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The authors describe 2 cases of osteoblastoma of the calvaria and review the clinical features of the 28 cases reported in the world literature. Benign osteoblastoma is a rare tumor that effects young patients, most frequently at temporal level. On the basis of its neuroradiological appearance, it is difficult to formulate a differential diagnosis against other osteoblastic tumors or against osteoid osteoma. In only a few cases MRI findings are reported. In our cases, MRI was more effective than CT scans and radiographs for evaluating the intracranial and intraosseous extension of the tumor. The definitive diagnosis was obtained by combining the histopathological features of the tumor with the clinical and radiological data. The prognosis of this tumor is very good regardless of the type of treatment performed, although both relapse and, more rarely, malignant tumor evolution are possible.

Osteoblastoma is a benign bone tumor which is common in the vertebral column and long bone of the extremities. The paranasal sinus involvement is rare. We reported a case of benign osteoblastoma of the ethmoid sinus in a nine-year-old boy who presented with exophthalmos. The tumor had aggressive growth with cranial base involvement. Radiologic finding was a mottled soft tissue mass with sclerotic margin. Histologic features were the presence of osteoblast, small trabeculae of woven bone and rich vascular fibrous stroma. Differential diagnoses consist of various kinds of fibro osseous lesions; the closest one is osteoid osteoma. Surgery is the treatment of choice, external ethmoidectomy with lateral rhinotomy was performed in this case. Recurrence is common according to previous reports. Previous literature were reviewed and discussed.

The case of a 25-year-old patient with a rare osteoblastoma-like osteosarcoma of the pars petrosa is discussed. CT scans (thin layers) showed a lytic, the skull basis-resorbing tumor with slight matrix calcification. MRI demonstrated a mainly signal intense tumor in T1-weighted images with less signal intensity at its borders which showed an enhancing peripheral zone after use of a gadolinium-containing medium.

Resection of the mandibular condyle inevitably leads to functional impairment even in cases of reconstruction with prosthesis or autogenous bone graft. Loss of function is caused by the loss of action of the lateral pterygoid muscle. Therefore, preservation and fixation of this muscle to a transplant should be performed whenever possible. A case of osteoblastoma of the condylar head and neck with functional reconstruction after ablative surgery is presented.

The authors report the case of a 5-year-old girl who presented with a parietal midline sub-scalp lesion. Skull radiographs demonstrated a lytic lesion surrounded by a sclerotic rim that resembled a dermoid cyst of the cranium. Histopathological analysis proved that the lesion was a benign osteoblastoma. As in other calvarial masses of uncertain nature, after diagnostic workup, we recommend surgical excision both for diagnosis and for treatment.

The authors report 38 reconstruction by Grosse-Kempf nailing for resection of bone tumor; there were: intercalar resections: 16; arthrodeses of the knee: 13; arthrodesis of the ankle joint: 5; gyroplasty: 4. Massive homoplastic bone graft was used in 26 cases, in 3 of which autoplastic grafting was associated; autoplastic grafts were used exclusively in 7 cases, and a cement spacer was used in 1. Twenty-nine patients (76%) obtained satisfactory final results, but in 10 cases secondary surgery was performed for a total of 14 operations, of which 7 major (1 nail substitution and 6 vascularized fibula operations). There were 7 failures: mechanical complications: 6; infection: 1. The highest number of non-unions were observed where massive homoplastic grafting was used: intercalar reconstruction: 11; arthrodesis of the knee: 7. The results were evidently better and the incidence of complications low in cases in which autoplastic grafting was used or where gyroplasty was performed. Absolute stiffness and best possible contact are difficult to obtain with blocked intramedullary nailing. On the contrary, when autoplastic grafts are used or when gyroplasty is performed micromovements allowed the instrumentation are compatible with good consolidation.

A 5-year-old girl presented with a 1-year history of a subcutaneous swelling in the right parietal region. There were no cerebral symptoms or signs. Plain X-ray of the skull showed a lytic bony lesion with sclerotic margin. Computed tomography showed a hypodense, osteolytic lesion with thinned and bulged inner and outer skull tables with intact continuity. There was no intracranial lesion. At operation, the mass was found to be pink and granular, and was totally enucleated. Histology revealed it to be a benign osteoblastoma.

