Ablation of Primary Bone and Soft Tissue Tumors

Abstract

Osteoid osteoma (OO) is a benign skeletal neoplasm of unknown etiology consisting of both osteoid and woven bone elements that are surrounded by osteoblasts. Vascularized lesion was clearly separate from reactive woven or lamellar bone. OO represents 4% of all bone tumors and accounts for 12% of all benign cases. The lesion is usually smaller than 1.5 cm in diameter and may occur in any bone, but af fl icts the appendicular skeleton in approximately two thirds of the patients. Neuroaxial location in approximately 6% of the cases. Dull or aching pain, worse during the night, typically relieved by salicylates (Aspirin) and nonsteroidal anti-in fl ammatory drugs (NSAIDs). Pain attributed to local release of prostaglandins (PGE2 and 6-keto-PGF1 a ) leading to a chronicin fl ammatory response and subsequent periosteal reaction and synovitis. Usual appearance is of a small sclerotic bone island within a circular lucent defect called a nidus. The central radiolucent nidus is surrounded by considerable cortical and endosteal bone sclerosis.

• OO is a benign skeletal neoplasm of unknown etiology consisting of both osteoid and woven bone. It represents 4% of all bone tumors and accounts for 12% of all benign cases. The lesion is usually smaller than 1.5 cm in diameter and produces dull or aching pain, worse during the night, typically relieved by salicylates (Aspirin).

• Depending on lesion size and anatomy, a combination of plain radiography, CT, gadolinium-enhanced MRI, or radionuclide bone scan may be necessary to adequately characterize tumor morphology. OOs are typically characterized by an intracortical nidus with fusiform cortical thickening, reactive sclerosis, and variable surrounding bone marrow edema.

• OOs are one of the best indications for minimally invasive percutaneous thermoablation. Radiofrequency ablation for OOs is performed under general anesthesia and computed tomography guidance with excellent clinical results and minimal complications.

• Radiofrequency ablation has been also successfully applied for the eradication of osteoblastomas, chondroblastomas, giant cell tumors, enchondromas, eosinophilic granulomas, bone hemangiomas, and intracortical chondromas. Cytoreduction of sacral chordomas and sarcomas, and local control of aggressive desmoid tumors with percutaneous ablative methods have been also reported.