Východiska: Osteom a osteoidní osteom jsou klasifikovány jako benigní podtypy osteogenních nádorů páteře a osteoblastom je klasifikován jako intermediární podtyp. Cílem tento studie bylo představit náš chirurgický přístup k pacientům s těmito nádory a poskytnout informace o vztahu mezi chirurgickou léčbou a recidivou. Metody: Retrospektivně bylo hodnoceno 18 pacientů, kteří podstoupili operaci na naší klinice. Byly zkoumány demografické charakteristiky, obtíže v době prezentace onemocnění a předoperační neurologické nálezy. Pro staging byl použit Ennekingův klasifikační systém a pro hodnocení nestability páteře bylo použito Skóre neoplastické nestability páteře (Spinal Instability Neoplastic Score; SINS). Výsledky: Mezi pacienty s osteoidním osteomem bylo šest mužů a tři ženy (ve věku 16– 54 let, průměrný věk 31,2 let) a mezi pacienty s osteoblastomem šest mužů a tři ženy (ve věku 5– 32 let, průměrný věk 17,9 let). Všichni pacienti s osteoidním osteomem měli podle Ennekingovy klasifikace stadium I a byla u nich provedena rozsáhlá totální resekce. Jeden pacient byl potenciálně nestabilní a po resekci u něj byla provedena stabilizace. Mezi pacienty s osteoblastomem mělo 44,4 % onemocnění ve stadiu II a 55,6 % ve stadiu III podle Ennekingovy klasifikace. Jeden pacient byl potenciálně nestabilní a po resekci u něj byla provedena stabilizace. V 77,8 % případů osteoblastomu byla provedena rozsáhlá totální resekce. Recidiva byla pozorována u 22,2 % případů. Podle Ennekingovy klasifikace byly recidivy lokalizované v krční páteři ve stadiu III a pacienti podstoupili subtotální resekci. Závěr: Recidivy a nutnost reoperace byly častější u osteoblastomů stadia III podle Ennekingovy klasifikace a v případech, kdy pacient podstoupil subtotální resekci, zejména u pacientů s nádory krční páteře.
Background: Osteoma and osteoid osteoma are classified as benign subtypes of osteogenic spinal tumors, and osteoblastoma is classified as an intermediate subtype. This study aimed to present our surgical approach for patients with these tumors and to provide information about the relationship between surgical treatment and recurrence. Methods: Eighteen patients who underwent surgery in our department were retrospectively evaluated. Demographic characteristics, presentation complaints, and preoperative neurological findings were examined. The Enneking classification system was used for staging, and the Spinal Instability Neoplastic Score was used for spinal instability assessment. Results: There were six males and three females (16– 54 years of age, mean age: 31.2) among the patients with osteoid osteoma and six males and three females (5– 32 years of age, mean age: 17.9) among the patients with osteoblastoma. In all patients with osteoid osteoma, the Enneking stage was I, and gross total resection was performed. One patient was potentially unstable, and stabilization was performed after resection. Among patients with osteoblastoma, there were 44.4% at Enneking stage II and 55.6% at Enneking stage III. One patient was potentially unstable, and stabilization was performed after resection. Gross total resection was performed in 77.8% of the osteoblastoma cases. Recurrence was observed in 22.2% of the cases. Recurrences were Enneking stage III in cervical localization and patients underwent subtotal resection. Conclusion: Recurrences and the need for reoperation were more frequent in Enneking stage III osteoblastomas and in cases in which the patient underwent subtotal resection, particularly in patients with cervical spine tumors.
- MeSH
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- nádory páteře * chirurgie diagnostické zobrazování patologie MeSH
- osteoblastom chirurgie diagnostické zobrazování patologie MeSH
- osteom osteoidní chirurgie diagnóza patologie MeSH
- recidiva MeSH
- statistika jako téma MeSH
- stupeň závažnosti nemoci MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- klinická studie MeSH
Autoři uvádí případ 44leté ženy s přítomností mnohočetných tvrdých papul na tvářích, které vznikly před 10 lety po ošetření jizev po akné frakčním CO2 laserem. Histopatologické vyšetření prokázalo mnohočetný miliární osteom kůže. Diskutována je problematika patologické osifikace v kůži a klasifikace kožních osteomů.
