Skip to main content
SpringerLink
Log in

Pseudomalignant osteoblastoma of the odontoid process

  • CASE REPORT
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Introduction

The anterior elements of the spine, particularly the odontoid processes, are a rare location for osteoblastomas. Pseudomalignant osteoblastomas are themselves rare histologic types and are also extremely rare in this location. Most osteoblastomas are Enneking stage 2 lesions; less frequently, they can be more aggressive with extra-capsular extension (Enneking stage 3). En bloc resection is recommended for aggressive lesions, but the literature is less clear regarding the approach to stage 2 tumors, particularly those with pseudomalignant histologic features.

Case report

A 6-year-old male child presented with a type III pathologic fracture of the odontoid. The fracture healed but upon 6-month follow-up CT scanning, an expansile lesion was detected. Surgical biopsy revealed an osteoblastoma which was treated with intralesional excision. Meanwhile, the excised specimen showed histological features of a pseudomalignant osteoblastoma. Despite this diagnosis, no further treatment was undertaken. At a 10-year follow-up, the patient was free from pain and had full range of motion of the cervical spine; no recurrence was detected.

Conclusion

This unique case of odontoid osteoblastoma illustrates that malignant behavior may not be predicted only by the presence of pseudomalignant features on histology.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Jaffe HL (1956) Benign osteoblastoma. Bull Hosp Joint Dis 17(2):141–151

    PubMed  CAS  Google Scholar 

  2. Lichtenstein L (1956) 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 9(5):1044–1052

    Article  PubMed  CAS  Google Scholar 

  3. Janin Y, Epstein JA, Carras R, Khan A (1981) Osteoid osteomas and osteoblastomas of the spine. Neurosurgery 8(1):31–38

    Article  PubMed  CAS  Google Scholar 

  4. Saccomanni B (2009) Osteoid osteoma and osteoblastoma of the spine: a review of the literature. Curr Rev Musculoskelet Med 2(1):65–67

    Article  PubMed  PubMed Central  Google Scholar 

  5. Frassica FJ, Waltrip RL, Sponseller PD, Ma LD, McCarthy EF (1996) Clinicopathologic features and treatment of osteoid osteoma and osteoblastoma in children and adolescents. Orthop Clin North Am 27(3):559–573

    PubMed  CAS  Google Scholar 

  6. Denaro V, Denaro L, Papalia R, Marinozzi A, Di Martino A (2007) Surgical management of cervical spine osteoblastomas. Clin Orthop Relat Res 455:190–195

    Article  PubMed  Google Scholar 

  7. Raskas DS, Graziano GP, Herzenberg JE, Heidelberger KP, Hensinger RN (1992) Osteoid osteoma and osteoblastoma of the spine. Clin Spine Surg 5(2):204–211

    CAS  Google Scholar 

  8. Bruneau M, Cornelius JF, George B (2005) Osteoid osteomas and osteoblastomas of the occipitocervical junction. Spine 30(19):E567–E571

    Article  PubMed  Google Scholar 

  9. Hladky JP, Lejeune JP, Singer B, Lecomte-Houcke M, Herbaux B, Dhellemmes P (1994) Osteoblastoma of the odontoid process. Pediatr Neurosurg 21(4):260–262

    Article  PubMed  CAS  Google Scholar 

  10. Mori Y, Takayasu M, Saito K, Seki Y, Shibuya M, Yoshida J (1998) Benign osteoblastoma of the odontoid process of the axis: a case report. Surg Neurol 49(3):274–277

    Article  PubMed  CAS  Google Scholar 

  11. Daszkiewicz P, Roszkowski M, Barszcz S, Kuczyński D, Grajkowska W (2004) Osteoblastoma of the dens axis in a 14-year-old boy. A case report. Neurol Neurochir Pol 39(5):420–423

    Google Scholar 

  12. Dahlin DC, Johnson EW (1954) Giant osteoid osteoma. J Bone Joint Surg Am 36(3):559–572

    Article  PubMed  Google Scholar 

  13. Jaffe HL (1935) Osteoid-osteoma: a benign osteoblastic tumor composed of osteoid and atypical bone. Arch Surg 31(5):709–728

    Article  Google Scholar 

  14. Kan P, Schmidt MH (2008) Osteoid osteoma and osteoblastoma of the spine. Neurosurg Clin N Am 19(1):65–70

    Article  PubMed  Google Scholar 

  15. Marsh BW, Bonfiglio M, Brady LP, Enneking WF (1975) Benign osteoblastoma: range of manifestations. J Bone Joint Surg Am 57(1):1–9

    Article  PubMed  CAS  Google Scholar 

  16. Tani T, Okada K, Shoji K, Hashimoto M, Sageshima M (2000) Osteoblastoma-like osteosarcoma. Skeletal Radiol 29(11):656–659

    Article  PubMed  CAS  Google Scholar 

  17. Mirra JM, Kendrick RA, Kendrick RE (1976) Pseudomalignant osteoblastoma versus arrested osteosarcoma. Cancer 37:2005–2014

    Article  PubMed  CAS  Google Scholar 

  18. Azouz EM, Kozlowski K, Marton D, Sprague P, Zerhouni A, Asselah F (1986) Osteoid osteoma and osteoblastoma of the spine in children. Pediatr Radiol 16(1):25–31

