Osteoblastoma is a rare benignneoplasm of the bone, which constitutes for almost 1% of all primary bone tumors and 3% of all benign tumors in the United States. One-third of patients have lesions in the posterior elements of the spine, most often the lumbar and sacral regions. In 1952, Lichtenstein first termed the lesion as osteogenic fibroma of bone. In 1956, Lichtenstein and Jaffe in their independent detailed studies of this neoplasm renamed the lesion as osteoblastoma. Osteoblastoma might be conventional benign or aggressive and malignant. The exact etiology of osteoblastoma is unknown. The osteoblastomas are more aggressive compared to the other benign tumors of the musculoskeletal system. Histologically osteoblastoma is similar to osteoid osteoma and is differentiated on the basis of its large size. Osteoblastoma is a benign tumor of the musculoskeletal system and is associated with little morbidity. The risk factors are not yet established and there is insufficient evidence to recommend routine screening for osteoblastoma. If not treated, it may grow and damage the bone and adjacent structures. If the untreated osteoblastoma invades the spinal canal or neural foramina, it may lead to progressive neurologic deficits. Once the tumor expands outside the bone, the recurrence rate of osteoblastoma reaches to nearly 20%. Biopsy is the diagnostic study of choice for the diagnosis of osteoblastoma which shows similar features to that of osteoid osteoma. The majority of patients with osteoblastoma have a positive history of pain which is dull and achy in nature, and the pain is not relieved by salicylates. There are no diagnostic laboratory, ECG, echocardiography or ultrasound findings associated with osteoblastoma. X-ray is a useful diagnostic tool in the diagnosis of osteoblastoma and may reveal a well circumscribed radiolucent lesion in the bony cortex. CT scan may be helpful in the diagnosis and management of osteoblastoma and may provide the size and extent of osteoblastoma. MRI may be helpful in determining the extent of osteoblastoma that has invaded the surrounding soft tissues, bone marrow, and spine. The most sensitive radiographic examination for the evaluation of osteoblastoma is bone scan. The angiography is performed if the information about the adjacent major ve sel locations or its involvement is needed. Surgery is the mainstay of treatment for osteoblastoma and the treatment with chemotherapy and radiation therapy are still controversial.
Historical Perspective
In 1952, Lichtenstein was the first physician who termed the lesion as osteogenic fibroma of bone.[1]
In 1954, Dahlin and Johnson, were able to identify 11 tumors of bone origin that shared aggressive but nonetheless benign qualities. Therefore, this made these tumors notoriously difficult to diagnose as benign or malignant.[2]
In 1954, Dahlin and Johnson, were the first to notice that an osteoid osteoma and osteoblastoma had many histological characteristics in common and they named it giant osteoid osteoma.
In 1956, Lichtenstein and Jaffe in their independent detailed studies of the neoplasm termed the lesion as osteoblastoma.[3][4]
In 1977, Jackson published a review of 181 osteoblastomas from the literature and reported that spine is the location of 36% of the osteoblastomas.[5]
In 1984, Dorfman and Weiss reported on the aggressive osteoblastoma and termed it as a borderline osteoblastic tumor entity.[6]
Classification
Osteoblastoma may be classified into two subtypes:[7]
The Enneking surgical staging system (also known as the MSTS system) for benign musculoskeletaltumors based on radiographic characteristics of the tumor host margin.[22]
It is widely accepted and routinely used classification.
Stage
Description
I
Latent: Well demarcated borders
II
Active: Indistinct borders
III
Aggressive: Indistinct borders
History and Symptoms
The majority of patients with osteoblastoma have a positive history of pain which is dull and achy in nature.[11]
Left acetabular fossa pubic bone expansile predominantly lytic lesion with a rim of reactive sclerosis. Case courtesy of Dr Amr Farouk, [29]Associated aneurysmalbone cyst component
The usual sites of osteoblastoma and their plain radiographic features are described below:
Surgery is the mainstay of treatment for osteoblastoma.[36]
The total removal of the tumor is the treatment of goal in osteoblastoma.
Extensive intra-lesional excision with a use of a high-speed burr is the recommended treatment for enneking stage 1 and 2 lesions.
