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Presented by Edward McCarthy, M.D. and prepared by Orin Buetens, M.D.
Case 6: This 70-year-old woman was found to have a large (12cm) mass in her pancreas on physical exam.
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Question 1 of 1
1. Question
Week 14: Case 6
A 30 year-old man had pain in his back for six months. The pain was worse at night and relieved by aspirin.
Correct
Answer: Osteoid osteoma
Histology: A CT scan shows a well-defined zone of radiolucency filled with a well-defined zone of radiodensity (a nidus) at the junction of the vertebral body and the posterior elements.
Histologically, the lesion is composed of sheets of osteoid as well as a lace-like pattern of osteoid associated with bland cells, fibrous tissue, and multinucleated giant cells.Discussion: The size of the lesion (1.5 cm) is the main distinguishing feature that differentiates it from an osteoblastoma. Osteoblastoma and osteoid osteoma may have identical histologic patterns. However, osteoid osteoma is a self-limiting lesion that causes pronounced reactive changes. By contrast, osteoblastoma is a growing lesion and can destroy large portions of the vertebra when they occur in the spine. Osteosarcoma, by contrast, contains bizarre and pleomorphic cells which are absent in this lesion. It is therefore crucial to consult the radiographic features to distinguish osteoblastoma from osteoid osteoma.
Incorrect
Answer: Osteoid osteoma
Histology: A CT scan shows a well-defined zone of radiolucency filled with a well-defined zone of radiodensity (a nidus) at the junction of the vertebral body and the posterior elements.
Histologically, the lesion is composed of sheets of osteoid as well as a lace-like pattern of osteoid associated with bland cells, fibrous tissue, and multinucleated giant cells.Discussion: The size of the lesion (1.5 cm) is the main distinguishing feature that differentiates it from an osteoblastoma. Osteoblastoma and osteoid osteoma may have identical histologic patterns. However, osteoid osteoma is a self-limiting lesion that causes pronounced reactive changes. By contrast, osteoblastoma is a growing lesion and can destroy large portions of the vertebra when they occur in the spine. Osteosarcoma, by contrast, contains bizarre and pleomorphic cells which are absent in this lesion. It is therefore crucial to consult the radiographic features to distinguish osteoblastoma from osteoid osteoma.
