Soft-tissue osteoma of the thenar eminence.

The development of osteoma in soft tissues without a direct contact with the adjacent osseous and articular structures is a very rare event. The involvement of the hand is even rarer, with only two previous cases reported so far. A 25-year-old man presented with a painless solid mass in the thenar region of his right palm, which appeared almost 2 years ago and showed a progressive enlargement in the last months. Under regional anesthesia an excisional biopsy was performed and the histopathological evaluation of the lesion confirmed the diagnosis of soft tissue osteoma. The postoperative follow-up period was uneventful without any complication or recurrence. Following a brief period of hand physiotherapy the patient has returned to normal daily activities.

[The analysis of 42 observations of paranasal sinus osteoma]. / Analiz 42 nablyudenii osteomy okolonosovykh pazukh.

The data on the incidence, localization, and histological structure of paranasal sinus osteoma (PSO) are reported along with the authors' experience in the diagnostics and surgical treatment of 42 patients presenting with this condition. The classification of the remote tumours based on their histopathological characteristics is considered. It is shown that 34 (80.9%) patients have osteomas of the compact type, 4 (9.5%) present with the tumours of the spongy type, and another 4 (9.5%) with the mixed type osteomas. It is maintained that the application of boron should be considered to facilitate the surgical removal of paranasal sinus osteomas.

Bilateral choroidal osteoma: visual acuity at 45-year follow-up.

PURPOSE: To report a case of bilateral choroidal osteoma, which demonstrated different visual outcomes in both eyes over a long follow-up of 45 years. METHODS: Case report. RESULTS: After 45 years of follow-up, choroidal osteoma showed slight enlargement in each eye and choroidal neovascularization and retinal pigment epithelium (RPE) changes had developed in the right eye. Visual acuity of the right eye was decreased to 20/200 from macular RPE loss and choroidal neovascularization scarring. The left eye preserved a visual acuity of 20/30 where choroidal osteoma demonstrated only partial decalcification of the nasal margin with preservation of RPE in the macular region. Spectral domain optical coherence tomography of the right macula confirmed broad RPE and choroidal atrophy and scarring related to previous choroidal neovascularization. Spectral domain optical coherence tomography of the left macula showed preserved retinal layers and RPE with underlying calcified choroidal osteoma. CONCLUSION: Choroidal osteoma can occasionally demonstrate intact calcification, preserved RPE, and photoreceptors with excellent vision.

Review of choroidal osteomas.

Choroidal osteomas are rare benign ossifying tumors that appear as irregular slightly elevated, yellow-white, juxtapapillary, choroidal mass with well-defined geographic borders, depigmentation of the overlying pigment epithelium; and with multiple small vascular networks on the tumor surface. Visual loss results from three mechanisms: Atrophy of the retinal pigment epithelium overlying a decalcified osteoma; serous retinal detachment over the osteoma from decompensated retinal pigment epithelium, and most commonly from choroidal neovascularization. Recent evidence points to the beneficial effects of intravitreal vascular endothelial growth factor antagonists in improving visual acuity in serous retinal detachment with or without choroidal neovascularization.

Osteoma of the skull base and sinuses.

Osteomata of the frontal and ethmoid sinuses have traditionally been surgically removed via external approaches. However, endoscopic techniques have increasingly been used for the surgical management of selected cases. Advances in visualization and instrumentation, as well as the excellent access provided by the Draf type 3 procedure, expanded the reach of endoscopes. We describe current limits of endoscopic approaches in the removal of osteomata from the frontal sinus and our algorithms for their management. We believe that the vast majority of frontal sinus osteomata can be managed endoscopically, and that only significant anterior or extreme infero-lateral extension constitute major limiting factors.

Osteoma de coroides / Choroidal osteoma

A raíz de un caso de osteoma de coroides que se diagnóstico en el Instituto Barraquer de Barcelona se hizo una revisión bibliográfica del tema y se revisaron las fichas con el diagnóstico de osteoma de coroides entre los años 1982 y 2004, encontrándose 29 casos diagnosticados como tal. La revisión de las fichas descartó a 13 pacientes que no cumplían con los parámetros para osteomas, ya sea por mala interpretación de la ecografía o de otros exámenes. Los 16 restantes, 9 habían concurrido a una segunda opinión ya con el diagnóstico de osteoma. Los exámenes hechos en nuestro centro corroboraron el diagnóstico. Cinco pacientes nos consultaron por primera vez por disminución de la agudeza visual y en nuestro examen se encontró el osteoma. Otro caso nos consultó por jaqueca y diagnóstico previo en otro centro de coroiditis posterior. Un caso fue un hallazgo casual en una ecografía practicada por nosotros.

Management of the large cranial osteoma: experience with 13 adult patients.

