An Atlas of Musculoskeletal Oncology: Volume 1
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Transcript of An Atlas of Musculoskeletal Oncology: Volume 1
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Contents for Volume 1
Osteoid osteoma--------------------------------Case 1-50 Osteoblastoma----------------------------------Case 51-94Osteofibrous dysplasia-------------------------Case 95-101Ossifying fibroma of jawbone----------------Case 102-107
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Osteoid Osteoid OsteomaOsteoma
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Osteoid Osteoma
The osteoid osteoma is the most common osteoid-forming tumorseen in the skeletal system, accounting for 10% of all benignbone tumors. It is more common in males than females with the peak incidence in the second decade of life. The lesions producesymptoms of dull, aching pain that is more severe at night. Thepain is relieved with anti-inflammatory medication such as aspirin or non-steroidal anti-inflammatory drugs (NSAID)that inhibit the high concentration of prostaglandins found in the nidus of the osteoid osteoma. The lesions occur typically inthe cortical structures of long bones such as the femur or tibia but can also be found in the small bones of the ankle, wrist or vertebral column. The lesion is characteristic for its dense,sclerotic response in the cortical bone resulting in a fusiform enlargement on the surface of the cortex as a response to thesmall inflammatory nidus or granuloma (measuring up to one
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centimeter in diameter) in the central area of the scleroticresponse. If the lesion is located in a central medullary area,such as the metaphysis or on the very superficial surface of abone, the sclerotic response is less severe. If the nidus is located close to or within a joint structure, as in the femoralneck area, there will be a significant inflammatory synovitisin the adjacent joint that gives the clinical appearance of apyarthrosis. In the spine, the lesions are usually located in theposterior elements of the spine such as the laminae or pedicles.The lumbar spine is the most common location followed secondby the dorsal spine. Atypical secondary painful scoliosis willdevelop with the convexity seen on the side opposite the inflammatory lesion. The two most significant diagnostic imaging studies are a CTscan through the nidus area to identify its anatomic location and a bone isotope scan which is invariably positive, especially in asymptomatic lesion. It is the current feeling that the osteoid.
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osteoma is a true benign neoplasm of bone in which a com-bination of osteoclastic and osteoblastic activity are seen. There are no inflammatory cells such as lymphocytes orplasma cells as would be seen in a Brodie’s abscess. Non-steroidal anti-inflammatory medications such as prostaglandininhibitors can be very effective in controlling the disablingsymptoms and helping the patient get thru a period of one ortwo years during which time the lesion will typically involuteinto a painless lesion that does not require surgery. However,if the patient is unable to live with the pain during this time,a surgical approach is indicated. Following exposure of the lesion, a high speed burr is used to burr into the inflammatorybone that is characterized by a pinkish hyperemia. When the nidus is found, a small curette is used to core the inflammatorynidus for pathological diagnosis and the cavity of the nidusis burred an additional 2 or 3 mm which usually results in a verydramatic relief of symptoms and a permanent cure from the
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disease process. It is not necessary to remove the large dense sclerotic bone surrounding the nidus; doing so couldresult in a pathologic fracture following surgery. In the spine, a simple laminectomy is frequently carried out. If the lesion islocated in the pedicle a simple burring into the pedicle will relieve the patient of the inflammatory pain. More recently, relatively non-invasive techniques have beentried to remove the nidus of the osteoid osteoma by means of a CT guided burr placed through a protective trocar or by place-ment of a heat-producing radio frequency probe that, when properly positioned, can destroy the nidus through thermal coagulation. These techniques are particularly valuable for deep-seated lesions located in the acetabulum. For lesions located inthe pedicle of a vertebra one must be careful not to damage anadjacent spinal root or spinal cord.
