A rare cause of type 1 complex regional pain syndrome: Osteoblastoma of the talus.

We report a 14-year-old boy who presented with pain in the left foot and ankle for about 9 months. The clinical symptoms of the patient suggested complex regional pain syndrome (CRPS). The radiographs and magnetic resonance imaging studies ravealed a bone tumor in the talus, consistent with an osteoblastoma. The patient underwent operative treatment with curettage and grafting. The complaints of the patient completely resolved by 6 months after surgery, and there was no recurrence at the postoperative 23th month follow-up.

Osteoblastoma of the elbow: analysis of 13 patients and literature review.

PURPOSE: To analyze the clinical and radiographic characteristics, treatment, and outcome of patients with elbow osteoblastoma. PATIENTS AND METHODS: We present 13 patients (7 males and 6 females; mean age, 28 years) diagnosed and treated for an elbow osteoblastoma from 1975 to 2012. Mean follow-up was 29 months (range 12-60 months). Clinical presentation, imaging, surgical treatment, complications, range of elbow motion, and functional outcome were evaluated. The MSTS, DASH, and OXFORD scores were used. RESULTS: Main symptom was pain (all patients) accompanied by stiffness (8 patients) and swelling or tumefaction (7 patients), with a median duration of symptoms of 32 months (range 6-96 months). Distal humerus was affected in 10 patients, proximal ulna in 2 patients, and proximal radius in one patient. All patients underwent surgical therapy that consisted of curettage of the lesion (7 patients), curettage and bone allografting (3 patients), wide resection (2 patients; total distal humerus and resection of the radial head), and radiofrequency thermal ablation (1 patient). One patient experienced a recurrence after surgical treatment. The mean MSTS score after treatment was 87% (range 50-100%), which corresponds to excellent results. CONCLUSIONS: Intralesional surgery is successful in tumor control in most patients with osteoblastoma of the elbow. Thermal ablation may be successful for smaller lesions. Most of the patients had a good-to-excellent functional outcome even if they had tumor-related elbow stiffness at diagnosis. LEVEL OF EVIDENCE: Therapeutic study, Level IV-1.

[Osteoblastoma in the os hamatum: a rare case report]. / Hamatum kemiginde osteoblastom: Nadir bir olgu sunumu.

Osteoblastoma in the os hamatum is rarely seen. Although curettage and grafting seems to be disadvantageous, it offers advantages in the functional protection in the treatment of carpal bone-located osteoblastoma. In a 39-year-old housewife who was admitted with painful left wrist through all day for the past one year, physical examination revealed painful hypothenar region with the wrist adduction to the ulna. Radiography showed radial inclination of the wrist, ring appearance in the scaphoid bone, and slight radiolucency in the hamatum and adjacent bones. Computed tomography demonstrated an expanded lesion which separated the surrounding tissue with a thin edge layer and perforated the cortex mildly. Intralesional curettage was performed. The pathological examination of the specimen obtained was consistent with osteoid osteoma or osteoblastoma. Curettage and grafting were performed in case of recurrence. In this article, we present a rare case of carpal bone and hamatum-located osteoblastoma. The patient was free of pain with normal wrist functions at 16 months postoperatively.

Tumors of the coracoid process: clinical evaluation of twenty-one patients.

OBJECTIVE: We present the incidence and management of bone tumors of the coracoid process and discuss the related clinical and imaging findings and treatment. MATERIALS AND METHODS: We present 21 patients (7 males and 14 females; mean age, 39 years) treated for bone tumors of the coracoid process from 1900 to 2010. Mean follow-up was 44 months (range, 12-132 months). Clinical presentation, imaging, surgical treatment, complications, range of shoulder motion, and Musculoskeletal Tumor Society (MSTS) function were evaluated. RESULTS: Bone tumors were benign in 7 (33%) and malignant in 14 (67%). The most common were chondrosarcomas, osteoblastomas, and chondroblastomas. The most common presentation was pain and palpable mass for a mean duration of 11 months. Limb salvage, with or without megaprosthetic reconstruction, was achieved in 20 patients. One patient required forequarter amputation. One patient with chondroblastoma and 2 with chondrosarcoma had local recurrence. The range of shoulder motion varied according to the type of resection: patients with curettage and limited resections without involvement of the abductor mechanism had better shoulder motion, and patients with scapulectomy and proximal humeral resections had significant limitations of motion. The mean MSTS score was 80% (range, 50%-100%). CONCLUSIONS: Chondrosarcomas, osteoblastomas, and chondroblastomas are the most common bone tumors of the coracoid process. Limited resections are associated with nearly normal range of motion and excellent function; however, limited resections are acceptable in only in a small number of patients. In patients with malignant and recurrent lesions, wide resection is required, which is associated with significant limitations of shoulder function.

