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Diagnostik und Therapie des Osteoidosteoms

Diagnostics and treatment of osteoid osteoma

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Zusammenfassung

Hintergrund

Das Osteoidosteom ist der dritthäufigste gutartige primäre Knochentumor und verursacht typischerweise starke Nachtschmerzen.

Ziel der Arbeit

Dieser Artikel soll einen umfassenden Überblick über die Epidemiologie, Pathogenese, das histologische und radiologische Bild sowie die diversen Behandlungsoptionen des Osteoidosteoms geben.

Material und Methodik

Präsentiert werden die Ergebnisse eines Literaturüberblicks, die wesentliche Arbeiten zu diesem Thema zusammenfassen.

Ergebnisse

Das Osteoidosteom ist durch einen zentralen Nidus von maximal 1,5 cm Durchmesser mit ausgedehnter Umgebungssklerose charakterisiert. Der Tumor tritt bevorzugt diaphysär an der unteren Extremität auf und manifestiert sich überwiegend zwischen dem 5. und 25. Lebensjahr. Die Schmerzen sind auf eine Prostaglandin-vermittelte Reizung afferenter Nervenfasern zurückzuführen. Neben der Röntgenaufnahme stellt die Computertomographie in Dünnschichttechnik den Goldstandard der Diagnostik dar, sollte jedoch durch magnetresonanztomographische oder nuklearmedizinische Verfahren ergänzt werden. Die konservative Therapie mit langfristiger Einnahme nichtsteroidaler Antirheumatika wird meistens durch die minimal-invasive Radiofrequenzablation als operative Therapie der Wahl ersetzt.

Diskussion

Die Erfolgsrate der Radiofrequenzablation und anderer minimal-invasiver Verfahren in der Behandlung des Osteoidosteoms ist hoch, Therapiekosten und Hospitalisierungsdauer sind niedrig. Daher ist die offene Herdausräumung seltenen Indikationen vorbehalten und die En-bloc-Resektion nur wiederholten Lokalrezidiven.

Abstract

Background

Osteoid osteoma is the third most common benign bone tumor and typically induces pain that is worse at night.

Objective

To identify the epidemiological, pathogenetic, histological and radiological characteristics of osteoid osteoma and to present the broad variety of treatment options.

Material and methods

This review article summarizes relevant clinical studies and meta-analyses on this topic.

Results

Osteoid osteoma is characterized by a central nidus smaller than 1.5 cm in diameter with surrounding bone sclerosis. In the majority of cases, the tumor occurs in the long bones of the lower extremities and is predominantly manifested in patients aged between 5 and 25 years. Pain is mediated by prostaglandins, which stimulate afferent peripheral nerve fibers. Besides plain radiographs, thin-section computed tomography represents the gold standard of diagnostics but should be complemented by magnetic resonance or nuclear medicine imaging modalities. The conservative treatment consists of long-term therapy with non-steroidal anti-inflammatory drugs. Minimally invasive radiofrequency ablation of the nidus is the current operative treatment of choice.

Conclusion

Success rates of radiofrequency ablation and other minimally invasive procedures are high while treatment costs and length of hospital stay are low. Thus, open surgical curettage is reserved for rare indications and en bloc excision of the nidus should only be performed in cases of recurrent lesions.

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Literatur

  1. Bergstrand H (1930) Über eine eigenartige, wahrscheinlich bisher nicht beschriebene osteoblastische Krankheit in den langen Knochen der Hand und des Fusses. Acta Radiol 11:596–613

    Article  Google Scholar 

  2. Campanacci M (1999) Bone and soft tissue tumors: clinical features, imaging, pathology and treatment, 2. Aufl. Springer, Wien, New York

    Book  Google Scholar 

  3. Jundt G (1995) Pathologic-anatomic characteristics of benign bone tumors. Orthopäde 24:2–14

    CAS  PubMed  Google Scholar 

  4. Iyer RS, Chapman T, Chew FS (2012) Pediatric bone imaging: diagnostic imaging of osteoid osteoma. AJR Am J Roentgenol 198:1039–1052

