CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2024; 43(01): e57-e61
DOI: 10.1055/s-0042-1746195
Case Report

Aggressive Osteoblastoma of Temporal Bone Causing Facial Palsy in a 9-year-old Child: A Case Report Based on 2020 WHO Classification of Bone Tumors

Osteoblastoma agressivo do osso temporal causando paralisia facial em uma criança de 9 anos: Um relato de caso baseado na classificação da OMS de 2020 de tumores ósseos
1   Department of Histology and Pathology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
2   Pathology Laboratory, Complexo Hospitalar Santa Casa, Porto Alegre, RS, Brazil
3   Pathology Laboratory, Grupo Hospitalar Conceição, Porto Alegre, RS, Brazil
4   Hemodynamics Service, Instituto de Cardiologia, Fundação Universitária de Cardiologia, Porto Alegre, RS, Brazil
,
Roque Domingos Furian
2   Pathology Laboratory, Complexo Hospitalar Santa Casa, Porto Alegre, RS, Brazil
,
Luiza Gomes Botega
2   Pathology Laboratory, Complexo Hospitalar Santa Casa, Porto Alegre, RS, Brazil
,
Nilo Devigli Júnior
2   Pathology Laboratory, Complexo Hospitalar Santa Casa, Porto Alegre, RS, Brazil
,
Eron Rodrigues Cunha Lopes
2   Pathology Laboratory, Complexo Hospitalar Santa Casa, Porto Alegre, RS, Brazil
› Author Affiliations
 

Abstract

Aggressive osteoblastoma (AO) is an uncommon bone tumor that represents a borderline lesion between osteoblastoma and osteosarcoma. The vertebral column, the sacrum, the pelvis, and jaw/craniofacial bones are primarily affected. Aggressive osteoblastoma does not metastasize and is treated by surgical resection. The authors report a case of AO in a 9-year-old female patient presenting with 5th and 7th cranial nerve palsy. Prior pathological history included resection of an expansile nodule in the left temporal bone. Conventional radiological examination and computed tomography (CT) of the skull revealed an osteoblastic lesion arising in the petrous portion of the left temporal bone, measuring 5.2 cm in the largest dimension. The patient was subjected to partial surgical resection of the process. Microscopy revealed a primary neoplastic bone composed of numerous epithelioid round osteoblasts disposed in solid sheets and with mild atypia, large eosinophilic cytoplasm, and an eccentric, ovoid nucleus. The process exhibited loose stroma, low mitotic index, osteoid formation, and a few osteoclast-like multinucleated giant cells. The diagnosis of AO was thus established. After 5 months of clinical follow-up, the patient is asymptomatic, without evidence of tumoral growth on CT scans.


#

Resumo

O osteoblastoma agressivo (AO) é um tumor ósseo incomum que representa uma lesão limítrofe entre osteoblastoma e osteossarcoma. A coluna vertebral, o sacro, a pelve e os ossos maxilares/craniofaciais são afetados principalmente. O osteoblastoma agressivo não metastatiza sendo tratado por ressecção cirúrgica. Os autores relatam um caso de OA em paciente do sexo feminino, de 9 anos, com paralisia de V e VII pares cranianos. A história patológica prévia incluiu ressecção de nódulo expansivo no osso temporal esquerdo. O exame radiológico convencional e a tomografia computadorizada (TC) de crânio revelaram lesão osteoblástica surgindo na porção petrosa do osso temporal esquerdo, medindo 5,2 cm em sua maior dimensão. O paciente foi submetido à ressecção cirúrgica parcial do processo. A microscopia revelou osso neoplásico primário composto por numerosos osteoblastos epitelióides redondos dispostos em lâminas sólidas e com leve atipia, grande citoplasma eosinofílico e núcleo ovoide excêntrico. O processo exibiu estroma frouxo, baixo índice mitótico, formação de osteóide e algumas células gigantes multinucleadas semelhantes a osteoclastos. O diagnóstico de OA foi assim estabelecido. Após 5 meses de acompanhamento clínico, o paciente encontra-se assintomático, sem evidência de crescimento tumoral na tomografia computadorizada.


