BENIGN TUMORS OF BONE

Dr. Abdulla Bin-shehna

BENIGN TUMARS OF BONE 1-

cystic lesions 2-fibrous lesions 3-cartilaginous lesions 4-benign (occasionally aggressive) bone tumors 5-bone forming tumors 6-miscellaneous bone tumors

Benign bone tumors

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Cystic lesions

1- unicameral bone cyst 2- aneurysmal bone cyst 3- ganglion cyst of bone 4- epidermoid cyst

Benign bone tumors

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Fibrous lesions

1- fibrous cortical defect 2- nonossifying fibroma 3- cortical desmoid 4- benign fibrous histiocytoma 5- fibrous dysplasia 6- osteofibrous dysplasia 7- desmoplastic fibroma 8- giant cell reaction [ giant cell reparative granuloma]

Benign bone tumor 

Cartilaginous tumors

1-osteochondroma 2- multiple osteochondromatosis 3- chondroma 4- multiple enchondromatosis [Ollier disease]

Benign bone tumors 

Benign [occasionally aggressive] tumors

1- giant cell tumor 2- chondroblastoma 3- chondromyxoid fibroma 4- langerhans cell histocytoma

Benign bone tumors 

Bone forming tumors

- Ostioid osteoma

Benign bone tumors 

Miscellaneous benign tumors

1- neural tumors 2- vascular tumors 3- fatty tumors

Unicameral [simple bone]cyst    Occurs in childhood, rare in adults, more in males Most in prox. Humerus or prox. Femur Two forms: - active       - inactive In their fluid has been reported PGE2 Malignant transformation has been reported asymtomatic unless fracture is present Obliteration after healing of fracture X.Ray : lytic lesion Treatment: -curettage with or without bone graft.

-aspiration followed by instillation of . . Methylprednisolone - F.I.N

Unicameral bone cyst

Technique of aspiration instillation

Pathological fracture :healing :remodling

Bone cyst after injection – fluid level

Treatment by intramedullary flexible nails

Installation of prednisalone

Aneurysmal bone cyst          Occurs in any age, common in young adults Located centrally X.Ray: lytic lesion have a honeycamb shape C.T: location & size – M.R.I: fluid levels Biopsy: to diff. Between G.C.T or Osteosarcoma Grow rapidly Treatment: curettage & bone grafting Recurrence approx. 25% Vertebral lesions treated surgically

Aneurysmal B.C of prox. Ulna, excision and large bone grafting

Aneurysmal bone cyst of phalange

Ganglion cyst of bone  X.Ray: well-demarked lytic defect with thin rim of sclerotic bone  Treatment: curettage

Ganglion bone cyst

Epidermoid cyst  Filled with keratinous material & lined with squamous epithelium

Epidermoid cyst

Epidermoid cyst including the bone

Fibrous lesions 

Fibrous cortical defect [non – ossifying fibroma] -

developmental abnormalities - the common benign in children , more in males - generally occurs in the metaphysial region of long bones [ femur, tibia] - multiple F.C.D occurs approx. in 50% of cases - x.ray: circular or oval with low radio lucent & margins well - defined thin rim of sclerosis - def. Diagnosis : G.C.T , fibrous dysplasia , xantogranuloma - treatment: F.C.D not necessary –N.O.F curettage

&

bone grafting

F.C.D

Non-ossifying fibroma ???!

Fibrous lesions 

Cortical desmoid [ periosteal desmoid]

- assymptomatic irregularity in posteriomedial aspect of distal femoral metaph. - large lesions give symptoms: soft tissue swelling- pain - x.ray: oblique view 20-40 deg. Externally & lesion appears as erosion of cortex with sclerotic base

Cortical desmoid

Fibrous lesions 

Benign fibrous histocytoma -

occurs most in soft tissues & less common in bones - similar to that of nonossifying fibroma histologically - more aggressive in its biological behavior & reotegen. Characteristics - occurs in any part of long bones or in pelvis - occurs in older patients - x.ray: well – defined lytic lesion with little periosteal reaction - treatment: aggressive curettage or wide exision

