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benign tumor of bone and fibrous tissue; occurs in the vertebrae or femur or tibia or arm bones (especially in young adults)

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2017/04/18 12:51:15」(JST)

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Osteoblastoma is an uncommon osteoid tissue-forming^[1] primary neoplasm of the bone.

It has clinical and histologic manifestations similar to those of osteoid osteoma; therefore, some consider the two tumors to be variants of the same disease,^[2] with osteoblastoma representing a giant osteoid osteoma. However, an aggressive type of osteoblastoma has been recognized, making the relationship less clear.

Although similar to osteoid osteoma, it is larger (between 2 and 6 cm).^[3]

Pathophysiology

The cause of osteoblastoma is unknown. Histologically, osteoblastomas are similar to osteoid osteomas, producing both osteoid and primitive woven bone amidst fibrovascular connective tissue, the difference being that osteoblastoma can grow larger than 2.0 cm in diameter while osteoid osteomas cannot. Although the tumor is usually considered benign, a controversial aggressive variant has been described in the literature, with histologic features similar to those of malignant tumors such as an osteosarcoma.

Frequency

In the US, Osteoblastomas account for only 0.5-2% of all primary bone tumors and only 14% of benign bone tumors making it a relatively rare form of bone tumor.

In regards to morbidity and mortality, conventional osteoblastoma is a benign lesion with little associated morbidity. However, the tumor may be painful, and spinal lesions may be associated with scoliosis and neurologic manifestations. Metastases and even death have been reported with the controversial aggressive variant, which can behave in a fashion similar to that of osteosarcoma. This variant is also more likely to recur after surgery than is conventional osteoblastoma.

Osteoblastoma affects more males than it does females, with a ratio of 2-3:1 respectively. Osteoblastoma can occur in persons of any age, although the tumors predominantly affect the younger population (around 80% of these tumors occurs in persons under the age of 30). No racial predilection is recognized.

It usually presents in the vertebral column or long bones.^[4]^[5] Approximately 40% of all osteoblastomas are located in the spine. The tumors usually involve the posterior elements, and 17% of spinal osteoblastomas are found in the sacrum. The long tubular bones are another common site of involvement, with a lower extremity preponderance. Osteoblastoma of the long tubular bones is often diaphyseal, and fewer are located in the metaphysis. Epiphyseal involvement is extremely rare. Although other sites are rarely affected, several bones in the abdomen and extremities have been reported as sites of osteoblastoma tumors.

Signs and symptoms

Patients with osteoblastoma usually present with pain of several months' duration. In contrast to the pain associated with osteoid osteoma, the pain of osteoblastoma usually is less intense, usually not worse at night, and not relieved readily with salicylates (aspirin and related compounds). If the lesion is superficial, the patient may have localized swelling and tenderness. Spinal lesions can cause painful scoliosis, although this is less common with osteoblastoma than with osteoid osteoma. In addition, lesions may mechanically interfere with the spinal cord or nerve roots, producing neurologic deficits. Pain and general weakness are common complaints.

Diagnosis

When diagnosing osteoblastoma, the preliminary radiologic workup should consist of radiography of the site of the patient's pain. However, computed tomography (CT) is often necessary to support clinical and plain radiographic findings suggestive of osteoblastoma and to better define the margins of the lesion for potential surgery. CT scans are best used for the further characterization of the lesion with regard to the presence of a nidus and matrix mineralization. MRI aids in detection of nonspecific reactive marrow and soft tissue edema, and MRI best defines soft tissue extension, although this finding is not typical of osteoblastoma. Bone scintigraphy (bone scan) demonstrates abnormal radiotracer accumulation at the affected site, substantiating clinical suspicion, but this finding is not specific for osteoblastoma. In many patients, biopsy is necessary for confirmation.

Treatment

The first route of treatment in Osteoblastoma is via medical means. Although necessary, radiation therapy (or chemotherapy) is controversial in the treatment of osteoblastoma. Cases of postirradiation sarcoma have been reported after use of these modalities. However, it is possible that the original histologic diagnosis was incorrect and the initial lesion was an osteosarcoma, since histologic differentiation of these two entities can be very difficult.

The alternative means of treatment consists of surgical therapy. The treatment goal is complete surgical excision of the lesion.^[6] The type of excision depends on the location of the tumor.

For stage 1 and 2 lesions, the recommended treatment is extensive intralesional excision, using a high-speed burr. Extensive intralesional resections ideally consist of removal of gross and microscopic tumor and a margin of normal tissue.
For stage 3 lesions, wide resection is recommended because of the need to remove all tumor-bearing tissue. Wide excision is defined here as the excision of tumor and a circumferential cuff of normal tissue around the entity. This type of complete excision is usually curative for osteoblastoma.