Osteoid osteoma (ICD: 9191/0) and osteoblastoma (ICD: 9200/0) are closely related entities of osteoblastic-type tumors. Osteoid osteoma is a small benign (lesion 1-2 cm or less) neoplasm that is richly vascularized. Nerve fibers within the tissue surrounding the nidus lead to the characteristic pain. A typical finding is the perifocal osseous reaction around the nidus. Osteoblastoma is a progressively growing lesion of a diameter larger than 2 cm; it is sometimes painful and is characterized by the absence of any reactive perifocal bone formation. For both tumors the treatment is complete surgical excision. If the nidus of the osteoid osteoma is removed, the patient will be free of pain. For the osteoblastoma the treatment depends on the stage and localization of the tumor. Forty-seven patients with osteoid osteoma and 10 patients with osteoblastoma have been treated in Heidelberg since 1980. The radiological investigations and surgical treatment are discussed.

Rickets or osteomalacia secondary to tumor in either bone or soft tissue is rare and interesting in that it can be cured after removal of the tumor. The majority of the reported cases occurred in adults older than 30 years, and the most commonly associated types were vascular and fibrous tumors. We present a new case of aggressive osteoblastoma in the ilium, which induced vitamin D-resistant rickets in an 8-year, 9-month-old boy. Radiographs and blood chemistry findings on admission showed typical features of active hypophosphatemic ricketts. He underwent three local excisions of the tumor. At 10-year follow-up, the patient was symptom free but short. When a child has symptoms of rickets that develop relatively later than ordinary vitamin D-resistant rickets, every effort should be made to search out a tumorous lesion before attributing it to a renal origin.

Osteoid osteoma or osteoblastoma of the cervical spine require complex therapeutic solutions in cases in which there is proximity to the vertebral artery. We describe four such cases. Generally, resection was efficacious and without recurrence, but twice the vertebral artery had to be sacrificed. Although we did not find any serious neurological complication, we concluded that a simple sacrifice of one of the vertebral arteries is not acceptable, principally because of the importance and variability of the unknown radiculomedullary branches of the vertebral artery. We discuss the therapeutic strategies for treating these lesions, namely preoperative investigations, surgical approaches, and vascular control.

Primary bone tumors arising in the 1st vertebra (atlas) are extremely uncommon, only 12 cases are known to have been reported previously. The present report describes the clinicopathological features of 3 additional bone tumors originated in the atlas (osteochondroma, benign osteoblastoma, and Ewing's sarcoma), as well as their therapeutic management.

This is a case report of a 12-year-old boy with reflex sympathetic dystrophy who had surgery for two benign tumors of the right talus. The reflex sympathetic dystrophy began before the first tumor was diagnosed and at a time when the boy was under emotional stress because of conflicts relating to his parents' divorce. The case is typical of reflex sympathetic dystrophy in children, which is only rarely reported. Associated with the syndrome are anxiety, depressive symptoms, emotional instability and acute stressful life events, which makes an interdisciplinary approach imperative.

We carried out the ankle arthroplasty by excision of the talar body (subtotal talectomy) on 10 ankles of nine patients with talar body tumor, paralytic talipes equinovarus, talipes varus due to spinal injury, or comminuted fracture of the talar body. Talar body excision was initiated by lateral incision and subsequent osteotomy of the fibula. The fibula was everted, leaving the lateral ligament (calcaneofibular ligament) intact. After the talus was exposed, the talar body was excised, leaving about 1.5 cm of head unresected. Subsequently, the fibula was shortened slightly, and the tibia was pulled down to the level of the calcaneus to form a joint, instead of arthrodesis being performed. After surgery, the joint formed by the tibia and calcaneus was mobile in seven of the 10 feet and immobile (arthrodesis) in the remaining three feet. The average follow-up period was 6 years. Although postoperative x-ray revealed slight osteoarthritic changes of Chopart's joint and the tibiocalcaneal joint, none of the patients showed ankle pain that impaired activities of daily living. Subtotal talectomy allows correction of talipes equinus without Achilles tendon lengthening.

Benign osteoblastoma is a rare spinal tumor, with the posterior element mainly involved. Symptoms do vary and there is a long diagnostic delay, especially in young people. We present two cases of benign osteoblastoma. One occurred in the atlas and presented with a painless neck mass. The other occurred in the lumbar spine with symptoms of long-term spinal pain and radicular pain. Preoperative Technetium bone scan and computed tomography (CT) resulted in exact localization and better operative planning. En bloc excision of tumor is indicated for complete pain relief and full return of spinal mobility.

