Head and neck pathology · 2025
Epithelioid Osteoblastoma: Clinicopathologic Features of a Classic Case with Aggressive Behavior.
СтатьяКлинический случайНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
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Silva Jamerson Carvalho, de Santana Dandara Andrade, Fernandes Isabela Teixeira, Santana Alessandra Monteiro, Padilha Walter Suruagy Motta, de Aquino Xavier Flávia Caló, Dos Santos Jean Nunes
Аннотация
INTRODUCTION: Epithelioid osteoblastoma is a rare variant of osteoblastoma, characterized by large osteoblasts with epithelioid morphology. Although benign, it can be locally aggressive, frequently affecting the spine and long bones, with up to 26% of cases in the craniofacial region, especially the mandible.
CASE PRESENTATION: We present a case of a 12-year-old male with a mandibular epithelioid osteoblastoma causing cortical expansion and tooth displacement. CT revealed a 4.7 cm mass with calcifications and periosteal reaction. Histology showed epithelioid osteoblast proliferation within a highly vascular stroma, scattered osteoclasts, and hemorrhagic areas, with a low Ki-67 index (< 5%) and no atypical mitoses or infiltrative growth.
DIFFERENTIAL DIAGNOSIS: Osteoid osteoma, cementoblastoma, fibro-osseous lesions, and osteosarcoma were considered. Osteosarcoma was excluded due to the absence of nuclear pleomorphism, atypical mitoses, and infiltrative growth. Clinical, radiographic, and histologic features, along with FOS/FOSB rearrangements and c-fos immunohistochemistry, aided accurate diagnosis.
MANAGEMENT AND OUTCOME: The patient underwent marginal resection with clear margins. Follow-up for 10 months showed no recurrence.
CONCLUSION: Epithelioid osteoblastoma reflects a histologic phenotype rather than clinical aggressiveness. Complete excision is recommended to prevent recurrence, while preoperative biopsy and careful differential diagnosis are crucial for distinguishing it from mimics, particularly osteosarcoma.
CASE PRESENTATION: We present a case of a 12-year-old male with a mandibular epithelioid osteoblastoma causing cortical expansion and tooth displacement. CT revealed a 4.7 cm mass with calcifications and periosteal reaction. Histology showed epithelioid osteoblast proliferation within a highly vascular stroma, scattered osteoclasts, and hemorrhagic areas, with a low Ki-67 index (< 5%) and no atypical mitoses or infiltrative growth.
DIFFERENTIAL DIAGNOSIS: Osteoid osteoma, cementoblastoma, fibro-osseous lesions, and osteosarcoma were considered. Osteosarcoma was excluded due to the absence of nuclear pleomorphism, atypical mitoses, and infiltrative growth. Clinical, radiographic, and histologic features, along with FOS/FOSB rearrangements and c-fos immunohistochemistry, aided accurate diagnosis.
MANAGEMENT AND OUTCOME: The patient underwent marginal resection with clear margins. Follow-up for 10 months showed no recurrence.
CONCLUSION: Epithelioid osteoblastoma reflects a histologic phenotype rather than clinical aggressiveness. Complete excision is recommended to prevent recurrence, while preoperative biopsy and careful differential diagnosis are crucial for distinguishing it from mimics, particularly osteosarcoma.