Osteoid-osteoma of trapezium bone in a child (clinical case)

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Abstract

BACKGROUND: Osteoid osteoma is a benign neoplasm of bones with a diameter of up to 1.5 cm. It is most common in children in the second decade of life and at the age of 20–30 years, predominantly in men. In large neoplasms (>1.5 cm) with a histological study identical to osteoid osteoma, the pathological process is regarded as osteoblastoma or giant osteoid osteoma. The tumor is most often located in long tubular bones and on the hand in 5%–15% of the patients. Differential diagnosis is carried out with rheumatoid arthritis, inflammation, and other neoplasms. Various options for the treatment of osteoid osteoma, both conservative and operative, have been proposed.

CLINICAL CASE: A 17-year-old patient underwent surgical treatment for trapezium bone neoplasm and pronounced chronic pain syndrome.

DISCUSSION: The identification and treatment of osteoid osteoma remain challenging, which is associated with the similarity of clinical symptoms and ineffectiveness (in the initial stages of its development) of X-ray examination. Thus, computed tomography is necessary to identify a pathological structure. If a formation on the hand is detected, surgery (tumor resection) is advised; if necessary, bone grafting of the defect is performed. After surgical treatment, relapse may occur within 7 months, which is associated with incomplete tumor removal. To confirm the diagnosis, a pathomorphological study is necessary.

CONCLUSIONS: Chronic pain syndrome requires a thorough examination of the patient and a differential diagnosis. Surgical treatment allows the restoration of hand functions and alleviates the tumor-associated pain syndrome.

About the authors

Natalia V. Avdeychik

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Author for correspondence.
Email: natali_avdeichik@mail.ru
ORCID iD: 0000-0001-7837-4676
SPIN-code: 6059-4464

MD, PhD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Sergey I. Golyana

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: ser.golyana@yandex.ru
ORCID iD: 0000-0003-1319-8979
SPIN-code: 8360-8078

MD, PhD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Denis Yu. Grankin

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: grankin.md@gmail.com
ORCID iD: 0000-0001-8948-9225
SPIN-code: 1940-3837

MD, Research Associate

Russian Federation, Saint Petersburg

Alexander D. Nilov

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: sh097@mail.ru
ORCID iD: 0009-0005-8845-7009
SPIN-code: 8289-3490

MD, pathologist

Russian Federation, Saint Petersburg

Varvara V. Chernyavskaya-Haukka

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: haukka90@mail.ru
ORCID iD: 0000-0002-6349-0559

MD, orthopedic and trauma surgeon

Russian Federation, Saint Petersburg

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Supplementary files

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2. Fig. 1. External appearance of the hands and amplitude of movements in the wrist joint in patient P (17 years old)

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3. Fig. 2. Patient P, 17 years old. X-ray of the hands in anteroposterior projection and computed tomography of the left hand in MPR mode (frontal and sagittal planes) demonstrating the localization of the tumor nest (arrows)

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4. Fig. 3. Patient P, 17 years old. Magnetic resonance imaging of the left hand demonstrating the localization of the tumor nest (arrow)calization of the tumor "nest" (indicated by the arrow)

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5. Fig. 4. Patient P, 17 years old. Intraoperative image: a, after subcutaneous isolation of the palmar/volar surface of the trapezium bone; b, after resection of the tumor “nest” within healthy tissues

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6. Fig. 5. Patient P, 17 years old. Microphotographs at histological examination: a, overview microphotograph showing a section of the tumor nidus bordering adjacent bone tissue, staining with hematoxylin and eosin, ×50; b, fragment of the nidus represented by moderately calcified bone beams with cellular fibrous connective tissue in the intertrabecular spaces, staining with hematoxylin and eosin, ×100; c, focal osteoclastic reaction with some large multinucleated cells of osteoclastic type, staining with hematoxylin and eosin, ×200; d, thickened bone beams bordering with sclerosed connective tissue fibers of the periosteum, staining with hematoxylin and eosin, ×100

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