    Article  PubMed  CAS  Google Scholar 

  19. Lichtenstein L (1952) Osteogenic fibroma of bone. Bone Tumors Ed 1:82–87

    Google Scholar 

  20. Lichtenstein L (1956) 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 9(5):1044–1052

    Article  PubMed  CAS  Google Scholar 

  21. Harrop JS, Schmidt MH, Boriani S, Shaffrey CI (2009) Aggressive “benign” primary spine neoplasms: osteoblastoma, aneurysmal bone cyst, and giant cell tumor. Spine 34(22S):S39–S47

    Article  PubMed  Google Scholar 

  22. Enneking WF, Spanier SS, Goodman MA (1980) A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res 153:106–120

    Google Scholar 

  23. Jawad UM, Scully SP (2010) Classifications in brief: enneking classification: benign and malignant tumors of the musculoskeletal system. Clin Orthop Relat Res 468(7):2000–2002

    Article  PubMed  PubMed Central  Google Scholar 

  24. Cheung FMF, Wu WC, Lam CK, Fu YK (1997) Diagnostic criteria for pseudomalignant osteoblastoma. Histopathology 31(2):196–200

    Article  PubMed  CAS  Google Scholar 

  25. Resnicke D, Kyriakos M, Greenway G (1995) Tumors and tumor-like lesions of bone: imaging and pathology of specific lesions. In: Resnicke D (ed) Diagnosis of bone and joint disorders, 3rd edn. W.B. Saunders Company, Philadelphia, pp 3647–3657

    Google Scholar 

  26. Lucas DR, Unni KK, McLeod RA, O’Connor MI, Sim FH (1994) Osteoblastoma: clinicopathologic study of 306 cases. Hum Pathol 25(2):117–134

    Article  PubMed  CAS  Google Scholar 

  27. Della Rocca C, Huvos AG (1996) Osteoblastoma: varied histological presentations with a benign clinical course: an analysis of 55 cases. Am J Surg Pathol 20(7):841–850

    Article  PubMed  CAS  Google Scholar 

  28. Boriani S, Amendola L, Bandiera S, Simoes CE, Alberghini M, Di Fiore M, Gasbarrini A (2012) Staging and treatment of osteoblastoma in the mobile spine: a review of 51 cases. Eur Spine J 21(10):2003–2010

    Article  PubMed  PubMed Central  Google Scholar 

  29. Flemming DJ, Murphey MD, Carmichael BB, Bernard SA (2000) Primary tumors of the spine. Seminars Musculoskelet Radiol 4(3):299–320

    Article  CAS  Google Scholar 

  30. Hosalkar HS, Garg S, Moroz L, Pollock A, Dormans JP (2005) The diagnostic accuracy of MRI versus CT imaging for osteoid osteoma in children. Clin Orthop Relat Res 433:171–177

    Article  Google Scholar 

  31. Davies M, Cassar-Pullicino VN, Davies MA, McCall IW, Tyrrell PN (2002) The diagnostic accuracy of MR imaging in osteoid osteoma. Skelet Radiol 31(10):559–569

    Article  Google Scholar 

  32. Greenspan A, Remagen W (1997) Differential diagnosis of tumors and tumor-like lesions of bones and joints. Lippincott-Raven, Philadelphia

    Google Scholar 

  33. Arkader A, Dormans JP (2008) Osteoblastoma in the skeletally immature. J Pediatric Orthop 28(5):555–560

    Article  Google Scholar 

  34. Dorfman HD, Weiss SW (1984) Borderline osteoblastic tumors: problems in the differential diagnosis of aggressive osteoblastoma and low-grade osteosarcoma. Semin Diagn Pathol. 1(3):215–234

    PubMed  CAS  Google Scholar 

  35. Schajowicz F, Lemos C (1976) Malignant osteoblastoma. Bone Joint J 58(2):202–211

    CAS  Google Scholar 

  36. Dehner LP, O’Sullivan MJ, Strauss BL, Wold LE, McAlister WH (2001) Skeletal system: congenital, developmental, and acquired disorders. Pediatric Pathol 2:1361–1362

    Google Scholar 

  37. Bhusnurmath S, Hoch B (2012) Benign bone-forming tumors: approach to diagnosis and current understanding of pathogenesis. Surg Pathol Clin 5(1):101–116

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Acknowledgements to Professor Afonso Fernandes past head of pathology department of University Hospital of Santa Maria for his critical input in following this patient.

Author information

Authors and Affiliations

  1. Orthopaedics Department, Centro Hospitalar Lisboa Norte, University Hospital of Santa Maria, Avenida Professor Egas Moniz, 1649-035, Lisbon, Portugal

    Pedro Fernandes, Joaquim Soares do Brito & Jacinto Monteiro

  2. Pathology Department, Centro Hospitalar Lisboa Norte, University Hospital of Santa Maria, Lisbon, Portugal

    Adília Costa

Authors
  1. Pedro Fernandes
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joaquim Soares do Brito
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Adília Costa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jacinto Monteiro
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joaquim Soares do Brito.

Ethics declarations

Conflict of interest

None of the authors has any potential conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fernandes, P., do Brito, J.S., Costa, A. et al. Pseudomalignant osteoblastoma of the odontoid process. Eur Spine J 27 (Suppl 3), 477–482 (2018). https://doi.org/10.1007/s00586-018-5500-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-018-5500-9

Keywords

Search

Navigation