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Patient Guide to What is a non-ossifying fibroma? How is a non-ossifying fibroma diagnosed?

Non-Ossifying Fibroma A Non-ossifying Fibroma (NOF) is one  Asymptomatic and usually discovered as an
of the most common benign bone tumors found incidental finding after a child has a minor
in 30 to 40% of children between 8 to 20 years injury and a plain x-ray is taken in the ER.
of age. They typically are non-cancerous, or  History of pain at a nearby joint rather than
life-threatening and do not spread to other areas at the lesion, and symptoms fit a sprain or
of the body. strain injury.
A NOF is a result from failure of the  If there was pain before the injury that
bone to properly close at its outer shell. They seems to arise from the lesion, the diagnosis
tend to persist or increase in size as the child of NOF is highly suspect.
grows but decrease in size or close once growth
ends. What is the treatment?
The most common complication of a
Where do non-ossifying fibromas commonly NOF is a fracture to the bone from increased
occur? stress related to injury or lesions that occupy
more than 50% of the bones diameter.
Immobilization in a cast is the treatment of
choice with close observation by an
Orthopaedic doctor. These fractures heal well
with a normal amount of callous but the NOF
may or may not resolve. Surgery is
recommended for those patients who do not
properly heal with a cast, or are likely to re-
break the bone again.

Treatment options
Non-surgical: Most lesions tend to heal
spontaneously by being replaced with normal
bone as the child becomes skeletally mature.

Surgery: A NOF in a structurally


compromising location may need surgery
including scraping the inside of the bone
(curettage). The hole left following this may
What are the symptoms of a non-ossiyfing require donor bone or a bone graft substitute to
fibroma? fill the defect.
Los Angeles Orthopaedic Medical  Well-defined border
Center  Clear lesion located on the outer portion of Useful links:
2501 S. Hope St. Los Angeles, CA 90007 the bone http://orthoinfo.aaos.org/category.cfm?topcategory=Tu
 Near the ends of bone mors
http://www.posna.org/index?service=page/pat 2501 S. Hope St. Los Angeles, CA 90007
ientInformation
What is an osteochondroma? Common presenting symptoms
Patient Guide to
Osteochondroma Solitary osteochondromas are thought to be the  Painless bump near the joints (most
most common non-cancerous (benign) bone commonly knee and shoulder)
tumor resulting from a developmental
abnormality of bone. It occurs when part of the
growth plate forms an outgrowth on the surface
of the bone. They become cancerous less than  Found at the ends of any long bone, and
1% of the time. along the pelvic and shoulder bones.

Multiple osteochondromatosis is diagnosed  If the stalk of a pedunculated


when two or more osteochondromas are seen on osteochondroma breaks, pain and swelling
plain X-rays. About 70 percent of the time, it is may start immediately.
inherited. About 30 percent of the time, it  Located under a tendon causing snapping of
occurs randomly. A patient may also have the tissue over the tumor may cause
deformities of the forearms, a short stature, and activity-related pain.
knock-knees and ankles. This is caused by
abnormal growth in the bones affected by the
osteochondromas. These can become
malignant about 10-20% of the time with large Treatment Options
tumors.
Observation: Most of the time, solitary
osteochondromas are not removed surgically.
The doctor will carefully observe it. He or she
How are osteochondromas diagnosed? may want to take regular X-rays to keep track
of any changes.
Plain x-ray: Will show the bony growth with a
stalk (pedunculated) or without a stalk (sessile)

Surgical: Surgery is recommended when


growth is complete (a mature skeleton by X-ray
Computed tomography (CT) scan: used to evaluation) before removing. This decreases the
look for cartilage on the surface of the bony chance of the tumor growing back.
Los Angeles Orthopaedic Medical growth or the lesion continuous with the bones
Center outershell (cortex)
Surgery may be considered when: fluid. It is a benign condition (non-cancerous)
usually found in patients younger than 20 years of
• Is causing pain with activity age. UBCs occur in one bone, in one location.
• Puts pressure on a nerve or blood vessel
• Has a large cap of cartilage

Where does a UBC commonly occur?