#

Introduction

Aggressive osteoblastomas (AOs) are very rare tumors classified as borderline lesions between osteoblastoma and osteosarcoma. Its peak age incidence is in the 2nd and 3rd decades of life.[1] [2] [3] Overall distribution patterns are similar to those of conventional osteoblastoma, with a predilection for the axial skeleton. The vertebral column, the sacrum, proximal parts of the appendicular skeleton such as the pelvis and femur, and jaw/craniofacial bones are primarily affected.[2] [3] [4] [5] Aggressive osteoblastomas do not metastasize, are likely to recur (in between 20 and 30% of cases) and are characterized by the presence of epithelioid osteoblasts. The lesion is not considered a precursor to osteosarcoma.[1] [2] [5] [6] [7] The present study reports a case of AO compromising the left temporal bone and causing 5th and 7th cranial nerve compression in a pediatric patient and discusses clinical and pathological findings of this rare bone tumor.


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Case Report

A female patient, 9 years old, was referred to the neurosurgery service with left 5th and 7th cranial nerve palsy. On physical examination, the patient exhibited good general condition and adequate weight and height development (48.7 kg/1.45 m), without evidence of other focal neurological deficits, optic nerve edema, or alterations in other systems. Her prior pathological history included resection of an expansile nodule in the left temporal bone 2 years earlier at another institution, where the diagnosis of osteofibrous dysplasia was established. Current laboratory tests were within normal values. Conventional radiological examination and computed tomography (CT) of the skull revealed an osteoblastic lesion arising in the petrous portion of the left temporal bone, which measured ∼ 5.2 cm in the largest dimension and caused compression of the 5th and 7th cranial nerves ([Fig. 1]). The patient was subjected to partial surgical resection of the process (∼ 80% of the tumoral volume). The patient was placed in right lateral decubitus and underwent a left frontobasal craniotomy. During the surgical procedure, an expansive lesion affecting the temporal bone was identified. The process determined compression of the brainstem and the foramina at the base of the skull. The tumor was resected through the Kawase trigone in its lowest portion and lateral to the Meckel cavum. The VII cranial pair was dissected and preserved during the procedure. On gross examination, the surgical specimen was composed of several irregular, pale gray fragments of bone tissue, the largest of which measured 1.8 × 1.2 × 1.0 cm. On microscopy, a primary neoplastic bone neoplasm was identified. The lesion was characterized by numerous epithelioid round osteoblasts disposed in solid sheets around irregular bone trabeculae and exhibiting mild atypia, large eosinophilic cytoplasm, and an eccentric, ovoid nucleus. The process had loose stroma, numerous small vascular channels, low mitotic index, osteoid formation, and a few osteoclast-like multinucleated giant cells. No chondroid areas were identified ([Fig. 2]). These findings culminated in a diagnosis of AO. After 8 months of clinical follow-up, the patient is asymptomatic, without cranial nerve palsy or evidence of tumoral growth on CT scans. Previous histological slides were reviewed, and the diagnosis of AO was confirmed.

Zoom Image
Fig. 1 Aggressive osteoblastoma: Computed tomography of the skull revealing an osteoblastic lesion (5.2 cm in the largest dimension) arising in the petrous portion of the left temporal bone.
Zoom Image
Fig. 2 Aggressive osteoblastoma of the temporal bone: (A) Epithelioid osteoblasts occupying intertrabecular spaces (hematoxylin–eosin, 200X); (B) Large epithelioid osteoblasts disposed in solid sheets and showing mild atypia. Note osteoid deposition and vascular channels in the tumor stroma (hematoxylin–eosin).

