Osteoblastoma

 

Osteoblastoma APOsteoblastoma 2

 

Epidemiology

 

Rare benign bone tumour

 

Usually present childhood / adolescence

 

Males 4 x more common

 

Location

 

Spine posterior elements 30%

 

Long bones 35%

 

Clinical

 

Back or limb pain

- pain less severe than osteoid osteoma

- minimal night pain

- not dramatically relieved by aspirin / NSAIDS

 

Limp

 

Scoliosis

 

Natural history

 

Can be locally aggressive

 

Mesfin et al World Neurosurg 2020

- 2 cases of recurrence of osteoblastoma after treatment

- transformation to osteosarcoma

 

X-ray

 

Long bone

- more common meta-diaphyseal

- large faintly radiolucent lesion

- thin reactive rim

- may be expansile

 

Osteoblastoma APOsteoblastoma 2

 

Spine

- difficult to see

- irregular cortex

- sclerotic or loss of pedicle

- enlargement of spinous process

 

CT 

 

Lucent lesion with nidus or calcification

 

Osteoblastoma CT 3Osteoblastoma CT 1Osteoblastoma CT 2

 

Spinal lesion

- bone expansion

- intralesional stippled ossification

 

Osteoblastoma CT 1Osteoblastoma CT 2

 

MRI

 

OB MRI 2OB MRI 3OB MRI 1

 

Pathology

 

Differential diagnosis osteoid osteoma

 

Gross

- > 1.5 cm nidus

- less sclerotic border

 

Histology

 

Management

 

Options

 

Radiofrequency ablation

 

Surgery

- intralesional excision

- wide excision

+/- radiotherapy

 

Radiofrequency ablation

 

Izzo et al J Clin Med 2021

- clinical success rate 90 - 95%

 

Surgery

 

OB curette 2OB curette 1

 

OB bone graftOB bone graft 1

 

Spine

 

Radiofrequency ablation

 

Arrigoni et al Int J Hyperthermia 2018

- 11 patients with spinal OB treated with RF ablation

- complete pain relief in all patients

- no additional treatment required

 

Surgical treatment

 

Boriani et al Eur Spine J 2012

- 51 patients with osteoblastoma spine

- 10 Enneking stage 2 treated with intralesional excision - no recurrences

- 27 Enneking stage 3 treated with intralesional excision - 18% recurrence (none with radiation)

- 13 Enneking stage 3 treated with en bloc resection - 15% recurrence

 

Recurrence

 

Versteeg et al J Neurosurg Spine 2017

- 73 patients treated for osteoblastoma spine

- 18% recurrence

- recurrence associated with mortality