J Korean Soc Spine Surg.  2019 Dec;26(4):160-165. 10.4184/jkss.2019.26.4.160.

Osteoid Osteoma of the Sacrum: A Case Report

• Lim CR
• Ryu JH
• Hwang ZO
• Kim KW

• KMID: 2467945
• DOI: http://doi.org/10.4184/jkss.2019.26.4.160

Abstract

STUDY DESIGN: Case report.
OBJECTIVES
To report a case of osteoid osteoma arising in the sacrum in a 29-year-old male patient. SUMMARY OF LITERATURE REVIEW: Osteoid osteoma is a benign osteoblastic tumor that usually arises in the long bones. Osteoid osteoma involving the sacrum is extremely rare.
MATERIALS AND METHODS
A 29-year-old male patient presented with pain localized in his sacral area for 10 months. His pain was worse at night, relieved by non-steroidal anti-inflammatory drugs, and independent of physical activity. Bone scintigraphy showed increased uptake in the second sacral vertebra (S2). Computed tomography revealed a nidus located in the S2 spinous process. Magnetic resonance imaging showed bone and soft tissue edema around the nidus.
RESULTS
En bloc excision including the nidus revealed a diagnosis of osteoid osteoma and provided immediate relief of the patient's long-lasting sacral pain.
CONCLUSIONS
When a young patient presents with localized sacral pain that is worse at night, relieved by non-steroidal anti-inflammatory drugs, independent of physical activity, and lasts longer than expected, proper imaging studies should be performed to rule out osteoid osteoma. Although less invasive treatment modalities have been introduced, classical en bloc excision is currently the gold standard for managing osteoid osteoma.

Keyword

Osteoid Osteoma; Sacrum; Benign bone tumor

MeSH Terms

Adult
Diagnosis
Edema
Humans
Magnetic Resonance Imaging
Male
Motor Activity
Osteoblasts
Osteoma, Osteoid*
Radionuclide Imaging
Sacrum*
Spine

Figure

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  Fig. 1. Plain radiographs.(A) An anteroposterior plain radiograph is normal. (B) A lateral plain radiograph is normal.

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  Fig. 2. Bone scintigraphy shows increased uptake in the middle of the second sacral vertebra (S2) (arrows).

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  Fig. 3. Magnetic resonance imaging.(A) A gadolinium-enhanced T1-weighted coronal magnetic resonance image shows a mass with high signal intensity in S2 (arrow).(B) A gadolinium-enhanced T1-weighted axial magnetic resonance image shows a mass with nonspecific surrounding edema in the bone marrow and soft tissue (arrow).

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  Fig. 4. Preoperative computed tomography (CT).(A) A coronal CT image shows an oval radiolucent nidus within surrounding sclerotic reactive bone in the spinous process of S2, and a central dot-like calcification within the nidus is also noted (arrow). (B) An axial CT image shows an osteoid osteoma bulging into the S2 spinal canal (ar-row).

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  Fig. 5. The surgically excised specimen shows ventral bulging of the osteoid osteoma (arrows) as seen on the computed tomography image (Fig 4B).

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  Fig. 6. Postoperative computed tomography (CT).(A) Coronal CT images show complete excision of the lesion (arrow). (B) Axial CT images show complete excision of the lesion (arrow).

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  Fig. 7. Histological findings (hematoxylin and eosin; original magnification ×40). The black dashed line indicates a borderline between the nidus (Ni) and surrounding reactive sclerotic bone (S). “N” represents normal bone.

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