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Dx: Osteoblastoma

KEY FACTS

Terminology Definition: Benign tumor of bone arising from osteoblasts and accounting for approximately 1% of all bone tumors Imaging Most commonly in vertebral column Mandible > maxilla Posterior > anterior; body of mandible most often Radiodensity varies from radiolucent to mixed with abundant calcification Tooth roots may be displaced or resorbed If close to tooth root, may be confused with cementoblastoma or periapical pathology, especially if pain is present Vitality testing and lack of etiology (caries/fracture) helps rule out pulpal pathology CBCT and bone CT: Will show expansion if present Top Differential Diagnoses
Osteoid osteoma Cementoblastoma Cemento-ossifying fibroma Osteosarcoma

Pathology Histologically identical to osteoid osteoma Aggressive osteoblastoma: Larger; rapid growth Clinical Issues Swelling; pain or tenderness ~ 50% Complete excision chemotherapy if aggressive Recurrence low: 13%; aggressive osteoblastoma: 50% Diagnostic Checklist Some believe aggressive osteoblastoma represents low-grade osteosarcoma: Look for periosteal reactions
TERMINOLOGY

Synonyms Giant osteoid osteoma, giant osteogenic fibroma Definitions Benign tumor of bone arising from osteoblasts and accounting for approximately 1% of all bone tumors
IMAGING

General Features Best diagnostic clue: Expansile, mixed radiopaque/radiolucent lesion in body of mandible Location Most commonly in vertebral column, ribs, pelvis; craniofacial bones rarely Mandible > maxilla

Posterior > anterior; body of mandible most commonly TMJ cases reported Size: 1.5 cm at discovery; greater growth potential than osteoid osteoma Morphology Well or ill defined; some may appear corticated or partly corticated Radiodensity varies from radiolucent to mixed with abundant calcification Radiographic Findings Intraoral and extraoral plain film Lesion of varying radiodensity If close to tooth root, may be confused with cementoblastoma or periapical pathology, especially if pain is present Vitality testing and lack of etiology (caries/fracture) helps rule out pulpal pathology Tooth roots may be displaced or resorbed CT Findings CBCT and bone CT Expansion may be present
DIFFERENTIAL DIAGNOSIS

Osteoid Osteoma

Usually smaller than osteoblastoma; painful Radiolucent nidus with sclerotic periphery
Cementoblastoma

Similar radiographic and histologic appearance to osteoblastoma but intimately related to tooth root Tooth apex is lost in lesion
Cemento-ossifying Fibroma

Peripheral zone of radiolucency with concentric growth pattern


Osteosarcoma

Well-differentiated osteosarcoma histologically similar to osteoblastoma More aggressive: Spiculated (sunray) periosteal reactions may be present
PATHOLOGY

General Features Associated abnormalities: Osteoblastoma reported in association with simple bone cyst and aneurysmal bone cyst Staging, Grading, & Classification Aggressive osteoblastoma is subcategory Larger, grows more rapidly, and tends to occur in older age group May invade soft tissues Gross Pathologic & Surgical Features Granular, semi-solid mass Microscopic Features Identical to osteoid osteoma Fibrous connective tissue stroma with spindle-shaped fibroblasts and vascular channels Osteoid and trabeculae rimmed with plump osteoblasts containing basophilic nuclei

CLINICAL ISSUES

Presentation Most common signs/symptoms Swelling Pain or tenderness ~ 50% Differentiating from osteoid osteoma on presence/absence or degree of pain, not definitive Osteoid osteoma: Nocturnal pain relieved by prostaglandin inhibitors such as aspirin May be asymptomatic Demographics Age: Range: 3-61 years; mean: Middle 3rd decade Gender: Males > females (2:1) Natural History & Prognosis Prognosis is generally good Spontaneous remission after biopsy reported Sarcomatous change reported in few cases Treatment Complete excision Recurrence low: 13%; aggressive osteoblastoma: 50% Adjuvant chemotherapy recommended by some for lesions showing aggressive features because of difficulty differentiating from low-grade osteosarcoma Radiographic follow-up important
DIAGNOSTIC CHECKLIST

Consider Some believe aggressive osteoblastoma represents low-grade osteosarcoma: Look for periosteal reactions