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19 yr old femaleOsteoid osteomafemur
painfulnidus
CLASSICCase #1
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Bone scan
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CT scan
nidus
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Macro section of nidus
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Photomic of nidus
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29 year maleosteoid osteomafemur
nidus
Case #2
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nidus
CT scan
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11 yr maleosteoid osteomafemur
Case #3
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Bonescan
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CT scan
nidus
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Photomic
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5 yr male osteoid osteoma femur
nidus
Case #4
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12 yr maleosteoid osteoma femur
Case #5
nidus
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10 yr maleosteoid osteomafemur
nidus
Case #6
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nidus
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CT scan
nidus
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30 yr femaleosteoid osteomafemur
nidus
Case #7
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Coronal T-1 MRI
nidus
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Axial PD MRI
edema
nidus
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Macrosection
nidus
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Case #8
23 yr femaleosteoid osteomafemur
nidus
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Bone Scan
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CT Scan
Nidus
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Case #9
12 yr maleosteoid osteomafemur nidus
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Macro section nidus
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Photomic
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Case #10
10 yr female with osteoid osteoma femoral neck
nidus
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Photomic
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One yr after curettement
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Case #11
25 yr male with osteoid osteoma femoral neck
nidus
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CT scan
nidus
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Case #12
6 yr male osteoid osteoma acetabulum
nidus
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nidus
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Bone scan
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Case #13
11 yr maleosteoid osteomadistal femur
nidus
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Bone scan
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Case #14
16 yr maleosteoid osteomadistal femur
nidus
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Case #15
6 yr maleosteoid osteomatibia
nidus
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Bone scan
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Excessivebone blockresection
nidus
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Macro section of nidus
nidus
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Photomic
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Post op x-ray
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Resultant fractureone year later
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Case # 16
10 yr maleosteoid osteomatibia
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Shaving down with osteotome
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Further shaving to find nidus
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Burred out nidus defect
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Case # 17
15 yr maleosteoid osteomatibia
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Lateral view
nidus
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Bone scan
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Coronal T-2 MRI
nidus
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Coronal Gad contrast MRI
nidus
edema
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T-1 axial MRI
nidus
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Photomic
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Photomic
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Case #17.1
52 year old male with ankle pain for 3 mos.
Osteoid osteoma
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Sag T-1 T-2 Gad
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Axial T-1 T-2
Gad
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Case #18
17 yr maleosteoid osteomafemur
nidus
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Grossspecimen
nidus
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Photomic
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Case #19
18 yr maleOsteoid osteoma tibia
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Case #20
18 yr femaleosteoid osteomatibia
nidus
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Case #21
12 yr male with parosteal osteoid osteoma tibia
nidus
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Case #22
17 yr maleosteoid osteomafibula
nidus
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Lateral view
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Case #23
26 year female with epiphyseal osteoidosteoma prox radius
nidus
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Case #24
16 yr femaleosteoid osteomaulna
nidus
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Bone scan
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Case #25
16 yr maleosteoid osteomahumerus
nidus
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Case # 26
14 yr maleosteoid osteomaL-4
nidus
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Bone scan
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Photomic
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Case # 27
15 yr maleosteoid osteomaL-3
nidus
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Case #28
46 yr maleosteoid osteomadorsal spine
nidus
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Bone scan
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Case #29
18 yr male with osteoid osteoma C-3
nidus
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Laminogram
nidus
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Bone scan
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Case #30
12 yr male with osteoid osteoma C-3 spine
nidus
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Case #31
25 yr maleosteoid osteomaC-5
