Presentation
The patient presents with left anterior elbow pain for over a year. There was no specific injury. The patient has tried oral steroids, physical therapy, anti-inflammatories, and ice and heat, but without relief of symptoms.
Patient Data
An ovoid lesion with central lucency and peripheral sclerosis projecting in the coronoid/olecranon fossa of the distal humerus. Subtle cortical irregularity/periosteal reaction at the anterior aspect of the distal humeral metaphysis.
A well-defined ovoid lesion with central lucency and peripheral sclerosis centered in the anterior cortex of the distal humerus. The lesion measures up to 7 mm in the craniocaudal dimension, with the long axis of the lesion oriented along the long axis of the bone. Surrounding lucent halo/bone defect and overlying cortical thinning. Adjacent sclerosis and periosteal reaction. Surrounding soft tissue edema or small elbow joint effusion.
An ovoid lesion with central T2/PD hyperintensity and peripheral hypointensity in the distal humeral supracondylar region, centered at the anterior cortex. Extensive adjacent marrow edema in the distal humerus. Small elbow joint effusion/synovitis.
Select images from CT-guided biopsy and cryoablation of the distal humeral lesion from a lateral approach through the lateral humeral epicondyle.
Histologic sections showed fragments of woven and lamellar bone with a focus of active bone remodeling corresponding to the nidus of the lesion. Osteoblasts and osteoclasts were seen without cytologic atypia and no lace-like osteoid deposition was present. (H&E, 200x magnification)
Case Discussion
Osteoid osteoma is a benign osteoblastic tumor, primarily affecting the metaphyseal-diaphyseal junction of the long bones, with prevalence in the lower limbs 1. This patient’s age and osteoid osteoma location at the distal humerus near the elbow make this an atypical presentation 2.
Following the MRI, the patient underwent CT-guided biopsy and cryoablation of the lesion. Pathology from the biopsy confirmed osteoid osteoma. Status post cryoablation, the osteoid osteoma resolved radiographically and clinically.
Case co-authors:
Sharmain Siddiqui
Sara Siddiqui
Emad Allam
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