Introduction

Special features
Incidence
Sites of predilection
Symptoms
Other Clinical Features
 Gross Appearance
Microscopy
Radiological findings
Why relief with aspirin !!!!
Differential Diagnosis
Treatment
Conclusion
 Osteoid osteomas are bone tumors less than
2 cm in greatest dimension and usually occur
in patients in their teens and twenties.
In fact, 75% of patients are under age 25.
Osteoid osteomas can arise in any bone but
have a predilection for the appendicular
skeleton.
 50% of cases involve the femur or tibia,
where they commonly arise in the cortex.
 Osteoid osteomas are painful lesions.
The pain is caused by excess prostaglandin E2
which is produced by the proliferating
osteoblasts.
It characteristically occurs at night and is
dramatically relieved by aspirin.
 Failure to increase in size with time
Spontaneous regression
Replacement by scar tissue
These features are unlike those
of other benign tumors
suggesting that the etiology
still remains an enigma.
 10-11% of all benign bone tumors
2.5%-5% of all bone tumors
First three decades of life
Most common-second decade
Most common-in men (2:1)
 Diaphysis of femur and tibia
Medial side of neck of femur
Posterior elements of spine
Humerus
Phalanges of hand
Fibula
Talus
Ribs
Skull
 Pain which has characteristic pattern
described variously as sharp,dull,boring
deep,or intense often worst at night and very
frequently relieved by salicylates*(aspirin)
Limp
Muscular atrophy due to disuse
Swelling and warmth if it is superficial
 Adjacent joint stiffness
Scoliosis
In children overgrowth and angular
deformities
Nerve root compression or cord compression
Point tenderness over the lesion
 Cherry red to gray red tissue
Overlying cortex distorted
Reactive periosteal new bone formation
Nidus may vary
from few mm to
1.5 cm in diameter.
Surrounding reactive bone
usually thick hard and
extensive..
 Numerous osteoblasts forming highly irregular
trabeculae of osteoid and woven bone
Numerous osteoclasts
Woven bone trabeculae variably mineralized
Calcification more near centre of lesion.
 At times no calcification of nidus
Surrounding bone shows reactive bone
formation which is lamellar bone in contrast
to woven bone of nidus
Thin zone of fibrovascular tissue between
nidus and reactive bone .
 Small to round to oval focus of decreased density
called nidus .sometimes nidus also sclerotic.
Surrounding area of sclerosis which is normal
reactive bone .
 Lesions usually in
diaphysis
Mostly cortical
sometimes inside
medullary canal or
subperiosteally
Periosteal reaction
when occurs is large
but smooth in
contrast to codman
triangle of
malignant lesions
 Useful in detecting small lesions
Double density sign which is a focal area of
increased activity with a second smaller area
of increased uptake superimposed on it is
said to be diagnostic.
 Sometimes required to localise the lesion
accurately.
 Osteoid osteoma. A lateral
view (A) of the proximal tibia
shows a very dense lesion in
the posterior cortex. A darker
central area contains a white
nidus. This lesion in a 20-year-
old man caused pain in this
area, relieved by aspirin. B, A
nuclear medicine bone scan in
a different patient with an
osteoid osteoma in the left
lower tibia shows increased
activity (arrows) at the site of
the lesion.
 Osteoid osteomas,
especially those that
arise beneath the
periosteum, usually elicit
a tremendous amount of
reactive bone formation
that encircles the lesion.
The actual tumor, known
as the nidus, manifests
radiographically as a
small round lucency that
Specimen radiograph of intracortical osteoid
osteoma. The round radiolucency with
is variably mineralized
central mineralization represents the lesion
and is surrounded by abundant reactive bone
that has massively thickened the cortex.
 High levels of prostaglandins present in
osteoid osteoma which mediate pain
receptor pathway
Aspirin (salicylates) act as prostaglandin
synthetase inhibitors
 Osteoblastoma
Osteosarcoma
Eosinophilic Granuloma
Ewings Sarcoma
Brodies Abscess
Stress Fractures
 Surgical removal of lesion
To relieve pain.secondary manifestations like
synovitis ,scoliosis, nerve root compression
 Necessary to remove the
NIDAL tissue
 Block resection of the nidus
Increases risk of subsequent # if lesion is in
cortical bone
Alternative method is to shave the reactive
bone with sharp osteotome until the nidus is
exposed ,then curette the exposed nidus
 Intraoperative localization of nidus possible
with pre operatively injected technetium
labelled methylene diphosphonate and
sterile wrapped geigercounter.
Intraoperative xrays of excised specimen to
document complete removal of nidus
 K-wire inserted into the
nidus
Biopsy punch inserted
over k-wire
Percutaneous CT guided
resection using a
trephine 2mm larger
then the lesion to ensure
complete removal.
 Done percutaneously
Initial core needle biopsy after which radiofrequency
electrode is inserted through cannula of biopsy
needle
Temperature at the tip raised to 90 degrees
centigrade for 6 minutes
Results:claim to be equivalent to surgical excision
Used only in extraspinal lesions that are away from
neurovascular structures
 Osteoid osteomas are considered benign
and are normally treated by conservative
surgery. However there is a possibility of
malignant transformation. This is rare
except when treated with radiation, which
promotes this complication.