eMedicine Specialties > Orthopedic Surgery > Neoplasms

Osteoblastoma

Author: Fred Ortmann, MD, Fellow, Department of Orthopedics, Division of Hand Surgery, Brown Medical School
Coauthor(s): John Eady, MD, Chief, Orthopaedic Surgery, Dorn VA Hospital, Columbia, SC 29209
Contributor Information and Disclosures

Updated: Feb 15, 2009

Introduction

Osteoblastoma is a rare primary neoplasm of bone, categorized as a benign bone tumor. However, an aggressive type of osteoblastoma has been described that has characteristics similar to those of osteosarcoma. Osteoblastoma is closely related to osteoid osteoma. It differs from osteoid osteoma in its ability to grow larger than 2.0 cm in diameter.1,2,3

The clinical course of osteoblastoma often makes it difficult to diagnose. The tumor may have a slow indolent course or display characteristics that are confused with malignancy. Other diagnoses that share similar clinical, radiographic, and histologic features with conventional osteoblastoma include osteoid osteoma, giant cell tumor, and fibrous dysplasia. Osteoblastomas may also have features that mimic malignant tumors such as osteosarcoma. Osteoblastoma is about 20 times less common than osteosarcoma.1,4,5,6,7,8

History of the Procedure

In his original descriptions of osteoblastoma, Lichtenstein termed the lesion an "osteogenic fibroma of bone."9,10 In 1954, Dahlin and Johnson reported 11 unusual tumors, all of which appeared to originate within bone.11 They chose to call the tumor a giant osteoid osteoma for its histologic similarity to osteoid osteoma. The current and accepted name, osteoblastoma, was obtained from independent publications by Lichtenstein and Jaffe.9,12

Problem

Osteoblastoma is a bone-forming lesion. It may be found within the cortex, medullary canal, or periosteal tissues. Multicentric foci within a single bone have also been described. There is a slight predominance of metaphyseal over diaphyseal lesions, with very few lesions reported in an epiphyseal location.13

According to the Musculoskeletal Society Tumor Staging (MSTS) system of benign bone tumors,14,15 most osteoblastomas are stage 2 lesions. Stage 2 lesions are characterized by benign cytologic characteristics, remain intracapsular, and do not metastasize. While stage 3 osteoblastomas destroy bone much more aggressively and extend extracapsularly, the histologic architecture and cell structure remain benign  (see Staging).

Frequency

In the United States, osteoblastoma accounts for approximately 1% of all primary bone tumors. The mean age at presentation in the largest series studied was 20.4 years, with a range of 6 months to 75 years.16 The male-to-female patient ratio is 2:1.

Etiology

The exact etiology of osteoblastoma is unknown.

Pathophysiology

Regardless of where these tumors originate within the musculoskeletal system, they are composed of numerous osteoblasts that produce osteoid and woven bone. When the primary site is within cortical bone, expansion is often present. However, the outer rim of the tumor is always covered by periosteum and a thin rim of reactive bone. In the largest series reported, the size of osteoblastomas ranged from 1-11 cm, with a mean of 3.2 cm.16

As opposed to more their benign counterparts, aggressive osteoblastomas display rapid resorption of adjacent host bone cortex and extension into surrounding soft tissues.

Presentation

Osteoblastoma most commonly occurs during the first three decades of life. The primary symptom is pain, and patients often characterize it as dull and achy. Unlike the pain of osteoid osteoma, the pain of osteoblastoma is more generalized, and less likely to be relieved by salicylates.

Osteoblastoma may affect any bone, but it most frequently arises within the vertebral column and long tubular bones. When these tumors develop in the spine, patients may present with neurologic symptoms as a result of spinal cord or nerve root compression.17,18,19,20 In addition, scoliosis or torticollis may be a presenting sign. A report of osteoblastomas and osteoid osteomas of the spine showed 9 of 13 patients had neurologic disorders before treatment, and 8 of 13 had an associated structural deformity of scoliosis, torticollis, or both.21

Indications

There are 2 primary indications for surgical management of an osteoblastoma when it is discovered within the musculoskeletal system. The first is to obtain a tissue sample that firmly establishes the diagnosis. Even with an appropriate, representative tissue sample, it is often very difficult to differentiate these aggressive (stage 3) lesions from osteosarcoma. The second reason for surgical management is to prevent the continued destruction of bony architecture by this aggressive tumor. While repairing the structural bony defect is an important secondary consideration, it cannot be accomplished until the primary indications are addressed.

Relevant Anatomy

Osteoblastoma commonly affects the vertebral column. Approximately 30% of these lesions arise within the posterior elements of the spine. A few reports have documented the vertebral body as the primary site, but these locations are rare, as seen in the images below. Equally common locations (30%) are the long bones of the appendicular skeleton, typically the femur and the tibia.

Standard radiograph of an osteoblastoma with a se...

Standard radiograph of an osteoblastoma with a secondary aneurysmal bone cyst of the lumbar spine.