nidus
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Case # 32
27 yr female with osteoid osteoma S-1
nidus
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Case #33
22 yr male with osteoid osteoma sacrum
nidus
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Case #34
18 yr maleosteoid osteomafinger
nidus
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X-ray
nidus
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AP x-ray
nidus
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Case #35
24 yr male with osteoid osteoma thumb
nidus
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Bone scan
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Case #36
19 yr female with osteoid osteoma finger
nidus
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Case #37
20 yr male with osteoid osteoma thumb
nidus
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Case #37.1
17 year female with dull aching pain index finger 1 yr
nidus
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Case #38
23 yr male with osteoid osteoma capitate
nidus
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Case #39
25 yr male with osteoid osteoma narvicular
nidus
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Case # 40
34 yr female with osteoid osteoma 2nd metatarsal
nidus
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CT scan
nidusdouble
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Axial T-2 MRI
edema
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Case #41
24 yr female with osteoid osteoma big toe
nidus
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Gross Specimen
nidus
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Photomic
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Photomic
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Case #42
Osteoid osteoma talus
nidus
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Photomic
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Case #43
Osteoid osteomapseudotumor
Brodie’s abscess13 yr femaletibia
nidus
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Gopher’s sign
tunnel
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Case # 44
Osteoid osteomapseudotumor
Brodie’s abscesstibia38 yr male
nidus
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Axial T-2 MRI
nidus
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Case #45
Osteoid osteoma pseudotumorstress fracture femoral neck 38 yr male
fractureline
pseudo-nidus
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Bone scan
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Case #46
Osteoid osteoma pseudotumor 33 year female
e
Early stressfracture femoralneck with pain for 3 mos
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Bone scan
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One month later
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Case #47
Osteoid osteoma pseudotumorstress fracture femoral neck 50 yr female
pseudonidus
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Axial T-2 MRI
pseudonidus
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Coronal T-2 MRI
fracture line
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Case #48
20 year old male with pre-tibial pain for 3 months
Stress fractureOO pseudotumor
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Sag T-1 PD Gad
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Case #49
Pseudo osteoid osteoma femur
Chronic stressperiostitis from adductor pull14 yr male
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CT scan
pseudonidus
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Bone scan
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Case #50
Pseudo osteoid osteoma femur
Bone island
38 yr male
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Bone scan
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CoronalT-1 MRI
pseudonidus
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OsteoblastoOsteoblastomama
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Osteoblastoma The so-called osteoblastoma is considered by most to be a largeor giant form of the similar clinical entity known as the osteoidosteoma. As with the osteoid osteoma, it is found in children andyoung adults, more often in males than females. It is less commonthan the osteoid osteoma, representing approximately 1% of allbone tumors. It is found mostly in metaphyseal areas of long boneand in the posterolateral elements of the axial skeleton wherenearly 50% of the lesions are identified. Radiographically these lesions are more osteolytic than the osteoid osteoma and have acentral nidus that measures more than 1.5 cm in diameter with less reactive sclerosis seen at the periphery than an osteoid osteoma. It is not unusual for an aneurysmal component to beassociated with the osteoblastoma, similar to the reaction seenadjacent to chondroblastomas and giant cell tumors. The micro-scopic appearance of the nidus material is almost identical to
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that of the osteoid osteoma and under higher power cannot bedifferentiated by even the most competent pathologists. The major concern is a microscopic appearance similar to an osteo-sarcoma and, for this reason, multiple samples must be evaluatedin order to establish the correct diagnosis in cases where these lesions arise from the metaphyseal areas of long bone. In the spinal area, the osteoblastoma is typically located in theposterolateral elements where it can cause problems with spinal cord or nerve root compression that may require aggressive surgical decompression and even spinal stabilization. On occasionan osteoblastoma will spontaneously convert into an osteo-sacoma, especially if it has been treated with radiation therapy. The primary treatment for the osteoblastoma is a surgical one witha fairly aggressive curettement of the lesion. There is no particularreason to take wide margins because the recurrence rate is quite low and in some cases the lesions resolve spontaneously with out any surgery at all, similar to what occurs with osteoid osteomas.
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A variant of the osteoblastoma, the so-called aggressive or“malignant” osteoblastoma, is a clinical entity halfway between theclassic benign osteoblastoma and a full blown malignant osteo-sarcoma. This “malignant” osteoblastoma appears and behaves clinically at the local site like an osteosarcoma but has no potential to metastasize to distant parts. In this situation, local treatment must be more aggressive and probably would require a wide localresection to avoid a local recurrence because radiation therapy or even systemic chemotherapy is not effective for this aggressive but benign entity.
