Skeletal Radiology

, Volume 22, Issue 7, pp 485–500 | Cite as

Benign bone-forming lesions: osteoma, osteoid osteoma, and osteoblastoma

Clinical, imaging, pathologic, and differential considerations
  • Adam Greenspan


The benign bone lesions — osteoma, osteoid osteoma, and osteoblastoma — are characterized as bone-forming because tumor cells produce osteoid or mature bone. Osteoma is a slow-growing lesion most commonly seen in the paranasal sinuses and in the calvaria. When it occurs in the long bones, it is invariably juxtacortical and may need to be differentiated from, among others, parosteal osteosarcoma, sessile osteochondroma, and a matured juxtacortical focus of myositis ossificans. Osteoid osteoma and osteoblastoma appear histologically very similar. Their clinical presentations and distribution in the skeleton, however, are distinct: osteoid osteoma is usually accompanied by nocturnal pain promptly relieved by salicylates; osteoblastoma arises predominantly in the axial skeleton, spinal lesions constituting one-third of reported cases. This review focuses on the application of the various imaging modalities in the diagnosis, differential diagnosis, and evaluation of these lesions. Their histopathology also is discussed, and their treatment briefly outlined.

Key words

Bone neoplasms Osteoblastic tumors Benign bone-forming lesions Osteoma Osteoid osteoma Osteoblastoma 