The osteochondroma is removed at the level of


the normal bone. Some of the inside of the bone
may also be removed.

How will my child do in the long run with an


osteochondroma?
Children usually do really well. If the tumor
does not cause a lot of pain, it can be left
alone for life. Also, it is important to note that
an oteochondroma stops growing when a
child reaches skeletal maturity (i.e. when he
or she stops growing.

Useful links:
http://orthoinfo.aaos.org/category.cfm?topcategory=Tu
mors
http://www.posna.org/index?service=page/patientInfor
mation

Patient Guide to
Unicameral Bone Cyst The location of the cysts tends to be in the upper arm
(proximal humerus) or thighbone (proximal femur). Less
common locations include the pelvis, ankle (talus) or heel
Los Angeles Orthopaedic Medical (calcaneus).
Center
2501 S. Hope St. Los Angeles, CA 90007

What is a unicameral (simple) bone cyst?

A unicameral (simple) bone cyst is a cavity found How are UBC’s diagnosed?
within a bone that is filled with straw colored
Plain X-rays: show a hollow cavity in the
metaphyseal portion of the bone with a well-
defined cortical rim. Surgical option #2: UBC in a structurally
compromising location may need surgery
including scraping the inside of the bone
(curettage). The hole left following this may
Computed tomography (CT) scan: ordered require donor bone or a bone graft substitute to
when the UBC is not typical in it appearance to fill the defect. Depending on the size and location
help determine the architecture of the bone. of the cyst, treatment with an internal fixation
device may also be needed.

Common presenting symptoms


Surgery is recommended when
 Asymptomatic  UBCs at risk of a pathologic fracture need
 Pain with weight-bearing activities from treatment.
thinning of the bone.  UBC is painful, growing larger or in a
 Incidental finding with a pathologic fracture location that may fracture
through the cyst, the affected arm or leg may
have pain, swelling and deformity. Useful links:
http://orthoinfo.aaos.org/category.cfm?topcategory=Tumors
http://www.posna.org/index?service=page/patientInformatio

Patient Guide to
Treatment Options
Bone Tumors
Non-Surgical: A UBC without pain or other
symptoms that the doctor discovers when
evaluating another problem can be watched with
repeated X-rays and routine doctor exams.
Pathologic fractures occasionally incite a healing
process not requiring surgical intervention.
Los Angeles Orthopaedic Medical
Center
2501 S. Hope St. Los Angeles, CA 90007
Surgical option #1: The doctor may treat it by
draining the cyst (aspiration) and injecting it with Description
a steroid or with demineralized bone from the
bone bank, supplemented occasionally with bone A tumor is a lump or mass of abnormal tissue and
marrow from the person's pelvis. This method of may be benign or rarely malignant (cancerous). For
treatment may require more than one most bone tumors, the cause is unknown. A growing
aspiration/injection. tumor may replace healthy tissue with abnormal
tissue and may weaken the bone, causing it to break. examine other parts of your body to rule out cancers
Aggressive tumors can lead to disability or death, that can spread to bone.
particularly if signs and symptoms are ignored. How are bone tumors diagnosed?

If you think you might have a bone tumor, see your


doctor as soon as possible for diagnosis and Imaging and tests ordered:
Most bone tumors are non-cancerous (benign), treatment. The doctor will collect detailed
usually not life threatening. Some are cancerous information about your general health and the X-rays/MRI/CT: Different types of tumors exhibit
(malignant). Malignant tumors can spread cancer tumor's type, size, location and possible extent of different characteristics on X-ray. Some dissolve
cells throughout the body (metastasize) through the spread. bone or make a hole in the bone. Some cause extra
blood or lymphatic system. Occasionally infection, formation of bone. Some can result in a mixture of
stress fractures and other non-tumor conditions can these findings. Some tumors have characteristic
closely resemble tumors. findings on X-rays. In other cases, it may be hard to
Symptoms tell what kind of tumor is involved.