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Standard radiograph of an osteoblastoma with a se...

Standard radiograph of an osteoblastoma with a secondary aneurysmal bone cyst of the lumbar spine.


(Click image to enlarge.) Osteoblastoma with a se...

(Click image to enlarge.) Osteoblastoma with a secondary aneurysmal bone cyst. CT findings are nonspecific; however, they demonstrate the extent of lesion arising in the vertebral column.

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(Click image to enlarge.) Osteoblastoma with a se...

(Click image to enlarge.) Osteoblastoma with a secondary aneurysmal bone cyst. CT findings are nonspecific; however, they demonstrate the extent of lesion arising in the vertebral column.


Other documented locations of osteoblastoma include the pelvic bones, small bones of the hands and feet, skull and facial bones, clavicle, scapula, ribs, and talus, as seen in the image below.22,23,24,25,26

Oblique and lateral radiographs of the ankle reve...

Oblique and lateral radiographs of the ankle reveal a lucent lesion within the talus.

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Oblique and lateral radiographs of the ankle reve...

Oblique and lateral radiographs of the ankle reveal a lucent lesion within the talus.


Associated aneurysmal bone cysts (see image below) may be seen with as many as 10% of osteoblastomas.

Standard radiograph of an osteoblastoma with a se...

Standard radiograph of an osteoblastoma with a secondary aneurysmal bone cyst of the lumbar spine.

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Standard radiograph of an osteoblastoma with a se...

Standard radiograph of an osteoblastoma with a secondary aneurysmal bone cyst of the lumbar spine.


Contraindications

No specific contraindications to the treatment of osteoblastoma have been documented. General precautions include avoiding harm to a growth plate when operating near one of the plates in the skeletally immature patient. Additionally, while removing these tumors from the spinal elements, care must be taken to protect the spinal cord during the procedure. Similar precautions need to be considered for the urinary bladder, sacral plexus, and other associated pelvic organs when removing lesions in this location. Since all patients need some form of surgery in the management of this tumor, they must be able to tolerate anesthesia.

More on Osteoblastoma

Overview: Osteoblastoma
Workup: Osteoblastoma
Treatment: Osteoblastoma
Follow-up: Osteoblastoma
Multimedia: Osteoblastoma
References
Further Reading
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References

  1. Biagini R, Orsini U, Demitri S. Osteoid osteoma and osteoblastoma of the sacrum. Orthopedics. Nov 2001;24(11):1061-4. [Medline].

  2. Ruggieri P, McLeod RA, Unni KK. Osteoblastoma. Orthopedics. Jul 1996;19(7):621-4. [Medline].

  3. Kan P, Schmidt MH. Osteoid osteoma and osteoblastoma of the spine. Neurosurg Clin N Am. Jan 2008;19(1):65-70. [Medline].

  4. Bertoni F, Unni KK, McLeod RA. Osteosarcoma resembling osteoblastoma. Cancer. Jan 15 1985;55(2):416-26. [Medline].

  5. Dorfman HD, Weiss SW. Borderline osteoblastic tumors: problems in the differential diagnosis of aggressive osteoblastoma and low-grade osteosarcoma. Semin Diagn Pathol. Aug 1984;1(3):215-34. [Medline].

  6. Frassica FJ, Waltrip RL, Sponseller PD. Clinicopathologic features and treatment of osteoid osteoma and osteoblastoma in children and adolescents. Orthop Clin North Am. Jul 1996;27(3):559-74. [Medline].

  7. Gitelis S, Schajowicz F. Osteoid osteoma and osteoblastoma. Orthop Clin North Am. Jul 1989;20(3):313-25. [Medline].

  8. Greenspan A. Benign bone-forming lesions: osteoma, osteoid osteoma, and osteoblastoma. Clinical, imaging, pathologic, and differential considerations. Skeletal Radiol. Oct 1993;22(7):485-500. [Medline].

  9. Lichtenstein L. 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. 1956;9:1044-1052.

  10. Lichtenstein L. Osteogenic Fibroma of Bone. In: Bone Tumors. St Louis, Mo: Mosby; 1952:82-87.

  11. Dahlin D, Johnson E. Giant Osteoid Osteoma. J Bone Joint Surg. 1954;36-A:559-572.

  12. Jaffe HL. Benign Osteoblastoma. Bull Hosp Joint Dis. 1956;17:141-151.

  13. Dorfman HD, Czerniak B. Benign Osteoblastic Tumors. In: Bone Tumors. 1st ed. St Louis, Mo: Mosby; 1998:85-127.

  14. Enneking WF. A system of staging musculoskeletal neoplasms. Clin Orthop. Mar 1986;(204):9-24. [Medline].

  15. Enneking WF. Osteoblastoma. In: Musculoskeletal Tumor Surgery. Vol 2. New York, NY: Churchill Livingstone; 1983:1043-1054.

  16. Lucas DR, Unni KK, McLeod RA. Osteoblastoma: clinicopathologic study of 306 cases. Hum Pathol. Feb 1994;25(2):117-34. [Medline].

