|Year : 2014 | Volume
| Issue : 2 | Page : 79-82
Osteoblastoma of the temporal bone: A recurrent case report and a review of the literature
Chen Shu-Lin1, Zhuang Hui-Wen2, Fan Yun-Ping1, Jiang Hong-Yan2
1 Department of Otorhinolaryngology, The Fifth Affiliated Hospital of Sun Yat-sen University, No.52 Meihua East Road, Zhuhai, Guangdong, China
2 Otorhinolaryngology Hospital, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, China
|Date of Web Publication||3-May-2014|
Department of Otorhinolaryngology, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, 510080
Source of Support: None, Conflict of Interest: None
Osteoblastoma (OB) is an uncommon mostly benign, vascular, osteoid-forming bone tumor, characterized by histological presence of rich in osteoblasts. The OBs of temporal bone are extremely rare. We reported a 27-year-old woman patient with recurrent temporal bone OB, who had three different diagnoses and underwent four operations. The purpose of the present case was to interpret the different clinical and radiological character of the tumor in different stages showed interestingly in one case. Meanwhile, to make a review on this disease further explored the general clinical, histological, and radiological features and treatment and prognosis of the tumor. It's proved that the clinical presentation and radiographic studies were in accordance with the character of different stage of the tumor. Total resection should be advocated whenever possible, due to good prognosis and relatively low recurrence, even in the recurrent cases.
Keywords: Osteoblastoma, Recurrent, Temporal bone
|How to cite this article:|
Shu-Lin C, Hui-Wen Z, Yun-Ping F, Hong-Yan J. Osteoblastoma of the temporal bone: A recurrent case report and a review of the literature. Indian J Otol 2014;20:79-82
|How to cite this URL:|
Shu-Lin C, Hui-Wen Z, Yun-Ping F, Hong-Yan J. Osteoblastoma of the temporal bone: A recurrent case report and a review of the literature. Indian J Otol [serial online] 2014 [cited 2019 Apr 24];20:79-82. Available from: http://www.indianjotol.org/text.asp?2014/20/2/79/131874
| Introduction|| |
Osteoblastoma (OB) is a mostly benign, richly vascular, bone tumor, characterized by the presence of numerous osteoblasts histologically. OBs usually develop in the vertebral column and long tubular bones, constituting about 1% of all main bone tumors. This tumor rarely develops in the calvaria. Here, we reported a recurrent case of temporal bone OB and reviewed nine related articles, from which we would learn more information about the clinical, histological, and radiological features; and get the idea of treatment and prognosis of the tumor.
| Case Report|| |
A 27-year-old female was admitted on June 2012 complaining of a 3 year history of right postauricular and napes pain without hearing loss, tinnitus, or facial palsy. In 2009, she was diagnosed in the primary hospital with "right postauricular abscess" and underwent incision, drainage, and antibiotic treatment; the symptoms gradually worsened. In July 2010, another hospital's cranial computed tomography (CT) scans revealed right postauricular soft tissue inflammation and mastoiditis; an operation was performed and the postoperative pathology was "osteoma". Her right postauricular pain remitted for only 3 months; its recurrence resulted in hospital admission in December. The temporal bone CT showed a 24 mm × 20 mm local expansile osteolytic mass within the right posterior and inferior mastoid and the posterior external auditory canal. The mass contained a calcified component and bony destruction of the bone cortex [Figure 1]. The magnetic resonance imaging (MRI) revealed an iso- and hypointense mass on a T1-weighted image (T1WI), main isointense and a little hyperintense mass on a T2WI [Figure 2], and inhomogenous enhancement after the administration of gadopentetate dimeglumine. The temporal bone tumor was removed via a right postauricular approach. The bone mass was loose involving the vertical facial nerve segment. The postoperative pathology was OB. The patient had been well without facial palsy, until 2012 when she complained of right postauricular pain again. Physical examination showed a reddish, soft, and ganoid mass occluding the right external auditory canal, and some dark red blood could be extracted from it. CT scans of the temporal bone were obtained, which revealed an expansile soft tissue and patchy ossification involving the original site [Figure 3]. The MRI revealed an isointense mass on a T1WI, hyperintense mass on a T2WI [Figure 4], and inhomogenous enhancement after the administration of gadopentetate dimeglumine. Single-photon emission computed tomography (SPECT)/CT bone scanning revealed a high uptake in the tumor. The tumor was totally removed in July 2012. It was vascular rich and bony loose, which involves the vertical facial nerve segment and jugular foramen. We removed three-fourth of the bony wall of vertical facial nerve segment and residual mastoid, leaving lamina separated from the jugular bulb. The photomicrograph showed a bone-forming tumor, with osteoblasts rimming osteoid and bony trabeculae. A few osteoclasts were seen locally and no mitosis or anaplasia was evident. These findings were compatible with benign OB. The patient was healthy without any sign of recurrence, 1.5 year after the surgery.