The authors report the case of a 44-year-old woman with the presence of multiple firm papules on her cheeks, which appeared 10 years ago after treatment of acne scars with a fractional CO2 laser. Histopathological examination revealed multiple miliary osteoma cutis. Pathological ossification in the skin and the classification of cutaneous osteomas are discussed.
- Klíčová slova
- mnohočetný miliární osteom kůže, histopatologie,
- MeSH
- dospělí MeSH
- lidé MeSH
- obličejové dermatózy etiologie patologie MeSH
- osteogeneze MeSH
- osteom * diagnóza etiologie MeSH
- papuloskvamózní nemoci kůže diagnóza etiologie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Introduction: Osteoid osteoma is a benign bone tumor with the classical characteristic of pain that subsides significantly with the use of nonsteroidal anti-inflammatory drugs. When conservative therapy fails, a surgical approach is then recommended. Radiofrequency ablation (RFA) has become more widely used compared to open resection due to fewer serious postoperative complications. But it is still important that the complications of RFA be recognized and addressed. Case report: We present a case of a 22-year-old man with acute pain on his left shin, accompanied by signs of localized inflammation. The clinical findings and radiology support the diagnosis of osteoid osteoma. A surgical intervention with percutaneous radiofrequency ablation was performed. However, post-operatively, the patient complains of prolonged fluid discharge from the surgical site. Following the biopsy and debridement surgery, both specimen culture and histopathology results revealed sterile inflammation with no specific process. Conclusion: RFA has become the most popular treatment of choice for osteoid osteoma, but it still comes with complications, most commonly involving subcutaneous bones such as the tibia. In conclusion, extra caution is needed when treating subcutaneously located bones with RFA.
- MeSH
- lidé MeSH
- mladý dospělý MeSH
- osteom osteoidní * komplikace terapie MeSH
- radiofrekvenční ablace škodlivé účinky MeSH
- tibie diagnostické zobrazování patologie MeSH
- zánět diagnostické zobrazování etiologie terapie MeSH
- Check Tag
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- MeSH
- chondrom diagnóza patologie MeSH
- chondrosarkom diagnóza patologie terapie MeSH
- Ewingův sarkom diagnóza patologie terapie MeSH
- lidé MeSH
- metastázy nádorů MeSH
- mnohočetný myelom diagnóza patologie terapie MeSH
- myositis ossificans diagnóza etiologie terapie MeSH
- nádory kostí * diagnóza klasifikace terapie MeSH
- obrovskobuněčný nádor kosti diagnóza patologie terapie MeSH
- osteom osteoidní chirurgie diagnóza patologie MeSH
- osteom chirurgie dietoterapie etiologie MeSH
- osteosarkom diagnóza patologie terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Východiska: Osteómy prinosových dutín sa v pediatrickej populácii vyskytujú zriedkavo, v literatúre nájdeme len málo údajov o symptomatických osteómoch. Názory na indikáciu na operačnú liečbu sú kontroverzné. Prípad: Autori opisujú pacienta – 12-ročného chlapca so symptomatickým osteómom čuchového labyrintu vpravo, ktorý bol liečený chirurgicky – endoskopickým endonazálnym prístupom. Diskutovaná je symptomatológia, diagnostika a terapia týchto nádorov u detského pacienta. Záver: Osteómy prinosových dutín sú pomaly rastúce benígne lézie. Symptomatické osteómy môžu rásť expanzívne a spôsobiť závažné komplikácie. Liečba osteómu je chirurgická a endoskopický prístup ponúka možnosť bezpečného odstránenia s kozmetickými výhodami.