A case of massive benign osteoblastoma involving the clivus and atlas is reported. Usually, these tumours involve the posterior elements of a vertebra and are detected when small as a result of the usual presenting symptom of pain. The unusual site, massive size and presentation with neurological deficits are rare for benign osteoblastomas. The problems encountered in the surgical management of the patient are discussed.

The author gives a survey of literature on bone tumours in childhood and a comparison with his own work. Introducing four cases he concluded, that the survival rate of malignant bone tumours are increasing, the autologous bone transplantation seems to take priority against prosthesis in childhood, and the autologous bone transplantation is more reliable method, than the homologous one.

A 24-year-old man presented with a painful and invalidating coccyx. Exploration revealed a bony lesion involving parts of 2nd and all of the 3rd coccygeal vertebrae. The pathology examination of the surgical specimen revealed the diagnosis of benign osteoblastoma of the coccyx. This exceptional localization required complete surgical resection going into healthy tissues to allow a full histological study and to ensure the absence of relapse. Post-operative follow-up was uneventful and the functional result was excellent.

A case of an osteoblastoma located in the odontoid process in a 7 year-old boy who presented with torticollis is reported. CT scan and MRI disclosed the lesion, but diagnosis was established by a CT-guided needle biopsy. Surgery through a transoral approach allowed total excision of the tumor. This is, to our knowledge, the first case reported of an osteoblastoma of the odontoid process.

A series of 11 osteosarcomas that histologically resembles osteoblastoma was reviewed. The ages of the seven males and four females ranged from 19 to 47 yr (average 29). In six patients the roentgenograms showed cortical destruction and poorly defined borders on the lesion; this roentgenographic presentation was suggestive of malignancy. Histologically, the tumor permeation of the surrounding host tissue allowed us to differentiate osteoblastoma-like osteosarcoma from osteoblastoma. The differential diagnosis can be very difficult or even impossible on a small biopsy. The first diagnosis was considered benign in nine of our cases. Osteoblastoma-like osteosarcoma is a rare variety of osteosarcoma (1.1% of all osteosarcoma). It is a low-grade malignant lesion in which recurrence is the rule when adequate surgical margins were not achieved (five patients). Two of these patients died from tumors after inadequate surgical treatment of the primary tumor as well as of the recurrences. The six patients who were treated with wide surgical margins were alive without recurrence. One of them had lung metastasis, twice, treated with wide-wedge resection. Osteoblastoma-like osteosarcoma is a low-grade variety of osteosarcoma with characteristic histopathologic features. It needs to be recognized by the pathologist to achieve the right treatment which is wide surgical procedure.

Osteoblastoma is a rare bone tumor involving spine, long bones and infrequently skull, especially with sinus localization. The orbital localization of the neoplasia may cause axial or paraxial exophthalmus, vertical diplopia, pulsatile orbital pain, soft tissue swelling with skin erythema. In addition the osteoblastoma may cause an optic nerve compression, with optic disc edema up to optic nerve atrophy. We describe a case of giant benign osteoblastoma with frontal occurrence and orbital involvement with optic nerve compression. Surgery was performed in order to obtain the partial ablation of the neoplasia. After a 4-year follow-up there was no evidence of recurrence.

Until now 19 patients were treated for osteoblastoma in our University Department. Operation was performed in every case and recurrence was found in one patient. The clinical-pathological characteristics of the benign, latent, active and aggressive osteoblastomas are discussed. In benign active process excision, in benign aggressive tumors, depending from the localization, resection en bloc is suggested. In cases localized near to the joint, weighing the damage of function in consequence of a possible resection and the increased risk too, a thorough excision is proposed completed with local adjuvant treatment and frequent control of the patient.

A bone tumour of intermediate grade malignancy in the skull is described. These tumours are extremely rare and share several histological features with the benign osteoblastomas and low grade osteosarcomas. They may be associated with local invasion and pulmonary metastases. Treatment of this tumour in the skull poses several problems in view of its proximity to the cerebral cortex.

A 26-year-old man with a chronic subgaleal hematoma containing calcific elements subsequently developed an aggressive osteoblastoma within the lesion. It is presumed that the osseous elements associated with the chronic process underwent neoplastic alteration. Such a lesion should be suspected in an individual with a long-standing subgaleal hematoma who reports changes occurring with respect to either size of the lesion or the development of tenderness.