Pediatric spinal osteoblastoma with a predominantly extraosseous growth pattern: a case report

Osteoblastoma is a rare bone-forming tumor with a predilection for the spine. Typically affecting adolescents and young adults, it presents with localized pain and neurologic deficits if spinal lesions extend into, or indeed predominantly involve, the epidural space. Its imaging appearance can mimic infection or other neoplasms, making diagnosis challenging.

We report on a 14-year-old boy with scoliosis and progressive thoracic back pain found to have a left T11 epidural mass. The lesion caused bony remodeling of the T11 posterior elements and spinal cord compression on MRI. Initial CT-guided and open biopsies were nondiagnostic, but definitive excisional surgery via T11 laminectomy confirmed osteoblastoma. Histopathology demonstrated tumor within both adjacent bone and perilesional soft tissue. The patient's pain resolved after resection, measures of scoliosis improved, and he remained neurologically intact. After nearly 5 years of follow-up, there has been no evidence of recurrence.

Painful scoliosis in a child warrants evaluation for underlying pathology. Small biopsies may be inconclusive; excision may be required for diagnosis and treatment. Histopathology in this case showed both osseous and perilesional soft-tissue involvement despite predominantly extraosseous growth, supporting complete resection when feasible. Recurrence-free status after prolonged follow-up is reassuring, but continued surveillance remains warranted.