Abstract
Introduction
Aggressive osteoblastoma (AO) represents a rare tumor with borderline features between benign osteoblastoma and osteosarcoma. Having a local aggressive behavior without metastasizing attitude, radical excision is a mainstay treatment. Conversely, spine fusion technique is still debated. We report a rare case of cervicothoracic junction (CTJ) AO and the tailored decision-making process to choose the best treatment.
Case presentation
A 34-year-old man complaining of neck pain was admitted to our department. Cervicothoracic MRI revealed a well-circumscribed lesion involving C7 left lamina with cortical erosion and mild spinal canal invasion. Additionally, STIR sequences exhibited a bright signal spreading through the posterior third of the C7 and T1 vertebrae which on T1-weighted and T2-weighted sequences appeared isointense and hyperintense, respectively. Therefore, the patient underwent a C7 laminotomy. Histology revealed an aggressive variant of osteoblastoma. Therefore, tumor was classified as AO and surgical management was reconsidered. A combined anterior and posterior approach was recommended to reach oncological radicality and spinal stability. At 6-years follow-up, patient remained neurologically intact without signs of recurrence and/or of instability.
Discussion
Due to its rarity and mimicking features, diagnosis of AO results challenging. Due to its aggressive behavior, radical surgery is the mainstay treatment. Conversely, the most suitable fusion technique is still debated. A proper surgical management should be focused on oncological radicality to guarantee the total tumoral removal avoiding progression or recurrences. Similarly, a proper evaluation of the long-term spinal balance should be assessed to avoid developing of spinal deformities or instrumentation failures.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Dorfman HD, Weiss SW. Borderline osteoblastic tumors: problems in the differential diagnosis of aggressive osteoblastoma and low-grade osteosarcoma. Semin Diagn Pathol. 1984;1:215–34. http://www.ncbi.nlm.nih.gov/pubmed/6600112.
Wu M, Xu K, Xie Y, Yan F, Deng Z, Lei J.et al. Diagnostic and management options of osteoblastoma in the spine. Med Sci Monit. 2019;25:1362–72. https://www.medscimonit.com/abstract/index/idArt/913666.
Galgano MA, Goulart CR, Iwenofu H, Chin LS, Lavelle W, Mendel E. Osteoblastomas of the spine: a comprehensive review. Neurosurg Focus. 2016;41:E4 http://www.ncbi.nlm.nih.gov/pubmed/27476846.
Lucas DR, Unni KK, McLeod RA, O’Connor MI, Sim FH. Osteoblastoma: clinicopathologic study of 306 cases. Hum Pathol. 1994;25:117–34. http://www.ncbi.nlm.nih.gov/pubmed/8119712.
Söylemez MS, Ozger H, Alpan B, Ozkan K, Salduz A, Bilgic B.et al. Clinical management of a challenging malignancy, osteoblastoma-like osteosarcoma: a report of four cases and a review of the literature. Ther Clin Risk Manag. 2016;12:1261–70. https://www.dovepress.com/clinical-management-of-a-challenging-malignancy-osteoblastoma-like-ost-peer-reviewed-article-TCRM.
Della Rocca C.Huvos AG, Osteoblastoma: varied histological presentations with a benign clinical course. Am J Surg Pathol. 1996;20:841–50. http://journals.lww.com/00000478-199607000-00007.
Atesok KI, Alman BA, Schemitsch EH, Peyser A, Mankin H. Osteoid osteoma and osteoblastoma. J Am Acad Orthop Surg. 2011;19:678–89. http://www.ncbi.nlm.nih.gov/pubmed/22052644.
Gahlot N, Jalan D, Elhence P. C4 cervical spine osteoblastoma associated with secondary aneurysmal bone cyst in an adolescent patient: 2-year follow-up. Spinal Cord Ser Cases. 2019;5:89 http://www.nature.com/articles/s41394-019-0233-5.
Nishida K, Doita M, Kawahara N, Tomita K, Kurosaka M. Total en bloc spondylectomy in the treatment of aggressive osteoblastoma of the thoracic spine. Orthopedics. 2008;31:403 http://www.ncbi.nlm.nih.gov/pubmed/19292265.
Schur S, Camlioglu E, Jung S, Powell T, Gutman G, Golan J. Preoperative embolization and complete tumoral resection of a cervical aggressive epithelioid osteoblastoma. World Neurosurg. 2017;106. http://www.ncbi.nlm.nih.gov/pubmed/28710051
Ando K, Imagama S, Kobayashi K, Nishida Y, Ishiguro N. Aggressive osteoblastoma of the cervical spine involving the canal and vertebral artery: a case report. Eur Spine J. 2017;26:111–6. http://www.ncbi.nlm.nih.gov/pubmed/27981453.
Kawahara N, Tomita K, Murakami H, Demura S. Total en bloc spondylectomy for spinal tumors: surgical techniques and related basic background. Orthop Clin North Am. 2009;40:47–63. http://www.ncbi.nlm.nih.gov/pubmed/19064055.
Orguc S, Arkun R. Primary tumors of the spine. Semin Musculoskelet Radio. 2014;18:280–99. http://www.ncbi.nlm.nih.gov/pubmed/24896744.
Boriani S, Capanna R, Donati D, Levine A, Picci P, Savini R Osteoblastoma of the spine. Clin Orthop Relat Res. 1992;37–45. http://www.ncbi.nlm.nih.gov/pubmed/1563167
Crim JR, Mirra JM, Eckardt JJ, Seeger LL. Widespread inflammatory response to osteoblastoma: the flare phenomenon. Radiology. 1990;177:835–6. https://doi.org/10.1148/radiology.177.3.2243998.
Revell PA, Scholtz CL. Aggressive osteoblastoma. J Pathol. 1979;127:195–8. https://doi.org/10.1002/path.1711270406.
Versteeg AL, Dea N, Boriani S, Varga PP, Luzzati A, Fehlings MG.et al. Surgical management of spinal osteoblastomas. J Neurosurg Spine. 2017;27:321–7. https://thejns.org/view/journals/j-neurosurg-spine/27/3/article-p321.xml.
Boriani S, Amendola L, Bandiera S, Simoes CE, Alberghini M, Di Fiore M. et al. Staging and treatment of osteoblastoma in the mobile spine: a review of 51 cases. Eur Spine J. 2012;21:2003–10. https://doi.org/10.1007/s00586-012-2395-8.
López-Puerta JM, Fernández-Marín MR, Martín Benlloch JA, Lorente R. Spinal osteoid osteoma recurring as an aggressive osteoblastoma. Neurocirugia. 31:146–50. http://www.ncbi.nlm.nih.gov/pubmed/31488355
Author information
Authors and Affiliations
Contributions
All authors have made substantial contributions to all the following: the conception and design of the study; drafting the article or revising it critically for important intellectual content; final approval of the version to be submitted.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Consent for publication
An informed consent for publication has been obtained from the patient.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary information
Rights and permissions
About this article
Cite this article
Elia, A., Vitali, M., Grasso, V. et al. Tailored surgery on aggressive osteoblastoma involving the cervicothoracic junction: an oncological and spinal stability long-term follow-up. Spinal Cord Ser Cases 7, 99 (2021). https://doi.org/10.1038/s41394-021-00463-w
Received:
Revised:
Accepted:
Published:
DOI: https://doi.org/10.1038/s41394-021-00463-w
