Osteoid osteoma of a mecacarpal bone: Case report

On altı yaşındaki bayan olgumuz beşinci metakarp üzerinde yaklaşık bir senedir geceleri artan, salisilatlara cevap veren ağrı şikayeti ile polikliniğimize başvurdu. Olgumuzda tanıya anamnez, klinik muayene ve görüntüleme yöntemleri ile ulaşıldı. Eksizyonel biyopsi yapılan hastada küretaj sonrasında otogreft ile greftleme işlemi yapıldı. Direkt grafide beşinci metakarp 1/3 orta bölümde korteksten medulla içine kadar uzanan skleroz artışı tespit edildi ve sonrasında manyetik rezonans görüntüleme yapıldı. Manyetik rezonans görüntülemede intrakortikal lezyon varlığı ile etrafındaki sklerotik dokunun artışı ve klinik olarak geceleri artıp, salisilatlara cevap veren ağrının olması ön tanı olarak bizi osteoid osteomaya yöneltti. Nidus olarak tahmin edilen bölgenin küretajı yapıldıktan sonra otogreft ile greftleme yapıldı. Eksizyonel biyopsi sonrasında yapılan patolojik değerlendirme sonucu osteoid osteoma olarak tanı kesinleştirildi. Biz bu olgu sunumuzda, metakarpal bölgede intrakortikal bir lezyon varlığında osteoid osteomanın akla getirilmesi gerektiğine dikkat çekmek istedik.

Metakarp yerleşimli osteoid osteoma: Olgu sunumu

A 16-year-old girl presented to our clinic with a nocturnally aggravating pain on her 5th metacarpal bone for approximately one year, which responded well to salicylate medication. Clinical diagnosis of our case was achieved through anamnesis, physical examination, and imaging studies. In plane X-Ray, increased sclerosis in middle 1/3 of the 5th metacarpal bone extending from cortical area to medulla was observed. MRI revealed an intracortical lesion surrounded by increased sclerotic tissue. History of nocturnally aggravating and salicylateresponding pain made us suspect osteoid osteoma for diagnosis. After curettage of the area we thought as nidus, autografting was performed. After excisional biopsy, histopathological examination confirmed the diagnosis. In our case, we would like to draw attention for the fact that although being a rare localization, osteoid osteoma should be kept in mind in patients with nocturnally aggravating and salicylate-responding pain in metacarpal region, where radiological studies showed an intracortical lesion.

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1) Jaffe HL. Osteoid-Osteoma: a benign osteoblastic tumor composed of osteoid and atypical bone. Arch Surg 1935;31:709-28.
2) Osteoblastoma-osteoid osteoma. In: Huvos AG. Bone tumors: diagnosis, treatment and prognosis. 2nd ed. Philadelphia: Saunders; 1979. p. 67-80.
3) Benign tumors and tumorlike conditions. In: Jaffe HL. Tumors and tumorous conditions of the bones and joints. Philadelphia: Lea and Febiger; 1958. p. 629.
4) Kayser F, Resnick D, Haghighi P, Pereira Edo R, Greenway G, Schweitzer M, et al. Evidence of the subperiosteal origin of osteoid osteomas in tubular bones: analysis by CT and MR imaging. AJR Am J Roentgenol 1998;170:609-14.
5) Resnick DL, Kyriakos M, Greenway G. Tumors and tumorlike lesions of bone: Imaging and pathology of specific lesions. In: Resnick DL, editor. Philadelphia: Saunders; 1982. p. 144-216.
6) Laffosse JM, Tricoire JL, Cantagrel A, Wagner A, Puget J. Osteoid osteoma of the carpal bones. Two case reports. Joint Bone Spine 2006;73:560-3.
7) Bilgin SS, Yıldız Y, Güçlü B, Sağlık Y. El yerleşimli osteoid osteomlu sekiz olgunun değerlendirilmesi. Acta Orthop Traumatol Turc 2004;38:206-11.
8) Bednar MS, McCormack RR Jr, Glasser D, Weiland AJ. Osteoid osteoma of the upper extremity. J Hand Surg [Am] 1993;18:1019-25.
9) Fehring TK, Green NE. Negative radionuclide scan in osteoid osteoma. A case report. Clin Orthop Relat Res 1984;(185):245-9.
10) Wold LE, McLeod RA, Sim FH, Unni KK, editors. Atlas of orthopedic pathology. Philadelphia: Saunders; 1990.
11) Carroll RE. Osteoid osteoma in the hand. J Bone Joint Surg [Am] 1953;35:888-93.
12) Healey JH, Ghelman B. Osteoid osteoma and osteoblastoma. Current concepts and recent advances. Clin Orthop Relat Res 1986;(204):76-85.
13) Benign osteoblastic tumors. In: Dorfman HD, Czerniak B, editors. Bone tumors. 1st ed. St Louis: Mosby; 1998. p. 85-127.
14) Norman A. Persistence or recurrence of pain: a sign of surgical failure is osteoid-osteoma. Clin Orthop Relat Res 1978;(130):263-6.
15) Arazi M, Memik R, Yel M, Oğün TC. Osteoid osteoma of the carpal bones. Arch Orthop Trauma Surg 2001;121:119-20.
16) Basu S, Basu P, Dowell JK. Painless osteoid osteoma in a metacarpal. J Hand Surg [Br] 1999;24:133-4.
17) Soler JM, Pizà G, Aliaga F. Special characteristics of osteoid osteoma in the proximal phalanx. J Hand Surg [Br] 1997;22:793-7.