Osteoid osteoma of Small bones
10 percent of osteoid osteomas occur in the small bones of the hands and feet. The tumour occurs twice more commonly in hands than feet.
In the hands, the phalanges are the most frequently involved sites.
In small bones, the nidus is usually surrounded by a distinct zone of sclerosis. The bone contour can be expanded, and the entire bone can be markedly enlarged.
Osteoid osteomas of small peripheral bones are almost always associated with a distinct swelling of soft tissue and synovitis of the adjacent joints.
They frequently mimic an inflammatory process in such locations. It is not unusual for a patient with osteoid osteoma of the hands and feet to be treated initially for chronic osteomyelitis or other inflammatory conditions.
Osteoid osteoma of vertebral column
10 percent to 15 percent of Osteoid osteomas occur in the vertebral column. Most frequently, they are located in the lumbar and lower thoracic portions of the spine.
Spinal lesions are difficult to detect on plain radiographs and are known to be responsible for unexplained backache and painful scoliosis.
In some patients, clinical symptoms may suggest a neurologic disorder, lumbar disc disease, or both conditions.
Underlying Osteoid osteoma be ruled out in virtually all cases of unexplained back pain and painful scoliosis that occur in children and young adults.
Removal of the lesion usually results in gradual regression of the curve, in neglected cases a prolonged delay in treatment may result in persistent structural scoliosis.
A vertebral nidus of Osteoid osteoma is difficult to detect on plain radiographs. At best, the radiographs may show an area of sclerosis, thickened and distorted sclerotic transverse process, or a deformed sclerotic pedicle with indistinct borders.
Locating the exact anatomic site of the nidus requires computed tomography. In vertebrae the nidus is most frequently located in the posterior arch.
Magnetic resonance imaging also may facilitate the identification of an inconspicuous nidus.
Other frequent locations include articular facets and pedicles. Less frequently the nidus is located in the transverse and spinous processes. A primary tumor in the vertebral body is extremely rare. Within the body the nidus is usually located eccentrically near the base of a transverse process.
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