Atypical osteoid osteomas

  • Mert CiftdemirEmail author
  • Sedat A. Tuncel
  • Ufuk Usta
General Review


Osteoid osteoma is a very painful benign bone tumor that affects young adults. It is exceptional before 5 and after 30 years of age. It can be seen in any part of the skeleton. Presentation of the tumor may be intracortical, juxta-cortical or cancellous. In long bones, the tumor is frequently intracortical, and in the spine, it is usually located at the posterior elements. Osteoid osteomas having radiologic and clinical features other than classical presentation of osteoid osteoma are called atypical osteoid osteomas. Atypical osteoid osteomas are important because the diagnosis and treatment are often complicated in these cases. Misdiagnosis with prolonged impairment and sometimes overtreatment appears as a major problem concerning atypical osteoid osteomas. This paper gives brief general information about the classical presentation of osteoid osteoma, discusses the pathogenesis of the lesion and focuses on the clinical presentation, radiologic features and characteristics of atypical osteoid osteomas as well as their treatment modalities.


Osteoid osteoma Multicentric nidus Atypical nidus Intra-articular osteoid osteoma 


Conflict of interest

All authors hereby declare that they have no conflicting interest to disclose.


  1. 1.
    De Souza Dias L, Frost HM (1974) Osteoid osteoma-osteoblastoma. Cancer 33:1075–1081CrossRefGoogle Scholar
  2. 2.
    Campanacci M (1999) Osteoid osteoma. In: Campanacci M (ed) Bone and soft tissue tumors, 2nd edn. Piccin Nuova Libraria, Padova, pp 391–415Google Scholar
  3. 3.
    Chai JW, Hong SH, Choi JY, Koh YH, Lee JW, Choi JA et al (2010) Radiologic diagnosis of osteoid osteoma: from simple to challenging findings. Radiographics 30:737–749PubMedCrossRefGoogle Scholar
  4. 4.
    Mungo DV, Zhang X, O’Keefe RJ, Rosier RN, Puzas JE, Schwarz EM (2002) COX-1 and COX-2 expression in osteoid osteomas. J Orthop Res 20(1):159–162PubMedCrossRefGoogle Scholar
  5. 5.
    Szendroi M, Köllo K, Antal I, Lakatos J, Szoke G (2004) Intraarticular osteoid osteoma: clinical features, imaging results, and comparison with extraarticular localization. J Rheumatol 31(5):957–964PubMedGoogle Scholar
  6. 6.
    Bhardwaj P, Sharma C, Sabapathy SR (2012) Synovitis of the wrist joint caused bay an intraarticular perforation of an osteoid osteoma of the scaphoid. Indian J Orthop 46(5):599–601PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    De Smet L (2000) Synovitis of the wrist joint caused by an intra-articular perforation of an osteoid osteoma of the radial styloid. Clin Rheumatol 29:229–230CrossRefGoogle Scholar
  8. 8.
    Yildiz Y, Bayrakci K, Altay M, Saglik Y (2001) Osteoid osteoma: the results of surgical treatment. Int Orthop 25:119–122PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Zampa V, Bargellini I, Ortori S, Faggioni L, Cioni R, Bartolozzi C (2009) Osteoid osteoma in atypical locations: the added value of dynamic Gadolinium enhanced MR imaging. Eur J Radiol 71(3):527–535PubMedCrossRefGoogle Scholar
  10. 10.
    Becce F, Theumann N, Rochette A, Larousserie F, Campagna R, Cherix S et al (2010) Osteoid osteoma and osteoid osteoma-mimicking lesions: biopsy findings, distinctive MDCT features and treatment by radiofrequency ablation. Eur Radiol 20(10):2439–2446PubMedCrossRefGoogle Scholar
  11. 11.
    Iyer RS, Chapman T, Chew FS (2012) Pediatric bone imaging: diagnostic imaging of osteoid osteoma. AJR Am J Roentgenol 198(5):1039–1052PubMedCrossRefGoogle Scholar
  12. 12.
    Atesok KI, Alman BA, Schemitsch EH, Peyser A, Mankin H (2011) Osteoid osteoma and osteoblastoma. J Am Acad Orthop Surg 19(11):678–689PubMedGoogle Scholar
  13. 13.