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CLASSICCase #51
26 yr maleosteoblastoma L-4
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Lateral view
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Bone scan
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CT scan
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Sagittal T-2 MRI
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Photomic
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Photomic
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5 yrs post op with spontaneous fusion
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AP x-ray 5 yrs post op
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Sagittal gad contrast MRI 5 yrs post op
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Axial gad contrast MRI 5 yrs post op
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Case #52
23 yr male with osteoid osteoma L-5
nidus
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CT scan
nidus
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Photomic
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Photomic
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Recurrence 8 mos post op laminectomy
Recurrence
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CT
Recurrence as an osteoblastoma
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ABC
Secondary ABCbehind osteoblastoma
osteoblastoma
Sagittal T-2 MRI
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Axial T-2 MRI
fluid-fluidlevel
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ABC histology
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ABC histology
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Osteoblastoma histology
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Osteoblastoma histology
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Post op posteriorresection and fusion
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AP x-raypost op fusion
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CT scan later shows anterior recurrence
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Post op anteriorresection and bonecement reconstruction
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Lateral x-ray showinganterior reconstructionwith cement
cement
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Post op CT scan showing cement reconstruction
cement
CD rods
bone graft
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Post op CT
cement
graft
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Case #53
26 yr male with osteoblastoma L-4 following a laminectomy curettement three years previous for an osteoid osteoma
surgical towel clip
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Appearance 4 months later with a 1.5 cm nidus
CT scan
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A curettement at this time revealed an osteoblastoma
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Myelogram 4 yrslater
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CT scan at same time and no pain
burned-outlesion
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Another CT cut
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Sagittal T-1 MRI at same time
Burnt outlesion
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Sagittal T-2 MRI same time
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T-2 MRI with residual ABC in inactive lesion
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Axial T-1 MRI same time
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Axial T-2 MRI with residual ABC component
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Case #54
7 yr femaleosteoblastoma L-2
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Bone scan
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T-2 MRI showshigh signal ABCposterior to low signalosteoblastoma
osteoblastoma
ABC
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SagittalT-2 MRI
osteoblastoma
ABC
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Osteoblastoma Photomic
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AP x-raypost op posteriorspinal fusion
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Lateral X-raypost op
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Case #55
14 yr femaleosteoblastoma L-5
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Oblique X-ray
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Bone scan
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CT scan
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CT scan
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Case #56
24 yr male with osteoblastoma L-3
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Lateral view
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Oblique view
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Opposite oblique
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Case #57
22 year male with osteoblastoma L-1 vertebra
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Oblique view
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Case #58
23yr male with burned out obteoblastoma L-4
![Page 194: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/194.jpg)
Case #59
14 yr maleosteoblastoma C-3
![Page 195: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/195.jpg)
Oblique view
![Page 196: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/196.jpg)
Opposite oblique
![Page 197: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/197.jpg)
post op posteriorfusion and recurrenttumor anterior
One year
![Page 198: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/198.jpg)
Anterior viewwith recurrence
![Page 199: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/199.jpg)
Post op anteriordebriedment andfusion
![Page 200: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/200.jpg)
Case #60
18 yr maleosteoblastomaC-7
![Page 201: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/201.jpg)
Oblique view
![Page 202: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/202.jpg)
Lateral view2 mo later
![Page 203: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/203.jpg)
AP view 1 mo later
![Page 204: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/204.jpg)
Resected nidus
![Page 205: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/205.jpg)
Photomic
![Page 206: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/206.jpg)
Photomic
