Sino-orbital osteoma: a clinicopathologic study of 45 surgically treated cases with emphasis on tumors with osteoblastoma-like features.
Ключові слова
Анотація
BACKGROUND
Osteomas are limited almost exclusively to craniofacial and jaw bones. Histologically, they can be divided into ivory, mature, or mixed types. Osteomas may have osteoblastoma-like areas and distinguishing it from true osteoblastoma can be challenging. Some believe osteomas with osteoblastoma-like features behave more aggressively.
OBJECTIVE
To perform a clinicopathologic comparison of sino-orbital osteomas both with and without osteoblastoma-like features.
METHODS
We studied 45 surgically excised sino-orbital osteomas. Tumors were categorized as ivory, mature, or mixed type and presence of osteoblastoma-like areas and Paget-like bone were noted. Clinical features of those with and without osteoblastoma-like areas were compared.
RESULTS
Men outnumbered women (3:2); median age was 37 years. Frontal sinus was the most common location (62%) followed by ethmoid and maxillary sinuses. Twelve tumors (27%) involved the orbit, 2 primarily and 10 secondarily. All cases were symptomatic with headache, sinusitis, visual changes, pain, and proptosis being most common. Seventeen tumors (38%) had osteoblastoma-like areas. Extension into an adjacent sinus/anatomic compartment was more common in osteoblastoma-like tumors (47% versus 29%), including more frequent orbital involvement (41% versus 13%). Visual changes were more frequent in the osteoblastoma-like group. Distribution of histologic subtypes and Paget-like bone were similar between the 2 groups. Osteomas with osteoblastoma-like features were more often incompletely excised (25% versus 14%). However, clinical recurrence was less common (8% versus 27%).
CONCLUSIONS
Osteoblastoma-like features are common in sino-orbital osteomas, but it does not correlate with more adverse clinical features or worse outcome. Osteoblastoma-like areas appear to represent active remodeling within an osteoma rather than defining a distinct clinicopathologic entity. Distinguishing it from osteoblastoma may require careful histologic evaluation and radiographic correlation.
