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Updated: Dec 27 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
  • 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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