|Figure 1: Computed tomography scan image showing a bony destructive mass lesion with calcified component involving the mastoid and external auditory canal|
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|Figure 2: Magnetic resonance imaging scan images showing a most isointense mass on a T2‑weighted image in the right temporal bone|
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|Figure 3: CT scan image showing original site was comprised of soft tissue extending and patchy ossification within it|
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|Figure 4: MRI scan images showing a hyperintense mass on T2WI in the right temporal bone|
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| Discussion|| |
OB is distinguished from other bone neoplasms for its pathological osteoblastic and nonﬁbroblastic description. Its occurrence in the temporal bone is extremely rare. Besides, 18 cases of temporal bone OBs reported by Shimizu in 2006,  we subsequently reviewed the other eight cases, including ours, ,,,,,, to summarize the feature of the tumor.
There is a female predominance in the temporal bone OBs, with the male to female ratio approximately being 1:3, which is opposite to a higher male incidence of 2.5:1 in OBs arising at the usual sites. These patients have ranged from 7 months of age to 68 years. The median age of the patients during tumor occurrence was 22, with a usual peak incidence aged from 10 to 30 years.
Because clinical symptoms of OB were nonspeciﬁc, patients usually neglected it in its early stages. In our statistic, the most common presenting symptoms of this tumor were postauricular pain/headache and local swelling. The incidence of hearing loss and tinnitus was respectively about 40 and 30%. Facial palsy, vertigo, hypogeusia, double vision, and lateral gaze palsy had also been reported because of the involvement of adjacent cranial nerves.
In present case, we noticed that there were different clinical and radiological features in different stages of the tumor. We considered that the first lesion misdiagnosed as "postauricular abscess" and the last recurrent lesion were newer lesion. The physical examination showed a reddish, soft, and ganoid mass occluding the external auditory canal and some dark red blood could be extracted from the mass, because of its lytic changes and richly vascularized. The images of CT and MRI also presented different character of the third preoperative lesion (regarded as older lesion) and of the last preoperative lesion (regarded as newer lesion). The CT scans of the older lesion [Figure 1] showed radiopaque mostly because of higher degree of calciﬁcation/ossiﬁcation of the trabeculae of the tumor; whereas the newer lesion [Figure 3] showed more radiolucent, with predominant osteoid areas and lytic changes. MRI usually shows an iso- or hypointense signal on T1WI in both stage tumor, but a change on T2WI from an isointense signal in the older lesion [Figure 2] to hyperintense signal in the newer lesion [Figure 4] in the present case. The changes of the signal on T2WI related to the degree of ossification and vascularization. In addition, bone scanning was an important accessory examination, which showed a high local radioactive aggregation on the mass lesion, and be helpful to detect multiple lesions.
In another hand, from review we found that the most invasion site of the temporal bone was the mastoid and the petrous bone. Five recurrent cases all involved mastoid extension, three of five involved petrous extension. The facial nerve tube, jugular foramen, and internal auditory canal involved in these two sites could be the reasons of higher recurrence for the difficulty to perform total resection.
Histologically, the tumor was comprised of regularly arranging trabeculae, surrounded by several rows of osteoblasts and richly vascularized stroma, sometimes with multinuclear giant cells of the osteoclastic type.  The histological image of most temporal bone OBs were benign. Today, there was no histopathological criterion predicting the clinical behavior of OB.
Surgical resection was performed in 24 of 26 cases; 14 underwent total resection, and eight had partial resection, among 22 cases for whom follow-up, information was available. Preoperative embolization surgery was performed in five cases. Tumor recurrence was seen in four of 22 patients (18%), occurring from 15 months to 10 years after resection. Of the recurrent cases, one underwent total resection, one underwent partial resection, and the other two underwent partial resection and radiation; and only one patient was histologically aggressive. It appeared that there was no correlation between the histological subtype and tumor recurrence.  In our present case, the tumor recurrence may correlate with the lesion location adjacent to the facial nerve and jugular bulb. Total resection should be advocated whenever possible, even in the recurrent cases. If the tumor is not suitable for total surgical excision due to its location, partial excision is the secondary choice. There is no role for radiotherapy or chemotherapy treatment for OB.
| Conclusions|| |
Temporal OB is very rare. Except for a female predominance, it is similar as which developing at usual sites. It often presents as a slow-growing painful lump, sometimes with hearing loss or tinnitus. The tumor of different stage presents different clinical and radiological character, related to the time from presentation. A correct diagnosis can be obtained by careful radiological and histological examination. Total resection is advocated whenever possible, even in the recurrent cases. It has a good prognosis and a relatively low recurrence rate. There is no necessity for adjuvant radiotherapy or chemotherapy for OB.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]