Dx: Osteoid Osteoma

KEY FACTS

Terminology Definition: Small, round benign tumor of bone 10-12% of all primary bone tumors Imaging Most common in long bones: Rare in jaws Mandible > maxilla; posterior > anterior Central radiolucent nidus surrounded by reactive sclerotic bone Radiolucent center < 2 cm Associated reactive sclerotic bone may be extensive May cause expansion of cortices T2WI: May show edema in adjacent soft tissues Top Differential Diagnoses Osteoblastoma
Cemento-ossifying fibroma Cementoblastoma

Pathology Round nidus contains osteoid trabeculae within vascularized fibrous connective tissue Clinical Issues Severe pain worsening at night: Prostaglandins concentrated in nidus of lesion thought to play significant role Relieved by NSAIDs Pain reported less frequently in gnathic lesions than lesions in long bones Adjacent soft tissue may be tender 2nd and 3rd decades Male:female = 2:1 Treatment: Excision Spontaneous regression reported; excision preferred because of immediate relief of pain
TERMINOLOGY

Definitions Small, round benign tumor of bone 10-12% of all primary bone tumors
IMAGING

General Features Best diagnostic clue: Central radiolucent nidus surrounded by reactive sclerotic bone Location Most common in long bones: Femur and tibia Rare in jaws Mandible > maxilla; posterior > anterior Has been reported in condyle Size Radiolucent center < 2 cm Associated reactive sclerotic bone may be extensive May cause expansion of cortices

Morphology: Rounded lesion with well-defined borders Radiographic Findings Intraoral and extraoral plain film Mixed density lesion with central nidus of radiolucency and surrounding sclerotic bone If located near root apices, may appear similar to cementoblastoma initially CT Findings CBCT and bone CT Will demonstrate expansion if present MR Findings T2WI In general, MR findings controversial May show edema in adjacent soft tissues
DIFFERENTIAL DIAGNOSIS

Osteoblastoma Thought by some authors to be same lesion as osteoid osteoma Others believe clinical and pathologic behavior differentiates Less painful than osteoid osteoma & not relieved by nonsteroidal anti-inflammatory agents (NSAIDs) Considered to be more aggressive with greater growth potential
Cemento-ossifying Fibroma

Expands around epicenter, which is usually radiopaque Often has thin radiolucent band at periphery representing fibrous capsule
Painless Cementoblastoma

Benign tumor of cementum around apex of tooth Root apex is lost in lesion Center of lesion more sclerotic compared to osteoid osteoma
Periapical Cemental Dysplasia Usually multifocal; osteoid osteoma solitary

Older age group: Middle-aged African-American females

Periapical Sclerosing Osteitis Reactive bone at apex of nonvital tooth

Apical periodontal ligament space is widened

PATHOLOGY

Staging, Grading, & Classification Some authors do not consider osteoid osteoma to be a true neoplasm but possibly of inflammatory origin or as result of unusual healing process Gross Pathologic & Surgical Features Mixed soft and bony tissues Literature reports presence of distinguishable capsule at surgery Microscopic Features Round nidus contains osteoid trabeculae within vascularized fibrous connective tissue

Multinucleated giant cells rarely seen

CLINICAL ISSUES

Presentation Most common signs/symptoms Severe pain worsening at night: Prostaglandins concentrated in nidus of lesion thought to play significant role Relieved by NSAIDs Pain reported less frequently in gnathic lesions than lesions in long bones Other signs/symptoms: Adjacent soft tissue may be tender Demographics Age: 2nd and 3rd decades Gender: Male:female = 2:1 Treatment Excision: Spontaneous regression has been reported; however, excision preferred because of immediate relief of pain
DIAGNOSTIC CHECKLIST

Consider Some authors consider osteoid osteoma to be early stage in formation of osteoblastoma