In most patients, radiographic findings are not diagnostic of osteoblastoma; therefore, further imaging is warranted. CT examination performed with the intravenous administration of contrast agent poses a risk of an allergic reaction to contrast material.

The lengthy duration of an MRI examination and a history of claustrophobia in some patients are limiting the use of MRI. Although osteoblastoma demonstrates increased radiotracer accumulation, its appearance is nonspecific, and differentiating these lesions from those due to other causes involving increased radiotracer accumulation in the bone is difficult. Therefore, bone scans are useful only in conjunction with other radiologic studies and are not best used alone.

References

^ "osteoblastoma" at Dorland's Medical Dictionary
^ George, Timothy; Daniel H. Kim; Kaufman, Bruce E.; Sean Lew; Narayan Yogananda; Patrick Barnes; Andy Herlich; Deletis, Vedran; Francesco Sala; Frederick Boop; Sigurd Berven; Menezes, Arnold H.; William C. Oakes; Keith Aronyk; Vaccaro, Alexander R. (2007). Surgery of the Pediatric Spine. Thieme New York. p. 312. ISBN 1-58890-342-7.
^ Rubash, Harry E.; Callaghan, John; Rosenberg, Aaron (2007). The adult hip. Hagerstwon, MD: Lippincott Williams & Wilkins. p. 542. ISBN 0-7817-5092-X.
^ Tugcu B, Gunaldi O, Gunes M, Tanriverdi O, Bilgic B (October 2008). "Osteoblastoma of the temporal bone: a case report". Minim Invasive Neurosurg. 51 (5): 310–2. doi:10.1055/s-0028-1083816. PMID 18855299.
^ Mortazavi SM, Wenger D, Asadollahi S, Shariat Torbaghan S, Unni KK, Saberi S (March 2007). "Periosteal osteoblastoma: report of a case with a rare histopathologic presentation and review of the literature". Skeletal Radiol. 36 (3): 259–64. doi:10.1007/s00256-006-0169-2. PMID 16868789.
^ Max Aebi; Gunzburg, Robert; Szpalski, Marek (2007). Vertebral Tumors. Hagerstwon, MD: Lippincott Williams & Wilkins. p. 172. ISBN 0-7817-8867-6.

UpToDate Contents

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1. 小児および思春期における良性骨腫瘍：概要 benign bone tumors in children and adolescents an overview
2. 骨肉腫：疫学、病因、臨床症状、診断、および組織学的検査 osteosarcoma epidemiology pathogenesis clinical presentation diagnosis and histology
3. 骨転移、多発性骨髄腫、およびリンパ腫における完全および切迫病的骨折の評価およびマネージメント evaluation and management of complete and impending pathologic fractures in patients with metastatic bone disease multiple myeloma and lymphoma
4. 小児および思春期における腰痛：原因の概要 back pain in children and adolescents overview of causes
5. オズグッド-シュラッター病（脛骨粗面剥離） osgood schlatter disease tibial tuberosity avulsion

English Journal

Clinical characteristics and treatment options for two types of osteoblastoma in the mobile spine: a retrospective study of 32 cases and outcomes.

Yin H, Zhou W, Yu H, Li B, Zhang D, Wu Z, Liu T, Xiao J.Author information Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.AbstractPURPOSE: A retrospective study of 32 patients with osteoblastoma (OBL) in the mobile spine was performed to analyze the clinical characteristics of two types of spinal OBL. We also aimed to find influential factors for OBL in the mobile spine.
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society.Eur Spine J.2014 Feb;23(2):411-6. doi: 10.1007/s00586-013-3049-1. Epub 2013 Oct 1.
PURPOSE: A retrospective study of 32 patients with osteoblastoma (OBL) in the mobile spine was performed to analyze the clinical characteristics of two types of spinal OBL. We also aimed to find influential factors for OBL in the mobile spine.METHODS: Between 2002 and 2011, 32 patients with either c
PMID 24081688

Primary atlantoaxial bone tumors in children: management strategies and long-term follow-up.