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  1. 1.
    Alani WO, Bartal E (1987) Osteoid osteoma of the femoral neck simulating an inflammatory synovitis. Clin Orthop 223:308Google Scholar
  2. 2.
    Ambrosia JM, Wold LE, Amadio PC (1987) Osteoid osteoma of the hand and wrist. J Hand Surg 12A:794Google Scholar
  3. 3.
    Ayala AG, Murray JA, Erling MA, Raymond AK (1986) Osteoid osteoma: intraoperative tetracycline-fluorescence demonstration of the nidus. J Bone Joint Surg [Am] 68:747Google Scholar
  4. 4.
    Azar CA (1978) Painless osteoid-osteoma in phalanx of finger: A case of unusual presentation and symptomatology. Bull Hosp Joint Dis 39:86Google Scholar
  5. 5.
    Azouz EM, Kozlowski K, Marton D, Sprague P, Zerhouni A, Asselah F (1989) Osteoid osteoma and osteoblastoma of the spine in children: a report of 22 cases with brief literature review. Pediatr Radiol 16:25Google Scholar
  6. 6.
    Baum PA, Nelson MC, Lack EE, Bogumill GP (1989) Case report 560. Parosteal osteoma of tibia. Skeletal Radiol 18:406Google Scholar
  7. 7.
    Bell RS, O'Connor GD, Waddell JP (1989) Importance of magnetic resonance imaging in osteoid osteoma: a case report. Can J Surg 32:276Google Scholar
  8. 8.
    Bertoni F, Unni KK, McLeod RA, Dahlin DC (1985) Osteosarcoma resembling osteoblastoma. Cancer 55:416Google Scholar
  9. 9.
    Brody JM, Brower AC, Shannon FB (1992) An unusual epiphyseal osteoid osteoma. AJR 158:609Google Scholar
  10. 10.
    Byers PD (1968) Solitary benign osteoblastic lesions of bone. Osteoid osteoma and benign osteoblastoma. Cancer 22:43Google Scholar
  11. 11.
    Capanna R, Ayala A, Bertoni F, Picci P, Calderoni P, Gherlinzoni F, Bettelli G, Campanacci M (1986) Sacral osteoid osteoma and osteoblastoma: a report of 13 cases. Arch Orthop Trauma Surg 105:205Google Scholar
  12. 12.
    Capanna R, Van Horn JR, Ayala A, Picci P, Betelli G (1986) Osteoid osteoma and osteoblastoma of the talus: a report of 40 cases. Skeletal Radiol 15:360Google Scholar
  13. 13.
    Cervilla V, Haghighi P, Resnick D, Sartoris DJ (1990) Case report 596: Parosteal osteoma of the acetabulum. Skeletal Radiol 19:135Google Scholar
  14. 14.
    Chang CH, Piatt ED, Thomas K, Watne A (1968) Bone abnormalities in Gardner's syndrome. AJR 103:645Google Scholar
  15. 15.
    Corbett JM, Wilde AH, McCormack LJ, Evarts CM (1974) Intra-articular osteoid osteoma: a diagnostic problem. Clin Orthop 98:225Google Scholar
  16. 16.
    Crim JR, Mirra JM, Eckardt JJ, Seeger LL (1990) Widespread inflammatory response to osteoblastoma: the flare phenomenon. Radiology 177:835Google Scholar
  17. 17.
    Cronemeyer RL, Kirchmer NA, De Smet AA, Neff JR (1981) Intraarticular osteoid osteoma of the humerus simulating synovitis of the elbow: a case report. J Bone Joint Surg [Am] 63:1172Google Scholar
  18. 18.
    Dahlin DC, Johnson EW Jr (1954) Giant osteoid osteoma. J Bone Joint Surg [Am] 36:559Google Scholar
  19. 19.
    Dahlin DC, Unni KK (1987) Bone tumors: general aspects and data on 8542 cases, 4th edn. Thomas, Springfield, pp 88–101Google Scholar
  20. 20.
    Damsin JP, Aufaure P, Sirinelli D, Carlioz H (1987) Epiphyseal osteoid osteoma: report of a case. Rev Chir Orthop 1:57Google Scholar
  21. 21.
    Denis F, Armstrong GW (1984) Scoliogenic osteoblastoma of the posterior end of the rib: a case report. Spine 9:74Google Scholar
  22. 22.
    DeSouza Dias L, Frost HM (1974) Osteoid osteoma-osteoblastoma. Cancer 33:1075Google Scholar
  23. 23.
    Destian S, Hernanz-Schulman M, Raskin K, Genieser N, Becker M, Crider R, Greco MA (1988) Case report 468: Epiphyseal osteoid osteoma distal end of femur. Skeletal Radiol 17:141Google Scholar
  24. 24.
