Back pain in the young athlete.

Back pain in the young athlete is a common finding. There are many different problems that can cause back pain in active children. It is important for the treating physician to obtain a thorough history and physical examination to help in establishing the underlying cause for the discomfort. Appropriate imaging can be determined by these findings and further help to define the pathology. Depending upon the specific pathology, appropriate treatment may help the patient to safely return to the activities that they enjoy.

An unusual case of posttransplant osteoid osteoma.

Posttransplant tumors are one of the important long-term complications of renal transplant. However, aside from noninvasive Kaposi sarcomas, increased production of benign tumors has not been observed after renal transplantation, and to our knowledge, no cases of posttransplant osteoid osteoma have been reported so far. Osteoid osteoma is a common, benign, bone neoplasm that occurs typically in the long bones and presents with severe, intractable pain. Here, we present a 49-year-old man, who presented with increasing bone pain in the right upper arm, 7 months after a renal transplant. Despite an initial normal right humerus radiograph, a raised subperiosteal tumor was diagnosed in the medial border of the right humerus a few months later. An excisional biopsy was performed, and the pathologic report was an osteoid osteoma. The patient's pain, which had been resistant to most analgesics, completely disappeared after surgery, and he is currently devoid of any lesions, 9 months after excision of the tumor.

Osteoid osteoma of the carpal bones. Two case reports.

Osteoid osteoma rarely develops in the wrist. The symptoms resemble atypical tenosynovitis, with variations according to the location of the tumor. As a result, diagnostic wanderings are common. In addition, the pain may seem related to an injury, as illustrated by two cases reported herein. Conventional investigations often fail to contribute to the diagnosis. The most specific investigation is thin-slice computed tomography (CT), which can be coupled to magnetic resonance imaging. CT typically visualizes a round lucency surrounded by a rim of sclerosis; in addition, CT shows the exact location of the tumor, particularly relative to neighboring joints. Complete excision of the nidus must be achieved to ensure a permanent cure. Same-stage carpal bone fusion may be required in patients with extensive joint involvement.

[Osteoid osteoma in the hand: an evaluation of eight patients]. / El yerlesimli osteoid osteomlu sekiz olgunun degerlendirilmesi.

OBJECTIVES: We retrospectively evaluated patients with osteoid osteoma localized in the hand, which is a rare location for this lesion. METHODS: Eight patients (5 females, 3 males; mean age 23 years; range 13 to 31 years) underwent surgery for osteoid osteoma localized in the hand. Involvement was in the right hand in five patients, and in the left hand in three patients, being in the proximal phalanges in all the patients. The affected fingers were the fourth in five patients, and the first, second, and third in the remaining three patients, respectively. Five patients presented with pain responsive to salicylates. The mean duration of symptoms before diagnosis was 20 months (range 12 to 36 months) and the mean follow-up was 38 months (range 15 to 86 months). RESULTS: Direct radiographs enabled the diagnosis in four patients. Computed tomography was utilized in four patients, two of whom required scintigraphy and magnetic resonance imaging. Computed tomography showed intraosseous involvement in three patients, but failed to demonstrate the nidus in one patient due to extreme sclerosis. The nidus was removed with excision and curettage in all the cases, combined with cancellous autografting in five patients. Five patients had complete recovery. One patient had stiffness of the adjacent joints, which responded well to rehabilitation. Plain x-rays showed a subcortical sclerotic zone in one patient who had persistent pain for a year postoperatively. Due to inadequate excision, recurrence occurred in one patient 18 months after surgery; revisional excision and bone grafting were performed, resulting in complete recovery. CONCLUSION: Satisfactory results are obtained with excision, curettage, and bone grafting of osteoid osteomas located in the hand.

Intracranial mesenchymal chondrosarcoma with osteoid formation: report of a pediatric case.

CASE REPORT: We present a case of a 14-year-old girl with a 3-week history of severe progressive headache and intermittent vomiting. Magnetic resonance imaging (MRI) revealed a large intensely enhancing mass, which seemed to arise from the right side of the cerebral fossa with implant base in the inferior face of the tentorium and significant mass effect on the nearby structures. A presumptive preoperative diagnosis of meningioma was made. Subtotal surgical resection was performed using the occipital approach. Histologically the neoplasms had the classic features of a mesenchymal chondrosarcoma associated with the focal presence of osteoid matrix. DISCUSSION: Clinical features, therapeutic approaches and prognosis of this rare tumour are discussed with regard to the known 30 cases in the literature.

[Osteoid osteoma after an old femoral shaft fracture]. / Ostéome ostéoïde sur le site d'une fracture diaphysaire ancienne du fémur.

