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 Table of Contents  
CASE REPORT
Year : 2015  |  Volume : 2  |  Issue : 3  |  Page : 262-264

Congenital (in growing) osteoma skull in 20-day-old neonate


1 Department of Pathology, GSL Medical College, Rajahmundry, Andhra Pradesh, India
2 Department of NeuroSurgery, GSL Medical College, Rajahmundry, Andhra Pradesh, India

Date of Web Publication12-Jun-2015

Correspondence Address:
Dr. Parasa Gayathri Devi
Floor No: 401, Chakravarhty's Satyadham, H.No: 75-1-16/10, Prakash Nagar, Rajahmundry - 533 104, East Godavari District, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2348-3334.158711

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  Abstract 

Osteomas are most common benign, slow growing bone-forming tumors of the skull. These bony outgrowths develop from membranous bones, composed of compact or trabecular bone limited exclusively to craniofacial bones, especially of paranasal sinuses. Congenital in growing osteomas presenting in neonates is extremely rare. Authors did not come across any case of congenital osteoma reported in the literature.

Keywords: Extra axial, in growing, neonate, osteoma


How to cite this article:
Devi PG, Venkatachalam TS, Sharma YV, Kumar MP. Congenital (in growing) osteoma skull in 20-day-old neonate. CHRISMED J Health Res 2015;2:262-4

How to cite this URL:
Devi PG, Venkatachalam TS, Sharma YV, Kumar MP. Congenital (in growing) osteoma skull in 20-day-old neonate. CHRISMED J Health Res [serial online] 2015 [cited 2020 Jan 24];2:262-4. Available from: http://www.cjhr.org/text.asp?2015/2/3/262/158711


  Introduction Top


Osteomas are benign slow-growing lesions from membranous bones found mostly on skull and paranasal sinuses. Most tumors are asymptomatic and account for 0.43-1% of bone tumors in the general population. [1] They are usually solitary and seen in middle-aged adults with a peak incidence in sixth decade (mean age 37 years), more often seen in men than women (3:1). [2],[3] Multiple osteomas are seen in Gardner syndrome.

In general, the osteomas are asymptomatic slow growing tumors of little clinical significance, [1],[2] except when they cause obstruction of the sinus cavity, impinge on the brain, or eye, interfere with oral cavity or produce cosmetic problems. [2] Imaging studies are helpful in delineating the lesion. [3],[4],[5]


  Case report Top


A 20-day-old female neonate was brought to the Neurosurgery Department with history of swelling over right temporal region since birth. On examination, a bony swelling measuring 5.0 × 5.0 cm was found on right parieto-occipital region [Figure 1]a. The skin over the swelling was normal. There was neither impulse on cough or cry nor any evidence of meningeal irritation. No other physical abnormalities were detected. The baby was second child, born of full term normal delivery without any history of birth trauma or birth asphyxia. There is no history of consanguineous marriage or any illness or trauma during pregnancy. Feeding patterns were normal. First child is normal without any such bony lesions or any other abnormalities. Her vitals were normal, and Glasgow scale was 15/15. Provisional diagnosis of congenital osteoma with both extra-axial and intra-axial extension was made. Computed tomography imaging study of brain showed a well-defined extra-axial, heterogeneously hyper-dense lesion measuring 3.6 × 3.6 cm in the right parieto-occipital convexity involving right parietal and occipital bones, with extension through the diploeic space in to subcutaneous tissue [Figure 1]b. There is widening with spiculated periosteal reaction and with foci of calcification within the lesion. Biopsy and Histopathological examination were advised. Craniotomy and excision of the lesion was done. Per operatively a 3.5 × 3.5 × 2.5 cm sized bony lesion was found involving diploeic space and eroding the inner table and extending into the soft tissue. Extra axial part was adherent and pressing the durra. A small extra dural hemorrhage was also noted. The tumor was excised completely. X-ray taken on seventh postoperative day confirmed complete removal of the tumor. Postoperative recovery was uneventful, and the baby was discharged on 15 th post-operative day. On followup after 4 months baby is doing well.
Figure 1: (a) Swelling over right parieto-occipital region. (b) Computed tomography scan showing well defined extra-axial, heterogeneously hyper-dense lesion, involving right parietal and occipital bones, with extension through the diploeic space in to subcutaneous tissue. (c) Gray brown, solid, bony hard mass. (D) Uniformly gray brown spongy, hard, bony tissue

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  Gross and Histological Findings Top