![Page 207: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/207.jpg)
Case #61
CT scan
55 yr female with osteoblastoma C-6
![Page 208: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/208.jpg)
Bone scan
![Page 209: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/209.jpg)
Sagittal T-1 MRI
![Page 210: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/210.jpg)
Sagittal T-2 MRI
![Page 211: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/211.jpg)
Axial T-2 MRI
![Page 212: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/212.jpg)
Case #62
25 yr female with osteoblastoma C-6
![Page 213: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/213.jpg)
AP x-ray
![Page 214: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/214.jpg)
10 yrs later
![Page 215: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/215.jpg)
Lateral view 10 yrs later
![Page 216: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/216.jpg)
Photomic
![Page 217: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/217.jpg)
Photomic
![Page 218: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/218.jpg)
Case #63
CT scan
40 yr male with osteoblastoma C 5-6
![Page 219: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/219.jpg)
CT scan
![Page 220: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/220.jpg)
Sagittal T-2 MRI
![Page 221: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/221.jpg)
T-2 MRI showing bulge in floor ofvertebral canal
Sagittal
![Page 222: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/222.jpg)
Case #64
13 yr female with osteoblastoma C-6
![Page 223: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/223.jpg)
Lateral view
![Page 224: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/224.jpg)
Post op X-rayAfter anteriorinterbody fusion
![Page 225: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/225.jpg)
Case #65
14 yr female with osteoblastoma C-7
AP X-ray
![Page 226: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/226.jpg)
AP myelogram
![Page 227: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/227.jpg)
Arteriogram showingpressure on vertebralartery
![Page 228: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/228.jpg)
Post op debriedment
![Page 229: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/229.jpg)
Case #66
CT scan
43 yr female with osteoblastoma T-8
![Page 230: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/230.jpg)
Axial T-2 MRI
![Page 231: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/231.jpg)
Sagittal T-1 MRI
![Page 232: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/232.jpg)
Post op posteriorspine fusion
![Page 233: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/233.jpg)
28 yr male with osteoblastoma thoracic spine
Case #67
![Page 234: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/234.jpg)
CT scan
![Page 235: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/235.jpg)
Post op resection
![Page 236: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/236.jpg)
CT scan post op resection
![Page 237: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/237.jpg)
Case #68
21 yr male osteoblastoma S-1
![Page 238: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/238.jpg)
2 years later
![Page 239: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/239.jpg)
5 years later
![Page 240: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/240.jpg)
Lateral view 5 years later
![Page 241: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/241.jpg)
Photomic
![Page 242: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/242.jpg)
Photomic
![Page 243: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/243.jpg)
Case #69
8 yr male with ostoblastoma sacrum
![Page 244: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/244.jpg)
Case #70
26 yr female with osteoblastoma acetabulum
![Page 245: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/245.jpg)
Close up AP
![Page 246: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/246.jpg)
Photomic
![Page 247: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/247.jpg)
Photomic
![Page 248: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/248.jpg)
X-ray 3 mosfollowing THA
![Page 249: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/249.jpg)
Case #71
19 yr male with aggressive osteoblastoma acetabulum
![Page 250: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/250.jpg)
Bone scan
![Page 251: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/251.jpg)
Gross specimen from curettement
![Page 252: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/252.jpg)
Photomic
![Page 253: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/253.jpg)
Photomic
![Page 254: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/254.jpg)
Post op internalhemipelvectomy
![Page 255: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/255.jpg)
Recurrence 4 months later
![Page 256: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/256.jpg)
Ablative hemipelvectomy specimen
tumor
![Page 257: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/257.jpg)
Hemipelvectomy specimen
tumor
![Page 258: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/258.jpg)
Several years later with recurrent tumor on sacrum
![Page 259: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/259.jpg)
Lateral view of recurrence
![Page 260: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/260.jpg)
Case #72
38 yr male osteoblastomapelvis
![Page 261: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/261.jpg)
Frog lateral
![Page 262: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/262.jpg)
Post op x-ray following curettage and cementation
![Page 263: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/263.jpg)
Case #73
33 yr female with osteoblastoma acetabulum
![Page 264: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/264.jpg)
Axial T-1 MRI
![Page 265: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/265.jpg)
Coronal T-2 MRI
![Page 266: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/266.jpg)
Case #74
26 yr male with osteoblastoma acetabulum
![Page 267: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/267.jpg)
Frog lateral
![Page 268: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/268.jpg)
Case #75
24 yr male with osteoblastoma pelvis
![Page 269: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/269.jpg)
18 mos later
![Page 270: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/270.jpg)
Case #76
22 yr male with osteoblastoma ischium
