and is associated with little morbidity. The risk factors are not yet established and there is insufficient evidence to recommend routine screening for osteoblastoma. If not treated, it may grow and damage the bone and adjacent structures. If the untreated osteoblastoma invades the spinal canal or neural foramina, it may lead to progressive neurologic deficits. Once the tumor expands outside the bone, the recurrence rate of osteoblastoma reaches to nearly 20%. Biopsy is the diagnostic study of choice for the diagnosis of osteoblastoma which shows similar features to that of osteoid osteoma. The majority of patients with osteoblastoma have a positive history of pain which is dull and achy in nature, and the pain is not relieved by salicylates. There are no diagnostic laboratory, ECG, echocardiography or ultrasound findings associated with osteoblastoma. X-ray is a useful diagnostic tool in the diagnosis of osteoblastoma and may reveal a well circumscribed radiolucent lesion in the bony cortex. CT scan may be helpful in the diagnosis and management of osteoblastoma and may provide the size and extent of osteoblastoma. MRI may be helpful in determining the extent of osteoblastoma that has invaded the surrounding soft tissues, bone marrow, and spine. The most sensitive radiographic examination for the evaluation of osteoblastoma is bone scan. The angiography is performed if the information about the adjacent major ve sel locations or its involvement is needed. Surgery is the mainstay of treatment for osteoblastoma and the treatment with chemotherapy and radiation therapy are still controversial.
Historical Perspective
In 1952, Lichtenstein was the first physician who termed the lesion as osteogenic fibroma of bone.[1]
In 1954, Dahlin and Johnson, were able to identify 11 tumors of bone origin that shared aggressive but nonetheless benign qualities. Therefore, this made these tumors notoriously difficult to diagnose as benign or malignant.[2]
In 1954, Dahlin and Johnson, were the first to notice that an osteoid osteoma and osteoblastoma had many histological characteristics in common and they named it giant osteoid osteoma.
In 1956, Lichtenstein and Jaffe in their independent detailed studies of the neoplasm termed the lesion as osteoblastoma.[3][4]
In 1977, Jackson published a review of 181 osteoblastomas from the literature and reported that spine is the location of 36% of the osteoblastomas.[5]
In 1984, Dorfman and Weiss reported on the aggressive osteoblastoma and termed it as a borderline osteoblastic tumor entity.[6]
Classification
Osteoblastoma may be classified into two subtypes:[7]
The Enneking surgical staging system (also known as the MSTS system) for benign musculoskeletaltumors based on radiographic characteristics of the tumor host margin.[22]
It is widely accepted and routinely used classification.
Stage
Description
I
Latent: Well demarcated borders
II
Active: Indistinct borders
III
Aggressive: Indistinct borders
History and Symptoms
The majority of patients with osteoblastoma have a positive history of pain which is dull and achy in nature.[11]
Left acetabular fossa pubic bone expansile predominantly lytic lesion with a rim of reactive sclerosis. Case courtesy of Dr Amr Farouk, [29]Associated aneurysmalbone cyst component
The usual sites of osteoblastoma and their plain radiographic features are described below:
Surgery is the mainstay of treatment for osteoblastoma.[36]
The total removal of the tumor is the treatment of goal in osteoblastoma.
Extensive intra-lesional excision with a use of a high-speed burr is the recommended treatment for enneking stage 1 and 2 lesions.
Wide resection for the removal of all tumor-bearing tissue is the recommended treatment for enneking stage 3 lesions, which is considered curative for osteoblastoma.
Recurrence
The recurrence risk is related to the adequacy of resection and is about at 10–24 %.[18]
Primary Prevention
There are no established measures for the primary prevention of osteoblastoma.
Secondary Prevention
There are no established measures for the secondary prevention of osteoblastoma.
References
↑Lichtenstein L. Osteogenic Fibroma of Bone. In: Bone Tumors. St Louis, Mo: Mosby; 1952:82-87.
↑DAHLIN DC, JOHNSON EW (June 1954). "Giant osteoid osteoma". J Bone Joint Surg Am. 36-A (3): 559–72. PMID13163088.
↑Jaffe HL. Osteoid-osteoma: a benign osteoblastic tumor composed of osteoid and atypical bone. Arch Surg. 1935;31:709–728.
↑LICHTENSTEIN L (1956). "Benign osteoblastoma; a category of osteoid-and bone-forming tumors other than classical osteoid osteoma, which may be mistaken for giant-cell tumor or osteogenic sarcoma". Cancer. 9 (5): 1044–52. PMID13364889.
↑Jackson RP, Reckling FW, Mants FA (October 1977). "Osteoid osteoma and osteoblastoma. Similar histologic lesions with different natural histories". Clin. Orthop. Relat. Res. (128): 303–13. PMID598169.
↑Dorfman HD, Weiss SW (August 1984). "Borderline osteoblastic tumors: problems in the differential diagnosis of aggressive osteoblastoma and low-grade osteosarcoma". Semin Diagn Pathol. 1 (3): 215–34. PMID6600112.
↑ 7.07.1Yin, Huabin; Zhou, Wang; Yu, Hongyu; Li, Binbin; Zhang, Dan; Wu, Zhipeng; Liu, Tielong; Xiao, Jianru (2013). "Clinical characteristics and treatment options for two types of osteoblastoma in the mobile spine: a retrospective study of 32 cases and outcomes". European Spine Journal. 23 (2): 411–416. doi:10.1007/s00586-013-3049-1. ISSN0940-6719.
↑Dorfman HD, Weiss SW (August 1984). "Borderline osteoblastic tumors: problems in the differential diagnosis of aggressive osteoblastoma and low-grade osteosarcoma". Semin Diagn Pathol. 1 (3): 215–34. PMID6600112.