Wide resection for the removal of all tumor-bearing tissue is the recommended treatment for enneking stage 3 lesions, which is considered curative for osteoblastoma.
Recurrence
The recurrence risk is related to the adequacy of resection and is about at 10–24 %.[18]
Primary Prevention
There are no established measures for the primary prevention of osteoblastoma.
Secondary Prevention
There are no established measures for the secondary prevention of osteoblastoma.
References
↑Lichtenstein L. Osteogenic Fibroma of Bone. In: Bone Tumors. St Louis, Mo: Mosby; 1952:82-87.
↑DAHLIN DC, JOHNSON EW (June 1954). "Giant osteoid osteoma". J Bone Joint Surg Am. 36-A (3): 559–72. PMID13163088.
↑Jaffe HL. Osteoid-osteoma: a benign osteoblastic tumor composed of osteoid and atypical bone. Arch Surg. 1935;31:709–728.
↑LICHTENSTEIN L (1956). "Benign osteoblastoma; a category of osteoid-and bone-forming tumors other than classical osteoid osteoma, which may be mistaken for giant-cell tumor or osteogenic sarcoma". Cancer. 9 (5): 1044–52. PMID13364889.
↑Jackson RP, Reckling FW, Mants FA (October 1977). "Osteoid osteoma and osteoblastoma. Similar histologic lesions with different natural histories". Clin. Orthop. Relat. Res. (128): 303–13. PMID598169.
↑Dorfman HD, Weiss SW (August 1984). "Borderline osteoblastic tumors: problems in the differential diagnosis of aggressive osteoblastoma and low-grade osteosarcoma". Semin Diagn Pathol. 1 (3): 215–34. PMID6600112.
↑ 7.07.1Yin, Huabin; Zhou, Wang; Yu, Hongyu; Li, Binbin; Zhang, Dan; Wu, Zhipeng; Liu, Tielong; Xiao, Jianru (2013). "Clinical characteristics and treatment options for two types of osteoblastoma in the mobile spine: a retrospective study of 32 cases and outcomes". European Spine Journal. 23 (2): 411–416. doi:10.1007/s00586-013-3049-1. ISSN0940-6719.
↑Dorfman HD, Weiss SW (August 1984). "Borderline osteoblastic tumors: problems in the differential diagnosis of aggressive osteoblastoma and low-grade osteosarcoma". Semin Diagn Pathol. 1 (3): 215–34. PMID6600112.
↑Lucas, David R.; Krishnan Unni, K.; McLeod, Richard A.; O'Connor, Mary I.; Sim, Franklin H. (1994). "Osteoblastoma: Clinicopathologic study of 306 cases". Human Pathology. 25 (2): 117–134. doi:10.1016/0046-8177(94)90267-4. ISSN0046-8177.
↑Greenspan, Adam (1993). "Benign bone-forming lesions: osteoma, osteoid osteoma, and osteoblastoma". Skeletal Radiology. 22 (7). doi:10.1007/BF00209095. ISSN0364-2348.
↑ 11.011.1Lucas, David R.; Krishnan Unni, K.; McLeod, Richard A.; O'Connor, Mary I.; Sim, Franklin H. (1994). "Osteoblastoma: Clinicopathologic study of 306 cases". Human Pathology. 25 (2): 117–134. doi:10.1016/0046-8177(94)90267-4. ISSN0046-8177.
↑Arkader, Alexandre; Dormans, John P. (2008). "Osteoblastoma in the Skeletally Immature". Journal of Pediatric Orthopaedics. 28 (5): 555–560. doi:10.1097/BPO.0b013e31817bb849. ISSN0271-6798.
↑Marsh BW, Bonfiglio M, Brady LP, Enneking WF (January 1975). "Benign osteoblastoma: range of manifestations". J Bone Joint Surg Am. 57 (1): 1–9. PMID1123354.
↑Peabody, Terrance (2014). Orthopaedic oncology : primary and metastatic tumors of the skeletal system. Cham: Springer. ISBN9783319073224.