Gross examination showed single 4 × 3.5 × 2 cm gray-brown, solid, bony hard mass [Figure 1]c. Cut section showed uniformly gray brown spongy, hard, bony tissue [Figure 1]d. Microscopic examination revealed a tumor tissue made up of well-developed trabeculae of lamellar bone with inter trabecular spaces showing marrow elements and some foci of loose vascular connective tissue [Figure 2]a, and focal osteoblastoma like areas [Figure 2]b. Histologically it was diagnosed as osteoma.
Figure 2: (a) Well developed trabeculae of lamellar bone with inter trabecular spaces showing marrow elements and some foci of loose vascular connective tissue (H and E, ×10). Inset shows trabecula lined by osteoblasts and inter trabecular spaces showing marrow elements. (b) Focal osteoblastoma like areas

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  Discussion Top


These osteomas are present as bosselated round to oval sessile tumors that project from the subperiosteal or endosteal surfaces of the cortex. [1],[2] Osteomas, osteoid osteomas and osteoblastomas are all benign bone-forming tumors. Osteoma and osteoid osteomas occur in middle age. [6],[7] Osteoblastomas may occur at any age but are very rare in children younger than 2 years, and these arise more commonly from the vertebral bodies and long bones. [7] Though etiology is unclear, histologically the tumor may simulate the reactive bone induced by infection, trauma or hemangiomas and hence these should be considered in the differential diagnosis, especially in this case. It is unlikely because the lesion is congenital and does not show any features of reparative bone formation. Osteomas of vault tends to arise from the outer table and grow outward, however large-sized lesions may cause epidural compression giving rise to symptoms. [6],[7]

Histologically there are three types of osteomas; compact or ivory type-made up of mature lamellar bone with no Haversian canal or fibrous component, being the first and the second type is trabecular-composed of cancellous trabecular bone with marrow surrounded by cortical bone. The third type osteomas may show mixed features of both. Some (38%) of osteomas may show osteoblastoma like areas. [8],[9]

Trabecular type can be found in central (endosteal) or peripheral (subperiosteal) locations. In the present case it is of endosteal trabecular type showing trabecular bone with intervening marrow elements and focal osteoblastoma like areas.

Osteoblastoma like areas are common in Sino-orbital osteomas, but do not correlate with adverse clinical features or worse outcome and appear to represent active remodeling within osteoma rather than a distinct clinicopathological entity. [8] Osteomas of calvaria usually arise from an external table; the inner table is only rarely involved. In some osteomas, both tables and diploeic space become involved [3] as in our present case.


  Conclusion Top


Osteomas are commonly seen in adults and rare in younger age groups. Though few cases were reported in children the youngest to develop was of 3 years. [3] All of these occurred in paranasal bones. None was reported to occur in neonatal age group that too in the calvarium. We have reported a trabecular type of congenital osteoma in a neonate.

 
  References Top

1.
Izci Y. Management of the large cranial osteoma: Experience with 13 adult patients. Acta Neurochir (Wien) 2005;147:1151-5.  Back to cited text no. 1
    
2.
Ehieli E, Chu J, Gordin E, Pribitkin EA. Frontal sinus osteoma removal with the ultrasonic bone aspirator. Laryngoscope 2012;122:736-7.  Back to cited text no. 2
    
3.
Schwartz MS, Crockett DM. Management of a large frontoethmoid osteoma with sinus cranialization and cranial bone graft reconstruction. Int J Pediatr Otorhinolaryngol 1990;20:63-72.  Back to cited text no. 3
    
4.
Kim KS. Symptomatic osteoma originated from lamina papyracea. Saudi J Ophthalmol 2011;25:427-9.  Back to cited text no. 4
    
5.
Smith ME, Calcaterra TC. Frontal sinus osteoma. Ann Otol Rhinol Laryngol 1989;98:896-900.  Back to cited text no. 5
    
6.
Savic DL, Djeric DR. Indications for the surgical treatment of osteomas of the frontal and ethmoid sinuses. Clin Otolaryngol Allied Sci 1990;15:397-404.  Back to cited text no. 6
    
7.
Virayavanich W, Singh R, O'Donnell RJ, Horvai AE, Goldsby RE, Link TM. Osteoid osteoma of the femur in a 7-month-old infant treated with radiofrequency ablation. Skeletal Radiol 2010;39:1145-9.  Back to cited text no. 7
    
8.
McHugh JB, Mukherji SK, Lucas DR. Sino-orbital osteoma: A clinicopathologic study of 45 surgically treated cases with emphasis on tumors with osteoblastoma-like features. Arch Pathol Lab Med 2009;133:1587-93.  Back to cited text no. 8
    
9.
Jichici D. Benign Skull Tumors. Available from: http://www.emedicine.medscape.com/article/1155917-overview. [Last accessed on 2013 Oct 13].  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2]



 

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