Plain radiograph, ct, mri, and ct angiography establish osteoblastoma. This appears as low signal intensity on t1weighted mri, with high signal. Osteoblastoma obl and osteoid osteoma oo are usually solitary tumours, only rarely being multicentric. In nonsacral spine, most tumors 44 cases arose from posterior elements, with partial involvement of vertebral body. Vertebrae are a common location for primary and metastatic neoplasm. Osteoblastoma most frequently involves the posterior vertebral elements 55% with extension into the vertebral body 42% and is rarely confined to the vertebral body 3%. The spine and sacrum are involved in 30% of cases and the long tubular bones in 34%. These cages combine rigid anterior front spinal column support, excellent fixation into the vertebral endplate, adequate room within the cage for bone graft, and generally unmatched ability for distraction surgically create space and sagittal lordosis, standing. Osteoblastoma of the vertebral body of the third lumbar.
This medical reference book will show you how to make confident, final diagnoses through accurate pattern recognition, clinical correlation, and differential diagnosis. Adequate imaging findings were available in 69 patients, and involvement of two levels was seen in 12 17%. Lymphoma may present in one or more vertebral bodies in middle aged or older adults. Primary and metastatic spinal tumors vertebral body. Primary neoplasms of the spine may present as benign lesions, such as the osteoid osteoma, osteoblastoma, or spinal osteochondroma, and are often found in patients between 10 and 40 yr of age. T2weighted sagittal mri of the left foot demonstrates a lesion in the talus with high signal intensity. A case with t1 osteoblastoma localized in the right vertebral body and pedicle. Mri findings are not specific enough to suggest the diagnosis of osteoblastoma but aid in determining the extent of the lesion. Aggressive osteoblastoma of the l5 vertebral body in a 34yearold woman with low back pain and neurologic symptoms. Imaging suggested a tumour of the dorsal portion of the fifth lumbar vertebral body. Ewing or ewings sarcoma is an aggressive tumor affecting adolescents and young adults. The posterior elements are involved in 55% of cases, but the tumor can extend to the vertebral body in 42% of cases. This paper describes four patients with spinal osteoblastoma that had unusual imaging features.
Minimally invasive percutaneous imagingguided techniques have been shown to be safe and effective for the treatment of benign tumors of the spine. Mri and ct revealed a hyperintense expansile and osteolytic mass destroying the s2 vertebral body, pedicles, and posterior arch with extension into the presacral space figures 2 and 3. Commonly, these are benign lesions that are found incidentally during radiology studies for other indications. They are bone and osteoidforming and is comprised of osteoblasts. Typically, the tumor forms a nidus and grows by creating a surrounding zone of. However, an aggressive type of osteoblastoma has been identified in very rare occasions that have led to metastasis, death, and mimicked osteosarcoma. The differential between osteoid osteoma, conventional osteoblastoma and aggressive osteoblastoma is based on size and the presence of epithelioid osteoblasts. However, an aggressive type of osteoblastoma has been. We highlight the rarity of the site of occurrence of osteoblastoma, the difficulty in diagnosis and the fact that a radical treatment needs to. It is mostly seen in the long bones of the extremities and posterior elements of the vertebrae. Benign primary spinal bony tumors dr sumit sinha ms, dnb, mnams, mch faculty, ao spine faculty, advanced trauma life support fellow, fujita health university, japan spine fellow, pontificial catholic university, curitiba, brazil associate professor deptt of neurosurgery, all india institute of medical sciences and associated jpna trauma center. Safak gungor mehmet fatih eksioglu ismail burak atalay. Ct scan is less sensitive than mri, but more specific especially for the visualization of.