↑Boriani S, Capanna R, Donati D, Levine A, Picci P, Savini R (May 1992). "Osteoblastoma of the spine". Clin. Orthop. Relat. Res. (278): 37–45. PMID1563167.
↑Elhawi, Mohamed E.; De La Roza, Gustavo L.; Damron, Timothy A. (2013). "Natural History of Untreated Osteoblastoma". JBJS Case Connector. 3 (4): e110. doi:10.2106/JBJS.CC.M.00130. ISSN2160-3251.
↑Aboulafia AJ, Kennon RE, Jelinek JS (1999). "Begnign bone tumors of childhood". J Am Acad Orthop Surg. 7 (6): 377–88. PMID11505926.
↑ 18.018.118.2Peabody, Terrance (2014). Orthopaedic oncology : primary and metastatic tumors of the skeletal system. Cham: Springer. ISBN9783319073224.
↑Yin, Huabin; Zhou, Wang; Yu, Hongyu; Li, Binbin; Zhang, Dan; Wu, Zhipeng; Liu, Tielong; Xiao, Jianru (2013). "Clinical characteristics and treatment options for two types of osteoblastoma in the mobile spine: a retrospective study of 32 cases and outcomes". European Spine Journal. 23 (2): 411–416. doi:10.1007/s00586-013-3049-1. ISSN0940-6719.
↑Saccomanni, Bernardino (2009). "RETRACTED ARTICLE: Osteoid osteoma and osteoblastoma of the spine: a review of the literature". Current Reviews in Musculoskeletal Medicine. 2 (1): 65–67. doi:10.1007/s12178-009-9047-6. ISSN1935-973X.
↑Yin, Huabin; Zhou, Wang; Yu, Hongyu; Li, Binbin; Zhang, Dan; Wu, Zhipeng; Liu, Tielong; Xiao, Jianru (2013). "Clinical characteristics and treatment options for two types of osteoblastoma in the mobile spine: a retrospective study of 32 cases and outcomes". European Spine Journal. 23 (2): 411–416. doi:10.1007/s00586-013-3049-1. ISSN0940-6719.
↑Galgano MA, Goulart CR, Iwenofu H, Chin LS, Lavelle W, Mendel E (August 2016). "Osteoblastomas of the spine: a comprehensive review". Neurosurg Focus. 41 (2): E4. doi:10.3171/2016.5.FOCUS16122. PMID27476846.
↑Kirwan EO, Hutton PA, Pozo JL, Ransford AO (January 1984). "Osteoid osteoma and benign osteoblastoma of the spine. Clinical presentation and treatment". J Bone Joint Surg Br. 66 (1): 21–6. PMID6693472.
↑Marsh BW, Bonfiglio M, Brady LP, Enneking WF (January 1975). "Benign osteoblastoma: range of manifestations". J Bone Joint Surg Am. 57 (1): 1–9. PMID1123354.
↑de Andrea CE, Bridge JA, Schiller A (2013) Osteoblastoma. In: Fletcher CDM, Bridge JA, Hogendoorn PCW, Mertens F, editors. WHO classification of tumours of soft tissue and bone. Lyon: International Agency for Research on Cancer; pp. 279-280
Information sourced from the following:
Erin O'Connor, MD, Assistant Professor, Department of Radiology, Temple University | Gregory Scott Stacy, MD, Assistant Professor of Radiology, Department of Radiology, University of Chicago Hospitals | Fred Ortmann, MD, Staff Physician, Department of Orthopaedics, University of South Carolina School of Medicine | John Eady, MD, Chairman, Professor, Department of Orthopedic Surgery, University of South Carolina School of Medicine | Bullough, Peter, Orthopaedic Pathologv (third edition), Times Mirror International Publishers Limited: London, 1997. | Gitelis S., R. Wilkins and EU Conrad, Benign Bone Tumors. Instructional Course Lectures, 45:425-46, 1991. | Huvos, Andrew, Bone Tumors: Diagnosis. Treatment and Prognosis, W.B. Saunders Co., 1991. | Ruggieri, P., RA McLeod, KK Unni and FH Sim, Osteoblastoma, Orthopedics, 19(7):621-4, July 1996.