Osteoid Osteoma of the Distal Phalanx: A Rare Condition

Abstract

Osteoid osteoma of the distal phalanges in the hand is rare and difficult to diagnose. We report a case of a 37-year-old Caucasian female patient who presented with a mass on the distal phalanx of the index finger. The patient was suffering from intermittent nocturnal pain for more than 18 months along with thickening, localized swelling, and clubbing of the distal phalanx of the right index finger. Radiographs revealed a lytic lesion of the distal phalanx of the right index finger with surrounding sclerosis. An MRI showed an intramedullary lesion with infiltration of the bone marrow, cortex, and surrounding tissue with focal sclerosis and elements of enhancements. A presumptive diagnosis of osteoid osteoma was made and surgical removal of the lesion by curettage and bone grafting was the treatment of choice. The curetted specimen was sent to pathology and the diagnosis of osteoid osteoma was confirmed. The patient was asymptomatic at six months postoperatively. Osteoid osteoma should be included in every differential diagnosis for patients presenting with atypical features of the distal phalanx of the hand.

Osteoid Osteoma, a Diagnostic Problem: A Series of Atypical and Mimicking Presentations and Review of the Recent Literature

“…Of the patients, 97% had painful lesions [ 31 ]. Sources report that the atypical presentation often involves the phalanges, where the main clinical feature is soft tissue oedema and skin tenderness over the tumour [ 32 , 33 , 34 , 35 ]. A rare presentation is a painless lesion; however, such a site may be, for example, a subungual location [ 36 ].…”

Recurrent osteoid osteoma of the index proximal phalanx: A case report with a new resection technique

“…Pain typically worsens at night and is relieved by nonsteroidal anti-inflammatory drugs. [4,5] It is radiologically described as a spherical single tumor, with a diameter of less than 1.5 cm, exhibiting a core zone of atypical bone known as the “nidus.” [6] Although a computed tomography (CT) scan is thought to be the most precise imaging modality for diagnosing OO, [5] magnetic resonance imaging (MRI) is considered more sensitive than a CT scan in phalanx OOs. [2]…”

“…[4,5] It is radiologically described as a spherical single tumor, with a diameter of less than 1.5 cm, exhibiting a core zone of atypical bone known as the "nidus." [6] Although a computed tomography (CT) scan is thought to be the most precise imaging modality for diagnosing OO, [5] magnetic resonance imaging (MRI) is considered more sensitive than a CT scan in phalanx OOs. [2] The pathological features of OO are a small, round, soft, and hyperemic tumor surrounded by a harder and more sclerotic reactive bone.…”