    Schulman L, Dorfman HD (1970) Nerve fibers in osteoid osteoma. J Bone Joint Surg Am 52(7):1351–1356PubMedGoogle Scholar
  14. 14.
    Kayser F, Resnick D, Haghighi P, Pereira Edo R, Greenway G, Schweitzer M et al (1988) Evidence of the subperiosteal origin of osteoid osteomas in tubular bones: analysis by CT and MR imaging. AJR Am J Roentgenol 170(3):609–614CrossRefGoogle Scholar
  15. 15.
    Lee EH, Shafi M, Hui JHP (2006) Osteoid osteoma: a current review. J Pediatr Orthop 26:695–700PubMedCrossRefGoogle Scholar
  16. 16.
    Kneisl JS, Simon MA (1992) Medical management compared with operative treatment for osteoid-osteoma. J Bone Joint Surg Am 74:179–185PubMedGoogle Scholar
  17. 17.
    Espander R, Radmehr A, Mohammadi MA, Saberi S, Haghpanah B (2012) Fracture-site osteoid osteoma in a 26-year-old man. Am J Orthop (Belle Mead NJ) 41(4):E57–E60Google Scholar
  18. 18.
    Schulze W, Richter J, Kuhnen C, Henschel MG, Muhr G (2001) Osteoid osteoma that occurred in a former fracture site. Clin Orthop Relat Res 387:200–206PubMedCrossRefGoogle Scholar
  19. 19.
    Adil A, Hoeffel C, Fikry T (1996) Osteoid osteoma after a fracture of the distal radius. AJR Am J Roentgenol 167(1):145–146PubMedCrossRefGoogle Scholar
  20. 20.
    Ilyas I, Younge DA (2002) Medical management of osteoid osteoma. Can J Surg 45(6):435–437PubMedCentralPubMedGoogle Scholar
  21. 21.
    Carpintero-Benitez P, Aguirre MA, Serrano JA, Lluch M (2004) Effect of rofecoxib on pain caused by osteoid osteoma. Orthopedics 27(11):1188–1191PubMedGoogle Scholar
  22. 22.
    Papathanassiou ZG, Megas P, Petsas T, Papachristou DJ, Nilas J, Siablis D (2008) Osteoid osteoma: diagnosis and treatment. Orthopedics 31(11):1118–1124PubMedCrossRefGoogle Scholar
  23. 23.
    Baruffi MR, Volpon JB, Neto JB, Casartelli C (2001) Osteoid osteomas with chromosome alterations involving 22q. Cancer Genet Cytogenet 124(2):127–131PubMedCrossRefGoogle Scholar
  24. 24.
    Shirado O, Nomoto T, Kuwazawa Y, Kim YT, Oda H, Hirose T (2005) Adolescent siblings with thigh pain at the same age. Lancet 366:1330PubMedCrossRefGoogle Scholar
  25. 25.
    Kalil RK, Antunes JS (2003) Familial occurrence of osteoid osteoma. Skeletal Radiol 32(7):416–419PubMedCrossRefGoogle Scholar
  26. 26.
    Aynaci O, Turgutoglu O, Kerimoglu S, Aydin H, Cobanoglu U (2007) Osteoid osteoma with a multicentric nidus: a case report and review of the literature. Arch Orthop Trauma Surg 127:863–866PubMedCrossRefGoogle Scholar
  27. 27.
    Schai P, Friederich N, Krüger A, Jundt G, Herbe E, Buess P (1996) Discrete synchronous multifocal osteoid osteoma of the humerus. Skeletal Radiol 25(7):667–670PubMedCrossRefGoogle Scholar
  28. 28.
    Schajowicz F, Lemos C (1970) Osteoid osteoma and osteoblastoma: closely related entities of osteoblastic derivation. Acta Orthop Scand 41:272–293PubMedCrossRefGoogle Scholar
  29. 29.
    Beck SE, Schwab JH, Rosenthal DI, Rosenberg AE, Grottkau GE (2011) Metachronous osteoid osteoma of the tibia and the T7 vertebral body: a case report. J Bone Joint Surg Am 93:e73 (1–5)Google Scholar
  30. 30.
    Sherman MS (1947) Osteoid osteoma: a review of the literature and report of 30 cases. J Bone Joint Surg Am 29(4):918–930PubMedGoogle Scholar
  31. 31.
    Lapidus PW, Salem EP (1949) Osteoid osteoma. Report of a case with probable double lesion. Arch Surg 58(3):318–327Google Scholar
  32. 32.
    Glynn J, Lichtenstein L (1973) Osteoid osteoma with multicentric nidus. A case report of two cases. J Bone Joint Surg Am 55(4):855–858Google Scholar
  33. 33.
    Greenspan A, Elguezabel A, Bryk D (1974) Multifocal osteoid osteoma. A case report and review of the literature. Am J Roentgenol Radium Ther Nucl Med 121(1):103–106Google Scholar
  34. 34.
    Alcalay M, Clarac JP, Bontoux D (1982) Double osteoid osteoma in adjacent carpal bones. J Bone Joint Surg Am 64:779–780Google Scholar
