Review of Benign Bone TUMORS

1
Review of Benign Bone TUMORS

• Scott Shelton, DPM R1

2
Common Benign Tumors/Lesions

• Enchondroma, osteochondroma, non-ossifying
  fibroma, chondroblastoma, osteoid osteoma,
  osteoblastoma, periosteal chondroma, giant cell
  tumor, and chondromyxoid fibroma.
• Some conditions such as aneurysmal bone cyst,
  unicameral bone cyst, and fibrous dysplasia are
  sometimes grouped with benign bone tumors. They
  often require similar treatment, but are not
  truly tumors.

3
Diagnostic Indicators for Evaluating a Solitary
Bone Lesion

• To get the most accurate diagnosis it is
  important to think of various factors
• Radiographic
• 1-Destructive Pattern
• 2-Size and Shape
• 3-Cortical Involvement
• 4-Periosteal reaction
• 5-Anatomic position (transverse and longitudinal
  planes)
• 6-Skeletal location
• 7-Trabeculation
• 8-Matrix production
• Non-radiologic
• 1-Clinical course
• 2-Age of patient

4
Age Ranges Benign Bone Tumors

• Osteoma 15 to 45
• Osteoid osteoma 10 to 23
• Benign osteoblastoma 10 to 30
• Osteochondroma 10 to 30
• Central Chondroma 10 to 40
• Chondroblastoma 10 to 20
• Chondromyxoid fibroma 10 to 30
• Eosinophilic granuloma 5 to 10
• Nonosteogenic granuloma 10 to 20
• Desmoplastic fibroma 10 to 30
• Intraosseous lipoma 30 to 50
• Neurilemoma 10 to 30
• Hemangioma 40 to 50
• Giant Cell Tumor 25 to 40
• Simple bone cyst 5 to 20
• Aneurysmal bone cyst 10 to 30
• Enchondroma 30s

5
Fibrous Tumors/Lesions

• Benign Fibrous Cortical Defect, Non-Ossifying
  Fibroma, Fibroma of Bone.
• Benign Aggressive Fibromatosis(desmoid),
  Ossifying Fibroma of bone, Fibrous Dysplasia.
• Malignant Malignant Fibrous Histiocytoma of
  bone, Fibrosarcoma.

6
Chondroid Lesions

• Benign Enchondroma, Peri-osteal Chondroma,
  Osteochondroma.
• Benign Aggressive Chondromyxoid Fibroma,
  Chondroblastoma.
• Malignant Chondrosarcoma.

7
Other Lesions

• Benign Bone Cyst, Ganglion, Hemangioma.
• Benign Aggressive Giant Cell Tumor, Aneurysmal
  Bone Cyst, EOG.
• Malignant Adamantinoma, Chordoma, Ewings Sarcoma.

8
What are its borders?

• Geographic
• Moth Eaten
• Permeative

9
Destructive Pattern

• Geographic - lesion has a recognizable form it
  is well defined
• Moth-eaten Permeative - have no definitive form
  or shape. Moth-eaten refers to cancellous bone
  and permeative to cortical bone.

10
Pattern of Destruction Geographic
11
Lytic vs. Blastic Lesions
Lytic
Blastic
12
Zone of Transition
Wide
Narrow
13
Anatomic Location
14
Osteoma

• Clinical features 40-50 yr. old, MF 21 Slow
  growing, multiple lesions
• No malignant potential
• Radiographic features Sharply circumscribed
  radiopaque mass protruding from the bone surface.

15
Osteoid Osteoma

• Osteoblastic lesion with central area of new bone
  formation, known as a nidus
• Known to cause pain, especially at night. Pain
  relieved by aspirin.
• 7.5 seen in the foot
• Age 5-25
• Male 21

16
Osteochondroma

• Most common benign lesion
• Protruding, mushroom-shaped exostosis with
  cartilage cap
• Points away from joint
• Male 21
• Typically originates from the metaphysis

17
Chondroblastoma

• Clinical features 5-25 yrs old. Epiphysis, knee
  and proximal humerus
• Radiographic features Well-defined epiphyseal
  radiolucency with spotty calcification

18
Fibrous Cortical Defect

• Asymptomatic incidental finding, usually
  self-healing may regress spontaneously.
• Age 4-8, rare after 14. Fairly common, may be
  present in 30 of the population.
• Round to oval radiolucent intracortical lesion
  that typically erodes the outer cortical surface

19
Fibrous Dysplasia

• Etiology Localized developmental arrest
• Sites Monostotic ribs, femur, tibia Polyostotic
  femur, skull, tibia Clinical signs Early
  adolescence, three types Monostotic (70)
  minimal Sx to fracture
• Polyostotic w/o (27) or w/ endocrinopathies
  (McCune-Albright's syndrome) (3) fractures and
  deformities - "shepherd crook" proximal femur
  rare malignant transformation to sarcomas
• Radiographic Features Well-defined intramedullary
  lesion Ground glass appearance

20
Giant Cell Tumor of Bone

• Clinical features 20-45 yrs old Female gt male
  the only bone tumor with female prevalence.
• Rapidly expansile radiolucent lesion. Epiphyseal
  and metaphyseal in adults metaphyseal in
  adolescents
• Phalanges and metatarsals most commonly affected
  also seen in the talus and posterior calcaneus

21
Enostosis (Bone Island)

• Discrete intramedullary sclerotic zone comprised
  of compact bone
• Asymptomatic, and are usually incidental findings
  on xray
• Posterior calcaneus, lesser metatarsal heads,
  talar neck, and distal tibia are most frequent in
  foot and ankle.