    Dockert MB, Ghormley RK, Jackson AE (1951) Osteoid osteoma; clinicopathologic study of 20 cases. Ann Surg 133:77Google Scholar
  25. 25.
    Dolan K, Seibert J, Seibert R (1973) Gardner's syndrome. AJR 119:359Google Scholar
  26. 26.
    Dorfman HD, Weiss SW (1984) Borderline osteoblastic tumors: problems in the differential diagnosis of aggressive osteoblastoma and low-grade osteosarcoma. Semin Diagn Pathol 1:215Google Scholar
  27. 27.
    Doyle T, King K (1989) Percutaneous removal of osteoid osteoma using CT control. Clin Radiol 40:514Google Scholar
  28. 28.
    Dunlap H, Martin DJ (1985) Osteoid osteoma of the femoral head. Pediatr Radiol 15:262Google Scholar
  29. 29.
    Eckel W, Palm D (1959) Statistische und röntgenologische Untersuchungen zu einigen Fragen des Nebenhöhlenosteoms. Arch ONK Heilkd 174:440Google Scholar
  30. 30.
    Edeiken J, DePalma AF, Hodes PJ (1966) Osteoid osteoma (roentgenographic emphasis). Clin Orthop 49:201Google Scholar
  31. 31.
    Esquerdo J, Fernandez CF, Gomas F (1976) Pain in osteoid osteoma: histological facts. Acta Orthop Scand 47:520Google Scholar
  32. 32.
    Fabris D, Traihiti G, Di Comun M, Agostini S (1983) Scoliosis due to rib osteoblastoma: report of two cases. J Pediatr Orthop 3:370Google Scholar
  33. 33.
    Farmlett EJ, Magid D, Fishman EK (1986) Osteoblastoma of the tibia: CT demonstration. J Comput Assist Tomogr 10:1068Google Scholar
  34. 34.
    Freiberger RH, Loitman BS, Helpern M, Thompson TC (1959) Osteoid osteoma: a report of 80 cases. AJR 82:194–205Google Scholar
  35. 35.
    Gamba JL, Martinez S, Apple J, Harrelson JM, Nunley JA (1984) Computed tomography of axial skeletal osteoid osteomas. AJR 142:769Google Scholar
  36. 36.
    Gardner DJ, Azouz EM (1988) Solitary lucent epiphyseal lesions in children. Skeletal Radiol 17:497PubMedGoogle Scholar
  37. 37.
    Gardner E, Richards R (1953) Multiple cutaneous and subcutaneous lesions occurring simultaneously with hereditary polyposis and osteomatosis. Am J Hum Genet 5:139Google Scholar
  38. 38.
    Gardner EJ, Plenk HD (1953) Hereditary pattern for multiple osteomas in a family group. Am J Hum Genet 4:31Google Scholar
  39. 39.
    Gentry JF, Schechter JJ, Mirra JM (1989) Case report 574: Periosteal osteoblastoma of rib. Skeletal Radiol 18:551Google Scholar
  40. 40.
    Geschickler CF, Copeland MM (1951) Parosteal osteoma of bone: a new entity. Ann Surg 133:790Google Scholar
  41. 41.
    Ghelman B, Thompson FM, Arnold WD (1981) Intraoperative radioactive localization of an osteoid osteoma. Case report. J Bone Joint Surg [Am] 63A:826Google Scholar
  42. 42.
    Glass RBJ, Poznanski AK, Fisher MR, Shkolnik A, Dias L (1986) Case report: MR imaging of osteoid osteoma. J Comput Assist Tomogr 10:1065Google Scholar
  43. 43.
    Glynn JJ, Lichtenstein L (1973) Osteoid osteoma with multicentric nidus: a report of two cases. J Bone Joint Surg [Am] 55:855Google Scholar
  44. 44.
    Goldberg VM, Jacobs B (1975) Osteoid osteoma of the hip in children. Clin Orthop 106:41Google Scholar
  45. 45.
    Goldman AB, Schneider R, Pavlov H (1993) Osteoid osteoma of the femoral neck: report of four cases evaluated with isotopic bone scanning, CT, and MR imaging. Radiology 186:227Google Scholar
  46. 46.
    Greenspan A (1991) Sclerosing bone dysplasias — a target-site approach. Skeletal Radiol 20:561Google Scholar
  47. 47.
    Greenspan A (1992) Orthopedic radiology, 2nd edn. Gower, New York, LondonGoogle Scholar
  48. 48.
    Greenspan A, Elguezabel A, Bryk D (1974) Multifocal osteoid osteoma: a case report and review of the literature. AJR 121:103PubMedGoogle Scholar
  49. 49.
    Healey JH, Ghelman B (1986) Osteoid osteoma and osteoblastoma: current concepts and recent advances. Clin Orthop 204:76Google Scholar
  50. 50.