#

Discussion

The true incidence and age distribution of AO remain largely unknown because of the rarity of the disease.[1] [2] [4] [5] [7] The first case series found in the literature, published in 1984 and 1996, described 15 and 36 cases, respectively.[1] [4] Clinical complaints are directly associated with compromised bone, and pain is a common symptom. Radiological findings usually comprise a circumscribed lytic defect sometimes surrounded by a rim of sclerosis.[1] [4] [6] [8] [9] The main difference from conventional osteoblastoma is that AO is larger, usually exceeding 4 cm.[2] [5] [6] [9] [10] The bone contour may be expanded and have a rim of reactive bone. Eventually, the tumor crosses the joint space, thereby compromising the adjacent bone, a reflection of its aggressive biological behavior. Soft tissues may be involved if the tumor arises in small bones.[1] [4] [5] [8] [11] [12]

On gross examination, the process is an oval to round, reddish, bright, soft to hard lesion with well-defined margins.[2] [4] [10] [13] [14] [15] The bone contour may be markedly expanded and exhibit a thinned, disrupted cortex.[2] [4] [10] [13] [14] [15] [16] The tumor stroma is characteristically rich in blood vessels. On microscopy, AO shows many similarities to conventional osteoblastoma. Aggressive osteoblastomas are composed of an irregular network of bone trabeculae distributed in a loose stroma with prominent vasculature.[2] [3] [7] [11] [14] [16] [17] The most important histological finding is the presence of epithelioid osteoblasts that form solid sheets in intertrabecular spaces or rim osteoid trabeculae. Epithelioid osteoblasts are round cells with abundant eosinophilic cytoplasm, an eccentric, oval nucleus with prominent nucleoli, and some degree of atypia.[2] [3] [7] [11] [14] [16] [17] Epithelioid osteoblasts are at least twice the size of normal osteoblasts and, frequently, show a large, clear cytoplasmic area with enlarged Golgi apparatus, which displaces the nucleus.[2] [3] [7] [11] [14] [16] [17] [18] Osteoid can be found around individual tumor cells or in broad zones surrounding epithelioid osteoblasts. The presence of benign osteoclast-like multinucleated giant cells and secondary aneurysmal bone cysts are common features.[2] [4] [7] [10] [13] [15] [17] [18] Aggressive osteoblastomas show 1 to 4 typical mitotic figures per 20 high-power fields. Necrosis is uncommon, and chondroid/cartilaginous differentiation has not been described.[7] [10] [13] [15] [17] [18] [19]

The differential diagnosis includes osteoid osteoma, conventional osteoblastoma, and osteosarcoma.[1] [7] [10] [14] [20] [21] Osteoid osteoma and osteoblastoma measure < 4 cm in diameter and do not exhibit epithelioid osteoblasts. The main diagnostic problem regarding the entity classified as AO centers around its distinction from osteosarcoma. Classical histological findings of conventional osteosarcoma include moderate to severe cellular atypia, high mitotic index, atypical mitotic figures, prominent osteoid deposition, infiltrative/permeating growth pattern, and presence of neoplastic cartilage.[4] [9] [10] [17] [20] [22] [23] [24] Aggressive osteoblastoma also exhibits a peripheral shell of reactive bone over the soft tissue extension, which is not characteristic of osteosarcoma. Genetic studies are not useful for distinguishing between AO and osteosarcoma or for determining prognosis. There is yet no evidence that AO undergoes spontaneous transformation to osteosarcoma.[1] [4] [14] [21] [22] [23] [24] Complete surgical resection, curettage, and/or partial resection is the mainstay of treatment for AO. Skull AO should be treated by wide local excision when technically feasible. Long-term follow-up is necessary to monitor recurrence.[1] [4] [7] [21] [23] [24] The > [Table 1] shows a summary of literature reports of aggressive osteoblastoma. Partial resection of skull AO have been accepted when the location of the tumor, such as the temporal bone or the base of the skull, denotes a high risk of vascular or cranial nerve damage or technical limitations.[1] [4] [7] [21] [23] [24]

Table 1

Summary of literature reports of aggressive osteoblastoma

Reference

Gender, age (years old)

Clinical complaint

Topography

Radiologic findings

Tumor size

Clinical management

Outcome

Morris et al.[5]

Female, 20

Pain

Left scapula

Lytic lesion

8.9 cm

Surgical resection

Disease-free at 3 years after surgery

Lu et al.[6]

Male, 18

Local tenderness

Temporal bone

Lytic lesion

3.3 cm

Surgical resection

No signs of recurrence at 1 year after surgery

Sharma et al.[7]

Male, 18

Progressive swelling

Right parietal bone

Lytic lesion

9.0 cm

Surgical resection

Persistent lesion at 21 months of follow-up

Salmen et al.[8]