Most patients with a bone tumor will experience: You may need more imaging studies to further
Most common types of malignant bone cancer in evaluate some tumors. These may include MRI
children are: • Pain in the area of the tumor. The pain is (magnetic resonance imaging) or CT (computed
generally described as dull and achy. It may or tomography).
• Osteosarcoma is the second most common may not get worse with activity. The pain often
bone cancer. It occurs in two or three new awakens the patient at night. Blood and or urine tests. If these tests are not
people per million people each year. Most • Although tumors are not caused by trauma, adequate to diagnose your tumor, you may require a
cases occur in teenagers. Most tumors occur occasionally injury can cause a tumor to start biopsy.
around the knee. Other common locations hurting. Injury can cause a bone weakened by
include the hip and shoulder. tumor to break, which often leads to severe Biopsy: Involves removing a sample of tissue from
pain. the tumor. The tissue sample is examined under a
• Ewing's sarcoma most commonly occurs • Some tumors can also cause fevers and night microscope. There are two basic methods of doing a
between age 5 and 20. The most common sweats biopsy.
locations are the upper and lower leg, • Many patients will not experience any
pelvis, upper arm and ribs. symptoms, but will instead note a painless mass. • Needle biopsy: The doctor inserts a needle
into the tumor to remove some tissue. This
may be done while you are under local
anesthesia in the doctor's office. Or a
Most common types of benign bone tumors. radiologist may do it, using an X-ray
Medical history and physical exam:
machine or CT or MRI scanner to help
• Non-ossifying fibroma direct the needle to the tumor.
Tell the doctor your complete medical history. This
• Unicameral (simple) bone cyst includes any medications you take, details about any
• Osteochondroma • Open biopsy: The doctor uses surgery to
previous tumors or cancers that you or your family
• Giant cell tumor, members may have had, and symptoms you are
remove tissue. This is generally done
• Enchondroma experiencing. Your doctor will physically examine
through a small incision while you are
• Osteoid osteoma you. The focus is on the tumor mass, tenderness in under general anesthesia in an operating
• Fibrous dysplasia. room.
bone and any impact on joints and/or range of
motion. In some cases, the doctor may want to
Treatment metallic implant (prosthesis) or bone
transplant.
Benign tumors: In many cases, benign tumors just • Amputation removes all or part of an arm
need to be watched. Some can be treated effectively or leg when the tumor is large and/or nerves
with medication. Some benign tumors will disappear and blood vessels are involved.
over time; this is particularly true for some benign • Radiation therapy uses high-dose X-rays.
tumors that occur in children. Certain benign tumors This kills cancer cells and shrinks tumors.
can spread or become cancerous (metastasize). • Systemic treatment (chemotherapy) is
Sometimes your doctor may recommend removing often used to kill tumor cells when they
the tumor (excision) or using other treatment have spread into the blood stream but
techniques to reduce the risk of fracture and cannot yet be detected on tests and scans.
disability. Some tumors may come back--even Chemotherapy is generally used when
repeatedly--after appropriate treatment. cancerous tumors have a very high chance
of spreading.
Malignant tumors: If you are diagnosed with a
malignant bone tumor, you might want to get a After Treatment
second opinion to confirm it. If you have bone
cancer, your treatment team may include several When treatment for a bone tumor is finished, you
specialists. These may include an orthopaedic may need more X-rays and other imaging studies.
oncologist, a medical oncologist, a radiation These can confirm that the tumor is actually gone.
oncologist, a radiologist and a pathologist. You may need to have regular doctor visits and tests
Treatment goals include curing the cancer and every few months. When the tumor disappears, it is
preserving the function of your body. To treat important to monitor your body for its possible
malignant bone tumors, doctors often combine return (relapse).
several methods. Treatment depends upon various
factors including whether the cancer has spread.

• Localized stage cancer cells are contained


to the tumor and surrounding area.
• Metastatic stage cancers have spread
elsewhere in the body. Tumors at this stage
are more serious and harder to cure.

Generally the tumor is removed using surgery.


Often radiation therapy is used in combination with
surgery.

• Limb salvage surgery removes the


cancerous section of bone but keeps nearby
muscles, tendons, nerves and blood vessels.
If possible, the surgeon will take out the
tumor and a margin of healthy tissue around
it. The excised bone is replaced with a