    Helms CA (1987) Osteoid osteoma: the double density sign. Clin Orthop 222:167Google Scholar
  51. 51.
    Helms CA, Hattner RS, Vogler JB (1984) Osteoid osteoma: radionuclide diagnosis. Radiology 151:779Google Scholar
  52. 52.
    Herrlin K, Ekelund L, Lövdahl R, Persson B (1982) Computed tomography in suspected osteoid osteomas of tubular bones. Skeletal Radiol 9:92Google Scholar
  53. 53.
    Jackson RP (1978) Recurrent osteoblastoma: a review. Clin Orthop 131:229Google Scholar
  54. 54.
    Jackson RP, Reckling FW, Mantz FA (1977) Osteoid osteoma and osteoblastoma: similar histologic lesions with different natural histories. Clin Orthop 128:303Google Scholar
  55. 55.
    Jacobson HG (1985) Dense bone — too much bone: radiological considerations and differential diagnosis. Part I. Skeletal Radiol 13:1Google Scholar
  56. 56.
    Jacobson HG (1985) Dense bone — too much bone: radiological considerations and differential diagnosis. Part II. Skeletal Radiol 13:97Google Scholar
  57. 57.
    Jaffe HL (1935) Osteoid osteoma: a benign osteoblastic tumor composed of osteoid and atypical bone. Arch Surg 31:709Google Scholar
  58. 58.
    Jaffe HL (1945) Osteoid osteoma of bone. Radiology 45:319Google Scholar
  59. 59.
    Jaffe HL (1956) Benign osteoblastoma. Bull Hosp Joint Dis 17:171Google Scholar
  60. 60.
    Jaffe HL, Lichtenstein L (1940) Osteoid osteoma: further experience with this benign tumor of bone. J Bone Joint Surg 22:645Google Scholar
  61. 61.
    Jaffe HL, Mayer L (1932) An osteoblastic osteoid tissue-forming tumor of a metacarpal bone. Arch Surg 24:550Google Scholar
  62. 62.
    Kattapuram SV, Kushner DC, Phillips WC, Rosenthal DI (1983) Osteoid osteoma: an unusual cause of articular pain. Radiology 147:383Google Scholar
  63. 63.
    Keim HA, Reina EG (1975) Osteoid osteoma as a cause of scoliosis. J Bone Joint Surg [Am] 57-A:159Google Scholar
  64. 64.
    Kendirck JL, Evarts CM (1967) Osteoid osteoma: a critical analysis of 40 tumors. Clin Orthop 54:51Google Scholar
  65. 65.
    Keret D, Harcke HT, MacEwen GD, Bowen JR (1989) Multiple osteoid osteomas of the fifth lumbar vertebra. Clin Orthop 248:163Google Scholar
  66. 66.
    Klein MH, Shankman S (1992) Osteoid osteoma: radiologic and pathologic correlation. Skeletal Radiol 21:23Google Scholar
  67. 67.
    Klein MJ, Lusskin R, Becker MH, Antopol SC (1979) Osteoidosteoma of the clavicle. Clin Orthop Rel Res 143:162Google Scholar
  68. 68.
    Kransdorf MJ, Stull MA, Gilkey FW, Moser RP Jr (1991) From the archives of the AFIP. Osteoid osteoma. Radiographics 11:671Google Scholar
  69. 69.
    Kricun ME (1993) Imaging of bone tumors. Saunders, Philadelphia, p 115Google Scholar
  70. 70.
    Krolls SO, Jacouny JR, Alexander WN (1971) Osseous choristomas (osteomas) of intraoral soft tissues. Oral Surg 32:580Google Scholar
  71. 71.
    Kroon HM, Schurmans J (1990) Osteoblastoma: clinical and radiologic findings in 98 new cases. Radiology 175:783Google Scholar
  72. 72.
    Kumar SJ, Harcke T, MacEwen GD, Ger E (1984) Osteoid osteoma of the proximal femur: new techniques in diagnosis and treatment. J Pediatr Orthop 4:669Google Scholar
  73. 73.
    Lawrie TR, Aterman K, Sinclair AM (1970) Painless osteoid osteoma: a report of two cases. J Bone Joint Surg [Am] 52-A:1357Google Scholar
  74. 74.
    Lichtenstein L (1956) Benign osteoblastoma. A category of osteoid- and bone-forming tumors other than classical osteoid osteoma, which may be mistaken for giant-cell tumor or osteogenic sarcoma. Cancer 9:1044Google Scholar
  75. 75.
    Lichtenstein L (1977) Bone tumors, 5th edn. Mosby, St Louis, p 11Google Scholar
  76. 76.
    Lichtenstein L, Sawyer WR (1964) Benign osteoblastoma: further observations and report of twenty additional cases. J Bone Joint Surg [Am] 46-A:755Google Scholar
