Case 17

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Case 17

• David R. Lucas, M.D.

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Case History

• 13-year-old young man history of painful
  scoliosis
• CT scan 2.2 cm expansile, osteolytic lesion
  posterior elements of T7

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Osteoblastoma

• 1 of primary bone tumors
• Adolesents young adults
• Mean age 20 years (range 6-75)
• Men gt women, 21
• Virtually any bone can be affected
• Spine/sacrum most common (32)
• Long bones
• Jaws

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Symptoms

• Progressive pain
• Neurological findings
• Painful scoliosis

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Radiology Highly Variable
Ossified nidus with halo (giant osteoid
osteoma)
Well-demarcated with sclerotic rind
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Radiolucent, expansile, intracortical
Ossifying, bone surface
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Small bones of hands and feet
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Spinal Osteoblastoma

• Dorsal elements only (55)
• Lamina
• Pedicle
• Spinous process
• Dorsal elements plus body (42)
• Body only (3)

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Can Mimic a Malignant Bone Tumor (up to 25)
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Osteoblastoma of the rib mimicking osteosarcoma
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Bony Maturation in Osteoblastoma

• Cords of activated osteoblasts with minimal
  osteoid
• Lace-like or wispy osteoid
• Broad anatamosing trabeculae of woven bone
• Sheets of sclerotic woven bone

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Osteoblastoma of Jaws

• More common in mandible
• Often associated with root of a tooth
• Also called cementoblastoma

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Multifocal Osteoblastoma

• Multiple nidi separated by variable amounts
  reactive bone or spindle cell stroma within a
  single area of tumefaction.
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• Often associated with epithelioid osteoblasts

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Osteoblastoma with Cartilage
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Pseudomalignant Osteoblastoma
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Aggressive Osteoblastoma

• Dorfmann and Weiss 1984
• Very rare
• Borderline between OB and OS
• Locally aggressive, but does not metastasize
• Epithelioid osteoblasts
• gt 2 x size of conventional osteoblast
• Rimming
• Sheets of cells
• Semin Diagn Pathol.
  19841215-34.

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32 M with tibial tumor
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Epithelioid Osteoblasts
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Differential Diagnosis

• Osteoid osteoma
• Aneurysmal bone cyst
• Giant cell tumor
• Osteoma with osteoblastoma-like features
• Osteoblastoma-like osteosarcoma

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Osteoid Osteoma

• OB and OO virtually indistinguishable
  microscopically
• Any tumor lt1.5 cm arbitrarily called OO
• OO less likely to progress

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Aneurysmal Bone Cyst
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Giant Cell Tumor
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Sino-orbital Osteoma
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Osteoma with Osteoblastoma-like Features
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Osteoblastoma-like Osteosarcoma

• OS can have areas indistinguishable from OB
• The cells tend to fill in the inter-trabecular
  spaces

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Osteoblastoma-like Osteosarcoma

• Permeative growth not seen in OB

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Thank-youQuestions?