Osteoid osteoma is a benign tumor that consists of osteblastic mass called a nidus that is surrounded by a distinct zone of reactive bone sclerosis. The zone of sclerosis represents a secondary reversible change that gradually disappears after the removal of the nidus.
The nidus tissue has a limited local growth potential and usually is less than 1 cm in diameter.
Osteoid osteomas account for about 10 percent to 12 percent of all benign bone tumors. The males are three times more commonly affected than females. More than 80 percent of the patients are between 5 and 25 years age, and the peak incidence is in the second decade of life. Half all osteoid osteomas occur in the long bones of the lower extremities.
The femoral neck is the single most frequently affected site anatomically.
In the long bones, osteoid osteoma is usually located near the end of the shaft, are often present in the small bones of the hands and feet.
In vertebrae, they are nearly exclusively located in the posterior arch. The primary location in the vertebral body is very rare. Osteoid osteomas occur very rarely in flat bones and almost never occur in craniofacial bones.
Clinical Profile
The most frequently reported symptom is pain of increasing severity that is worse at night, relieved by aspirin and other nonsteroidal anti-inflammatory agents.
If the involved bone is superficial, painful swelling of the adjacent soft tissue may be present. This often occurs in the small bones of the hands and feet.
Scoliosis may occur with vertebral osteoid osteoma.
Imaging
The radiographic features of osteoid osteoma are characteristic and diagnostic. Conventional radiographs reveal a well-demarcated lytic lesion (nidus) surrounded by a distinct zone of sclerosis. A zone of central opacity that represnts a more sclerosis. A zone of central opacity that represents a more slecrotic portion of the nidus and is surrounded by a lucent halo may be present within the nidus.
The intracortical lesions of long bones produce extensive fusiform thickening of the cortex with dense radiopacity that sometimes obscures the nidus.
In many cases, nidus may not be visible, so additional imaging techniques, such as computed tomography, radioisotope scanning, and magnetic resonance imaging, may be necessary to document the lesions.
In vertebral locations, conventional radiographs show increased density of the pedicle, loss of a distinct contour, or both features. The nidus is often not seen on conventional radiographs. Exact anatomic localization of the nidus usually requires computed tomography. Most frequently, the nidus is present in the area of the posterior arch or at the base of a pedicle. In very unusual instances, it is present within the transverse or spinous process.
Different Diagnoses
- Chronic and acute osteomyelits
- Bone abscess
- Intracortical hemangioma
- Bone island
- Stress fracture
- Ewing’s sarcoma
- Intracortical osteosarcoma.
Treatment
Osteoid osteomas has limited growth potential. The majority of lesions are about 0.5 cm in diameter. Some may even spontaneously regress.
The primary treatment is surgical removal of the nidus and some of the surrounding bone by enbloc excision after precise localization of the nidus.
Some of these patients can be managed with prolonged treatment with nonsteroidal anti-inflammatory durgs.
Ablation of the nidus with a percutaneously placed radiofrequency electrode has also been advocated as an alternative approach. This could prove to be valuable where it is difficult to surgically remove the tumor.
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13 old male with medial side thigh pain since 6 to 8 months, pt have pain off and on,pain more in nigth, nasid relifed pain , but last 2 mo pian was continue in nigth and morning , xray shoe medial side sclerosis leison near LT, serum alk po4 234. s ca 8.3, other inv normal limit,
Dr Arun Pal Singh Reply:
November 11th, 2010 at 8:28 pm
@sachin,
MRI?
CT?
ESR?
Hi
my father in law is about 60 years old he is suffering from Osteoid Osteoma with so much pain. please tell me what can we do for treatment of this disease.
thanking you
ARADHANA
Dr Arun Pal Singh Reply:
November 11th, 2010 at 4:02 pm
@aradhana,
Did you go through the article. I think the article covers the outline of the treatment well.
If yu want to inquire further please let me know.
I suffered from an Osteoid Osteoma on the end of my femur within the hip joint. The pain was unbelievable , especially at night. Surgery would have required a lengthy recovery. I searched all over the internet to find an alternative. Ultimately I discovered that Radiofrequency Ablation was being done at Mass General. I pursued this option and I have been pain free ever since. It was an outpatient procedure and I actually walked out of the Hospital under my own power!
This was 7 years ago and I remain grateful that this option was available.
