Updated: 6/21/2021

Osteoblastoma

0%
Topic
Review Topic
0
0
0%
0%
Flashcards
6
N/A
N/A
Questions
3
0
0
100%
0%
Evidence
5
0
0
Topic
Images
https://upload.orthobullets.com/topic/8013/images/Case B - xray - Parsons_moved.png
https://upload.orthobullets.com/topic/8013/images/Case B - CT - Parsons_moved.png
https://upload.orthobullets.com/topic/8013/images/Case B - bone scan - Parsons_moved.png
https://upload.orthobullets.com/topic/8013/images/Case C - xray - Parsons_moved.png
https://upload.orthobullets.com/topic/8013/images/Histology C - parsons_moved.png
https://upload.orthobullets.com/topic/8013/images/osteoblastoma ct.jpg
  • summary
    • Osteoblastomas are benign, aggressive osteogenic bone lesions commonly found in the posterior elements of the spine. Patients typically present between ages 10 and 30 with regional pain with only partial response from NSAIDs.
    • Diagnosis is made radiographically by a characteristic lesion that is > 2 cm in diameter with a sclerotic margin and radiolucent nidus. 
    •  Treatment is usually curettage or marginal excision with bone grafting.
  • Epidemiology
    • Incidence
      • relatively rare
      • less common than osteoid osteoma
    • Demographics
      • males > females (2:1)
      • majority of patients 10-30 years of age
    • Anatomic location
      • most common in posterior elements of spine
  • Etiology
    • Genetics
      • unknown
    • Associated conditions
      • oncogenic osteomalacia
      • secondary ABC
        • 10%-40% associated with secondary ABC
  • Presentation
    • Symptoms
      • pain
        • slowly progressive dull aching pain
        • partial response to NSAIDs
      • may see neurologic symptoms with spine involvement
    • Physical exam
      • swelling
      • muscle atrophy
      • limp
  • Imaging
    • Radiographs
      • recommended views
        • AP and lateral of symptomatic area
      • findings
        • lytic or mixed lytic-blastic lesion with radiolucent nidus > 2cm
        • reactive sclerotic bone
        • 66% cortically based, 33% medullary based
        • often expansile with extension into soft tissues with rim of reactive bone
          • 25% appear very aggressive and often mistaken for malignant lesion
    • CT
      • indications
        • necessary to fully evaluate lesion
    • Bone scan
      • hot with intense focal uptake
  • Studies
    • Histology
      • similar to osteoid osteoma but with more giant cells
      • distinct demarcation between nidus and reactive bone
        • nidus of immature osteoid and osteoblasts with abundant cytoplasm and normal nuclei
      • fibrovascular stroma that merges with normal trabeculae of bone
      • rim of osteoblasts surrounds osteoid
      • numerous mitotic figures, but not atypical
  • Differential
    • Radiographic differential for osteoblastoma includes
      • osteosarcoma
      • ABC
      • osteomyelitis
      • osteoid osteoma
    • Differentiating from osteoid osteoma
      • characteristics specific to osteoblastoma
        • rare and locally aggressive but benign (not self limiting)
        • over 40% occur in posterior elements of spine or sacrum
        • dull pain less likely to be relieved by NSAIDs
        • larger
        • more giant cells
    • Differential for lesions of the posterior spinal elements includes
      • aneurysmal bone cyst
      • osteoid osteoma
      • osteoblastoma
    • Osteoid osteoma vs. Osteoblastoma
      Osteoid Osteoma
      Osteoblastoma
      Incidence
      10% of benign tumors
      3% of benign tumors
      Size
      < 2 cm (typically <1.5cm)
      > 2 cm (average, 3.5 - 4.0 cm)
      Site
      > 50 % in long bone diaphysis
      > 35% in posterior elements of the spine
      Location
      Proximal femur > tibia diaphysis > spine
      Vetebral column > proximal humerus > hip
      Natural history
      Self-limited
      Progressive
      Histology
      Benign appearance. No growth potential. Central nidus composed of more organized osteoid and lined by osteoblasts.
      Benign appearance. Localized growth, with aggressive potential. Central lesion less organized, with greater vascularity.
      Symptoms
      Nocturnal pain, relieved by NSAIDS
      Dull ache which is less likely to be relieved by NSAIDS (partial response). >50% of spine tumors have neurologic symptoms.
      Management of Spine Lesions
      Nonsurgical management is indicated as first-line treatment.
      Surgery is always indicated as they do not respond to nonsurgical treatment.
  • Treatment
    • Nonoperative
      • observation
        • indications
          • rarely, if ever, indicated as the lesion will continue to grow
    • Operative
      • curettage or marginal excision with bone grafting
        • indications
          • standard of care
        • recurrence 10-20%

Please rate this review topic.

You have never rated this topic.

Thank you. You can rate this topic again in 12 months.

Flashcards (6)
Cards
1 of 6
Questions (3)
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Evidence (5)
EXPERT COMMENTS (4)
Private Note