Male, 7

Pain

Maxilla

Lytic lesion

2.1 cm

Surgical resection

No signs of recurrence at 1 year after surgery

Al-Ibraheem et al.[9]

Male, 25

Hemimandibular swelling

Mandible

Sclerotic lesion

2.2 cm

Surgical resection

No signs of recurrence at 1 year after surgery

Sharma et al.[10]

Male, 17

Pain in left hip

Acetabulum

Lytic lesion

6.4 cm

Extended curettage

No signs of recurrence at 1 year after surgery

Sonnylal et al.[11]

Male, 21

Painful

mass

Left femur

Sclerotic lesion

20.0 cm

Radical resection of the left femur and cryosurgery

No signs of recurrence at 32 months after surgery

Harrington et al.[12]

Male, 25

Enlarging palatal mass

Maxilla

Sclerotic lesion

4.0 cm

Surgical resection

No signs of recurrence at 8 months after surgery

Miyayama et al.[13]

Female, 29

Pain

Left calcaneus

Lytic lesion

3.0 cm

Surgical resection

No signs of recurrence at 10 years after surgery

Ando et al.[14]

Male, 25

Neck pain

6th and 7th cervical vertebrae

Lytic lesion

3.5 cm

Surgical resection

No signs of recurrence at 2 years after surgery

Dixit et al.[15]

Male, 20

Hearing loss and tinnitus in left ear

Left temporal bone

Lytic lesion

6.0 cm

Partial resection

Unknown

Kukwa et al.[16]

Female, 12

Persistent exophthalmia

Sphenoid

Lytic lesion

5.5 cm

Surgical resection

Recurrence at 4 months after surgery

Pontual et al.[17]

Male, 13

Swelling on the left side of the face

Mandible

Lytic lesion

5.7 cm

Surgical resection

No signs of recurrence at 4 years after surgery

Kashikar et al.[18]

Male, 18

Swelling of the oral cavity

Mandible

Lytic lesion

1.2 cm

Extended curettage

No signs of recurrence at 6 months after surgery

Cikojević et al.[19]

Female, 14

Right-sided nasal obstruction and severe headache

Right middle turbinate

Sclerotic lesion

2.2 cm

Surgical resection

No signs of recurrence at 1 year after surgery

Mohanty et al.[20]

Male, 23

Painful swelling

Temporal bone

Sclerotic lesion

3.0 cm

Surgical resection

No signs of recurrence at 8 months after surgery

Baker et al.[21]

Female, 12

Right thigh pain

Right femur

Lytic lesion

5.7 cm

Surgical resection

No signs of recurrence at 9 months after surgery

Chatterjee et al.[22]

Male, 2

Swelling over dorsum of right hand

Third metacarpal shaft

Lytic lesion

3.0 cm

Surgical resection

No signs of recurrence at 2 years after surgery

Singh et al.[23]

Male, 24

Painful swelling

Mandible

Lytic lesion

5.3 cm

Surgical resection

No signs of recurrence at 5 months after surgery

Castro et al.[24]

Female, 7

Swelling

Mandible

Sclerotic and lytic lesion

5.6 cm

Extended curettage

No signs of recurrence at 6 years after surgery

Present case

Female, 9

Left 5th and 7th cranial nerve palsy

Left temporal bone

Osteoblastic

5.2 cm

Partial surgical resection

No signs of tumoral growth at 5 months of follow-up


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Conflict of Interests

The authors have no conflict of interests to declare.

