Osteoblastoma
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Synonyms and keywords::Osteogenic fibroma of bone; Giant osteoid osteoma
| Osteoblastoma | |
| DiseasesDB | 31488 |
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| MeSH | C4557 |
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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.
Historical Perspective
- In 1952, Lichtenstein first termed the leision as Osteogenic fibroma of bone.[1]
- 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.[2]
- In 1956, Lichtenstein and Jaffe in their independent detailed studies of the neoplasm termed the leision as osteoblastoma.[3][4]
- 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.[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]
- Conventional/benign osteoblastoma
- Aggressive/malignant osteoblastoma
- A controversial aggressive tumor is reported which is malignant in nature as compared to the conventional/benign osteoblastomas.[8]
- On histological examination the aggressive/malignant Osteoblastoms contain:
- A large number epithelioid osteoblasts with abnormal appearance of the cell nuclei.
Pathophysiology
- 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.[9]
- The expansion usually occurs when the primary site of osteoblastoma is with in the cortical 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.
- 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.
Causes
The cause of osteoblastoma has not been identified.
Differentiating Osteoblastoma from Other Diseases
- Osteoblastoma must be differentiated from:
Epidemiology and Demographics
- In the United States, osteoblastoma constitutes for almost 1% of all primary bone tumors and 3% of all benign tumors.[10][11][12]
- Patients of all age groups may develop osteoblastoma.
- 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.
- Males are more commonly affected by osteoblastoma than females.
- The male to female ratio is 2 to 1.
- Osteoblastoma is a benign tumor of the musculoskeletal system and is associated with little morbidity.
Risk Factors
There are no established risk factors for osteoblastoma.
Screening
There is insufficient evidence to recommend routine screening for osteoblastoma .
Natural History, Complications, and Prognosis
- If left untreated, osteoblastoma may progress to grow and it may damage the bone and ajacent structures.[13][14]
- If the untreated osteoblastoma invades the spinal canal or neural foramina it may leas to progressive neurologic deficits.
- If the lesion expands outside the bone the recurrence rate of osteoblastoma is nearly 20%.[15]
- Since osteoblastoma is a benign tumor the prognosis is generally good.[16]
Diagnosis
Diagnostic Criteria
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 osteoblastoma have a positive history of pain which is dull and achy in nature.[11]
- The pain is not relieved by salicylates.
- Neurologic conditions occur often due to compression of either the spinal cord or nerve roots, and lead to:[17]
- Paralysis
- Spinal stiffness
Physical Examination
- Common physical examination findings of osteoblastoma include:
- Scoliosis
- Torticolis
Laboratory Findings
There are no diagnostic laboratory findings associated with osteoblastoma.
Electrocardiogram
There are no ECG findings associated with osteoblastoma.
X-ray
- An x-ray may be helpful in the diagnosis of osteoblastoma.
- Findings on an x-ray suggestive of/diagnostic of osteoblastoma include:[18][19][20]
- A well-circumscribed radiolucent lesion in the bony cortex
- A thin shell of peripheral new bone separating the tumor from the surrounding soft tissue
- The lesion is typically > 2.0 cm in diameter
- The lesion does not have a surrounding, intense, reactive zone of bone surrounding
- Cortical bone lesions often present with reactive bone formation, more so than those lesions in the spongy bone of the spine, ilium, or talus.
- Usually due to the associated aneurysmal bone cyst component the osteoblastoma may have features similar to those of malignancy, such as:
- Cortical destruction
- Extraosseous soft-tissue expansion
- The usual sites of osteoblastoma and their plain radiographic features are described below:
| Site | Radiographic features |
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Echocardiography or Ultrasound
There are no echocardiography or ultrasound findings associated with osteoblastoma.
CT scan
- CT scan may be helpful in the diagnosis and management of osteoblastoma.
- CT scan may provide information during the preoperative evaluation of osteoblastoma in cortical bone such as:
- Size of the tumor
- Extent of the tumor
- CT scan is best beneficial for the vertebral column lesions which are hard to clearly localize on plain radiographs.
- CT scan generally results in smaller and more precise surgical resections.
MRI
- MRI may be helpful in determining the extent of osteoblastoma that has invaded the surrounding soft tissues, bone marrow and spine.
Other Imaging Findings
- The most sensitive radiographic examination for the evaluation of osteoblastoma is a bone scan.[21]
- The typical appearance of an osteoblastoma on a technetium bone scan is:[22]
- A hot spot
Other Diagnostic Studies
- Angiography is performed if the information about the adjacent major vessel locations or its involvement is needed.
Treatment
Medical Therapy
- The treatment of osteoblastoma with chemotherapy and radiation therapy is controversial.[7]
- The radiation therapy may lead to postirradiation sarcoma.
Surgery
- Surgery is the mainstay of treatment for osteoblastoma.[23]
- The total surgical removal of the tumor is the treatment goal in osteoblastoma.
- Extensive intralesional excision with a use of a high-speed burr is the recommended treatment for stage 1 and 2 lesions.
- Wide resection for the removal of all tumor-bearing tissue is the recommended treatment for stage 3 lesions, which is considered curative for osteoblastoma.
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. PMID 13163088.
- ↑ 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. PMID 13364889.
- ↑ 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. PMID 598169.
- ↑ 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. PMID 6600112.
- ↑ 7.0 7.1 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. ISSN 0940-6719.
- ↑ 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. PMID 6600112.
- ↑ 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. ISSN 0046-8177.
- ↑ Greenspan, Adam (1993). "Benign bone-forming lesions: osteoma, osteoid osteoma, and osteoblastoma". Skeletal Radiology. 22 (7). doi:10.1007/BF00209095. ISSN 0364-2348.
- ↑ 11.0 11.1 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. ISSN 0046-8177.
- ↑ Arkader, Alexandre; Dormans, John P. (2008). "Osteoblastoma in the Skeletally Immature". Journal of Pediatric Orthopaedics. 28 (5): 555–560. doi:10.1097/BPO.0b013e31817bb849. ISSN 0271-6798.
- ↑ 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. PMID 1563167.
- ↑ 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. ISSN 2160-3251.
- ↑ Aboulafia AJ, Kennon RE, Jelinek JS (1999). "Begnign bone tumors of childhood". J Am Acad Orthop Surg. 7 (6): 377–88. PMID 11505926.
- ↑ 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. ISSN 0940-6719.
- ↑ 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. PMID 6693472.
- ↑ 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. ISSN 1935-973X.
- ↑ Kroon HM, Schurmans J (June 1990). "Osteoblastoma: clinical and radiologic findings in 98 new cases". Radiology. 175 (3): 783–90. doi:10.1148/radiology.175.3.2343130. PMID 2343130.
- ↑ Resnick D. Tumors and tumor-like lesions of bone: imaging and pathology of specific lesions. In: Diagnosis of Bone and Joint Disorders.
- ↑ 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. PMID 27476846.
- ↑ 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. PMID 6693472.
- ↑ 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.