I searched this topic today out of curiosity to see if there have been any improvements to the availability of this option for treatment and I am disappointed that it is not referenced in more widely available information. Its a shame. It makes me wonder what other medical options have been developed and still remain a virtual “secret”
Dr Arun Pal Singh Reply:
December 14th, 2010 at 3:04 pm
@Jeffrey Spalt,
There is no secret. Things happen painstakingly slowly when the treatment aspect is a concern.
Good to know it worked for you.
Hi,
I am 26, generally fit and healthy. I was playing basketball and pulled back my middle finger, ring finger and baby finger. At the a@e, they said I fractured my 4th metacarpal, was referred to fracture clinic who then said no fracture but an osteoid osteoma. This is quite painful and a very slow process and the waiting is ridiculous! I’m being referred for an MRI, is this normal? Also can an osteoma be caused by trauma?
Thanks in advance, Joy.
Dr Arun Pal Singh Reply:
March 8th, 2011 at 1:44 pm
@Joy,
Trauma results in tissue injury. Osteoma is a kind of tumor. Both are entirely different.
Has MRI been done. Can you send me the xray and MRI pictures to contact [at] boneandspine dot com
Dear Sir/Madam,
I am 39years old.Long time back i got pain by heating heavy iron stick.Now i have continious pain on my right thigh middle shaft.Night time it is giving more pain and i went to doctor and did CT Scan,MRI,And X-ray,they are telling it is an osteod osteoma.I did an RFA but still have same pain.My question is it possible to occure this osteod osteoma by heating something?.they are telling i have to do same RFA again.Am I now right way to my treatment?What i can do please tell me.
Thanks
Santo
Dr Arun Pal Singh Reply:
March 31st, 2011 at 1:03 pm
@Santo,
Yes! Your treatment appears on the right line. If RFA des not work another option is removal by surgery.
I was recently diagnosed with an atypical osteoid osteoma in my lower femur (there was no nidus present). My ortho oncologist plans on following me for a while to see what happens. The pain was horrible before my biopsy. I had a wide excisional biopsy to rule out chondrosarcoma. The pain after the surgery was much better, after recovering from the surgery itself which was aweful. I still hurt at times, but nothing like it was before. NSAIDs seem to work pretty good.
Dr Arun Pal Singh Reply:
June 14th, 2011 at 12:56 am
@Chris,
Good to here that you were relieved of the ailment.
Dear Doc,
Recently my wife was diagnosed to be suffering from osteod osteoma in hip joint area & also with vitamin D defficiency. She is having trouble walking. Pl suggest what should we do & which is the ideal place for treatment. Is the problem permanently curable by surgery or RFA.Pl help with your suggestions
Dr Arun Pal Singh Reply:
June 14th, 2011 at 7:52 am
@rajesh,
Both surgery and RFA are effective. The best place of treatment would a center with experience in musculoskeletal cancer surgeries.
I have a small bone growth in my forehead. I cannot find any surgeon to remove it.Please help
Dr Arun Pal Singh Reply:
June 14th, 2011 at 12:54 am
@Diana,
Please ask your local health care provider
Hey,
I have being suffering with a ankle problem for 7 years, I’ve had 4 MRI scans, many X-rays& key hole surgery as well as many sessions with a physio therapist. After my 4th MRI scan they now suspect I have osteod osteoma. It is possible to be suffering with this for 7 years? I have researched all the symptoms and I have had most of them. If I do have osteod osteoma and it’s been going on for this long could it be more difficult to cure?
I look forward to you reply
Many thanks
Erin
Dr Arun Pal Singh Reply:
August 13th, 2011 at 12:01 pm
@Erin lewis,
Osteoid osteoma needs either surgery or ablation. Did you discuss it with your treating doctor.
Dear Sir/Madam,
My son is being diagnosed having osteoid osteoma in his right leg just below the knee joint, he is 6 yrs old, he is being given vitamins and pain killers and under observation for next 15 months. My wife and parents are suggesting to go ayurvedic treatment in sri lanka. Please tell me what is the best possible treatment, will he suffer in the long run, he is only 6 years, what would be his future?? please help
Thank you very much.