![Page 271: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/271.jpg)
X-ray of resected specimen
nidus
![Page 272: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/272.jpg)
Case #77
26 yr male with osteoblastoma ilium
![Page 273: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/273.jpg)
CT scan
![Page 274: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/274.jpg)
Post op x-ray appearance after resection and cementation
![Page 275: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/275.jpg)
Case #78
23 yr maleosteoblastomafemur
![Page 276: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/276.jpg)
CT scan
![Page 277: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/277.jpg)
T-2 MRI
![Page 278: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/278.jpg)
Sagittal T-2 MRI
![Page 279: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/279.jpg)
Photomic
![Page 280: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/280.jpg)
Case #78.1
19 year male with tibial pain for 6 mos
![Page 281: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/281.jpg)
Axial
T-1 T-2
Gad +
![Page 282: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/282.jpg)
Coronal T-1 T-2 Gad
![Page 283: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/283.jpg)
X-ray 3 months post op
![Page 284: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/284.jpg)
Case #79
15 yr maleosteoblastomafemur
![Page 285: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/285.jpg)
Bone scan
![Page 286: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/286.jpg)
CT scan
![Page 287: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/287.jpg)
Axial T-2 MRI
![Page 288: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/288.jpg)
Coronal T-1MRI
![Page 289: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/289.jpg)
X-ray at time ofsurgery with markerin tumor defect
![Page 290: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/290.jpg)
Photomic of nidus
![Page 291: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/291.jpg)
Case #79.1
14 yr male with dull aching thigh pain for 1 year
CT scan Sclerosing osteomyelitis of Garre
![Page 292: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/292.jpg)
Coronal T-1 Coronal T-2
![Page 293: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/293.jpg)
Sagittal T-2 Axial T-2
![Page 294: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/294.jpg)
Case #80
13 yr male with osteoblastoma femoral neckfrog lateral view
![Page 295: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/295.jpg)
AP view
![Page 296: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/296.jpg)
Bone scan
![Page 297: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/297.jpg)
Case #81
22 yr male with osteoblastoma talus
![Page 298: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/298.jpg)
Sagittal T-1 MRI
![Page 299: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/299.jpg)
Coronal T-2 MRI
![Page 300: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/300.jpg)
Coronal T-2 MRI
![Page 301: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/301.jpg)
Photomic
![Page 302: An Atlas of Musculoskeletal Oncology: Volume 1](https://reader037.fdocuments.in/reader037/viewer/2022103110/54814672b4af9fe4338b4682/html5/thumbnails/302.jpg)
Case #82
25 yr maleosteoblastomatalus
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Lateral view
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Close up lateral
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Photomic
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Case #83
18 yr female with osteoblastoma talus
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Mortise view
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X-ray 1 yr after curettage
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Case #84
23 yr male with osteoblastoma talus
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Case #85
25 yr female with osteoblastoma os calcis
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Os calcis view
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X-ray several months with progression of disease
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Case #86
29 yr male with osteoblastoma os calcis
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Case #87
53 yr male with osteoblastoma distal humerus
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X-ray 3 years later
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tumor
edema
Axial T-2 MRI
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Coronal T-2 MRI
nidusedema
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Post op x-rayfollowing distalhumeral resectionand allograft reconstruction
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Case #88
9 yr femaleosteoblastomadistal humerus
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Coronal T-1 MRI
edema
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Axial T-2 MRI
tumor
edema
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Case #88.1
11 yr male with ABC response to osteoblastoma humerus
nidus
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Sag T-1
Sag T-2
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Axial T-2 MRI shows the multiloculated aneurysmal cysts
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Case #89
21 yr male with osteoblastoma ring finger
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AP and Lateral radiographs
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Gross specimen
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Photomic
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Case #90
18 yr male with osteoblastoma finger
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Case #91
21 yr male with osteoblastoma thumb
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Case #92
10 yr female with osteoblastoma finger tip
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AP X-ray
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Case #93
9 yr femaleosteoblastoma tibia
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AP x-ray
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Case #94
24 yr male with osteoblastoma fibula
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Lateral view
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Osteofibrous Osteofibrous DysplasiaDysplasia
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Osteofibrous Dysplasia