Menezes AH, Ahmed R.Author information Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa.AbstractObject Atlantoaxial tumors account for a substantial proportion of primary bone tumors in children. Before resection, surgeons must consider the complex regional anatomy, the potential for neurological compromise, craniocervical instability, and the question of tumor resectability in a growing spine. Using current technology, the authors analyzed surgical cases in this light and present outcomes and treatment recommendations after long-term patient follow-up. Methods: The authors reviewed clinical records for 23 children whose primary atlantoaxial bone tumors were treated from 1996 through 2010. Results Pathological lesions among the 23 patients were 4 aneurysmal bone cysts, 2 osteochondromas, 5 chordomas, 4 osteoblastomas, 3 fibrous dysplasias, 4 eosinophilic granulomas, and 1 Ewing's sarcoma. Clinical presentation consisted of neck pain (n = 23), headaches and occipital pain (n = 16), myelopathy (n = 8), and torticollis (n = 4). Selective angiography and coil embolization were undertaken for all patients with aneurysmal bone cysts and osteoblastomas, 2 patients with chordomas, 1 patient with fibrous dysplasia, and 1 patient with Ewing's sarcoma. Primary embolization treatment of radiation-induced aneurysmal bone cyst of the atlas showed complete reossification. Results of CT-guided needle biopsy were diagnostic for 1 patient with eosinophilic granuloma and 1 with Ewing's sarcoma. Needle biopsies performed before referral were associated with extreme blood loss for 1 patient and misdiagnosis for 2 patients. Surgery involved lateral extrapharyngeal, transoral, posterior, and posterolateral approaches with vertebral artery rerouting. Complete resection was possible for 9 patients (2 with osteochondroma, 3 with fibrous dysplasia, 2 with chordoma, and 2 with osteoblastoma). Decompression and internal fusion were performed for 3 patients with aneurysmal bone cysts. Of the 23 patients, 7 underwent dorsal fusion and 4 underwent ventral fusion of the axis body. Chemotherapy was necessary for the patients with eosinophilic granuloma with multifocal disease and for the patient with Ewing's sarcoma. There was no morbidity, and there were no deaths. All patients with benign lesions were free of disease at the time of the follow-up visit (mean ± SD follow-up 8.8 ± 1.1 years; range 2-18 years). Chordomas received proton or LINAC irradiation, and as of 4-15 years of follow-up, no recurrence has been noted. Conclusions Because most atlantoaxial tumors in children are benign, an intralesional procedure could suffice. Vascular control and staged resection are critical. Ventral transoral fusion or lateral extrapharyngeal fusion has been successful. Resection with ventral fusion and reconstruction are essential for vertebral body collapse. Management of eosinophilic granulomas must be individualized and might require diagnosis through needle biopsy.
Journal of neurosurgery. Pediatrics.J Neurosurg Pediatr.2014 Jan 17. [Epub ahead of print]
Object Atlantoaxial tumors account for a substantial proportion of primary bone tumors in children. Before resection, surgeons must consider the complex regional anatomy, the potential for neurological compromise, craniocervical instability, and the question of tumor resectability in a growing spine
PMID 24437986

Cervical Osteoid Osteoma Progression to Osteoblastoma.

Cappuccio M1, De Iure F2, Amendola L2, Corghi A2, Gasbarrini A3.Author information 1Department of Orthopedics and Traumatology - Spine Surgery, Maggiore Hospital, Largo Nigrisoli, 2 - 40100 Bologna, Italy. Electronic address: m.cappuccio73@gmail.com.2Department of Orthopedics and Traumatology - Spine Surgery, Maggiore Hospital, Largo Nigrisoli, 2 - 40100 Bologna, Italy.3Department of Oncologic and Degenerative Spine Surgery, Rizzoli Orthopedics Institute, Via G.C. Pupilli, 1 - 40100 Bologna, Italy.KEYWORDS: Osteoblastoma, Osteoid Osteoma, Spine
The spine journal : official journal of the North American Spine Society.Spine J.2014 Jan 17. pii: S1529-9430(14)00055-2. doi: 10.1016/j.spinee.2013.12.021. [Epub ahead of print]
PMID 24445325

Japanese Journal

Aggressive "Benign" Primary Spine Neoplasms : Osteoblastoma, Aneurysmal Bone Cyst, and Giant Cell Tumor

HARROP James S.,SCHMIDT Meic H.,BORIANI Stefano,SHAFFREY Christopher I.
Spine 34(22), S39-S47, 2009-10-15
NAID 10029045196

多椎間に黄色靭帯骨化を伴った胸椎骨芽細胞腫の1例

小林倫子,池田義和,雄賀多聡,清水耕,中島文毅,青木保親,吉原正和,齊藤雅彦,山縣正庸
関東整形災害外科学会雑誌 40(3), 193-198, 2009-06-01
NAID 10024755083

上顎前歯部に発生した骨芽細胞腫の1例

瀬田修一,高野正行,高崎義人,古澤圭,柿澤卓,松坂賢一
日本口腔診断学会雑誌 = Japanese journal of oral diagnosis/oral medicine 22(1), 78-84, 2009-03-30
NAID 10026398611

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