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Presented by Edward McCarthy, M.D. and prepared by Maryam Farinola M.D.
Case 1: A ten year old boy had pain in his leg for six months. The pain was worse at night.
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Question 1 of 1
1. Question
Week 214: Case 1
A ten year old boy had pain in his leg for six months. The pain was worse at night.A radiograph demonstrated a dense periosteal reaction covering the mid portion of his femur. At the center was a slightly radiolucent area.
images/osteoid osteoma 3.jpg
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images/osteoid osteoma 4.jpgCorrect
Answer: Osteoid osteoma
Histology: There is a proliferation of benign osteoblasts laying down new bone. There is a loose fibrovascular stromal which contains osteoclast-like giant cells and bland stromal cells.
Discussion: An osteoid osteoma is a less than 1 cm proliferation of benign osteoblasts laying down new bone. There is a loose fibrovascular stromal which contains osteoclast-like giant cells and bland stromal cells. Sometimes, the osteoid formation can be extensive.
While the radiographic features in this case are suggestive of chronic osteomyelitis, the granulation tissue and inflammatory exudate are not present in the lucent area.
Osteoblastoma may have an identical histologic pattern to osteoid osteoma. However, the distinction between osteoblastoma and osteoid osteoma is based on size. Osteoblastomas are, by definition, greater than 2 cm. In addition, osteoblastomas generally don’t provoke the extensive periosteal bone that osteoid osteoma does. Therefore, based on size, this lesion is best regarded as an osteoid osteoma.
The lesion is not an osteosarcoma because the typical sarcomatous, pleomorphic stroma is not present.
Incorrect
Answer: Osteoid osteoma
Histology: There is a proliferation of benign osteoblasts laying down new bone. There is a loose fibrovascular stromal which contains osteoclast-like giant cells and bland stromal cells.
Discussion: An osteoid osteoma is a less than 1 cm proliferation of benign osteoblasts laying down new bone. There is a loose fibrovascular stromal which contains osteoclast-like giant cells and bland stromal cells. Sometimes, the osteoid formation can be extensive.
While the radiographic features in this case are suggestive of chronic osteomyelitis, the granulation tissue and inflammatory exudate are not present in the lucent area.
Osteoblastoma may have an identical histologic pattern to osteoid osteoma. However, the distinction between osteoblastoma and osteoid osteoma is based on size. Osteoblastomas are, by definition, greater than 2 cm. In addition, osteoblastomas generally don’t provoke the extensive periosteal bone that osteoid osteoma does. Therefore, based on size, this lesion is best regarded as an osteoid osteoma.
The lesion is not an osteosarcoma because the typical sarcomatous, pleomorphic stroma is not present.