  35. 35.
    Rand JA, Sim FH, Unni KK (1982) Two osteoid osteomas in one patient. J Bone Joint Surg Am 64(8):1243Google Scholar
  36. 36.
    Calderoni P, Gusella A, Martucci E (1984) Multiple osteoid osteoma in the 7th dorsal vertebra. Ital J Orthop Traumatol 10(2):257–260Google Scholar
  37. 37.
    Allieu Y, Lussiez B, Benichou M, Cenac P (1989) Double nidus osteoid osteoma in the finger. J Hand Surg Am 14(3):538–541Google Scholar
  38. 38.
    Keret D, Harcke HT, MacEwen GD, Bowen JR (1989) Multiple osteoid osteomas in the fifth lumbar vertebra. A case report. Clin Orthop Relat Res 248:163–168Google Scholar
  39. 39.
    Larsen LJ, Mall JC, Ichtertz DF (1991) Metachronous osteoid-osteomas. J Bone Joint Surg Am 73(4):612–614Google Scholar
  40. 40.
    Muren C, Höglund M, Engkvist O, Juhlin L (1991) Osteoid osteoma of the hand. Report of three cases and review of the literature. Acta Radiol 32(1):62–66Google Scholar
  41. 41.
    Kenan S, Abdelwahab IF, Klein MJ, Hermann G, Lewis MM (1994) Case report 864: Elliptical, multicentric periosteal osteoid osteoma. Skeletal Radiol 23(7):565–568Google Scholar
  42. 42.
    Nelson MC, Lack EE, Freedman MT (1994) Case report 856. Multifocal osteoid osteoma in a 2.5-year-old child. Skeletal Radiol 23(6):465–467Google Scholar
  43. 43.
    Gonzalez G, Abril JC, Mediero IG, Epeldegui T (1996) Osteoid osteoma with a multicentric nidus. Int Orthop 20(1):61–63PubMedCrossRefGoogle Scholar
  44. 44.
    Stanley AJ, Campbell RSD (2000) A painful tibial lesion. British Journal of radiology 73:1337–1338Google Scholar
  45. 45.
    Niamane R, Lespessailes E, Deluzarches P, Vialat JF, Maitre F, Benhamou LC (2002) Osteoid osteoma multifocally located and recurrent in the carpus. Joint Bone Spine 69(3):327–330Google Scholar
  46. 46.
    Chiou YY, Rosenthal DI, Rosenberg AE (2003) “Beaded” osteoid osteoma: a possible transition between solitary and multicentric tumor. Skeletal Radiol 32(7):412–415PubMedCrossRefGoogle Scholar
  47. 47.
    Etemadifar MR, Ebrahimzadeh AR, Karimian M (2005) Osteoid osteoma of cervical spine in two adjacent vertebrae. Journal of Research in Medical Sciences 10(5):319–321Google Scholar
  48. 48.
    Sinha S, Housden P (2004) Discrete synchronous multifocal osteoid osteoma of the femur. Pediatr Radiol 34:280Google Scholar
  49. 49.
    Zmurko MG, Mott MP, Lucas DR, Hamre MR, Miller PR (2004) Multicentric osteoid osteoma. Orthopedics 27(12):1294–1296PubMedGoogle Scholar
  50. 50.
    Chandak RM, Phatak SV, Jain L, Kolwadkar PK (2006) Multifocal osteoid osteoma- a case report. Ind J Radiol Imag 16(1):53–54Google Scholar
  51. 51.
    Ersozlu S (2007) Concomitant osteoid osteoma of the carpal bones. J Hand Surg Eur Vol 32(4):478–479Google Scholar
  52. 52.
    Bush LA, Gayle RB, Berkey BD (2008) Multicentric osteoid osteoma presenting a diagnostic dilemma. Radiol Case Rep (Online) 3:217Google Scholar
  53. 53.
    Tamam C, Yildirim D, Tamam M (2009) Multicentric osteoid osteoma with a nidus located in the epiphysis. Pediatr Radiol 39:1238–1241Google Scholar
  54. 54.
    Buluc L, Akansel G, Arslan A, Sarlak AY, Tosun B (2008) Synchronous multicentric osteoid osteoma with associated fibrous cortical defect. Orthopedics 31(1):95Google Scholar
  55. 55.
    Miyazaki M, Miyazaki A, Kurabayashi T, Shinozaki T, Endo K, Tsushima Y (2012) CT-fluoroscopy guided radiofrequency ablation of osteoid osteoma with double nidi. Jpn J Radiol 30:78–80Google Scholar
  56. 56.
    Sreenivas T, Menon J, Nataraj AR (2012) Synchronous symmetrical atypical osteoid osteoma of the tibia: a case report. Eur J Orthop Surg Traumatol 22(Suppl 1):251–254Google Scholar
  57. 57.
    Bruneau M, Polivka M, Cornelius JF, George B (2005) Progression of an osteoid osteoma to an osteoblastoma. J Neurosurg Spine 3(3):238–241PubMedCrossRefGoogle Scholar