  • References

  • 1 Dorfman HD. Proceedings: Malignant transformation of benign bone lesions. Proc Natl Cancer Conf 1972; 7: 901-913
  • 2 Dorfman HD, Weiss SW. Borderline osteoblastic tumors: problems in the differential diagnosis of aggressive osteoblastoma and low-grade osteosarcoma. Semin Diagn Pathol 1984; 1 (03) 215-234
  • 3 Rath A, Mandal S, Goswami S, Khurana N, Dhal A. Aggressive osteoblastoma involving the navicular bone of foot: a rare tumor in a unique location. J Foot Ankle Surg 2020; 59 (06) 1279-1282
  • 4 Dorfman HD, Weiss SW. Borderline osteoblastic tumors: problems in the differential diagnosis of aggressive osteoblastoma and low-grade osteosarcoma. Semin Diagn Pathol 1984; 1 (03) 215-234
  • 5 Morris CD, Hameed MR, Agaram NP, Hwang S. Elevated β-hCG associated with aggressive Osteoblastoma. Skeletal Radiol 2017; 46 (09) 1187-1192
  • 6 Lu ZH, Cao WH, Qian WX. Aggressive osteoblastoma of the temporal bone: a case report and review of the literature. Clin Imaging 2013; 37 (02) 386-389
  • 7 Sharma R, Mahajan S, Gupta D. Aggressive cranial Osteoblastoma of the parietotemporooccipital bone: a case report and review of literature with a special emphasis on recurrence/residue. World Neurosurg 2020; 142: 255-267 DOI: 10.1016/j.wneu.2020.06.093.
  • 8 Salmen FS, Oliveira MR, Navarro CM, Dedivitis RA, Pereira Filho VA, Gabrielli MFR. Aggressive Osteoblastoma in the Maxilla: Unusual Lesion in the Craniofacial Skeleton. J Craniofac Surg 2017; 28 (03) 794-797
  • 9 Al-Ibraheem A, Yacoub B, Barakat A. et al. Case report of epithelioid osteoblastoma of the mandible: findings on PET/CT and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128 (01) e16-e20
  • 10 Sharma A, Gogoi P, Arora R, Haq RU, Dhammi IK, Bhatt S. Aggressive osteoblastoma of the acetabulum: A diagnostic dilemma. J Clin Orthop Trauma 2018; 9 (Suppl 2): S21-S25 DOI: 10.1016/j.jcot.2017.09.007.
  • 11 Sonnylal L, Peterson JR, Decilveo AP, O'Connor IT, Wittig JC. Giant periosteal aggressive epithelioid osteoblastoma: 21-year-old male presents case in the midshaft of his femur. Skeletal Radiol 2018; 47 (10) 1443-1448 DOI: 10.1007/s00256-018-2922-8.
  • 12 Harrington C, Accurso BT, Kalmar JR. et al. Aggressive osteoblastoma of the maxilla: a case report and review of the literature. Head Neck Pathol 2011; 5 (02) 165-170 DOI: 10.1007/s12105-010-0234-y.
  • 13 Miyayama H, Sakamoto K, Ide M. et al. Aggressive osteoblastoma of the calcaneus. Cancer 1993; 71 (02) 346-353
  • 14 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 (Suppl 1): 111-116 DOI: 10.1007/s00586-016-4904-7.
  • 15 Dixit R, Gupta S, Chowdhury V, Khurana N. Aggressive osteoblastoma of the temporal bone: an unusual cause of facial palsy. Rev Bras Otorrinolaringol 2018; 84 (01) 119-121
  • 16 Kukwa W, Oziębło A, Oecińska A, Czarnecka AM, Włodarski K, Kukwa A. Aggressive osteoblastoma of the sphenoid bone. Oncol Lett 2010; 1 (02) 367-371 DOI: 10.3892/ol_00000065.
  • 17 Pontual MLA, Pontual AA, Grempel RG, Campos LR, Costa AdeL, Godoy GP. Aggressive multilocular osteoblastoma in the mandible: a rare and difficult case to diagnose. Braz Dent J 2014; 25 (05) 451-456 DOI: 10.1590/0103-6440201300220.
  • 18 Kashikar S, Steinle M, Reich R, Freedman P. Epithelioid Multinodular Osteoblastoma of the Mandible: A Case Report and Review of Literature. Head Neck Pathol 2016; 10 (02) 182-187 DOI: 10.1007/s12105-015-0665-6.
  • 19 Cikojević D, Colović Z, Lozić B, Klančnik M. Aggressive middle turbinate osteoblastoma with intracranial extension: a case report. J Med Case Reports 2014; 8 (01) 161 DOI: 10.1186/1752-1947-8-161.
  • 20 Mohanty S, Rani A, Urs AB, Dabas J. A rare case of an aggressive osteoblastoma of the squamous temporal bone: a unique presentation with literature review. J Craniomaxillofac Surg 2014; 42 (07) 1207-1210
  • 21 Baker AC, Rezeanu L, Klein MJ. et al. Aggressive osteoblastoma: a case report involving a unique chromosomal aberration. Int J Surg Pathol 2010; 18 (03) 219-224 DOI: 10.1177/1066896908319675.
  • 22 Chatterjee D, Mukhopadhyay KK, Kumar S, Chakraborty S. The rare aggressive osteoblastoma in a two year old child in an unusual localization. J Bone Oncol 2013; 2 (02) 89-91 DOI: 10.1016/j.jbo.2013.02.001.
  • 23 Singh DK, Das KK, Mehrotra A. et al. Aggressive osteoblastoma involving the craniovertebral junction: A case report and review of literature. J Craniovertebr Junction Spine 2013; 4 (02) 69-72 DOI: 10.4103/0974-8237.128533.
  • 24 Castro PHS, Molinari DL, Stateri HQ, Borges AH, Volpato LER. Agressive osteoblastoma in a seven-year-old girl's mandible: Treatment and six-year monitoring. Int J Surg Case Rep 2016; 27: 5-9 DOI: 10.1016/j.ijscr.2016.07.033.