Fibrous lesions 

fibrous dysplasia

- developmental anomaly of bone formation - the hallmark is replacement of normal bone and marrow by fibrous tissue and small woven bone - occurs in any part of bone - associated abnormalities : sexual precocity thyroid disease-abnormal skin pegmentation - large lesion gives: pain, pathological fracture - x.ray: fine & granular area [ ground glass ] - classic sign: shepherd’s crook deformity in prox. Femur - biopsy is necessary - malignant reported - treatment: curettage & bone grafting

Fibrous dysplasia

Fibrous dysplasia

Fibrous dysplasia

Fibrous lesions 

Osteofibrous dysplasia [ossifying fibroma of long bones- Campanacci disease

- rare lesion, affecting tibia& fibula [usually diaphysial] - most patients in the first decade- more in boys - clinically: path. Fracture, tibia is enlarged& bowed anterolaterally x.ray: intra cortical osteolysis with expansion of cortex - treatment: paht. Fractures by cast immobilizing & curettage + subperiosteal resection in 15 y - deformity corrected by osteotomy

Osteofibrous dysplasia

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Osteochondroma- cartilage capped exostosis

-the most common of benign tumors; more in males -originate within the periosteum as small nodules -their growth usually stopped when skeletal maturity is reacted -clinically: mass or pain -x-ray: 2 types; stalked & broad based . Calcification within the cap -the cap usually thin and thicker should be studied (secondary chondrosarcoma) -treatment: surgery in large lesions or produce symptoms or roentgenographic features suggest malignancy -Recurrence is rare -spontaneous disappearance has been reported

osteochndroma

Osteochondroma of radius

Osteochondroma of prox. femur

Intaarticullar osteochondroma of femur

Osteochondroma of hand

Cartilaginous tumors 

Multiple osteochondromatosis

-The most striking feature is the presence of many exostosis -caused by anomaly of skeletal development -most regions involved are about the knees , ankles and scapula -surgery indicated to remove painful mass, improve joint motion and correct deformity

osteochndromatosis

Cartilaginous tumors 

Multiple enchondromatosis (OLLIER disease)

-rare disease in witch many cartilaginous tumors appear in both large and small tubular bones and in flat bones -failure of normal endochondral ossification -located in epiphysis and metaphysis Deformities and shorting resulting from the tumors including bowing of long bones -associated with hemangiomas disease is known as MAFFUCCI disease -50% malignant transformation -treatment: more obvious deformities can be corrected by osteotomy

Oller disease

Cartilaginous tumors 

Chondroma (including enchondroma and periosteal chondroma) -

chondromas are less common than osteochondromas -occur third & forth decades located centrally in small bones of hands and feet -some times referred to as cart. Hamartoma -asymptomatic and seen incidently or after path. Fracture

-x-ray:

low radiolucent appears as well circumscribed with small foci of calcification -signs of transformation to malignant tumor is; age > 30 , pain , increasing mass, cortical lysis -treatment: curettage and bone grfting , periosteal chondroma should be excised en bloc

8-y child & enchondromas of 5 th metacarp. & microfracture

After 6 mon… after curt. & bone graf.

Enchond. Of hand

Enchond. Of femur,& after curettage

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Gaint cell tumor -

occur in mature long bones(dis. femur & prox. Tibia), in age 20-40 and rarely in adolescent -located in epiphysis abut subchondral bone -pulmonary metastases occur in 3% of pat.

