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Synchronous Multicentric Osteoid Osteoma With Associated Fibrous Cortical Defect
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Osteoid osteoma is a benign osteoblastic tumor localized primarily in the long bones of the lower extremities. Multifocal or multicentric osteoid osteomas are rare. Multifocal osteoid osteoma refers to more than one nidus in the same bone, whereas synchronous multicentricity refers to the development of a primary osteoid osteoma in more than one bone at the time of discovery.1,2
Although osteoid osteoma involving multiple adjacent bones has been reported previously,2-11 there are no cases of multiple distant osteoid osteomas in the literature. This article presents a case of multiple distant osteoid osteomas and a coexisting fibrous cortical defect.
Case Report
A 19-year-old man presented to a local hospital with pain in his right wrist, the onset of which coincided with his new job in a factory that included screwing bolts. He was diagnosed with soft-tissue injury and treated conservatively.
After remaining asymptomatic for 2 months, the patient returned with recurrent pain that was more severe and constant. The pain was aggravated by physical activity and temporarily relieved by nonsteroidal anti-inflammatory drugs. He was referred to our hospital for further evaluation.
On physical examination, there was tenderness and slight swelling at the base of the dorsal aspect of the second metacarpal bone. Laboratory studies, including erythrocyte sedimentation rate and serum alkaline phosphatase level, yielded normal values.
Radiographs of the wrist revealed an increased hazy density over the trapezoid. Computed tomography (CT) showed a sclerotic focus in the trapezoid, and magnetic resonance imaging (MRI) of the wrist showed the focus was surrounded by medullary edema (Figure 1).
Three-phase bone scan using technetium Tc 99m methylene diphosphonate was positive not only in the right wrist but also in the proximal femur and the superolateral aspect of the left orbit (Figure 2). On further questioning, the patient reported having dull pain in his left...