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:
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 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
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
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 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 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
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 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 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 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
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 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%.
Chondroblastoma associated with aneurysmal bone cyst
Chondroblastoma of g.trochanter curettage & prevented fixation
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.
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.
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.
Eso. Granuloma,& path. Frac. Healed after pin fixation
Langerhans cell histiocytosis- 20y. Male patient
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 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
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