BENIGN TUMORS OF

1

• BENIGN TUMORS OF
• BONE
• Dr. Abdulla Bin-shehna

2
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

3
Benign bone tumors

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

4
Benign bone tumors

• 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

5
Benign bone tumor

• Cartilaginous tumors
• 1-osteochondroma
• 2- multiple osteochondromatosis
• 3- chondroma
• 4- multiple enchondromatosis Ollier disease

6
Benign bone tumors

• Benign occasionally aggressive tumors
• 1- giant cell tumor
• 2- chondroblastoma
• 3- chondromyxoid fibroma
• 4- langerhans cell histocytoma

7
Benign bone tumors

• Bone forming tumors
• - Ostioid osteoma

8
Benign bone tumors

• Miscellaneous benign tumors
• 1- neural tumors
• 2- vascular tumors
• 3- fatty tumors

9
Unicameral simple bonecyst

• 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

10
Unicameral bone cyst
11
Technique of aspiration instillation
12
Pathological fracture healing remodling
13
Bone cyst after injection fluid level
14
(No Transcript)
15
Treatment by intramedullary flexible nails
16
(No Transcript)
17
Installation of prednisalone
18
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

19
(No Transcript)
20
(No Transcript)
21
Aneurysmal B.C of prox. Ulna, excision and large
bone grafting
22
Aneurysmal bone cyst of phalange
23
Ganglion cyst of bone

• X.Ray well-demarked lytic defect with thin rim
  of sclerotic bone
• Treatment curettage

24
Ganglion bone cyst
25
Epidermoid cyst

• Filled with keratinous material lined with
  squamous epithelium

26
Epidermoid cyst
27
Epidermoid cyst including the bone
28
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

29
F.C.D
30
Non-ossifying fibroma ???!
31
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

32
Cortical desmoid
33
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

34
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 shepherds crook deformity in
  prox. Femur
• - biopsy is necessary
• - malignant reported
• - treatment curettage bone grafting

35
Fibrous dysplasia
36
Fibrous dysplasia
37
Fibrous dysplasia
38
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

39
Osteofibrous dysplasia
40

• 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

41
osteochndroma
42
Osteochondroma of radius
43
Osteochondroma of prox. femur
44
Intaarticullar osteochondroma of femur
45
Osteochondroma of hand
46
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

47
osteochndromatosis
48
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

49
Oller disease
50
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 gt 30 , pain , increasing mass, cortical lysis
• -treatment curettage and bone grfting ,
  periosteal chondroma should be excised en bloc

51
8-y child enchondromas of 5-th metacarp.
microfracture
52
After 6 mon after curt. bone graf.
53
Enchond. Of hand
54
(No Transcript)
55
(No Transcript)
56
Enchond. Of femur, after curettage
57

• 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)

58
(No Transcript)
59
GCT of medial condyle
60
After curettage and bone cement
61
GCT excision and arthrodesis
62
(No Transcript)
63
GCT of 5-th. Metatarsal bone
64
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.

65
Chondroblastoma associated with aneurysmal bone
cyst
66
Chondroblastoma of g.trochanter curettage
prevented fixation
67
Chondroblastoma in intracondyl notch
68
Chondroblastoma- 8years female child
69
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.

70

• 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.

71

• 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.

72
Eso. Granuloma, path. Frac. Healed after pin
fixation
73
Langerhans cell histiocytosis- 20y. Male patient
74
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

75
Os. Osteoma , after resection
76
CT-guide resection
77
Os. Osteoma, sclerotic lesion seen in L-3
78
(No Transcript)
79
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

80
Hemangioma of vertebrae
81
Neural tumors

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

82

• THANK
• YOU

83
MoKazem.com

• ??? ???????? ?? ?? ????? ??????? ?? ??????? ?
  ??????? ?? ??? ??????? ???????? ?? ???? ???????
  ??????? ?? ???? ????, ??? ????? ?. ???? ??????.
• ?????? ??? ????? ?? ??????? ??????? ?? ???
  ????????.
• 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.
• This site is not responsible of any mistake may
  exist in this lecture.

?. ???? ????
Dr. Muayad Kadhim