Epithelioid osteoblastoma is a bone-producing tumour that is a subtype of osteoblastoma, on the spectrum between osteoblastoma and osteosaroma. Whilst rare, it is important to differentiate this benign, locally aggressive tumour, from a malignant osteosarcoma, and from metastatic lesions. Disease recurrence can occur if lesions are not completely excised. Metastases are not known to occur. The possibility of malignant transformation is remote, though slightly less so if there has been previous treatment with radiotherapy.
Radiologically, these lesions in the long bones usually appear ovoid, sometimes expansile, radiolucent with variable amounts of sclerosis, and can cause cortical destruction and an aggressive periosteal reaction. High uptake on FDG-PET scans can be present despite the lesion's pathologically benign nature. Thus osteosarcoma remains a differential diagnosis on imaging.