    Article  PubMed  Google Scholar 

  5. Toepfer A, Lenze U, Holzapfel BM et al (2012) Tumors of the foot: diagnostics and therapy. Orthopäde 41:563–580 (quiz 581–562)

    Article  CAS  PubMed  Google Scholar 

  6. Ciftdemir M, Tuncel SA, Usta U (2015) Atypical osteoid osteomas. Eur J Orthop Surg Traumatol 25:17–27

    Article  PubMed  Google Scholar 

  7. Kayser F, Resnick D, Haghighi P et al (1998) Evidence of the subperiosteal origin of osteoid osteomas in tubular bones: analysis by CT and MR imaging. AJR Am J Roentgenol 170:609–614

    Article  CAS  PubMed  Google Scholar 

  8. Sherman MS (1947) Osteoid osteoma; review of the literature and report of 30 cases. J Bone Joint Surg Am 29:918–930

    CAS  PubMed  Google Scholar 

  9. Boscainos PJ, Cousins GR, Kulshreshtha R, Oliver TB, Papagelopoulos PJ (2013) Osteoid osteoma. Orthopedics 36:792–800

    Article  PubMed  Google Scholar 

  10. Golding JS (1954) The natural history of osteoid osteoma; with a report of twenty cases. J Bone Joint Surg Br 36-B:218–229

    CAS  PubMed  Google Scholar 

  11. O’Connell JX, Nanthakumar SS, Nielsen GP, Rosenberg AE (1998) Osteoid osteoma: the uniquely innervated bone tumor. Mod Pathol 11:175–180

    PubMed  Google Scholar 

  12. Leonhardt J, Bastian L, Rosenthal H, Laenger F, Wippermann B (2001) Post-traumatic osteoid osteoma. Case report and review of the literature. Unfallchirurg 104:553–556

    Article  CAS  PubMed  Google Scholar 

  13. Sprengel SD, Weber MA, Lehner B, Rehnitz C (2015) Osteoidosteoma. From diagnosis to treatment. Radiologe 55:479–486

    Article  CAS  PubMed  Google Scholar 

  14. Wold LE, Pritchard DJ, Bergert J, Wilson DM (1988) Prostaglandin synthesis by osteoid osteoma and osteoblastoma. Mod Pathol 1:129–131

    CAS  PubMed  Google Scholar 

  15. Gebhardt MC, Lippiello L, Bringhurst FR, Mankin HJ (1985) Prostaglandin E2 synthesis by human primary and metastatic bone tumors in culture. Clin Orthop Relat Res. doi:10.1097/00003086-198506000-00043

    Google Scholar 

  16. Mungo DV, Zhang X, O’Keefe RJ et al (2002) COX-1 and COX-2 expression in osteoid osteomas. J Orthop Res 20:159–162

    Article  CAS  PubMed  Google Scholar 

  17. Henrichs MP, Hardes J, Gosheger G, Vieth V (2011) Monarthritis of the ankle due to osteoid osteoma of the talus. Difficulties in diagnosis and treatment. Orthopäde 40:344–348

    Article  PubMed  Google Scholar 

  18. Keim HA, Reina EG (1975) Osteoid-osteoma as a cause of scoliosis. J Bone Joint Surg Am 57:159–163

    Article  CAS  PubMed  Google Scholar 

  19. Bullmann V, Liljenqvist U (2013) Benign and semimalignant spinal tumors. Characteristics in children and adults. Orthopäde 42:700–708

    Article  CAS  PubMed  Google Scholar 

  20. Liu PT, Kujak JL, Roberts CC, de Chadarevian JP (2011) The vascular groove sign: a new CT finding associated with osteoid osteomas. AJR Am J Roentgenol 196:168–173

