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Osteoblastoma is a solitary, benign bone tumor that is rarely localized in the frontal sinus. It consists of hypocellular mineralized tissue that may form large masses or irregular trabeculae. A 31 year old man came to our attention with a 7 month history of diplopia, photophobia, frontal headhaches and progressive exophthalmos with proptosis of the left eye. The patient was submitted to computed tomography (CT) which allowed to appraise the extension of the lesion. The mass expanded inside the left frontal sinus and the upper ethmoidal cells invading the left orbital roof. Considering the extension of the tumor, the site and the connections with contiguous structures, a combination of endoscopic endonasal technique with intraorbital approach was performed. At histological examination typical features of benign osteoblastoma were observed. The sites of predilection for the tumor are the long bones, vertebral column, and small bones of hands and feet. Its occurrence in the skull and jaw bones is relatively rare and represents only 15% of all osteoblastomas. To our knowledge, only 5 cases of osteoblastoma of the frontal sinus have been previously reported in the English-language literature. This report describes a case of benign osteoblastoma in a rare site, namely, the frontal sinus with particular attention about the differential diagnosis and the treatment.

A study of twenty-five new cases of osteoblastoma and a review of 172 previously reported cases demonstrated the wide spectrum of manifestations of the lesion. The ratio of males to females was 2:1, with 80 per cent of the patients being under thirty years of age. The duration of complaints prior to diagnosis averaged seventeen months. The majority of the lesions were found in the spine or major long bones of the lower extremity. When complete excision of the tumor was done a cure always was the result, but incomplete curettage also affected a cure in some cases. Three cases presented in detail emphasize the wide variation in biological behavior which this lesion may exhibit. Histological characteristics of aneurysmal bone cyst may frequently appear in the tumor tissue. Radiotherapy does not alter the course of the disease and appears to be contraindicated.

In a tri-institutional, retrospective study with long-term follow-up, forty-four patients who had multiple enchondromas were identified. Thirty-seven patients did not have hemangiomas (Ollier disease) and seven did (Maffucci syndrome). Of the thirty-seven patients who had Ollier disease, a low-grade chondrosarcoma developed in four; an astrocytoma, in one; and a granulosa-cell ovarian tumor, in one. In four of the seven patients who had Maffucci syndrome, there were six low-grade chondrosarcomas, one high-grade osteosarcoma, one pancreatic adenocarcinoma, one biliary adenocarcinoma, and one astrocytoma. None of the patients in either group died of the skeletal sarcoma, but four of five patients who had a non-skeletal malignant lesion died. From life-table analyses of these patients, we estimated that the incidence of secondary chondrosarcoma in patients who have Ollier disease is about 25 per cent at the age of forty years, and that malignant degeneration is almost a certainty in patients who have Maffucci syndrome. We concluded that periodic surveillance of the brain and abdomen for occult malignant lesions is indicated in patients who have enchondromatosis.

Twenty-one patients were treated with Zickel nail for neoplastic pathological fracture or impending pathological fracture: in the femoral neck in three, in the intertrochanteric region in three, and in the subtrochanteric region in fifteen. Nineteen patients were restored to bed-chain status by the third postoperative day, and twenty were able to walk. Failure of fixation did not occur and there were no infections.

The authors performed a retrospective study of 33 patients to assess the effect of pregnancy on the behavior of primary bone malignancies, and to develop a strategy for pregnant women with such malignancies focusing on decisions concerning the fetus. This study indicates that pregnancy has no effect on the clinical behavior of bone sarcomas, and, therefore, there is no reason to perform an abortion because of their simultaneous occurrence. However, optimal treatment of the tumor may cause irreparable harm to the fetus. Three main medical factors need to be considered when the future of the fetus is being decided: (1) the trimester at the time of diagnosis; (2) the anatomic site of the tumor; and (3) the type and grade of the tumor, as it relates to the expected treatment of the tumor.

A case of a malignant phenochromocytoma of the organ of Zuckerkandl is reported. There was a solitary functional metastasis in the left femur, which was treated by hip disarticulation after removal of the primary. The patient is asymptomatic and free of further metastases after 3 years. Other reported cases of solitary metastases from malignant pheochromocytomas are cited. These occurred most frequently in the skeleton system, which is the most common site of distant metastases in malignant pheochromocytoma. The reported case and the review of the literature indicate that solitary or limited metastatic lesions should be treated surgically by partial or, when possible, complete resection.