  17. Griffin JB. Benign osteoblastoma of the thoracic spine. Case report with fifteen- year follow-up. J Bone Joint Surg Am. Sep 1978;60(6):833-5. [Medline].

  18. Kirwan EO, Hutton PA, Pozo JL. Osteoid osteoma and benign osteoblastoma of the spine. Clinical presentation and treatment. J Bone Joint Surg Br. Jan 1984;66(1):21-6. [Medline].

  19. Pettine KA, Klassen RA. Osteoid-osteoma and osteoblastoma of the spine. J Bone Joint Surg Am. Mar 1986;68(3):354-61. [Medline].

  20. Saifuddin A, White J, Sherazi Z. Osteoid osteoma and osteoblastoma of the spine. Factors associated with the presence of scoliosis. Spine. Jan 1 1998;23(1):47-53. [Medline].

  21. Ozaki T, Liljenqvist U, Hillmann A. Osteoid Osteoma and Osteoblastoma of the Spine: Experiences with 22 Patients. Clinical Orthopaedics and Related Research. 2002;397:394-402. [Medline].

  22. Khermosh O, Schujman E. Benign osteoblastoma of the calcaneous. Clin Orthop. 1977;(127):197-9. [Medline].

  23. Marsh BW, Bonfiglio M, Brady LP. Benign osteoblastoma: range of manifestations. J Bone Joint Surg Am. Jan 1975;57(1):1-9. [Medline].

  24. Papagelopoulos PJ, Galanis EC, Sim FH. Clinicopathologic features, diagnosis, and treatment of osteoblastoma. Orthopedics. Feb 1999;22(2):244-7; quiz 248-9. [Medline].

  25. Papagelopoulos PJ, Galanis EC, Sim FH. Osteoblastoma of the acetabulum. Orthopedics. Mar 1998;21(3):355-8. [Medline].

  26. White LM, Kandel R. Osteoid-producing tumors of bone. Semin Musculoskelet Radiol. 2000;4(1):25-43. [Medline].

  27. Resnick D. Tumors and tumor-like lesions of bone: imaging and pathology of specific lesions. In: Diagnosis of Bone and Joint Disorders. 3rd ed. Philadelphia, Pa: WB Saunders; 1995:3786-3796.

  28. Kroon HM, Schurmans J. Osteoblastoma: clinical and radiologic findings in 98 new cases. Radiology. Jun 1990;175(3):783-90. [Medline].

  29. Berry M, Mankin H, Gebhardt M, Rosenberg A, Hornicek F. Osteoblastoma: a 30-year study of 99 cases. J Surg Oncol. Sep 1 2008;98(3):179-83. [Medline].

  30. Saglik Y, Atalar H, Yildiz Y, Basarir K, Gunay C. Surgical treatment of osteoblastoma : a report of 20 cases. Acta Orthop Belg. Dec 2007;73(6):747-53. [Medline].

  31. Denaro V, Denaro L, Papalia R, Marinozzi A, Di Martino A. Surgical management of cervical spine osteoblastomas. Clinical Orthopaedics and Related Research. February 2007;455:190-5. [Medline].

  32. Hosono A, Yamaguchi U, Makimoto A, Endo M, Watanabe A, Shimoda T, et al. Utility of immunohistochemical analysis for cyclo-oxygenase 2 in the differential diagnosis of osteoblastoma and osteosarcoma. Journal of Clinical Pathology. April 2007;60:410-4. [Medline].

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Keywords

osteoblastoma, osteoblastic osteoid tissue-forming tumor, spindle-cell variant of a giant cell tumor, GCT, osteogenic fibroma, giant osteoid osteoma, benign osteoblastoma, benign bone tumor, osteosarcoma, bone cancer

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Contributor Information and Disclosures

Author

Fred Ortmann, MD, Fellow, Department of Orthopedics, Division of Hand Surgery, Brown Medical School
Fred Ortmann, MD is a member of the following medical societies: Alpha Omega Alpha
Disclosure: Nothing to disclose.

Coauthor(s)

John Eady, MD, Chief, Orthopaedic Surgery, Dorn VA Hospital, Columbia, SC 29209
John Eady, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Orthopaedic Association, and Southern Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Lynn A Crosby, MD, FACS, Chief of Shoulder Division, Professor, Department of Orthopedic Surgery, Wright State University School of Medicine
Lynn A Crosby, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American College of Sports Medicine, American College of Surgeons, American Fracture Association, American Medical Association, American Medical Tennis Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Arthroscopy Association of North America, Mid-America Orthopaedic Association, and Orthopaedic Research Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Sean P Scully, MD, PhD, Professor, Department of Orthopedics, University of Miami
Sean P Scully, MD, PhD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, International Society on Thrombosis and Haemostasis, and Society of Surgical Oncology
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD, Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami School of Medicine
Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society
Disclosure: Nothing to disclose.

 
 
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