Osteoid osteoma of the pisiform. Can it exist in a child?

Abstract

Carpal osteoid osteomas are extremely rare, and only six cases in the pisiform have ever been described, but all concerned exclusively adults. We have treated a unique case of osteoid osteoma in the pisiform of a 13-year-old girl. We excised en bloc the nidus, which resulted in total excision of the pisiform. At follow-up after 15 years there was no recurrence and the patient remains asymptomatic with equal functionality of both hands. Henceforth, we must include osteoid osteoma in the differential diagnosis of pisiform lesions in children. En bloc resection prevents its recurrence and even the complete pisiform excision renders excellent results.

Osteoid osteoma of the pisiform: A case report

“… 5 , 14 In addition to these physical examination findings history of a wrist injury may ease misleading diagnosis. 1 , 3 , 15 Nonspecific symptoms and this rare location frequently cause 12–24 months overdue diagnosis, 5 , 10 , 14 , 15 misdiagnosis, 5 , 16 and insufficient or unnecessary treatment. 5 , 16 , 17 …”

“…Imaging studies are essential in diagnosing OO. Radiographies are frequently not helpful and up to 25% of cases can be missed because of bony superposition in the carpal region or its nonspecific appearance 1 , 3 , 5 , 16 ; although it is the major imaging modality for other localizations. 8 But particularly for the pisiform, 30° of supination relative to the X-ray beam with the ulnar side of the hand on the table can clearly visualize an OO.…”

“…18 MRI is the most sensitive imaging modality, 1 while CT scan is the most specific. 1 , 3 In MRI, OO is seen as a low signal intensity area with a centrally localized signal increase of nidus. 1 The typical CT scan of OO is composed of sclerosis surrounding a lucent nidus with variable degrees of central mineralization.…”

“…Osteoid osteoma (OO), first described by Jaffe HL, et al in 1935, 1 , 2 , 3 is an uncommon benign bone-forming tumor of the musculoskeletal system with uncertain etiology. 1 , 4 It accounts for 3%–4% of all primary bone tumors, 1 , 5 and 10%–14% of all benign bone tumors.…”

“… 1 , 2 , 9 Seven cases and six articles was reported in literature about OO of the pisiform. 1 , 3 , 9 , 10 , 11 , 12 …”