Updated: 3/25/2021

Benign Bone Tumors

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Snapshot
  • A 31-year-old man presents to his primary care provider with left knee pain. He noted a bulge on his left knee 6 months ago that has gradually grown in size. A radiograph of the left knee is shown demonstrating a large lytic tumor in the fibular head. The patient is diagnosed with a giant cell tumor.  
Osteoma
  • Definition
    • benign bone tumor (osteogenic) derived from osteoblasts
  • Presentation
    • location
      • skull
      • mandible
    • symptoms
      • painless mass
    • associated conditions
      • Gardner syndrome
  • Associated findings
    • histology
      • proliferating osteoblasts with active intramembranous ossification
    • radiography
      • radiodense and smooth bony mass 
  • Treatment
    • surgical resection for symptomatic masses
Osteoid Osteoma
  • Definition
    • benign bone tumor (osteogenic) derived from osteoblasts
    • small (< 2 cm)
  • Presentation
    • location
      • proximal femur (most common)
      • tibial diaphysis
      • vertebrae
    • symptoms
      • focal pain that resolves with NSAIDs  
      • if arising in the spine, may cause painful scoliosis
  • Associated findings
    • histology
      • nidus of osteoid and immature osteoblasts surrounded by a rim of reactive bone formation
    • radiography
      • radiolucent nidus (< 2 cm) surrounded by reactive bone 
  • Treatment
    • observation and NSAIDs
Osteoblastoma
  • Definition
    • benign but locally aggressive bone tumor (osteogenic) derived from osteoblasts
    • larger than an osteoid osteoma (> 2 cm)
  • Presentation
    • location
      • vertebrae (most common)
      • long bone diaphyses
    • symptoms
      • focal pain that is not relieved by NSAIDs
      • if arising in the spine, may cause neurologic symptoms
  • Associated findings
    • histology
      • nidus of osteoid and immature osteoblasts surrounded by a rim of reactive bone formation
    • radiography
      • radiolucent nidus (> 2 cm) surrounded by reactive bone 
        • large lesions may extend into neighboring soft tissues
  • Treatment
    • observation and NSAIDs
Giant Cell Tumor (Osteoclastoma)
  • Definition
    • benign but locally aggressive tumor derived from stromal cells with accompanying giant cells
      • stromal cells resemble interstitial fibroblasts and are neoplastic cells
      • giant cells are derived from monocyte/macrophage lineage and have similar characteristics to osteoclasts
  • Presentation
    • location
      • metaphyseal and epiphysiseal regions of long bones
        • distal femur (most common)
        • proximal tibia
        • distal radius
    • symptoms
      • focal pain
        • may be referred to nearby joint
  • Associated findings
    • histology
      • 3 cells types may be seen 
        • stromal cells resembling fibroblasts
          • neoplastic cells
        • monocyte/macrophage cells recruited from peripheral blood
          • precursors to giant cells
        • giant cells
          • multiple nuclei
          • similar to osteoclasts
          • resorb bone
    • radiography 
      • eccentric lytic metaphyseal lesion that may extend into the distal epiphysis
      • characteristic "double bubble" or "soap bubble" appearance
        • increased activity of osteoclasts results in a cavitary lesion
  • Treatment
    • curettage or marginal excision with bone grafting
Osteochondroma (Exostosis)
  • Definition
    • benign cartilage-derived tumor (chondrogenic) containing bone and a cartilage cap
      • arises as a lateral projection of the growth plate
    • most common cartilage-derived tumor
    • two forms
      • solitary osteochondroma
        • may be caused by Salter-Harris fracture, surgery, or radiation therapy
      • syndromatic osteochondromas
        • multiple hereditary exostosis (MHE)
  • Presentation
    • location
      • metaphyseal regions of long bones
        • distal femur
        • proximal tibia
        • proximal humerus
    • symptoms
      • painless mass
  • Associated findings
    • histology
      • normal bony trabeculae with a thin cartilaginous cap
    • radiography
      • sessile (broad base) or pedunculated (narrow stalk) lesions found on the surface of bones 
  • Treatment
    • medical
      • bisphosphonates
      • denosumab
    • surgical
      • curettage and reconstruction
Enchondroma
  • Definition
    • benign cartilage-derived (chondrogenic) tumor
      • arises when chondroblasts and epiphyseal cartilage escape from the physis, enter the metaphysis, and proliferate
    • second most common cartilage-derived tumor
    • two forms
      • solitary enchondroma
      • syndromatic enchondromas
        • Ollier disease
        • Maffucci syndrome
  • Presentation
    • location
      • medullary cavity in the metaphyseal or diaphyseal regions
        • hand (most common)
        • feet
        • distal femur
    • symptoms
      • most often asymptomatic
      • pathologic fracture
  • Associated findings
    • histology
      • bland mature hyaline cartilage
    • radiography
      • well-defined lucent medullary lesion 
  • Treatment
    • observation

 

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