Benign Bone

Tumours
 Name some characteristics of benign bone
tumours?
 Relatively common

 Usually recognised by their position and radiographic

appearance

 Require careful assessment to exclude malignancy

 Majority occur in the adolescent / young adult

 Tumours cease growth when skeletal maturity reached

 What is an Osteoid Osteoma?
 M > F, presents between age 10 – 25 yrs
 Severe and persistent pain – typically
relieved by aspirin
 Femur, tibia – most commonly. Spine -
usually pedicle
 Lesion in cortex of bone with reactive
sclerosis around a radiolucent central nidus
 Nidus – immature osteoid tissue + highly
vascular cellular tissue
 Rarely larger than 1 cm in diameter
 If doubt
 CT / MRI scan – useful
 Bone scan – intense “hot spot” in affected
area
 Treatment
 surgical excision, if complete, is curative
 What is a Chondroma?
 Most common of all bone tumours
 Two varieties – enchondroma and ecchondroma
 Enchondroma – confined within intact cortex

causes cortex to become

structurally thin
 Ecchondroma – protrudes beyond cortex of bone

 Both most common in tubular bones of hands and feet

 Less common in larger tubular / flat bones
 Malignant transformation
 Rare in solitary chondromas

 25% of cases in multiple enchondromatosis (Ollier’s

disease)
 Treatment
 excision and currettage ± bone grafting
 What is an Osteochondroma?
 Comparatively common tumour
 Typically occurs on the external surface of
metaphysis
 Distal femur, proximal tibia, proxiaml
humerus
 ? Result of failure of bone remodelling during
growth
 Typical pedunculated / sessile growth arising from
metaphysis
 Usually identified incidentally after minor injury
 Always stop growing at skeletal maturity
 Any enlargement thereafter – treat with
suspicion
 Treatment
 Excision if causing symptoms or pain /
enlargement in adult
 What is a Solitary Bone Cyst?
 Predominantly in adolescent boys
 Most common sites proximal humerus / femur
 Often presents as pathological fracture
 Radiographic appearance
 Ovoid radiolucent area with thinning of the
overlying cortex
 Tends to abut growth plate, never penetrates it
 Treatment
 If tumour found in association with fracture –
may resolve spontaneously as union proceeds
(usually at normal rate)
 If this does not occur – excision and
curettage ± bone grafting
 Some evidence that intracystic injection with
methylprednisolone as effective as surgery
 What is an Aneurysmal Bone Cyst?
 Characterised by blood-filled cavities
separated by fibrous septa and areas of
new bone formation
 Affects adolescents / young adults
 Metaphyseal regions of long bones /
vertebral column
 Radiographic appearance
 Eccentric radiolucent lesion expanding
beyond margins of the thinned cortex
 Growth may be extremely rapid – often
mistaken as malignant
 Treatment
 Complete surgical excision usually
curative
 ? Radiotherapy alone / in combination
with surgery
 What are Juxta-Articular Bone Cysts?
 Also known as interosseous ganglions
 Mature adults – incidence ↑ with age
 Common in distal tibia, acetabulum
and carpus
 Radiographic appearance
 Well defined, radiolucent cystic
space with sclerotic margin
 Similar to the cysts of OA
 ? Cause - ? Fibrous metaplasia with
superimposed ucoid degeneration
 Treatment
 Deroofing and currettage ± bone
graft (if large)
 What are Fibrous Cortical Defects?
 Occurs in metaphysis during
growth
 If incorporated within bone –
non-ossifying fibroma
 Most are incidental x-ray
anomalies or present as
fractures
 Well circumscribed lesions –
difficult to differentiate from
simple cysts
 Treatment
 No specific treatment
necessary unless it is a cause of
recurrent fracture – curettage
and bone grafting usually
curative
 What is a Haemangioma?
 A few occur in skull / long bones
 Can present as pathological fracture of
long bones
 Majority affect vertebral body – usually
incidental finding
 Radiographic appearance
 Increased density and striations in
vertebral body
 Absence of bone destruction / expansion
 Can be mistaken for malignancy
 MRI useful to establish diagnosis
 Treatment
 Symptomless – conservative mx
 Pathological fracture long bone –
stabilization ± fixation
 Radiotherapy to inaccessible areas for
Haemangioma in spine
symptomatic lesions only
 What is a Eosinophilic Granuloma?
 Histiocytosis “X”
 One of a family of conditions which includes
Hand-Schuller-Christian and Letterer-Swie
disease
 Presents in adolescence
 Skull, mandible, vertebral bodies, ribs,
metapysis long bones
 Pain is presenting feature
 Radiographic appearance
 Lucent area with cortical thinning
 Vertebral body lesions have a typical
flattened, dense appearance
 Treatment
 Biopsy is essential – currettage usually
erradicates it
 Multiple lesions – suggests more complex
form of disease