BACKGROUND: Large osteomas are benign, slow-growing and rare neoplasms of the skull, which are usually asymptomatic but may need surgical resection. PATIENT AND METHODS: We reported a series of 13 adult patients who had large cranial osteomas and who underwent surgical treatment over a period of 5 years. All of the patients were male and the mean age was 21.8 years. FINDINGS: Craniectomy associated with cranioplasty was performed in 10 patients and drilling of the bone tumor was performed in 3 patients. Tumour regrowth was not observed in any patient. CONCLUSION: Although most of the cranial osteomas are asymptomatic, surgical treatment is indicated for large ones. Each patient must be individualized and the selection of the type of surgery depends on the shape and growth pattern of the osteoma.

Multiple intracranial subarachnoid osteomas.

OBJECTIVE AND IMPORTANCE: Intracranial osteomas, which have no connections with the dura or the skull, are very rare. Here we report one case of multiple intracranial subarachnoid osteomas. CLINICAL DESCRIPTION: A 24-year-old gentleman, who had no previous history of systemic disease, meningitis or head injury, presented with a 6-month history of non-specific intermittent headache over the whole head. Neuro-imaging showed multiple ossified lesions in the right frontal area, which were found to compress the underlying cerebral hemisphere. The patient underwent a right frontal craniotomy. The masses were dissected from the depressed brain along the intact pial planes, however, all of the white bone-hard masses tightly adhered to the superficial cortical veins. The masses were removed and the cortical veins were sacrificed. The patient had headaches and was nauseous for three days after the surgery due to venous congestion; however, the patient was neurologically intact on discharge. Pathological diagnosis was osteoma. CONCLUSION: To our knowledge, this is the first report of multiple intracranial subarachnoid osteomas. Surgical findings strongly support the hypothesis of the origin of the tumour that the primitive mesenchymal cells from the connective tissue might have migrated into the subarachnoid space accompanying the intracerebral blood vessels.

Osteoma of the mandibular condyle: report of a case with 5-year follow-up.

Osteomas of the mandibular condyle are rare. An unusual case of an osteoma occurring in the mandibular condyle of a 22-year-old man with mandibular deviation and malocclusion is reported; this represents the 14th documented case in the English language literature. The tumor was resected with condylectomy. Postoperatively, mandibular deviation was minimized.

Machado-Joseph shoe.

Machado-Joseph shoe (MJS), defined as a shoe/slipper with a deep hallux imprint at its base, and hyperostosis/osteoma toe were two early ataxic signs in 17 of 31 patients (55%) and 24 of 31 patients (77%) with Machado-Joseph disease (MJD), respectively. The MJS plus hyperostosis/osteoma toes may be helpful in the diagnosis of MJD in a patient during early truncal ataxia.

Nodular osteochondrogenic activity in soft tissue surrounding osteoma in neurogenic para osteo-arthropathy: morphological and immunohistochemical study.

BACKGROUND: Neurogenic Para-Osteo-Arthropathy (NPOA) occurs as a consequence of central nervous system injuries or some systemic conditions. They are characterized by bone formation around the main joints. METHODS: In order to define some biological features of NPOAs, histological and immunohistological studies of the soft tissue surrounding osteoma and Ultrasound examination (US) of NPOA before the appearance of abnormal ossification on plain radiographs were performed. RESULTS: We have observed a great number of ossifying areas scattered in soft tissues. US examination have also shown scattered ossifying areas at the early stage of ossification. A high osteogenic activity was detected in these tissues and all the stages of the endochondral process were observed. Mesenchymal cells undergo chondrocytic differentiation to further terminal maturation with hypertrophy, which sustains mineralization followed by endochondral ossification process. CONCLUSION: We suggest that periosteoma soft tissue reflect early stage of osteoma formation and could be a model to study the mechanism of osteoma formation and we propose a mechanism of the NPOA formation in which sympathetic dystony and altered mechanical loading induce changes which could be responsible for the cascade of cellular events leading to cartilage and bone formation.

Progressive osseous heteroplasia in the face of a child.

We describe a rare case of progressive osseous heteroplasia of the face in a child. Biopsy showed osteoma cutis superficially with ectopic bone formation in the deeper tissues including skeletal muscle. Analysis of DNA from peripheral blood leukocytes showed mutations in the gene encoding the alpha subunit of the stimulatory G protein of adenylyl cyclase (GNAS1), confirming the diagnosis of progressive osseous heteroplasia.

Button osteoma: its etiology and pathophysiology.