  58. 58.
    Chotel F, Franck F, Solla F, Dijoud F, Kohler R, Berard J et al (2012) Osteoid osteoma transformation into osteoblastoma: fact or fiction? Orthop Traumatol Surg Res 98(6 Suppl):98–104CrossRefGoogle Scholar
  59. 59.
    Byers PD (1968) Solitary osteoblastic lesions of bone. Osteoid osteoma and benign osteoblastoma. Cancer 22(1):43–57PubMedCrossRefGoogle Scholar
  60. 60.
    Kawaguchi Y, Sato C, Hasegawa T, Oka S, Kuwahara H, Norimatsu H (2000) Intraarticular osteoid osteoma associated with synovitis: a possible role of cyclooxygenase-2 expression by osteoblasts in the nidus. Mod Pathol 13(10):1086–1091PubMedCrossRefGoogle Scholar
  61. 61.
    Allen SD, Saifuddin A (2003) Imaging of intra-articular osteoid osteoma. Clin Radiol 58(11):845–852PubMedCrossRefGoogle Scholar
  62. 62.
    Laurence N, Epelman M, Markowitz RI, Jaimes C, Jaramillo D, Chauvin NA (2012) Osteoid osteomas: a pain in the night diagnosis. Pediatr Radiol 42:1490–1501PubMedCrossRefGoogle Scholar
  63. 63.
    Sink EL, Bucholz RW (2004) Coxa magna in a nonoperatively treated osteoid osteoma of the femoral neck. Orthopedics 27(7):777–779PubMedGoogle Scholar
  64. 64.
    Weber K, Morrey BF (1999) Osteoid osteoma of the elbow: a diagnostic challenge. J Bone Joint Surg Am 81(8):1111–1119PubMedGoogle Scholar
  65. 65.
    Franceschi F, Marinozzi A, Papalia R, Longo UG, Gualdi G, Denaro E (2006) Intra- and juxta-articular osteoid osteoma: a diagnostic challenge: misdiagnosis and successful treatment: a report of four cases. Arch Orthop Trauma Surg 126(10):660–667PubMedCrossRefGoogle Scholar
  66. 66.
    Virayavanich W, Singh R, O’Donnell RJ, Horvai AE, Goldsby RE, Link TM (2010) Osteoid osteoma of the femur in a 7-month-old infant treated with radiofrequency ablation. Skeletal Radiol 39:1145–1149PubMedCentralPubMedCrossRefGoogle Scholar
  67. 67.
    Ozturkmen Y, Karamehmetoglu M (2011) Ribbing disease: a case report and literature review. Acta Orthop Traumatol Turc 45(1):58–65PubMedCrossRefGoogle Scholar
  68. 68.
    Reverte-Vinaixa MM, Velez R, Alvarez S, Rivas A, Perez M (2013) Percutaneous computed tomography-guided resection of non-spinal osteoid osteomas in 54 patients and review of the literature. Arch Orthop Trauma Surg 133(4):449–455PubMedCrossRefGoogle Scholar
  69. 69.
    Campanacci M, Ruggieri P, Gasbarrini A, Ferraro A, Campanacci L (1999) Osteoid osteoma: direct visual identification and intralesional excision of the nidus with minimal removal of bone. J Bone Joint Surg Br 81(5):814–820PubMedCrossRefGoogle Scholar
  70. 70.
    Napoli A, Mastantuono M, Cavallo Marincola B, Anzidei M, Zaccagna F, Moreschini O (2013) Osteoid osteoma: MR-guided focused ultrasound for entirely noninvasive treatment. Radiology 267(2):514–521PubMedCrossRefGoogle Scholar
  71. 71.
    Gangi A, Dietemann JL, Gasser B, Mortazavi R, Brunner P, Mourou MY et al (1997) Interstitial laser photocoagulation of osteoid osteomas with use of CT guidance. Radiology 203:843–848PubMedCrossRefGoogle Scholar
  72. 72.
    Pikoulas C, Mantzikopoulos G, Thanos L, Passomenos D, Dalamarinis C, Glampedaki-Dagianta K (1995) Unusually located osteoid osteomas. Eur J Radiol 20(2):120–125PubMedCrossRefGoogle Scholar
  73. 73.
    David P, Legname M, Dupond M (2009) Arthroscopic removal of an osteoid osteoma of the talar neck. Orthop Traumatol Surg Res 95(6):454–457PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag France 2013

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryTrakya University School of MedicineEdirneTurkey
  2. 2.Department of RadiologyTrakya University School of MedicineEdirneTurkey
  3. 3.Department of PathologyTrakya University School of MedicineEdirneTurkey

Personalised recommendations