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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.

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Presentation on theme: "BENIGN TUMORS OF BONE Dr. Abdulla Bin-shehna. BENIGN TUMARS OF BONE 1-cystic lesions 2-fibrous lesions 3-cartilaginous lesions 4-benign (occasionally."— Presentation transcript:

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 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

10 Unicameral bone cyst

11 Technique of aspiration instillation

12 Pathological fracture :healing :remodling

13 Bone cyst after injection – fluid level

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15 Treatment by intramedullary flexible nails

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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

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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 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: shepherd’s crook deformity in prox. Femur - biopsy is necessary - malignant reported - treatment: curettage & bone grafting

35 Fibrous dysplasia

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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 > 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

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56 Enchond. Of femur,& after curettage

57  Gaint cell tumor -occur in mature long bones(dis. femur & prox. Tibia), in age 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)

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59 GCT of medial condyle

60 After curettage and bone cement

61 GCT excision and arthrodesis

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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

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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 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. د. مؤيد كاظمDr. Muayad Kadhim


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