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| Year : 2009 | Volume
: 20
| Issue : 4 | Page : 514-515 |
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| Osteoid osteoma |
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BS Manjunatha1, D Nagarajappa2
1 Department of Oral and Maxillofacial Pathology, K M Shah Dental College & Hospital, Pipariya - 391 760, Waghodia, Vadodara, Gujarat, India
2 Department of Oral and Maxillofacial Surgery, S J M Dental College and Hospital, P B Road, Chitradurga - 577 501, India
Click here for correspondence address and email
| Date of Submission | 10-Dec-2008 |
| Date of Decision | 06-Mar-2009 |
| Date of Acceptance | 15-Jul-2009 |
| Date of Web Publication | 29-Jan-2010 |
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 Abstract | | |
Osteoid osteoma is a benign tumor of the bone which arises from osteoblasts and is extremely rare in jaws. Only 15 cases of osteoid osteoma have been reported in English-language literature. This case report is presented here due to its rarity. Keywords: Osteoid osteoma, osteoblastoma, prostaglandins, nonsteroidal anti-inflammatory drugs
How to cite this article:
Manjunatha B S, Nagarajappa D. Osteoid osteoma. Indian J Dent Res 2009;20:514-5 |
Osteoid osteoma is a benign tumor of the bone and rarely involves the craniofacial bones. This lesion accounts for approximately 10-12% of all benign bone tumors. The true nature of this lesion is unknown. [1] Characteristic clinical symptoms include severe pain which worsens at night and is usually relieved by nonsteroidal anti-inflammatory drugs (NSAID's), mainly aspirin. It is believed that the pain is due to prostaglandins, produced by tumor cells. Based on the size, location, clinical presentation and radiographic appearances, osteoid osteoma and osteoblastoma are distinguished. [2] Treatment of the lesion includes complete removal including the nidus which usually relieves all symptoms.
| Case Report | |  |
An 18 year old female patient was referred with a chief complaint of swelling and pain on the right lower back region of the face since three months. No facial asymmetry was noted and the swelling was present on the right angle of the mandible. On palpation, the lesion was hard in consistency, measuring about 1cm in diameter, round to oval in shape. The swelling was fixed to the underlying bone and was not mobile. The overlying skin was intact and normal in color. Intra oral examination revealed no significant findings. Patient also gave a history of severe pain and was worsening during night and completely relieved by analgesics given by a local dentist. Based on symptoms, clinical findings and patient's history, differential diagnosis of sclerosing osteitis, ossifying f ibroma and osteoblastoma were considered. Various extra-oral radiographs like lateral oblique, orthopantamogram (OPG) and PA view of the mandible were taken. Radiographically, a well defined radio-opaque mass was noted near the angle of mandible at the gonion point. A provisional diagnosis of osteoid osteoma was made. The lesion was surgically exposed by an extra-oral incision and was removed under anesthesia. Cosmetic recontouring of the excised bony surface was also done. On gross examination, the tissue appeared as a small, round to oval, clay white colored hard tissue mass with smooth surface and regular borders measuring about 1 cm in diameter. The tissue was sent for histopathological examination.Microscopically, the lesion was composed of an ovoid or spherical nidus of osteoid-rich tissue and immature bone within a connective tissue stroma which is richly vascular [Figure 1]. The bony trabeculae were irregular and interconnected and showed varying degrees of calcification with many basophilic reversal lines. Many plump hyperchromatic osteoblasts were seen lining the trabeculae. In few areas, multinucleated giant cells were also evident [Figure 2]. Based on clinical details, patient's history, radiographic findings and microscopic examination of the tissue mass, a final diagnosis of 'osteoid osteoma' was given.
| Discussion | | |
Osteoid osteoma was first recognized by Jaffe in 1935 as distinct pathological entity. Lichenstein described osteoid osteoma as 'a small round tumor like nidus composed of osteoid and trabeculae of newly formed bone deposited within a highly vascularized osteogenic connective tissue'. [3] The precise nature of this lesion remains unclear. Some authors consider it neoplasm: Others feel it arises as an inflammatory and few others believe it to be the consequence of an unusual healing process. [4]
Characteristic clinical symptoms include severe pain which worsens at night and usually relieved by salicylates, mainly aspirin. It is believed that pain may be caused by nerves which accompany the blood vessels to the tumor which is richly vascularized. In addition to this, the tumor produces prostaglandins which result in significant pain that is relieved by non-steroidal anti-inflammatory drugs (NSAID).[5]
The characteristic radiologic feature is a central radiolucent nidus of size less than 2 cm in diameter with a sclerotic bony margin. The zone of sclerosis is included in the measurement as it is considered a secondary reaction.[6] Differential diagnosis of this lesion includes osteoblastoma, cementoblastoma, sclerosing osteomyelitis, chronic periapical abscess and ossifying fibroma. Based on the size and clinical features (characteristic symptoms such as pain relieved by NSAIDs) osteoblastoma was ruled out. Cementoblastoma was differentiated as the lesion appears as radiopaque mass fused to the surface of the root. Chronic sclerosing osteomyelitis is characterized by localized swelling with intermittent pain and histologically shows chronic inflammatory cells and necrotic bony trabeculae. The pain will be dull and intermittent in nature. Ossifying fibroma is asymptomatic, grows large in size with no nidus, can cause resorption and displacement of teeth.This lesion rarely involves the craniofacial bones and only 15 cases have been reported in the English-language literature. [6],[7] Considering the rarity of this lesion in jaws, the case is presented here. To conclude, clinical presentation and symptoms play a critical role in the pathologic diagnosis of osteoid osteoma with other similar lesions.
| References | | |
| 1. | Shafer WG, Hine MK, Levy BM. A textbook of Oral Pathology, 4 th Edition, WB Saunders Company, Philadelphia: Pennsylvania; 1993. p. 164-5.  |
| 2. | Schajowicz F, Sissons HA, Sobin LH. The World Health Organization's Histologic Classification of Bone Tumors: A Commentary on the Second Edition. Cancer 1995;75:1208-14. [PUBMED] |
| 3. | Zulian MA, Vincent SK, Hiatt WR. Osteoid osteoma of the mandible ramus. J Oral Maxillofac Surg 1987;45:712-4. [PUBMED] |
| 4. | Lee EH, Shafi M, Hui JH. Osteoid osteoma: A current review. J Pediatr Orthop 2006;26:965-70. |
| 5. | Neville BW, Damn DD, Allen CM, Bouquot JE. In: Oral and maxillofacial Pathology, 2 nd Edition, Elsevier publishing, Philadelphia: Pennsylvania; 2002. p. 569. |
| 6. | Yang C, Qiu WL. Osteoid osteoma of the eminence of the tempo mandibular joint. Br J Oral Maxillofac Surg 2001;39:404-6. [PUBMED] [FULLTEXT] |
| 7. | Badauy C, Carrard V, Rados P, Sant'ana Filho M. Radiopaque mass of the posterior mandible with lingual expansion. J Oral Maxillofac Surg 2007;65:2498-502. [PUBMED] [FULLTEXT] |
Correspondence Address:
B S Manjunatha
Department of Oral and Maxillofacial Pathology, K M Shah Dental College & Hospital, Pipariya - 391 760, Waghodia, Vadodara, Gujarat
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0970-9290.59438
[Figure 1], [Figure 2] |
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