The present study investigates a circumscribed bony overgrowth on the cranial vault, known as button osteoma (BtO) and referred to here as button lesion (BtL). We discuss its anthropological implications. Data on its histology, location, and population distribution (by age, race, and gender) are provided. Microscopically, BtL is composed of well-organized dense lamellated bone which is poorly vascularized and with very few osteocytes. It forms a dome-shaped roof over an underlying diploeized area which includes the ectocranial table. The frequency of BtL is similar in modern (37.6%) and archaeological (41.1%) populations, in blacks, whites, males, and females, and correlates with age. It is rare in nonhuman primates. Fifty-five percent of the human skulls studied by us had BtL only on the parietal, 23.6% on the frontal, and 3.6% on the occipital bones. Fifteen percent had BtL on both the frontal and parietal bones. No lateral preference was found. Most skulls with BtL (64.1%) had only one lesion, 20.4% had two BtL, and 15.4% demonstrated multiple BtL. The average number of button osteomas on an affected skull was 1.97. The frequency of large osteomas (0.5-1.0 cm) was similar in young and old age groups. The demographic characteristics of BtL, mainly its high frequency among ancient and modern populations, its independence of sex and race, its scarcity in other primates, and the fact that its macro- and microstruture are indicative of an hamartoma (and not an osteoma or exostosis) suggest an evolutionary background to the phenomenon.

Osteoma gigante do seio maxilar: relato de caso / Giant osteoma of the maxillary sinus: case a report

Paciente com 14 anos de idade, do sexo feminino, de cor negra, com história de obstrução nasal unilateral esquerda e rinorréia com evolução de dois anos. A tomografia computadorizada dos seios paranasais revelou lesão expansiva sólida de contornos bocelados, com ossificação central, localizada em fossa nasal esquerda e seio maxilar esquerdo, medindo 5,2 x 4 x 3,1 cm. Foi submetida a tratamento cirúrgico por degloving, com diagnóstico anátomo-patológico de osteoma.

A 14 year-old african american girl presented with a two-year history of left nasal obstruction and nasal discharge. A CT scan of the paranasal sinus revealed a 5,2 x 4 x 3,1 cm solid, lobulated tumor, extending from the left nasal cavity to the left maxillary sinus. Surgical excision by the degloving approach was dono. Histopathological examination of this lesion showed the typical features of the osteoma.

Electrophysiologic and echographic findings with choroidal osteoma.

The explanation by differential diagnosis of pathological changes of the fundus may be particularly difficult in case of diseases of sporadic occurrence. The examination findings in a 19-year-old patient with a choroidal osteoma are presented. Large arciform, atrophic areas with distinct boundaries and star-shaped vascular structures were dominant in the fundus on both sides. With peripapillar manifestation, the optic nerve head was ophthalmoscopically noncontributory. A submacular bleeding had caused sudden reduction of visual acuity and caused the patient to visit the ophthalmologist. The most important diagnostic key was supplied by echography, which established peripapillar scleral calcification. The posterior eye segment was highly reflective in ultrasonic echography (B mode), showing concave deformation and causing the sound shadow. Visually evoked potentials indicated the onset of the compression of the optic nerve by the choroidal osteoma. Diagnostic and treatment possibilities are discussed.

Diagnosis and management of middle ear osteomas: a case report and literature review.

Osteomas of the middle ear are exceedingly rare benign neoplasms. To date, 16 cases have been reported in the literature, the vast majority of which appear as middle ear masses in young males with a progressive conductive hearing loss. In most patients, the diagnosis is confirmed by computed tomography (CT) or at the time of surgical exploration. Although these lesions have been described as slow-growing, no long-term follow-up has been reported. We present the seventeenth case of a middle ear osteoma in a 33-year-old man who remains asymptomatic and without evidence of tumor growth after nine years of follow-up. We suggest that asymptomatic middle ear osteomas can be appropriately managed without removal in a select group of patients.

Osteoma de seno maxilar: informe de un caso y revisión de la literatura / Osteoma of the maxillary sinus: case report and review of the literature

El osteoma es el tumor benigno más común de nariz y senos paranasales; sin embargo, su localización en el seno maxilar es extremadamente rara. Este tumor puede ser descubierto accidentalmente en radiografías, o crecer de tal manera que ocasione sintomatología y, más raro aun, complicaciones debido a su localización cerca del ostium de drenaje del seno. Se presenta el caso de un paciente masculino de 43 años. Se comenta el cuadro clínico, hallazgos radiológicos y las indicaciones para su tratamiento quirúrgico. Finalmente se revisa la literatura

[Intracranial pneumatocele secondary to fronto-ethmoidal osteoma. Apropos of a case]. / Pneumatocèle intracrânienne secondaire à un ostéome fronto-ethmoïdal. A propos d'un cas.

The authors report a case of spontaneous pneumatocele consecutive fronto-ethmoidal osteoma which was unrecognized until its complication. This cases illustrated the interest of the CT scan for the topographie diagnostic of the pneumatocele and the visualization of the osteomeduremerienne breache.