    Article  PubMed  Google Scholar 

  21. Hosalkar HS, Garg S, Moroz L, Pollack A, Dormans JP (2005) The diagnostic accuracy of MRI versus CT imaging for osteoid osteoma in children. Clin Orthop Relat Res 433:171–177

    Article  Google Scholar 

  22. Helms CA, Hattner RS, Vogler JB 3rd (1984) Osteoid osteoma: radionuclide diagnosis. Radiology 151:779–784

    Article  CAS  PubMed  Google Scholar 

  23. Imperiale A, Moser T, Ben-Sellem D et al (2009) Osteoblastoma and osteoid osteoma: morphofunctional characterization by MRI and dynamic F‑18 FDG PET/CT before and after radiofrequency ablation. Clin Nucl Med 34:184–188

    Article  PubMed  Google Scholar 

  24. Bremer R, Niethard F, Ewerbeck V (1995) Benign bone tumors in the growth years – osteoid osteoma and osteoblastoma. Orthopäde 24:24–28

    CAS  PubMed  Google Scholar 

  25. Sung HW, Liu CC (1979) Can osteoid osteoma become osteoblastoma? A case report. Arch Orthop Trauma Surg 95:217–219

    Article  CAS  PubMed  Google Scholar 

  26. Abril JC, Castillo F, Casas J, Diaz A (2000) Brodie’s abscess of the hip simulating osteoid osteoma. Orthopedics 23:285–287

    CAS  PubMed  Google Scholar 

  27. Pitt MJ, Graham AR, Shipman JH, Birkby W (1982) Herniation pit of the femoral neck. AJR Am J Roentgenol 138:1115–1121

    Article  CAS  PubMed  Google Scholar 

  28. Motamedi D, Learch TJ, Ishimitsu DN et al (2009) Thermal ablation of osteoid osteoma: overview and step-by-step guide. Radiographics 29:2127–2141

    Article  PubMed  Google Scholar 

  29. Moberg E (1951) The natural course of osteoid osteoma. J Bone Joint Surg Am 33 A:166–170

    Article  Google Scholar 

  30. Sim FH, Dahlin CD, Beabout JW (1975) Osteoid-osteoma: diagnostic problems. J Bone Joint Surg Am 57:154–159

    Article  CAS  PubMed  Google Scholar 

  31. Rosenthal DI, Alexander A, Rosenberg AE, Springfield D (1992) Ablation of osteoid osteomas with a percutaneously placed electrode: a new procedure. Radiology 183:29–33

    Article  CAS  PubMed  Google Scholar 

  32. Adam G, Keulers P, Vorwerk D et al (1995) The percutaneous CT-guided treatment of osteoid osteomas: a combined procedure with a biopsy drill and subsequent ethanol injection. Rofo 162:232–235

    Article  CAS  PubMed  Google Scholar 

  33. Doyle T, King K (1989) Percutaneous removal of osteoid osteomas using CT control. Clin Radiol 40:514–517

    Article  CAS  PubMed  Google Scholar 

  34. Skjeldal S, Lilleas F, Folleras G et al (2000) Real time MRI-guided excision and cryo-treatment of osteoid osteoma in os ischii – a case report. Acta Orthop Scand 71:637–638

    Article  CAS  PubMed  Google Scholar 

  35. Gangi A, Dietemann JL, Gasser B et al (1997) Interstitial laser photocoagulation of osteoid osteomas with use of CT guidance. Radiology 203:843–848

    Article  CAS  PubMed  Google Scholar 

  36. Pfeiffer M, Sluga M, Windhager R, Dominkus M, Kotz R (2003) Surgical treatment of osteoid osteoma of the extremities. Z Orthop Ihre Grenzgeb 141:345–348

    Article  CAS  PubMed  Google Scholar 

  37. Rosenthal DI, Hornicek FJ, Wolfe MW et al (1998) Percutaneous radiofrequency coagulation of osteoid osteoma compared with operative treatment. J Bone Joint Surg Am 80:815–821