An osteoid osteoma was discovered at the site of fusion of a mid-third femoral shaft fracture in an 18-year-old girl. This unusual localization was revealed by persistent pain after ablation of the material after fracture healing. Postoperatively, a discharge from the skin wound that persisted for a few days, raised the differential diagnosis between low-grade bone infection and an osteoid osteoma suggested by the patient's age and the clinical presentation. Computed tomography and leukocyte-labeled bone scintigraphy provided the diagnosis of osteoid osteoma that was confirmed at pathology examination after resection. Isotopic mapping of this very small intraosseous lesion that exhibited strong isotope uptake was particularly contributive.

Osteoid osteoma that occurred in a former fracture site.

Diagnosis of osteoid osteoma often is delayed, despite its high incidence, because of similarities in presenting symptoms with other pathologic entities. The current case report describes a posttraumatic osteoid osteoma. Three years after osteosynthesis of a distal tibial fracture an osteoid osteoma was diagnosed at the former fracture site. After excluding osteomyelitis as a possible diagnosis, the tumor was excised successfully. Based on current knowledge of the pathogenesis of osteoid osteoma, it is unlikely that the lesion observed in the patient was attributable to the previous fracture.

[Medullary osteoid osteoma. A pathogenic discussion]. / L'ostéome ostéoïde médullaire. Discussion pathogénique.

PURPOSE OF THE STUDY: Medullary osteoid osteoma is exceptional. We report one case. PATIENT: A 15-year-old patient presented osteoid osteoma localized in the medullary canal of the tibial shaft, associated with intense medullary and cortical hyperosteosis. DISCUSSION: The origin of the osteogenesis in medullary osteoid osteoma could be a localized hemodynamic change involving venous congestion with stimulation of periosteal venous drainage.

Osteoid osteoma after a stress fracture of the tibia: a case report.

A 24-year-old man presented with a stress fracture over his left tibia following an infantry training 6 years ago. X-rays of his left tibia revealed a stress fracture and bone scan showed marked tracer uptake at the fracture. He was treated conservatively but his pain persisted since then. Five years later, X-rays and histological examination confirmed the diagnosis of osteoid osteoma. The stress fracture may act as a trigger for the formation of osteoid osteoma and caused a delay in diagnosis.

Osteoid osteoma after a fracture of the distal radius.

We report a case of osteoid osteoma occurring at the site of a previous fracture of the radius treated by internal fixation with insertion of a rod. The fracture may have acted as a trigger for the formation of an osteoid osteoma.

[Post-traumatic osteoid osteoma. Apropos of 2 cases and review of the literature]. / Ostéomes ostéoïdes post-traumatiques. A propos de deux cas et revue de la littérature.

Two cases of osteoid osteoma which became clinically apparent after a prolonged silent period are reported. One was located in the tibia in a 30-year-old female and the other in the femur in a 26-year-old male. Both developed after a surgical procedure, at the site of the operation; one was located on the track of an internal fixation screw. Diagnosis was delayed despite the suggestive timing of the pain; isotopic scanning, CT scan and angiography provided suggestive data and diagnosis was confirmed by histologic studies. A review of the literature found 13 other cases meeting the following criteria: initial trauma, silent period, suggestive pain, discovery of an osteoid osteoma at the site of the trauma, and recovery following surgical treatment. The role of the trauma is discussed.

[The essence of osteoid osteomas and osteoblastomas]. / O sushchnosti osteoidnykh osteom i osteoblastom.

178 cases of osteoid osteomas and osteoblastomas collected during 35 years were studied morphologically and roentgenologically (angiography--28 cases). Clear-cut differences between these two lesions were revealed. The differences concerned: 1) the character of the border with the surrounding bone tissue; 2) the morphology of bone structures being chaotic in the osteoblastoma; 3) intensity of proliferation in the osteogenic tissue; 4) differences in the angiographic data. According to the author's opinion osteoblastoma is a blastomogenic process with destructive growth and intensive proliferation. Classical osteoid osteoma does not possess these properties and is the result of dysontogenetic development of the intraosseous vascular system.

Psammous desmo-osteoblastoma. Ultrastructural and immunohistochemical evidence for an osteogenic histogenesis.

Fibro-osteo-cemental lesions of the jaw bones are a heterogeneous group of diseases which present problems in classification. Psammous desmo-osteoblastoma is one of four newly proposed entities (Makek 1983) and has until now been characterized by its light microscopic, clinical and radiological features. On electron microscopy this tumour exhibits fibroblastic (preosteoblastic), osteoblastic and osteocytic cells and a globular mineralization unlike the mineralization of the psammoma bodies. Immunohistological investigations with anti-osteonectin, a bone specific protein linking mineral to collagen, showed positive intracellular staining in all tumour cells and extracellular staining in the osteoid. The psammoma bodies were, however, not stained. These results confirm the view of the osteogenic histogenesis of psammous desmo-osteoblastoma, with an osteogenic differentiation of the tumour cells, bone formation and association of psammoma bodies which are not of bone origin. This combination of findings supports the view that psammous desmo-osteoblastoma represents a new and distinct entity occurring in desmal preformed cranio-facial bones which should be incorporated in a revised WHO-classification.