BENIGN TUMORS OF BONE Dr. Abdulla Bin-shehna

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

15. Treatment by intramedullary flexible nails

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

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 – 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

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 20-40 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

36. Fibrous dysplasia

37. Fibrous dysplasia

38. 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

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