Osteofibrous dysplasia is a rare condition occurring in children less than 10 years of age. This benign lesion has radiographic and microscopic features similar to fibrousdysplasia of the tibia, the main difference being the presenceof more heavily ossified tissue at the periphery of the lesiongiving it a soap-bubbly appearance on x-ray. Microscopicallyit has a similar “alphabet-soup” metablastic bone appearance in a benign fibrous tissue stroma but with the additional featureof heavy osteoblastic rimming of the trabeculae not seen in fibrous dysplasia. It typically arises from the anterior cortex of the tibia at mid shaft and causes a progressive anterior bowing of the tibia over time, creating a cosmetic deformity associated with pain of a dull, aching nature. The radiographic appearanceIs very similar to and impossible to separate from that of theMalignant adamantinoma that also affects the tibia in children
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and, for this reason, a biopsy must be performed to rule out themalignant possibility. Occasionally osteofibrous dysplasia of thetibia can progress gradually into a well-differentiated formof the adamantinoma, which will have the microscopic features of both osteofibrous dysplasia and adamantinomain the same lesion. As far as treatment is concerned, early surgical debriedment and bone grafting before age 15 years results in a high local recurrence rate and thus should be discouraged until the child reaches full bone maturity at which time a definitive debriedment and bone grafting procedurecan be performed without significant risk of recurrence. Thislesion occurs bilaterally in a very small percentage of cases and can also involve the fibula on the same side. This processin newborns appears to be more osteolytic and destructive in nature.
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CLASSICCase #95
9 yr male osteofibrous dysplasiatibia
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AP and lateral x-ray
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Photomic
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Case #96
6 year femaleosteofibrous dysplasiatibia
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Same case
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Case #97
16 year femaleosteofibrous dysplasiatibia
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Case #98
8 yr maleosteofibrous dysplasiatibia
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X-ray appearance3 yrs later
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8 yrs later with spontaneous healing
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Case #98.1
61 year old male with incidental finding in tibia for years
Burnt out osteofibrous dysplasia
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Bone scan
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Sag T-1 PD FS Gad
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Cor STIR Gad
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Axial T-1 T-2 FS
Gad
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Case #99
15 yr femaleosteofibrous dysplasiatibia
AP x-ray
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Lateral x-ray
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Case #100
Newborn with osteofibrous dysplasia tibia
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T-2 axial MRI
edema
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Photomic
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Photomic
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X-ray 1 yr later
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Case #101
Another newbornosteofibrous dysplasiatibia
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Another view
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Ossifying Ossifying Fibroma of Fibroma of
JawboneJawbone
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Ossifying Fibroma of Jawbone
Ossifying fibroma of jawbone is a benign condition similar toosteofibrous dysplasia of the tibia in that histologically they arealmost identical. It is also a condition that is related to fibrous dysplasia, which can have a very similar radiographic appearance,but in the case of fibrous dysplasia of jawbone osteoblastic rimming of the trabecular bone is not seen under microscopicevaluation. As with fibrous dysplasia, this condition is found in children and is almost always an asymptomatic process resulting in cosmetic deformation of the maxilla or mandible, usually on one side but can be bilateral. The condition can result in significant malocclusion of the teeth because of deformationof the subadjacent alveolar ridge or maxillary structures. It alsocan create problems with normal drainage from the air sinuses in the maxilla that can lead to infection requiring surgical drainage.Most of the surgical treatment for this condition is for cosmeticdeformity.
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Case #102
5 yr female ossifying fibromamaxilla
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Maxillary view
tumor
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Tomogram cut
tumor
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CT scan
tumor
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Another cut
tumor
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Another cut
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Photomic
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Case #103
18 yr female with ossifying fibroma mandible
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Oblique view
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Photomic
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Closeup of alphabet-soup metaplastic bone
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Case #104
12 yr female with ossifying fibroma mandible
tumor
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Opposite ramus
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Case #105
14 yr female with ossifying fibroma mandible
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Case #106
Young adultosteoma skull
tumor
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Occipital view
tumor
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Lateral view
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Case #107
Cementoma mandible
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Oblique view