  77. 77.
    Lindbom Å, Lindvall N, Söderberg G, Spjut H (1960) Angiography in osteoid osteoma. Acta Radiol 54:327Google Scholar
  78. 78.
    Lisbona R, Rosenthall L (1979) Role of radionuclide imaging in osteoid osteoma. AJR 132:77Google Scholar
  79. 79.
    Marsh BW, Bonfiglio M, Brady LP, Enneking WF (1975) Benign osteoblastoma: range of manifestations. J Bone Joint Surg [Am] 57-A:1Google Scholar
  80. 80.
    McConnell JR, Daneman A (1984) Case report: fatty replacement of muscles adjacent to spinal osteoid osteoma. J Comput Assist Tomogr 8:147Google Scholar
  81. 81.
    McConnell III B, Dell PC (1984) Localization of an osteoid osteoma nidus in a finger by use of computed tomography: a case report. J Hand Surg [Am] 9:139Google Scholar
  82. 82.
    McLeod RA, Dahlin DC, Beabout JW (1976) The spectrum of osteoblastoma. AJR 126:321Google Scholar
  83. 83.
    Mirra JM, Gold RH, Pignatti G, Remotti F (1988) Case report 497: Compact osteoma of iliac bone. Skeletal Radiol 17:437Google Scholar
  84. 84.
    Mirra JM, Picci P, Gold RH (1989) Bone tumors: clinical, pathologic, and radiologic correlations. Lea & Febiger, Philadelphia, pp 226–248Google Scholar
  85. 85.
    Mobey E (1951) The natural course of osteoid osteoma. J Bone Joint Surg [Am] 33:166Google Scholar
  86. 86.
    Moser RP, Kransdorf MJ, Brower AC, Hudson T, Aoki J, Berrey BH, Sweet DE (1990) Osteoid osteoma of the elbow: a review of six cases. Skeletal Radiol 19:181Google Scholar
  87. 87.
    Norman A (1978) Persistence of recurrence of pain: a sign of surgical failure in osteoid osteoma. Clin Orthop 130:263Google Scholar
  88. 88.
    Norman A, Abdelwahab IF, Buyon J, Matzkin E (1986) Osteoid osteoma of the hip simulating an early onset of osteoarthritis. Radiology 158:417Google Scholar
  89. 89.
    O'Hara JP, Tegtmeyer C, Seeet DE, McCue FC (1975) Angiography in the diagnosis of osteoid-osteoma of the hand. J Bone Joint Surg [Am] 57:163Google Scholar
  90. 90.
    Pettine KA, Klasen RA (1986) Osteoid osteoma and osteoblastoma of the spine. J Bone Joint Surg [Am] 68:354Google Scholar
  91. 91.
    Pool JL, Darras J, Fallas P (1962) Osteomas and mucoceles of the frontal paranasal sinuses. J Neurosurg 19:130Google Scholar
  92. 92.
    Prabhakar B, Raja Reddy D, Dayananda B, Raghava Rao G (1972) Osteoid osteoma of the skull. J Bone Joint Surg [Br] 54:146Google Scholar
  93. 93.
    Rinsky LA, Goris M, Bleck EE, Halpern A, Hirshman P (1980) Intraoperative skeletal scintigraphy for localization of osteoid osteoma in the spine. Case report. J Bone Joint Surg [Am] 62:143Google Scholar
  94. 94.
    Rosenthal DI, Alexander A, Rosenberg AE, Springfield D (1992) Ablation of osteoid osteomas with a percutaneously placed electrode: a new procedure. Radiology 183:29Google Scholar
  95. 95.
    Rosenzweig J, Pintar K, Mikail M, Mayman A (1963) Benign osteoblastoma (giant osteoid osteoma): report of an unusual rib tumor and review of the literature. Can Med Assoc J 89:1189Google Scholar
  96. 96.
    Sabanas AO, Bickel WH, Moe JH (1956) Natural history of osteoid osteoma of the spine: review of the literature and report of three cases. Am J Surg 91:880Google Scholar
  97. 97.
    Sadry F, Hessler C, Garcia J (1988) The potential aggressiveness of sinus osteomas. A report of two cases. Skeletal Radiol 17:427Google Scholar
  98. 98.
    Schajowicz F, Lemos C (1970) Osteoid osteoma and osteoblastoma — closely related entities of osteoblastic derivation. Acta Orthop Scand 41:272Google Scholar
  99. 99.
    Schajowicz F, Lemos C (1976) Malignant osteoblastoma. J Bone Joint Surg [Br] 58:202Google Scholar
  100. 100.