Address for correspondence

Eduardo Cambruzzi, PhD
Department of Pathology, Santa Rita Hospital, Complexo Hospitalar Santa Casa
Rua Sarmento Leite, 187, 2° andar, Porto Alegre, RS
Brazil   

Publication History

Received: 16 March 2021

Accepted: 16 June 2021

Article published online:
10 October 2023

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  • References

  • 1 Dorfman HD. Proceedings: Malignant transformation of benign bone lesions. Proc Natl Cancer Conf 1972; 7: 901-913
  • 2 Dorfman HD, Weiss SW. Borderline osteoblastic tumors: problems in the differential diagnosis of aggressive osteoblastoma and low-grade osteosarcoma. Semin Diagn Pathol 1984; 1 (03) 215-234
  • 3 Rath A, Mandal S, Goswami S, Khurana N, Dhal A. Aggressive osteoblastoma involving the navicular bone of foot: a rare tumor in a unique location. J Foot Ankle Surg 2020; 59 (06) 1279-1282
  • 4 Dorfman HD, Weiss SW. Borderline osteoblastic tumors: problems in the differential diagnosis of aggressive osteoblastoma and low-grade osteosarcoma. Semin Diagn Pathol 1984; 1 (03) 215-234
  • 5 Morris CD, Hameed MR, Agaram NP, Hwang S. Elevated β-hCG associated with aggressive Osteoblastoma. Skeletal Radiol 2017; 46 (09) 1187-1192
  • 6 Lu ZH, Cao WH, Qian WX. Aggressive osteoblastoma of the temporal bone: a case report and review of the literature. Clin Imaging 2013; 37 (02) 386-389
  • 7 Sharma R, Mahajan S, Gupta D. Aggressive cranial Osteoblastoma of the parietotemporooccipital bone: a case report and review of literature with a special emphasis on recurrence/residue. World Neurosurg 2020; 142: 255-267 DOI: 10.1016/j.wneu.2020.06.093.
  • 8 Salmen FS, Oliveira MR, Navarro CM, Dedivitis RA, Pereira Filho VA, Gabrielli MFR. Aggressive Osteoblastoma in the Maxilla: Unusual Lesion in the Craniofacial Skeleton. J Craniofac Surg 2017; 28 (03) 794-797
  • 9 Al-Ibraheem A, Yacoub B, Barakat A. et al. Case report of epithelioid osteoblastoma of the mandible: findings on PET/CT and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128 (01) e16-e20
  • 10 Sharma A, Gogoi P, Arora R, Haq RU, Dhammi IK, Bhatt S. Aggressive osteoblastoma of the acetabulum: A diagnostic dilemma. J Clin Orthop Trauma 2018; 9 (Suppl 2): S21-S25 DOI: 10.1016/j.jcot.2017.09.007.
  • 11 Sonnylal L, Peterson JR, Decilveo AP, O'Connor IT, Wittig JC. Giant periosteal aggressive epithelioid osteoblastoma: 21-year-old male presents case in the midshaft of his femur. Skeletal Radiol 2018; 47 (10) 1443-1448 DOI: 10.1007/s00256-018-2922-8.
  • 12 Harrington C, Accurso BT, Kalmar JR. et al. Aggressive osteoblastoma of the maxilla: a case report and review of the literature. Head Neck Pathol 2011; 5 (02) 165-170 DOI: 10.1007/s12105-010-0234-y.
  • 13 Miyayama H, Sakamoto K, Ide M. et al. Aggressive osteoblastoma of the calcaneus. Cancer 1993; 71 (02) 346-353