Background: Osteomas of the paranasal sinuses occur rarely in the pediatric population, we find only a few reference of symptomatic osteomas in the literature. Opinions on the indication for surgical treatment are controversial. Case: The authors present a case of symptomatic osteoma of the right ethoimoidal sinus in a 12-year-old boy, who was treated surgically, with endoscopic endonasal approach. The symptomatology, diagnosis and therapy of these tumors in the pediatric patient are discussed. Conclusion: Osteomas of the paranasal sinuses are slow-growing benign lesions. Symptomatic osteomas can grow expansively and cause serious complications. The treatment of osteoma is surgical and the endoscopic approach offers the possibility of removal with cosmetic benefits.
- MeSH
- dítě MeSH
- lidé MeSH
- nádory nosu * chirurgie diagnóza MeSH
- osteom osteoidní chirurgie diagnóza MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Osteoid osteoma is a primary benign bone tumor with rare intra-articular occurrence. Our case report describes a rare case of a 21-year-old man with long-term severe pain in the right hip region caused by osteoid osteoma managed by arthroscopic excision. The clinical finding of pains and a limited range of motion did not correlate with the normal plain X-ray finding. The osteoid osteoma was suspected based on the CT scan. In literature, several methods of resection of intraarticular osteoid osteoma of the hip are described. Since our department has long specialised in arthroscopic hip surgery and based on the available examinations the tumor appeared to be located within the arthroscopic reach, we decided for arthroscopic resection of the tumor. Our study comprises a detailed description of the entire surgical procedure, the used arthroscopic approaches and the arthroscopic technique of tumor excision. The histological examination of samples taken from the mass confirmed the suspected osteoid osteoma. The success of arthroscopic excision of the tumor was later confirmed also by very positive postoperative recovery when the patient very soon experienced a considerable reduction of pain observed during our five-year follow-up of the patient (Day 13, Week 2 and 6, Year 1, 2 and 5). During the follow-up period, an increase of the Harris Hip Score (13.5 preoperatively vs 76.6/91/94/96/96 postoperatively) and a decrease in VAS (9 preoperatively vs. 3/1/1/1/1) were reported. The follow-up CT and MRI performed at 2 or 5 years after surgery did not show tumor recurrence. The case report includes also illustrations consisting of X-rays, CT and MRI scans before and after surgery as well as multiple scans taken intraoperatively. It has to be emphasized that this is a rare case and an evaluation of a larger group of patients would be necessary to verify the successful outcomes of arthroscopic technique in treatment of the hip joint osteoid osteoma.
- MeSH
- bolest MeSH
- dospělí MeSH
- hlavice femuru MeSH
- lidé MeSH
- lokální recidiva nádoru MeSH
- mladý dospělý MeSH
- nádory kostí * diagnostické zobrazování chirurgie MeSH
- osteom osteoidní * diagnostické zobrazování chirurgie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
PURPOSE OF THE STUDY Osteoid osteoma is a benign tumor that forms in bone, which accounts for 3% of all primary bone tumors. The classical clinical finding is substantial nocturnal pain and imaging findings. The management of osteoid osteomas include open surgical excision or minimally invasive percutaneous interventions. Why and which treatment modality should be considered between CT-guided radiofrequency ablation and open surgical excision for osteoid osteomas in unusual locations? MATERIAL AND METHODS We retrospectively reviewed 17 patients with osteoid osteomas in unusual locations included cuboid, triquetrum, coronoid process, and proximal phalanx. We evaluated the duration from symptoms to diagnosis, activity related pain, clinical findings, and possible recurrence or complications. The minimum clinical follow-up was 51 ± 34.8 months. RESULTS CT-guided radiofrequency ablation was applied to 3 patients and open surgical excision procedures to 14. All the complaints of patients gone after treatment. No major complications were observed following CT-guided radiofrequency ablation or surgical excision. Transient weakness/paresthesia was determined in 1 patient in the treated shoulder after CT-guided radiofrequency ablation, which resolved spontaneously in the 6th week. There was only recurrence seen in 1 patient, who had 2nd proximal phalangeal osteoid osteoma. Proximal interphalangeal joint arthrodesis was performed after recurred lesion. DISCUSSION The main challenge in management of the osteoid osteomas of the unusual locations are the diagnosis. When we examined the literature, the interval from the beginning of the symptoms to accurate diagnosis did not change over the past decades. Techniques for management of these lesions should be chosen with consideration of the location of the lesion. CONCLUSIONS If there is long-term complaint of undiagnosed limb pain, the physician should suspect osteoid osteoma. However, the selection of treatment modality should be considered according to the location of the lesion. Which management modality is superior may change depending on the location of the lesion between CT-guided radiofrequency ablation and surgical excision. Key words: osteoid osteoma, unusual locations, CT guided, radiofrequency ablation, benign bone tumor.