Bisphosphonates for treatment and prevention of bone metastases.

Bone metastases are a major cause of morbidity for men with prostate cancer. Complications of bone metastases include pain, fractures, and spinal cord compression. Although they appear osteoblastic by radiographic imaging, most bone metastases are characterized by excess osteoclast number and activity. In addition, pathologic osteoclast activation is associated with increased risk of skeletal complications. Zoledronic acid, a potent inhibitor of osteoclast activity, differentiation, and survival, decreases the risk of skeletal complications in men with androgen-independent prostate cancer and bone metastases. Other bisphosphonates, including pamidronate and clodronate, seem to be ineffective in this setting. The reduction in risk of skeletal complications with zoledronic acid must be weighed against potential adverse effects. Additional studies are needed to determine the optimal timing, schedule, and duration of treatment in men with bone metastases as well as the potential role of bisphosphonates in other settings including the prevention of bone metastases.

Intra-articular benign osteoblastoma of the acetabulum: a case report.

The acetabulum is an unusual location for benign osteoblastoma, usually seen in adolescents and young adults. This article reports a case of an intra-articularly expanding benign osteoblastoma of the acetabulum in a 6-year-old boy. The diagnostic and surgical features of the disease in this unusual location at this young age are discussed. Excisional biopsy and curettage of the lesion followed by bone grafting resulted in healing of the acetabular lesion without acetabular dysplasia, but with a resultant coxa magna.

Osteoblastoma de los maxilares / Osteoblastoma of the maxilla

El osteoblastoma es una neoplasia benigna, rara, de origen osteoblástico. Se caracteriza por ser una lesión de crecimiento lento y asintomático que en ocasiones puede sufrir transformación sarcomatosa. Se localiza en huesos craneomandibulares en el 14.6 por ciento de los casos. El objetivo de este trabajo fue determinar la frecuencia de osteoblastoma en maxilar y mandíbula, su distribución de acuerdo a la edad y sexo de los pacientes, así como su sintomatología. Se realizó una revisión de la literatura y se encontraron 44 casos registrados. De ellos, 32 se localizaron en la mandíbula (73 por ciento) y 12 en maxilares (27 por ciento). Predominaron en los varones con una relación hombre mujer de 1.5:1. Las edades variaron entre los cinco y 38 años, teniendo mayor incidencia entre los 10 y 19 años de edad. En general, las lesiones medían desde 0.7 hasta 7.5 cm. El 90.3 por ciento de los casos presentaron dolor y todos mostraron aumento de volumen. Debido a su comportamiento biológico, es necesario hacer una minuciosa observación microscópica que, aunada a los datos clínicos y radiográficos, permita establecer el diagnóstico de osteoblastoma

Pamidronate administration improves the secondary hyperparathyroidism due to "Bone Hunger Syndrome" in a patient with osteoblastic metastases from prostate cancer.

BACKGROUND: The so-called Bone Hunger Syndrome is a metabolic derangement that sometimes complicates the natural history of prostate cancer patients with osteoblastic bone metastases. An excessive bone formation leads to calcium entrapment in bone and the subsequent increase of parathyroid hormone (PTH) levels, in response to calcium demand. PTH elevation stimulates the osteoclasts in sites distant from those involving the tumor, leading to osteomalacia. METHODS: PTH and markers of bone turnover were monitored every 3 weeks, from the start of pamidronate treatment in a prostate cancer patient with progressive disease, to luteinizing hormone releasing hormone analog (LHRH-A) administration, developing hyperparathyroidism, hypophosphatemia, and albumin corrected serum calcium close to the lower limit of normality. Serum bone alkaline phosphatase (BALP), assessed by two different methods: electrophoretic and immunoradiometric, and urinary levels of markers of bone collagen breakdown were also remarkably elevated. RESULTS: As a consequence of pamidronate infusion (60 mg e.v. every 3 weeks for a total of four times), BALP and PTH decreased consistently, serum calcium and phosphorus returned within the normal range, while markers of collagen resorption showed a significant decrease at the 9th week, preceded by a transient rise. CONCLUSIONS: This case report indicates that bisphosphonates could inhibit both osteoclast activity. The anti-osteoblastic effect is mainly responsible for the improvement of the pretreatment calcium imbalance of our patient towards hypocalcemia and the consequent hyperparathyroidism.