  • 14 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 (Suppl 1): 111-116 DOI: 10.1007/s00586-016-4904-7.
  • 15 Dixit R, Gupta S, Chowdhury V, Khurana N. Aggressive osteoblastoma of the temporal bone: an unusual cause of facial palsy. Rev Bras Otorrinolaringol 2018; 84 (01) 119-121
  • 16 Kukwa W, Oziębło A, Oecińska A, Czarnecka AM, Włodarski K, Kukwa A. Aggressive osteoblastoma of the sphenoid bone. Oncol Lett 2010; 1 (02) 367-371 DOI: 10.3892/ol_00000065.
  • 17 Pontual MLA, Pontual AA, Grempel RG, Campos LR, Costa AdeL, Godoy GP. Aggressive multilocular osteoblastoma in the mandible: a rare and difficult case to diagnose. Braz Dent J 2014; 25 (05) 451-456 DOI: 10.1590/0103-6440201300220.
  • 18 Kashikar S, Steinle M, Reich R, Freedman P. Epithelioid Multinodular Osteoblastoma of the Mandible: A Case Report and Review of Literature. Head Neck Pathol 2016; 10 (02) 182-187 DOI: 10.1007/s12105-015-0665-6.
  • 19 Cikojević D, Colović Z, Lozić B, Klančnik M. Aggressive middle turbinate osteoblastoma with intracranial extension: a case report. J Med Case Reports 2014; 8 (01) 161 DOI: 10.1186/1752-1947-8-161.
  • 20 Mohanty S, Rani A, Urs AB, Dabas J. A rare case of an aggressive osteoblastoma of the squamous temporal bone: a unique presentation with literature review. J Craniomaxillofac Surg 2014; 42 (07) 1207-1210
  • 21 Baker AC, Rezeanu L, Klein MJ. et al. Aggressive osteoblastoma: a case report involving a unique chromosomal aberration. Int J Surg Pathol 2010; 18 (03) 219-224 DOI: 10.1177/1066896908319675.
  • 22 Chatterjee D, Mukhopadhyay KK, Kumar S, Chakraborty S. The rare aggressive osteoblastoma in a two year old child in an unusual localization. J Bone Oncol 2013; 2 (02) 89-91 DOI: 10.1016/j.jbo.2013.02.001.
  • 23 Singh DK, Das KK, Mehrotra A. et al. Aggressive osteoblastoma involving the craniovertebral junction: A case report and review of literature. J Craniovertebr Junction Spine 2013; 4 (02) 69-72 DOI: 10.4103/0974-8237.128533.
  • 24 Castro PHS, Molinari DL, Stateri HQ, Borges AH, Volpato LER. Agressive osteoblastoma in a seven-year-old girl's mandible: Treatment and six-year monitoring. Int J Surg Case Rep 2016; 27: 5-9 DOI: 10.1016/j.ijscr.2016.07.033.

Zoom Image
Fig. 1 Aggressive osteoblastoma: Computed tomography of the skull revealing an osteoblastic lesion (5.2 cm in the largest dimension) arising in the petrous portion of the left temporal bone.
Zoom Image
Fig. 2 Aggressive osteoblastoma of the temporal bone: (A) Epithelioid osteoblasts occupying intertrabecular spaces (hematoxylin–eosin, 200X); (B) Large epithelioid osteoblasts disposed in solid sheets and showing mild atypia. Note osteoid deposition and vascular channels in the tumor stroma (hematoxylin–eosin).