Department of Anatomic Pathology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
Virchows Arch. 2023 Jul;483(1):41-46. doi: 10.1007/s00428-023-03576-9. Epub 2023 Jun 9.
Osteoid osteomas typically arise in the long bones of extremities. Patients often report pain relieved by NSAIDS, and radiographic findings are often sufficient for diagnosis. However, when involving the hands/feet, these lesions may go unrecognized or misdiagnosed radiographically due to their small size and prominent reactive changes. The clinicopathologic features of this entity involving the hands and feet are not well-described. Our institutional and consultation archives were searched for all cases of pathologically confirmed osteoid osteomas arising in the hands and feet. Clinical data was obtained and recorded. Seventy-one cases (45 males and 26 females, 7 to 64 years; median 23 years) arose in the hands and feet, representing 12% of institutional and 23% of consultation cases. The clinical impression often included neoplastic and inflammatory etiologies. Radiology studies demonstrated a small lytic lesion in all cases (33/33), the majority of which had a tiny focus of central calcification (26/33). Nearly, all cases demonstrated cortical thickening and/or sclerosis and perilesional edema which almost always had an extent two times greater than the size of the nidus. Histologic examination showed circumscribed osteoblastic lesions with formation of variably mineralized woven bone with single layer of osteoblastic rimming. The most common growth pattern of bone was trabecular (n = 34, 48%) followed by combined trabecular and sheet-like (n = 26, 37%) with only 11 (15%) cases presenting with pure sheet-like growth pattern. The majority (n = 57, 80%) showed intra-trabecular vascular stroma. No case showed significant cytology atypia. Follow up was available for 48 cases (1-432 months), and 4 cases recurred. Osteoid osteomas involving the hands and feet follow a similar age and sex distribution as their non-acral counterparts. These lesions often present with a broad differential diagnosis and may initially be confused with chronic osteomyelitis or a reactive process. While the majority of cases have classic morphologic features on histologic exam, a small subset consists solely of sheet-like sclerotic bone. Awareness that this entity may present in the hands and feet will help pathologists, radiologists, and clinicians accurately diagnose these tumors.
骨样骨瘤通常发生在四肢的长骨中。患者常报告 NSAIDs 可缓解疼痛，且影像学表现通常足以确诊。然而，当病变累及手/脚时，由于病变较小且伴有明显的反应性改变，这些病变可能在影像学上无法识别或误诊。涉及手和脚的此类病变的临床病理特征尚未得到很好的描述。我们对所有经病理证实发生在手和脚的骨样骨瘤的机构和会诊档案进行了搜索。获取并记录了临床数据。71 例（45 例男性，26 例女性，7-64 岁；中位数 23 岁）发生在手和脚，占机构病例的 12%和会诊病例的 23%。临床印象常包括肿瘤和炎症病因。放射学研究显示所有病例均为小溶骨性病变（33/33），其中大多数具有微小的中央钙化灶（26/33）。几乎所有病例均表现为皮质增厚和/或硬化以及周围水肿，其范围几乎总是比病灶的两倍大。组织学检查显示界限清楚的成骨病变，形成不同程度矿化的编织骨，单层成骨细胞包绕。最常见的骨生长方式为小梁状（n=34，48%），其次为小梁状和板状混合（n=26，37%），仅有 11 例（15%）呈单纯板状生长方式。大多数（n=57，80%）显示小梁内血管基质。无病例有明显的细胞学异型性。48 例可获得随访（1-432 个月），4 例复发。累及手和脚的骨样骨瘤的发病年龄和性别分布与非肢端骨样骨瘤相似。这些病变常表现出广泛的鉴别诊断，最初可能与慢性骨髓炎或反应性过程混淆。虽然大多数病例在组织学检查中具有典型的形态学特征，但一小部分仅由板状硬化骨组成。认识到该实体可能发生在手和脚，将有助于病理学家、放射科医生和临床医生准确诊断这些肿瘤。