    Schulman L, Dorfman HD (1970) Nerve fibers in osteoid osteoma. J Bone Joint Surg [Am] 52:1351Google Scholar
  101. 101.
    Schweitzer ME, Greenway G, Resnick D, Haghighi P, Snoots WE (1992) Osteoma of soft parts. Skeletal Radiol 21:177Google Scholar
  102. 102.
    Sherman MS (1947) Osteoid osteoma associated with changes in adjacent joints. J Bone Joint Surg 29:483Google Scholar
  103. 103.
    Sherman MS (1947) Osteoid osteoma: review of the literature and report of thirty cases. J Bone Joint Surg 29:918Google Scholar
  104. 104.
    Sim FH, Dahlin DC, Beabout JW (1975) Osteoid osteoma: diagnostic problems. J Bone Joint Surg [Am] 57:154Google Scholar
  105. 105.
    Smith FW, Gilday DL (1980) Scintigraphy appearances of osteoid osteoma. Radiology 137:191Google Scholar
  106. 106.
    Spence AJ, Lloyd-Roberts GC (1961) Regional osteoporosis in osteoid osteoma. J Bone Joint Surg [Br] 43-B:501Google Scholar
  107. 107.
    Spencer MG, Mitchell DB (1987) Growth of a frontal sinus osteoma. J Laryngol Otol 101:726Google Scholar
  108. 108.
    Spjut HJ, Dorfman HD, Fechner RE, Ackerman LV (1971) Tumors of bone and cartilage. In: Firminger HI (ed) Atlas of tumor pathology, 2nd series, fascicle 5. Armed Forces Institute of Pathology, Washington, pp 117–119Google Scholar
  109. 109.
    Steinberg GG, Coumas JM, Breen T (1990) Preoperative localization of osteoid osteoma: a new technique that uses CT. AJR 155:883Google Scholar
  110. 110.
    Steinberg I (1959) Huge osteoma of the eleventh left rib. JAMA 170:1921Google Scholar
  111. 111.
    Steiner GC (1976) Ultrastructure of osteoid osteoma. Hum Pathol 7:309Google Scholar
  112. 112.
    Stern PJ, Lim EVA, Krieg JK (1985) Giant metacarpal osteoma. A case report. J Bone Joint Surg [Am] 67:487Google Scholar
  113. 113.
    Strach EH (1953) Osteoid osteoma. Br Med J 1:1031Google Scholar
  114. 114.
    Swee RG, McLeod RA, Beabout JW (1979) Osteoid osteoma. Detection, diagnosis, and localization. Radiology 130:117Google Scholar
  115. 115.
    Tamarito LV, Pardo J (1977) Parosteal osteoma: clinopathologic approach. Pathol Annu 1:373Google Scholar
  116. 116.
    Vickers CW, Pugh DC, Ivind JC (1959) Osteoid osteoma: a fifteen-year follow-up of an untreated patient. J Bone Joint Surg [Am] 41:357Google Scholar
  117. 117.
    Voto SJ, Cook AJ, Weiner DS, Ewing JW, Arrington LE (1990) Treatment of osteoid osteoma by computed tomography guided excision in the pediatric patient. J Pediatr Orthop 10:510Google Scholar
  118. 118.
    Wilner D (1982) Radiology of bone tumors and allied disorders. Saunders, Philadelphia, p 629Google Scholar
  119. 119.
    Winter PF, Johnson PM, Hilal SK, Feldman F (1977) Scintigraphic detection of osteoid osteoma. Radiology 122:177Google Scholar
  120. 120.
    Wiss DA, Reid BS (1983) Painless osteoid osteoma of the fingers — report of three cases. J Hand Surg [Am] 8:914Google Scholar
  121. 121.
    Woods ER, Martel W, Mandell SH, Crabbe JP (1993) Reactive soft-tissue mass associated with osteoid osteoma: correlation of MR imaging features with pathologic findings. Radiology 186:221Google Scholar
  122. 122.
    Yeager BA, Schiebler ML, Wertheim SB, Schmidt RG, Torg JS, Perosio PM, Dalinka MK (1987) Case report: MR imaging of osteoid osteoma of the talus. J Comput Assist Tomogr 11:916Google Scholar

Copyright information

© International Skeletal Society 1993

Authors and Affiliations

  • Adam Greenspan
    • 1
    • 2
  1. 1.Departments of Radiology and Orthopedic SurgeryUniversity of California, Davis School of MedicineSacramentoUSA
  2. 2.Section of Musculoskeletal RadiologyUC Davis Medical CenterSacramentoUSA
  3. 3.Department of RadiologyUC Davis Medical CenterSacramentoUSA

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