PMC3771467_01
Preoperative clinical photograph of the left great toe.
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fig1
In the physical examination, it was seen that his left great toe was enlarged when compared with the right side (Figure 1).
Preoperative AP X-ray of both feet.
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Preoperative erythrocyte sedimentation rate, C-reactive protein, and leukocyte values were all within normal ranges, while preoperative plain radiographs demonstrated a lytic bone lesion with a sclerotic rim in the medial part of the distal phalanx (Figure 2).
Preoperative coronal T1-weighted MR image of the left foot.
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Preoperative MRI showed bone marrow and soft tissue edema in the distal phalanx, compatible with osteomyelitis (Figure 3). 99mTc scintigraphy showed increased activity in the left great toe.
An osteoid osteoma nidus and the normal bone at the border of the lesion are demonstrated in the histological section. The nidus is composed of vascular fibrous tissue in which there are small, irregular, but connected, trabeculae of woven bone, demonstrating both prominent osteoblasts and prominent osteoclasts (H and E, x4 obj.).
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fig4
Two musculoskeletal pathologists conducted histological examinations, revealing vascular fibrous tissue with spongious bone formation in the center, which was interpreted as the nidus of an osteoid osteoma (Figure 4).