Osteoblastoma originates in the neural arch and often extends into the vertebral body. It is a rare tumor that often develops in the bones of the spine, as well as the legs, hands, and feet. Osteoblastoma in a lumbar vertebral body springerlink. Osteoblastoma is a rare, benign osteoblastic bone tumor that most commonly develops in the spine, sacrum, long bones, and flat bones. We present the case of a 20yearold female with occipital osteoblastoma and discussion of imaging modalities of calvarial osteoblastoma. Lesions confined to vertebral body were less frequent 12 cases. The mass significantly narrows the central canal, and the spinal cord is compressed. Techniques available include a variety of tumor ablation technologies, including radiofrequency ablation, cryoablation, microwave ablation, alcohol ablation, and laser photocoagulation. Rimmed by single layer of benign activated osteoblasts. Can have epithelioid osteoblasts in osteoid osteoma and conventional osteoblastoma but they do not occur in cohesive sheets that fill intertrabecular spaces. Pain radiating to his left lower limb, mild atrophy of the left lower limb. Here, we report a case of osteoid osteoma at the body of t8 vertebra, with its imaging findings.
The common differential for the ivory vertebral body is metastasis or lymphoma. Another feature of on of the vertebral body is the intravertebral fluid analogous to. Imaging characterization of osteoblastoma may vary. Osteoblastoma is an uncommon, benign osteoblastic tumor accounting for osteoblastoma is a variant of osteoblastoma. Osteoblastoma is a rare benign bone tumor accounting for 14% of bone tumors, arising usually in the second and third decades and with preferential site in the axial skeleton with spinal lesion. In the spine, the predominent sites for ob are the posterior elements of the vertebrae with extension of the lesions to the vertebral bodies in 11% to 31% of cases 2, 3. Destructive osteoblastoma of the cervical spine with. Common malignancies that occur in the vertebrae include osteoblastoma, osteosarcomas, and osteoid osteomas. It has a narrow zone of transition, and a mixed scleroticlytic internal matrix. Vertebral hemangiomas are a common etiology estimated to be found in 1012% of humans at autopsy. Osteoblastoma is histologically similar to an osteoid osteoma but they are larger. Many lesions exhibit characteristic radiologic features. Osteoblastoma is an uncommon osteoid tissueforming primary neoplasm of the bone.
All typical imaging features of osteoblastoma are demonstrated in this rather uncommon location. A wide variety of lesions can be found in the osseous spine. Osteoblastoma, osteoblastoma of the vertebral body, computerized tomography, mrl introduction about 3% to 12% of spinal primary bone neoplasms are osteoblastomas ob 1. Expandable cages offer surgeons a vertebral body reconstruction solution.
Spinal tumors originate in dorsal elements, may secondarily involve vertebral body up to 25% of radiographs are suspicious for malignancy ajr am. Osteoblastoma is a rare benign bone tumor accounting for 14% of bone tumors, arising usually in the second. Patients with osteoblastoma usually present with pain of several months duration. Operation suggested a giantcell tumour and subsequent histology showed an osteoblastoma. Onethird in spine, where in vertebrae, osteoblastoma. We report a young man with low back pain suspected to have a disc protrusion. An imaging approach to bone tumors musculoskeletal key. These lesions can be solitary or multiple with a benign or malignant aetiology. Diagnostic imaging of solitary tumors of the spine.
It has clinical and histologic manifestations similar to those of osteoid osteoma. Pdf osteoblastoma is a locally aggressive osteoblastic lesion of bone with rare malignant transformation. Preoperative sagittal a and axial b ct scans demonstrate an expansile lesion with peripheral hardening of bony destruction of right vertebral body white arrow. In our own practice we sometimes used angiography, especially for osteoblastomas localized on the cervical. Benign primary spinal bony tumors linkedin slideshare. Cervical spine conditions, tumors everything you need to.
Metachronous osteoblastoma of the spine and osteoid. Radiological appearances of vertebral osteoblastoma. About 7 to 25% of osteoblastomas involve the spine 3 and it commonly tends to involve the posterior components including the pedicle in most cases, in contrast to other benign tumors, which often involve the vertebral body 4. Xray and mri indicated massive involvement of the anterior and posterior elements of the 6th vertebrae with a large soft tissue mass. Primary osseous tumors of the pediatric spinal column. Total en bloc spondylectomy in the treatment of aggressive. Ct and mri of fibrous dysplasia of the spine 2012 the british institute of radiology. Mri is the investigation of choice in the diagnosis and treatment evaluation of osteomyelitis following radiographs. A vertebral hemangioma vh is a vascular lesion within a vertebral body.
