Osteoid osteoma is a benign bone tumor that does not have the ability to become malignant. It often causes severe pain at night, which can be relieved by nonsteroidal anti-inflammatory drugs. Sometimes, it may resolve spontaneously without treatment. Surgery is recommended when conservative treatment methods are no longer effective.
Overview of Osteoid Osteoma
Osteoid osteoma is a benign bone tumor that commonly occurs in the long bones of affected individuals. These tumors are typically small, measuring about 1.5-2cm, and are characterized by small nests surrounded by hard, fibrous tissue in otherwise normal bone. This bone tumor is more prevalent in young male patients and often affects the long bones of the thigh and shin.
Osteoid osteoma is a relatively common bone tumor, accounting for about 1/8 to 1/10 of all symptomatic benign bone tumors and 5% of all primary bone tumors.
The cause of osteosarcoma is not fully understood, but genetics are considered an important factor. In addition, some authors suggest that the disease is caused by viral infection, inflammation, or immune-related factors. One proposal is that the formation of the tumor may be due to neoplastic growth or the result of previous trauma.
Osteosarcoma is commonly seen in children and adolescents, and is very rare in people over 50 years of age and more common in males than females.
Overview of Osteoid Osteoma.
How is osteosarcoma diagnosed?
Clinical symptoms of osteosarcoma
The symptoms of osteosarcoma can last from several weeks to several years before diagnosis and final surgical treatment.
Pain is the main symptom, both initially and in recurrence. The pain is continuous, deep, and severe in varying degrees. Osteosarcoma patients often experience localized pain at the site of the lesion. The pain is usually worse at night in 95% of patients and gradually decreases in the morning. The pain can wake the patient up in 29% of cases. In some patients, particularly those with internal injuries, inflammation of the synovial membrane, or effusion, movement may be restricted, and the patient may have to make an effort to move. Pain can also affect the patient’s gait.
Swelling is the next common symptom in osteosarcoma and is thought to be due to increased blood supply to the tumor. If the tumor is in or near a joint, synovial inflammation, effusion, and joint changes may occur. Osteoarthropathy affecting the femur and tibia bones can cause limb-length discrepancy.
If the osteosarcoma patient has lesions in the spine, they usually have back or neck pain, spinal deformities, or radicular pain, which may spread to the limbs and shoulders. These patients’ symptoms may be similar to those of people with herniated discs or other injuries that cause similar symptoms.
Osteosarcoma in the hand presents with symptoms similar to arthritis, abnormal hand shape, and swan-neck deformity.
Imaging diagnosis of osteosarcoma
X-rays of osteosarcoma show a hard fibrous mass surrounding a radiolucent core, and diagnosis is based on 4 distinct characteristics as follows:
Lesions are clearly visible in a circular or oval shape. Osteosarcomas have a diameter of less than 2cm. The central region of the osteosarcoma appears dense and homogeneous. A translucent area with a diameter of about 1-2 mm can be seen. Computed tomography (CT) scans are taken to determine the location of the tumor. The results of the CT scan…
MRI is not useful in diagnosing osteoid osteomas. It is reserved for cases that are unclear as it may suggest the diagnosis of bone joint tumors. It is highly sensitive in detecting bone marrow, periosteal edema, and soft tissue abnormalities.
Radionuclide imaging is performed when the X-ray result is normal or inconclusive, especially in children with back pain. This method can identify small nidus lesions up to 2 mm.
Arteriography is applied to patients with osteosclerosis where other methods cannot identify small nidus lesions.
Regarding the histopathology of osteoid osteomas, they are typically cherry-red in color and may be peeled off from the bone, with a gritty texture. Nidus lesions are usually a separate cavity, carefully surrounded by varying thicknesses of sclerotic bone. Nidus lesions vary in consistency from vascular, soft, friable, gritty, and small to dense sclerotic.
How is osteoid osteoma treated?
The initial treatment for osteoid osteoma is non-surgical. Surgical intervention is usually indicated for patients who do not respond to internal treatment and those who do not comply with activity restriction requirements.
How is osteoid osteoma treated?
Internal treatment for patients with osteoid osteoma
The initial treatment for osteoid osteoma includes medication such as aspirin or other NSAIDs. Aspirin is used for patients with osteoid osteoma at a daily dose ranging from 650 to 3250mg. In addition, patients can use other NSAIDs such as naproxen, Ibuprofen.
Patients who fail with internal treatment or cannot continue the treatment regimen due to chronic pain, with diminishing pain-relieving effects over time, particularly in young, active patients who can’t tolerate constant pain.
Surgical methods for treating osteoid osteoma
There are currently many surgical methods for treating osteoid osteoma. Among them, open surgery to completely remove the tumor mass reduces pain for the patient immediately and reduces the risk of recurrence.
The next surgical method for patients with bone tumors is minimally invasive surgery with the following techniques:
CT-guided core biopsy: The patient is locally anesthetized and the exact location of the bone tumor is determined by CT. Then, with CT guidance, a Kirschner wire (K wire) is inserted and drilled through the bone cortex into the nidus. Afterwards, a small incision is made and a biopsy needle is passed through the wire to completely remove the tumor. Postoperative CT is performed to confirm complete nidus excision. CT-guided percutaneous biopsy has a success rate of 83-100%. Complications that may occur are postoperative bone fractures, limited mobility, weight loss within 3 months after surgery, and skin burns.
Surgical removal of bone tumors using radioisotopes: To remove the tumor, the patient is diagnosed by bone scintigraphy using hydroxymethylene diphosphonate (HMDP) and dichloromethylene diphosphonate (DMDP). Three hours before surgery, the patient is given radioactive seeds and 1 hour after injection, a hot spot scan is performed. A probe detecting radiation is then used to determine the hot spot location based on the signal generated. This method can be used to determine the location of the nidus with an accuracy of 2 mm, allowing for minimal injury. However, narrow probes may result in false negative results.
Computer-assisted bone tumor surgery: This is a set of techniques in which 3D imaging and tracking devices are combined to improve surgical performance. This surgery is based on the initial diagnostic CT scan processed into 3D images. The advantage of this technique is that it can accurately identify bone lesions, especially small ones located deep within the bone where there may be no surface changes.
After surgery, patients need to be continuously monitored for at least 1 year to prevent recurrence. Every 3 months, 6 months, and 9 months, the patient is examined with X-rays or CT scans.
Johnny Jacks was born in 1985 in Texas, USA. He is the founder of Good Health Plan and is passionate about helping people improve their health and physical well-being. With over a decade of experience working in the healthcare industry, he currently works at Goodheathplan.com – a blog that shares knowledge on beauty and health.