    Article  CAS  PubMed  Google Scholar 

  38. Sluga M, Windhager R, Pfeiffer M, Dominkus M, Kotz R (2002) Peripheral osteoid osteoma. Is there still a place for traditional surgery? J Bone Joint Surg Br 84:249–251

    Article  CAS  PubMed  Google Scholar 

  39. Furukawa M, Anazawa U, Horiuchi K et al (2011) Arthroscopic removal of intra-articular osteoid osteoma in the knee: case report and review of the literature. J Orthop Sci 16:321–325

    Article  PubMed  Google Scholar 

  40. Omlor GW, Lehner B, Wiedenhofer B et al (2012) Radiofrequency ablation in spinal osteoid osteoma. Options and limits. Orthopäde 41:618–622

    Article  CAS  PubMed  Google Scholar 

  41. Widmann G, Schullian P, Fasser M, Niederwanger C, Bale R (2013) CT-guided stereotactic targeting accuracy of osteoid osteoma. Int J Med Robot 9:274–279

    Article  PubMed  Google Scholar 

  42. Ramseier LE, Duc S, Exner GU (2006) Osteoid osteoma. CT guided drilling and radiofrequency ablation. Orthopäde 35:989–992

    Article  CAS  PubMed  Google Scholar 

  43. Vanderschueren GM, Taminiau AH, Obermann WR, van den Berg-Huysmans AA, Bloem JL (2004) Osteoid osteoma: factors for increased risk of unsuccessful thermal coagulation. Radiology 233:757–762

    Article  PubMed  Google Scholar 

  44. Lanza E, Thouvenin Y, Viala P et al (2014) Osteoid osteoma treated by percutaneous thermal ablation: when do we fail? A systematic review and guidelines for future reporting. Cardiovasc Intervent Radiol 37:1530–1539

    Article  PubMed  Google Scholar 

  45. Schmidt D, Clasen S, Schaefer JF et al (2011) CT-guided radiofrequency (RF) ablation of osteoid osteoma: clinical long-term results. Rofo 183:381–387

    Article  CAS  PubMed  Google Scholar 

  46. Sans N, Galy-Fourcade D, Assoun J et al (1999) Osteoid osteoma: CT-guided percutaneous resection and follow-up in 38 patients. Radiology 212:687–692

    Article  CAS  PubMed  Google Scholar 

  47. Coupal TM, Mallinson PI, Munk PL et al (2014) CT-guided percutaneous cryoablation for osteoid osteoma: initial experience in adults. AJR Am J Roentgenol 202:1136–1139

    Article  PubMed  Google Scholar 

  48. Gangi A, Alizadeh H, Wong L et al (2007) Osteoid osteoma: percutaneous laser ablation and follow-up in 114 patients. Radiology 242:293–301

    Article  PubMed  Google Scholar 

  49. Kostrzewa M, Diezler P, Michaely H et al (2014) Microwave ablation of osteoid osteomas using dynamic MR imaging for early treatment assessment: preliminary experience. J Vasc Interv Radiol 25:106–111

    Article  PubMed  Google Scholar 

  50. Napoli A, Mastantuono M, Cavallo Marincola B et al (2013) Osteoid osteoma: MR-guided focused ultrasound for entirely noninvasive treatment. Radiology 267:514–521

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik für Orthopädie und Orthopädische Chirurgie, Universitätsklinikum des Saarlandes, Kirrberger Strasse 100, Gebäude 37–38, 66421, Homburg/Saar, Deutschland

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Correspondence to P. Orth.

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P. Orth und D. Kohn geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Orth, P., Kohn, D. Diagnostik und Therapie des Osteoidosteoms. Orthopäde 46, 510–521 (2017). https://doi.org/10.1007/s00132-017-3428-0

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