Here, we report a case of osteoid osteoma at the body of t8 vertebra, with its. Oo maybe in different localizations involving mainly long bones of the extremities and posterior elements of the vertebrae. Total spondylectomy together with anterior and posterior fusion was carried out in a twostage procedure. Expansile bone lesion centered on the left t5 pedicle and lamina. Vertebral body reconstruction using expandable cages. Ct scan will best define bony architecture, while mri is more useful to characterize softtissue extension or edema. Osteoblastoma is a rare benign tumor of the calvarium. We believe that our unique case represents the first report of a metachronous obl and an oo, and this presentation may confirm the close. They are benign in nature and frequently asymptomatic.
Because osteoblastomas can grow to a large size, treatment always involves surgery. Benign tumors of the osseous spine account approximately for 1% of all primary skeletal tumors. Clinicopathologic features, diagnosis, and treatment of. The spine ct l s vertebral body only 2 2 2 lamina only 4 pedicle only 8 body plus two or more posterior elements 262 posterior elements 2 8 26.
Diagnostic medical imaging tests such as mri and ct scans are used along with a biopsy to confirm a vertebral tumor diagnosis. The term vertebral tumor does not refer to tumors that develop within the spinal cord components. Imaging characteristics of occipital bone osteoblastoma. To our knowledge, this is the ninth reported case of occipital osteoblastoma. The mass significantly narrows the central canal, and the spinal cord is. Ct is the best imaging modality for the diagnosis of osteoblastoma of the spine. The ct scan revealed a 23 cm ovoid lesion in the posterior arch of the second lumbar vertebrae and an mri of the lumbar spine confirmed a reactive, hypointense softtissue swelling in t 1 with a mildly increased t 2 signal figure 1. Typically, in vertebral osteomyelitis, there is contiguous involvement of the vertebral body. These tumors are common in the pedicle and vertebral body and may cause paraparesis. Osteoblastoma of the spine national library of serbia. An osteoblastoma is an uncommon primary neoplasm of the bone that has clinical and histologic manifestations that are similar to those of an osteoid osteoma. Mri of osteoblastoma in posterior elements of c3 and c4 seen on. Metastatic bone disease usually presents as multiple vertebral body lesions and is the most common vertebral tumour.
Loose fibrovascular stroma between bone trabeculae. Ct and mri of fibrous dysplasia of the spine the british. The obl was diagnosed through a ct scan and an mri that demonstrated an osteolytic lesion of the second lumbar vertebrae. Axial t2weighted image b demonstrates increased signal in this lesion with some areas of. It is a lytic lesion of the vertebral body that will show on xray as a dense ring of collapsed cortical bone sandwiched between intact vertebral discs vertebral plana.
Osteoid osteomas and osteoblastomas are boneproducing lesions that often occur in long. Three tumours were associated with diffuse sclerosis of the vertebral body an ivory vertebra. Clinically, ostoeblastoma is differentiated from osteoid osteoma by the dull. Osteoblastomas almost never involve the vertebral body alone. In a clear clinical context, the diagnosis can be easily made. In both ct and mri images, the tumor showed intense enhancement with contrast administration. Axial ct scan image a shows an expansile lytic lesion involving the posterior elements and posterior aspect of a lumbar vertebral body. Herein, we report an unusual case in which a typical obl of the spine was followed by an oo of the femur after a diseasefree interval of 5 years. Benign tumors do not spread to various sites or organs. Lateral cervical spine xray demonstrating osteoblastoma in posterior elements of. In addition to age and location of the lesion, radiographs are an essential step in the initial detection and characterization but are limited to complex anatomy and superposition. Usually, this phenomenon shows low signal intensity with all magnetic. Imaging appearance of primary bony tumors and pseudo.
The main features include the airoccupied intravertebral cleft visualized as a radiolucent shade of linear or semilunar xray, namely an intravertebral vacuum cleft ivc sign. Two cases arose in the cervical spine and two in the thoracic spine. The case of a 22yearold woman presenting with progressive low back pain as a result of a recurrent osteoblastoma of the body of l3, is reported. Vertebral osteonecrosis on is a rare, underdiagnosed disease, also called pseudarthrosis due to ischemia following a compression fracture cf.
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