-pul. Metas. May have spontaneous regression or lead to death -path. Fractures occur in 10-30% -x-ray: purely lytic lesion and expands through cortex . Malignant expands to soft tissues -MRI; determine the extent of the lesion -

treatment

: extended curettage with phenol or argon beam arthroplasty or aethrodesis may be indicated =radiation may be used for inoperable lesions(spine , pelvis)

GCT of medial condyle

After curettage and bone cement

GCT excision and arthrodesis

GCT of 5-th. Metatarsal bone

Benign(occasionally aggressive) bone tumors 

Chondroblastoma

-rare, typically occur in patients ages, 10-20y, more in males. Most common sites; dis. Femur & prox. Tibia -clinically ; pat. C\O progressive pain that may mimic a chronic synovitis -x-ray; well-circumscribed lytic lesion centered in epiphysis of long bones surrounding rim bone. May be located in apophysis such as greater trochanter -it is usually present as stage 2 , less aggressive than GST treatment: extended curettage & bone grafting or cement -recurrence treated as primary -pulmonary metas. Occur approx. in 1%.

Chondroblastoma associated with aneurysmal bone cyst

Chondroblastoma of g.trochanter curettage & prevented fixation

Chondroblastoma in intracondyl notch

Chondroblastoma- 8years female child

Benign (occasionally aggressive) bone tumors 

Chondromyxoid fibroma

-occur in any age most in (10-30y) -any bone involved but the prox. Tibia is the most common -clinically: patients c\o pain if the lesion located in hands or feet, or painless mass -x-ray; well-circumscribed lytic lesion with rim of sclerosis.,.-may have bubbly appearance -treatment: wide resection or extended curettage -malignancy is rare.. Diagnosed rontegengraphiclly.

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Osteoblastoma

-is a rare bone forming tumor -occur in age 10-30y more in males. In metaphysis or diaph.

-50% of lesions occur in spine -clinically: pain most common symptom, similar as osteod osteoma(worse at night and relieved by NAID) -in the spine; painful scoliosis and symptoms of root compression -x-ray; the classic appearance is calcified central lesion surrounding halo and reactive sclerosis -it have low-grade aggressiveness -treatment; extended curettage of wide resection ; sometimes radiation in spinal lesions.

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Langerhans cell histiocytosis

-it is group of diseases with similar pathologic features;(eosinophilic granuloma, Christian disease and Letterer-Siwe) 

Eosinophilic granuloma -

pat. Ages 5-20y -clinical picture as osteomyelitis -occur in any bone ,but common in vertebral bodies -x-ray; vertebra plana and the lesion purely lytic may have hole within hole -lesions in long bones similar as Ewing sarcoma -treatment; most conservatively(including steroid injection) ; curettage with bone grafting ; radiation ; and surgical decompression and fusion in spine for rapidly progressive neurologic signs.

Eso. Granuloma,& path. Frac. Healed after pin fixation

Langerhans cell histiocytosis 20y. Male patient

Bone-forming tumors 

Osteoid osteoma

-occur in first three decades, often in young females -any bone can be involved, 50% the femur or tibia -no malignant changes -pain worse at night and relieved by aspirin -when the lesion near a joint, swelling, stiffness and contracture may occur or scoliosis -x-ray: cortical sclerosis and multicentric fuci . CT, to detect nidus Treatment: block resection of the nidus CT-guided percutaneous resection -spontaneous disappearance may occur

Os. Osteoma ,& after resection

CT-guide resection

Os. Osteoma, sclerotic lesion seen in L-3

Miscellaneous benign tumors of bone 

Vascular tumors: hemangioma

-is the most common benign vascular tumor -most involve the vertebral body or skull -x-ray: show multiple lytic lesions -treatment: vertebral involvement requair surgery when neurological function compromised – curettage and bone grafting radiotherapy   

Massive osteolysis- disappearing bone disease Cystic angiomatosis Epithelioid hemangioma

Hemangioma of vertebrae

Neural tumors 

Neurofibromatosis

-rare lytic lesion -develop in bone especially in Von Recklinghausen disease

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ةرضاحملا هذه يف ةدراولا ءاطخلأا نع لوؤسم ريغ عقوملا • This lecture is one of a series of lectures were prepared and • presented by residents in the department of orthopedics in Damascus hospital, under the supervision of Dr. Bashar Mirali.

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Dr. Muayad Kadhim مظاك ديؤم .

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