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| Year : 1999 | Volume
: 47
| Issue : 4 | Page : 330-1 |
Osteoblastoma of dorsal spine : a case report.
Tripathy P, Sarkar S, Maiti B
Lake Gardens Rental Housing Estate, Block - 'M', Flat No. 3, Sultan Alam Road, Calcutta, 700033, India.
Correspondence Address:
Lake Gardens Rental Housing Estate, Block - 'M', Flat No. 3, Sultan Alam Road, Calcutta, 700033, India.
A case of benign osteoblastoma affecting posterior element of spine with pain and paraplegia in a female is being presented with brief review of literature. Early diagnosis and surgical excision remains the mainstay of treatment.
How to cite this article:
Tripathy P, Sarkar S, Maiti B. Osteoblastoma of dorsal spine : a case report. Neurol India 1999;47:330 |
Primary bone tumours are uncommon and only about 12% affect the spine.[1] Benign osteoblastoma are larger than osteoid osteoma and approx. 30% occur in the spine, usually posteriorly.[2] It is a rare primary neoplasm comprising less than 1% of primary bone tumours.[3],[4] The tumour was first described as a distinct entity by Jaffe and Lichtenstein in 1956. It is more common in males and usually presents in the second decade of life.[5] This case has been presented for its rarity and more so for its occurrence in a female.
A seventeen year old female from West Bengal was admitted with history of pain in the upper part of the chest radiating from the back for the last one year. It had increased and localized on the upper dorsal region for the last three months. She gradually developed progressive weakness of both lower limbs within two months along with bladder involvement. There was no history of trauma, fever or any other disease.
On examination she had normal higher functions and had no signs of upper limbs involvement. Lower limbs were spastic with grade 0/5 power. The deep tendon jerks were exaggerated and planters were extensor. There was clear sensory level involving all modalities at D7. Spinal tenderness was present at D4, D5, D6 levels. Routine blood examination was within normal limits. X-ray dorsal spine centering at D4 showed radiolucent area surrounded by an area of sclerosis with non-visualisation of the pedicle of D4 vertebra on left side. MRI (T1 weighted image) showed hypo to isointense contrast enhancing lesion compressing the spinal cord posteriorly at the level of D3, D4, D5 vertebrae with evidence of cord oedema at that level. The lesion was hyperintense on T2 weighted image [Figure. 1a],[Figure. 1b],[Figure. 1c]. The left pedicle of fourth dorsal vertebra was destroyed. There was associated paravertebral shadow.
Laminectomy of 3rd, 4th and 5th dorsal vertebra was done with total removal of mass. After exposing the spines and laminae, a cherry-red mass arising from D4 lamina on the left side, at its junction with the spine was noted. The total tumour was lifted from the dura. There were thin broken pieces of bone forming a pseudocapsule over the durameter. Post-operative recovery was uneventful. Patient became pain free after the operation. The power in the lower limbs improved steadily with physiotherapy. Histopathological report was suggestive of osteoblastoma [Figure. 2] showing osteoid seams lined by osteoblasts; a few osteoclastic giant cells were also seen.
After the description of osteoid osteoma by Jaffe in 1935 and osteoblastoma by Jaffe and Lichtenstein in 1956, there remained several controversies regarding the nomenclature of the same disease process. Most authors now believe that the both osteoid osteoma and osteoblastoma are variant manifestations of benign osteoblastic process, resulting in a osteoid nidus surrounded by sclerotic bone. The primary difference between the two lesions is the tendency of the osteoblastoma to form a less sclerotic, more expansile mass. Mcleod et al arbitrarily defined lesions of less than 1.5 cm. in diameter as osteoid osteoma and of more than 1.5 cm. in diameter as osteoblastoma.[3] In the present case, the lesion was more than 1.5 cm. in diameter and it affected the dorsal element of spine. Local or radicular pain is the characteristic presenting feature of both osteoid osteoma and benign osteoblastoma; however, the latter is more expansile in nature and is often associated with narrowing of the spinal canal or neural foramina, resulting in some neurological deficit.[5]
Plain X-ray showing radiolucent area with surrounding sclerosis with increase in uptake at the tumour site by isotope bone scan and CT scan of the involved region invariably give good detail of the lesion. In the present case, isotope bone scan and CT was not done. As there were features of compressive myelopathy, MRI was conducted. Treatment of this condition is surgical, involving complete excision of the lesion. Relieve of pain within hours to day is expected in case of successful excision of the entire lesion. Post-operative irradiation, particularly in case of incomplete removal of the lesion, does not decrease the rate of recurrence. It may, on the other hand lead to an increase in the incidence of sarcomatous change.[2]
Of the 123 cases reported from Mayo Clinic in 1976, 39 were located in the vertebral column; of which 11 were found in the dorsal spine and 62% were limited to the dorsal element.[3] Pettine and Klassen reported 11 cases of osteoblastoma spine, out of which 4 cases affected the dorsal element of the dorsal vertebrae. Neurological deficit was found in 3 out of 11 cases.[6] Osteoblastoma should be included in the differential diagnosis of pain in the back or neck, painful scoliosis or radicular or referred type of pain in young individuals.
| 1. | Dahlin DC, Unni KK : Bone tumours : General aspects and data on 8,542 cases, 1986 : In : Surgery of the spine, Vol. 1, Findlay G and Owen R (Eds.) Blackwell Scientific Publication London. 1992; 519-521.  |
| 2. | Myles ST, Mac Rae ME : Benign osteoblastoma of the spine in childhood. J Neurosurg 1988; 68 : 884-888. |
| 3. | Mcleod RA, Dahlin DC, Beabout JW : The spectrum of osteoblastoma. Am J Roentgenol 1976; 126 : 321-335. |
| 4. | Akbarnia B, Rooholamini S : Scoliosis caused by benign osteoblastoma of the thoracic and lumbar spine. J Bone Jt Surg 1981; 63 : 1146-1155. |
| 5. | Moran RM, Webb JK : Primary tumours of the spine. In : Surgery of the spine Vol.1, Findlay G and Owen R (Ed.) Blackwell Scientific Publication, London. 1992; 539-543. |
| 6. | Kroon HM, Shurmans J : Clinical and Radiologic findings in 98 New Cases. Radiology 1990; 175 : 783. |
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