Dr Arun Pal Singh Reply:
September 14th, 2011 at 12:33 pm
@B K Perera,
I cannot comment on Ayurvedic treatment. Osteoid osteomas are known to resolve spontaneosly and that is why you might been asked to wait while your child is put on symptomatic treatment.
Best thing now is to wait.
Dear doctor..
i am having pain in my right knew from last 3 weeks..it occurs mostly in the night and the pain is very strong.. i had my knee surgry done about 4 years ago and the bone tumer was removed with the lazor in orthopedic hospital….i have been to my doctor and he adviced me to take asprine..and if the treatment is done once.. why does it come back again ??
Dr Arun Pal Singh Reply:
October 14th, 2011 at 3:29 pm
@RAY,
What tumor was removed?
Osteoid osteoma?
Hello
am 25 years old male
i have diagnosed with osteoid osteoma in the lower quarter of the femur
i dont want to do the surgery
and thereis not ablation in my country
could i stay like that
if there is just a little pain wich i can bare
please give me the ansower
Dr Arun Pal Singh Reply:
October 8th, 2011 at 9:17 am
@fuad,
Most of them spontaneously resolve. You might want to wait if you could bear the discomfort or manage with symptomatic treatment.
Dear Dr.Singh- My son who is now almost 14 is going through his second bout with an O.O. that initially occured in the L5-S1 juncture. He is experiencing unbelievable pain that predictably worsens even more @ night. The first time this tumor occured it took over 4 months of tests & misleading diagnosis (he had developed a 7degree scoliosis of the spine) & went through a nightmare of being told by 2 MD’s that he should not be in the amount of pain that he was reporting. Thankfully we were seen by Dr. Frank Gerow, MD who was able to diagnose my son with 1 examination & a thin-slice CT of the area.(Tx.Children’s Hosp.,Houston, Tx.) It took another 2 months to find an Interventional Radiologist who was willing & able to do the RF ablation procedure in Feb.2010. My son was pain free til the recurrance in the last 2 mo. We are awaiting a surgical date for the 2nd RF ablation. Due to my son’s age, it seems doctors have been reluctant to treat his pain & anxiety appropriately until surgery. (He is 5’6″ & now weighs 180# due to his inability to be mobile.) Thank you for putting good info out for research. Do you think that this tumor will keep recurring?
Dr Arun Pal Singh Reply:
October 19th, 2011 at 1:32 pm
@Niki W.,
Recurrence can occur and usually the second procedure provides complete cure.
If still it recurs, the tumor should be removed surgically.
All the best.
my son is suffering from osteoid osteoma neck of femur (Lt -intra articular) from 2005. the size is around 1cm. Initially he had lot of pain. Now no pain. As per the latest CT the size is same. He plays bascketball and can run for long distance (5 Km). What should we do. I want to know that this OO remains benign or it becomes malignant?. If it gets cured on its own than after how many years approx. Since physical excision is complicated in this case, for RF ablation also requires drilling through bones or what?. If yes than how much time required to heal. I eagerly waiting for the reply. Thank you.
Dr Arun Pal Singh Reply:
November 9th, 2011 at 5:50 am
@vageesan R,
Would you please ask your query at http://boneandspine.net
That way we can discuss over a longer period of time, and discuss all the options and concerns.
I was diagnosed with this osteoma on the side of my skull. The hospital consultant said it was nothing to worry about and removal would only be cosmetic and shaving some of my long hair off. He said, if it wasn’t causing any pain, not to worry about it. I have read that osteoma is benign. But that could change to malignant right??
Dr Arun Pal Singh Reply:
November 19th, 2011 at 12:36 pm
Yes! But then risk is with every living cell. Just watch it and if there is a pain or sudden increase in the size, seek consultation. Otherwise be in regular followup with your doctor.
I was suffered from Osteoid Osteoma for which I had undergone a surgery in april 2011,but their is no relief from pain,again I have repeated CT & MRI scan last week,but nidus was not seen in it,now what to do? Are their any other tests?Whether I should prefer RFA? if yes then please mention me best centre of RFA in India which should also be cost effective to me,and whether mediclaim can be received against RFA. Please suggest….
Dr Arun Pal Singh Reply:
December 17th, 2011 at 7:17 am
@Manoj,
If the nidus has been removed, I do not think there is need to worry.
But as the area involves the skull please consult your doctor if RFA is applicable to that part.
I would look at info on RFA centers in India and would let you know.