PURPOSE OF THE STUDY Osteoid osteoma (OO) of the upper extremity is a rare pathology representing a major diagnostic challenge. The patients are often times incorrectly treated due to a misdiagnosis and therefore the final management of symptoms is delayed by several months. During this time the pain, which is the main symptom, increases. The surgical treatment is a fast and efficient solution. This paper aims to highlight the specificity of the OO of the upper extremity, evaluate our study group, the time to diagnosis and the benefits of individual imaging techniques. MATERIAL AND METHODS In the period 2007-2017, a total of 8 patients with a histologically verified OO of the upper extremity were consulted and treated at the authors departments. The group of patients was retrospectively evaluated based on the medical reports, surgical protocols, imaging examinations, histology results of preoperative samples and a postoperative questionnaire. Pain was assessed on the Visual Analogue Scale (VAS) preoperatively, at 2 weeks, 2 months and at one year postoperatively and in January 2018. The mean follow-up period was 48 months (range 16-78). The presence of swelling, synovitis and a limited range of motion were clinically assessed. The removed tissue was tested in an accredited biopsy laboratory. RESULTS 8 patients with OO of the elbow, wrist and hand were treated in the period 2007-2017. In 5 cases the OO was located in the wrist (scaphoid, 2x trapezoid, hamate and capitate) and in 2 cases in finger phalanges (middle and distal phalanx). The mean age of the patients was 24.5 years (median 21.5, range 18-42). The male to female ratio was 7:1. The mean interval between the onset of symptoms and the final diagnosis was 16.25 months (median 15.5, range 12-25). The CT examination proved to be the most beneficial imaging techniques. A plain radiograph led to a diagnosis in 1 case only. The preoperative mean pain VAS value 9.25 dropped to VAS 1 at two weeks after the surgery. No recurrence was reported. DISCUSSION The main challenge in treating the OO of the upper extremity is the diagnosis. Despite of the availability of advanced imaging techniques, the interval from the onset of symptoms to correct diagnosis did not change over the past decades. As to the treatment, despite the development of new procedures the method of choice continues to be the surgical excochleation. CONCLUSIONS Osteoid osteoma of the upper extremity is a rare pathology which shall be considered in case of an increasing pain, especially in young men. A plain radiograph of the anatomically complex terrain of the hand and wrist is mostly not useful in diagnosis, whereas the CT examination can visualise even a small size nidus. The surgical excochleation results in pain relief and early functional recovery with swelling disappearance. To diagnose the OO is not difficult provided we take it into consideration. Key words:osteoid osteoma, upper extremity, hand, wrist, diagnosis.
- MeSH
- dospělí MeSH
- lidé MeSH
- lokální recidiva nádoru MeSH
- loket MeSH
- mladý dospělý MeSH
- nádory kostí * diagnóza chirurgie MeSH
- osteom osteoidní * diagnóza chirurgie MeSH
- počítačová rentgenová tomografie MeSH
- retrospektivní studie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- diferenciální diagnóza MeSH
- dítě MeSH
- kožní manifestace MeSH
- lidé MeSH
- mentální retardace diagnóza etiologie MeSH
- osteom osteoidní diagnóza etiologie MeSH
- předškolní dítě MeSH
- pseudopseudohypoparatyreóza * farmakoterapie genetika MeSH
- thyroniny aplikace a dávkování MeSH
- vitamin D aplikace a dávkování MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- Publikační typ
- kazuistiky MeSH
