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Radiation and chemotherapy is required for definitive treatment
1%
52/5519
An increase in cyclooxygenase activity has been demonstrated within these lesions
89%
4925/5519
Spontaneous resolution does not occur
5%
263/5519
A definitive diagnosis cannot be made without MRI
2%
132/5519
Pain is most severe during the day, and typically improves at night
116/5519
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The clinical history and figures are consistent with a diagnosis of osteoid osteoma. An increase in cyclooxygenase activity has been demonstrated within osteoid osteomas. Osteoid osteomas are commonly seen between the ages of 10 and 35, with the average age at presentation of 19. They are characterized by pain, often worse at night, which often responds to aspirin and other nonsteroidal anti-inflammatory drugs. Studies have shown an increased production of prostaglandins in these tumors, which likely explains the effect of these medications. Linder et al. treated 58 patients with osteoid osteoma by CT-guided radiofrequency ablation (RF). The primary rate of success for all patients was 95% and the secondary rate was 100%. They concluded that CT-guided RF ablation is a safe, simple and effective method of treatment for osteoid osteoma. Mungo et al. evaluated the expression of cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) in osteoid osteoma tissues from patients following surgery. They found high levels of both COX-1 and COX-2 in the tested specimens and concluded that the increased production of prostaglandins by osteoid osteomas implicates that COX-2 is one of the mediators of this condition. Figure A shows the typical radiographic finding of an osteoid osteoma in the phalanx. Figure B shows a CT scan of this lesion. Notice the nidus, which is classic for these lesions. Incorrect Answers: Answer 1: Radiation and/or chemotherapy are not used to treat osteoid osteoma. Typically they are treated either with observation, resection (usually in foot and ankle, hand, and spine) or CT-guided radiofrequency ablation. Answer 3: Spontaneous resolution may occur with time, especially in the hand, however it can take 2 to 4 years in some cases. Answer 4: Diagnosis of osteoid osteoma can reliably be made based on clinical history, response to NSAID therapy, and radiograph/CT imaging findings. Answer 5: Pain with osteoid osteoma is classically worse at night.
4.1
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