↑Lucas, David R.; Krishnan Unni, K.; McLeod, Richard A.; O'Connor, Mary I.; Sim, Franklin H. (1994). "Osteoblastoma: Clinicopathologic study of 306 cases". Human Pathology. 25 (2): 117–134. doi:10.1016/0046-8177(94)90267-4. ISSN0046-8177.
↑Greenspan, Adam (1993). "Benign bone-forming lesions: osteoma, osteoid osteoma, and osteoblastoma". Skeletal Radiology. 22 (7). doi:10.1007/BF00209095. ISSN0364-2348.
↑ 11.011.1Lucas, David R.; Krishnan Unni, K.; McLeod, Richard A.; O'Connor, Mary I.; Sim, Franklin H. (1994). "Osteoblastoma: Clinicopathologic study of 306 cases". Human Pathology. 25 (2): 117–134. doi:10.1016/0046-8177(94)90267-4. ISSN0046-8177.
↑Arkader, Alexandre; Dormans, John P. (2008). "Osteoblastoma in the Skeletally Immature". Journal of Pediatric Orthopaedics. 28 (5): 555–560. doi:10.1097/BPO.0b013e31817bb849. ISSN0271-6798.
↑Marsh BW, Bonfiglio M, Brady LP, Enneking WF (January 1975). "Benign osteoblastoma: range of manifestations". J Bone Joint Surg Am. 57 (1): 1–9. PMID1123354.
↑Peabody, Terrance (2014). Orthopaedic oncology : primary and metastatic tumors of the skeletal system. Cham: Springer. ISBN9783319073224.
↑Boriani S, Capanna R, Donati D, Levine A, Picci P, Savini R (May 1992). "Osteoblastoma of the spine". Clin. Orthop. Relat. Res. (278): 37–45. PMID1563167.
↑Elhawi, Mohamed E.; De La Roza, Gustavo L.; Damron, Timothy A. (2013). "Natural History of Untreated Osteoblastoma". JBJS Case Connector. 3 (4): e110. doi:10.2106/JBJS.CC.M.00130. ISSN2160-3251.
↑Aboulafia AJ, Kennon RE, Jelinek JS (1999). "Begnign bone tumors of childhood". J Am Acad Orthop Surg. 7 (6): 377–88. PMID11505926.
↑ 18.018.118.2Peabody, Terrance (2014). Orthopaedic oncology : primary and metastatic tumors of the skeletal system. Cham: Springer. ISBN9783319073224.
↑Yin, Huabin; Zhou, Wang; Yu, Hongyu; Li, Binbin; Zhang, Dan; Wu, Zhipeng; Liu, Tielong; Xiao, Jianru (2013). "Clinical characteristics and treatment options for two types of osteoblastoma in the mobile spine: a retrospective study of 32 cases and outcomes". European Spine Journal. 23 (2): 411–416. doi:10.1007/s00586-013-3049-1. ISSN0940-6719.
↑Saccomanni, Bernardino (2009). "RETRACTED ARTICLE: Osteoid osteoma and osteoblastoma of the spine: a review of the literature". Current Reviews in Musculoskeletal Medicine. 2 (1): 65–67. doi:10.1007/s12178-009-9047-6. ISSN1935-973X.
↑Yin, Huabin; Zhou, Wang; Yu, Hongyu; Li, Binbin; Zhang, Dan; Wu, Zhipeng; Liu, Tielong; Xiao, Jianru (2013). "Clinical characteristics and treatment options for two types of osteoblastoma in the mobile spine: a retrospective study of 32 cases and outcomes". European Spine Journal. 23 (2): 411–416. doi:10.1007/s00586-013-3049-1. ISSN0940-6719.
↑Galgano MA, Goulart CR, Iwenofu H, Chin LS, Lavelle W, Mendel E (August 2016). "Osteoblastomas of the spine: a comprehensive review". Neurosurg Focus. 41 (2): E4. doi:10.3171/2016.5.FOCUS16122. PMID27476846.
↑Kirwan EO, Hutton PA, Pozo JL, Ransford AO (January 1984). "Osteoid osteoma and benign osteoblastoma of the spine. Clinical presentation and treatment". J Bone Joint Surg Br. 66 (1): 21–6. PMID6693472.
↑Marsh BW, Bonfiglio M, Brady LP, Enneking WF (January 1975). "Benign osteoblastoma: range of manifestations". J Bone Joint Surg Am. 57 (1): 1–9. PMID1123354.
↑de Andrea CE, Bridge JA, Schiller A (2013) Osteoblastoma. In: Fletcher CDM, Bridge JA, Hogendoorn PCW, Mertens F, editors. WHO classification of tumours of soft tissue and bone. Lyon: International Agency for Research on Cancer; pp. 279-280
Information sourced from the following:
Erin O'Connor, MD, Assistant Professor, Department of Radiology, Temple University | Gregory Scott Stacy, MD, Assistant Professor of Radiology, Department of Radiology, University of Chicago Hospitals | Fred Ortmann, MD, Staff Physician, Department of Orthopaedics, University of South Carolina School of Medicine | John Eady, MD, Chairman, Professor, Department of Orthopedic Surgery, University of South Carolina School of Medicine | Bullough, Peter, Orthopaedic Pathologv (third edition), Times Mirror International Publishers Limited: London, 1997. | Gitelis S., R. Wilkins and EU Conrad, Benign Bone Tumors. Instructional Course Lectures, 45:425-46, 1991. | Huvos, Andrew, Bone Tumors: Diagnosis. Treatment and Prognosis, W.B. Saunders Co., 1991. | Ruggieri, P., RA McLeod, KK Unni and FH Sim, Osteoblastoma, Orthopedics, 19(7):621-4, July 1996.