22
Nonossifying Fibroma

• Usually asymptomatic, incidental findings.
• Fairly uncommon
• May regress spontaneously
• Age 4-40, median age 13
• Round to oval geographic lesion, eccentric
  medullary location, multiloculated

23
Chondromyxoid Fibroma

• Markedly eccentric, oval geographic lesion of the
  metaphysis
• Lobules of myxoid and/or chondroid tissue
  separated by fibrous septa
• Male 21
• Most commonly seen in first 2 decades
• Knees and proximal tibia most commonly affected
• In the feet the talus and plantar mid-calcanues
  are most frequent pedal locations

24
Enchondroma

• Most common tumor of the phalanges (hand 61)
• Age 10-35
• Male Female
• Usually painless except with pathologic fracture
• Central intramedullary oval geographic lesion
  with sharp margination and a thin rim of reactive
  sclerosis

25
Olliers Disease

• Multiple enchondromatosis, especially involving
  the hands and feet.
• One extremity is affected more than the other

26
Maffuccis Syndrome

• Multiple enchondromatosis with soft tissue
  hemangiomas

27
Simple Bone Cyst(Unicameral or Solitary Bone
Cyst)

• Fluid filled intramedullay cavity
• Fluid may be serous, serosanguineous, or frank
  blood.
• Peak incidence in first two decades of life
• Asymptomatic unless pathologic fracture occurs
• Common in calcaneus neutral triangle

28
Aneurysmal Bone Cyst(ABC)

• Is a reactive process
• Rapidly expansile lesion with multiple blood
  filled cystic cavities.
• Age 5-20
• Rapid onset of pain

29
Tumors of the foot and ankle Analysis of 196
cases MUSTAFA OZDEMIR H. YILDIZ Y. YILMAZ C.
SAGLIK Y.

• A retrospective assessment was performed on 196
  tumors of the foot and ankle between March 1986
  and March 1996
• Mean age was 28 years (range 3 to 75 years).
• Of the 196 foot and ankle tumor cases,
• 171 (87.2) were benign
• 25 (12.8) were malignant.
• One hundred ninety-four (98.9) were primary
  tumors
• 2(1.1) were metastatic tumors.
• One hundred thirty-six (69.4) originated from
  bone
• 60 (30.6) originated from soft tissue.
• The most frequent foot and ankle tumors were
• Osteosarcoma among malignant osseous tumors
• Squamous cell carcinoma among malignant soft
  tissue lesions,
• Solitary exostosis among benign osseous tumors,
  and xanthoma and giant cell tumor among benign
  soft tissue tumors.
• Mean follow-up time was 21.3 months (12 to 90
  months).
• One hundred forty (71.4) of the patients
  underwent various operations
• 56 (28.6) were treated conservatively.
• Of the 140 surgical cases, 13 (9.3) had a
  recurrence, 3 (2.1) died, and 124 (88.6) had a
  clinical cure.
• For most of the patients who required surgery,
  nonaggressive procedures were sufficient while
  amputations were required for 14 patients.

MUSTAFA OZDEMIR H. YILDIZ Y. YILMAZ C. SAGLIK
Y. Tumors of the foot and ankle Analysis of 196
cases. The Journal of foot and ankle surgery.
1997, vol. 36, pp. 403-408
30
Common vs Rare Tumors
31
WHO Classification of Bone Tumors (1993)
32
References

• 1-grading of bone tumors. Joon, Choi MD _at_
  pathology.yu.ac.kr/lecture/grading_of_bone_tumors.
  pdf.
• 2-Bone Tumors-Benign _at_Uptodate.com keyword bone
  tumors
• 3-Hershey Manual. Singer, Jonathan DPM. PPMA
  2003.
• 4-Hetherington Manual. Dagnall, J. Coughlin
• 5-Bone Tumors _at_http//orthoinfo.aaos.org/fact/thr_
  report.cfm?Thread_ID278. 7/16/07.
• 6-MUSTAFA OZDEMIR H. YILDIZ Y. YILMAZ C.
  SAGLIK Y. Tumors of the foot and ankle Analysis
  of 196 cases. The Journal of foot and ankle
  surgery. 1997, vol. 36, pp. 403-408
• 7-Christman R.A. Foot and Ankle Radiology. Church
  Hill Livingstone. 2003