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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. Cystic lesions

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benign tumors of bone dr abdulla bin shehna
BENIGN TUMORS OF

BONE

Dr. Abdulla Bin-shehna

benign tumars of bone
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
Benign bone tumors
  • Cystic lesions

1- unicameral bone cyst

2- aneurysmal bone cyst

3- ganglion cyst of bone

4- epidermoid cyst

benign bone tumors4
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]

benign bone tumor
Benign bone tumor
  • Cartilaginous tumors

1-osteochondroma

2- multiple osteochondromatosis

3- chondroma

4- multiple enchondromatosis [Ollier disease]

benign bone tumors6
Benign bone tumors
  • Benign [occasionally aggressive] tumors

1- giant cell tumor

2- chondroblastoma

3- chondromyxoid fibroma

4- langerhans cell histocytoma

benign bone tumors7
Benign bone tumors
  • Bone forming tumors

- Ostioid osteoma

benign bone tumors8
Benign bone tumors
  • Miscellaneous benign tumors

1- neural tumors

2- vascular tumors

3- fatty tumors

unicameral simple bone cyst
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

aneurysmal bone cyst
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
ganglion cyst of bone
Ganglion cyst of bone
  • X.Ray: well-demarked lytic defect with thin rim of sclerotic bone
  • Treatment: curettage
epidermoid cyst
Epidermoid cyst
  • Filled with keratinous material & lined with squamous epithelium
fibrous lesions
Fibrous lesions
  • Fibrous cortical defect [non – ossifyingfibroma]

- 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

fibrous lesions31
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

fibrous lesions33
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 lesions34
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 lesions38
Fibrous lesions
  • Osteofibrous dysplasia [ossifying fibromaof 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

slide40
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

cartilaginous tumors
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

cartilaginous tumors48
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

cartilaginous tumors50
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

slide57
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)

benign occasionally aggressive bone tumors
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%.
benign occasionally aggressive bone tumors69
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.

slide70
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.

slide71
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.

bone forming tumors
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

miscellaneous benign tumors of bone
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
neural tumors
Neural tumors
  • Neurofibromatosis

-rare lytic lesion

-develop in bone especially in Von-Recklinghausen disease

thank you
THANK

YOU

mokazem com
MoKazem.com
  • هذه المحاضرة هي من سلسلة محاضرات تم إعدادها و تقديمها من قبل الأطباء المقيمين في شعبة الجراحة العظمية في مشفى دمشق, تحت إشراف د. بشار ميرعلي.
  • الموقع غير مسؤول عن الأخطاء الواردة في هذه المحاضرة.
  • 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

د. مؤيد كاظم