Should one treat osteoid osteoma?
Q: About three years ago, immediately after a dance party my daughter developed severe pain just above the right knee joint. Consulted an orthopaedician and after some X rays, nothing was found. The pain persisted, though not regular. Some ointments/gel and painkillers helped. She is working as a program executive for a TV channel. The pain has again started troubling her. When she was home last week we had a MRI and the report said: Technical details: Axial T1,T2wt,coronal T1,T2wt, IR and sagittal T1,T2wt sequences were performed through right thigh. In addition, few axial C.T. sections were studied at midshaft. Observations: Focal linear altered marrow signal seen in midshaft of femur, which is hypointense on T1 and hyperintense on STIR sequences. Cortical bone is intact. No obvious periosteal reaction or paraosteal oedema. Muscles of the right thigh are normal. Normal flow void is noted within femoral vessels. Intermuscular fat planes are normal. No mass lesion/inflammation seen. Knee joint appears to be normal. Impression: Focal linear altered marrow signal area in mid shaft of femur. The posssibilities are: 1. Medullary osteioid osteoma. 2. Bone infarct. Both our family orthopaedician and the radiologist say that there is nothing wrong, nothing that requires immediate attention although follow-up is suggested. She has been given some gel and tabs in case the pain is unberable. Please advise. We are worried.
A:Osteoid osteoma is a benign bone tumor. Benign means that it is not as aggressive as cancer. A bone infarct is just an island of dead bone, which doesn't cause much trouble. She may have twisted her leg or might have injured it unknowingly. The MRI findings may be incidental. If symptomatic treatment is not making her better, it is better to have a bone scan to see if the lesion is active or not. If it is not, there is usually no need for further intervention, except for periodic observation. If the lesion is active, it may be necessary to currete (remove) the lesion through surgery. However, the decision has to be from the orthopaedic surgeon who is taking care of her, based on history, physical examination and judgement.