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Benign Bone


Name some characteristics of benign bone


Relatively common
Usually recognised by their position and radiographic

Require careful assessment to exclude malignancy

Majority occur in the adolescent / young adult

Tumours cease growth when skeletal maturity reached

What is an Osteoid Osteoma?

M > F, presents between age 10 25 yrs

Severe and persistent pain typically
relieved by aspirin
Femur, tibia most commonly. Spine usually pedicle
Lesion in cortex of bone with reactive
sclerosis around a radiolucent central nidus

If doubt

Nidus immature osteoid tissue + highly

vascular cellular tissue
Rarely larger than 1 cm in diameter

CT / MRI scan useful

Bone scan intense hot spot in affected


surgical excision, if complete, is curative

What is a Chondroma?

Most common of all bone tumours

Two varieties enchondroma and ecchondroma
Enchondroma confined within intact cortex
causes cortex to become
structurally thin
Ecchondroma protrudes beyond cortex of bone
Both most common in tubular bones of hands and feet
Less common in larger tubular / flat bones
Malignant transformation
Rare in solitary chondromas
25% of cases in multiple enchondromatosis (Olliers
excision and currettage bone grafting

What is an Osteochondroma?

Comparatively common tumour

Typically occurs on the external surface of
Distal femur, proximal tibia, proxiaml humerus
? Result of failure of bone remodelling during
Typical pedunculated / sessile growth arising from
Usually identified incidentally after minor injury
Always stop growing at skeletal maturity
Any enlargement thereafter treat with
Excision if causing symptoms or pain /
enlargement in adult

What is a Solitary Bone Cyst?

Predominantly in adolescent boys

Most common sites proximal humerus / femur
Often presents as pathological fracture
Radiographic appearance
Ovoid radiolucent area with thinning of the
overlying cortex
Tends to abut growth plate, never penetrates it
If tumour found in association with fracture
may resolve spontaneously as union proceeds
(usually at normal rate)
If this does not occur excision and
curettage bone grafting
Some evidence that intracystic injection with
methylprednisolone as effective as surgery

What is an Aneurysmal Bone Cyst?

Characterised by blood-filled cavities

separated by fibrous septa and areas of
new bone formation
Affects adolescents / young adults
Metaphyseal regions of long bones /
vertebral column
Radiographic appearance
Eccentric radiolucent lesion expanding
beyond margins of the thinned cortex
Growth may be extremely rapid often
mistaken as malignant
Complete surgical excision usually
? Radiotherapy alone / in combination
with surgery

What are Juxta-Articular Bone Cysts?

Also known as interosseous ganglions

Mature adults incidence with
Common in distal tibia, acetabulum
and carpus
Radiographic appearance

Well defined, radiolucent cystic

space with sclerotic margin
Similar to the cysts of OA

? Cause - ? Fibrous metaplasia with

superimposed mucoid degeneration

Deroofing and currettage bone

graft (if large)

What are Fibrous Cortical Defects?

Occurs in metaphysis during

If incorporated within bone
non-ossifying fibroma
Most are incidental x-ray
anomalies or present as
Well circumscribed lesions
difficult to differentiate from
simple cysts

No specific treatment
necessary unless it is a cause of
recurrent fracture curettage
and bone grafting usually

What is a Haemangioma?

A few occur in skull / long bones

Can present as pathological fracture of
long bones
Majority affect vertebral body usually
incidental finding
Radiographic appearance

Increased density and striations in

vertebral body
Absence of bone destruction / expansion
Can be mistaken for malignancy
MRI useful to establish diagnosis


Symptomless conservative mx
Pathological fracture long bone
stabilization fixation
Radiotherapy to inaccessible areas for
symptomatic lesions only

Haemangioma in spine

What is a Eosinophilic Granuloma?

Histiocytosis X
One of a family of conditions which includes
Hand-Schuller-Christian and Letterer-Swie
Presents in adolescence
Skull, mandible, vertebral bodies, ribs,
metapysis long bones
Pain is presenting feature
Radiographic appearance
Lucent area with cortical thinning
Vertebral body lesions have a typical
flattened, dense appearance
Biopsy is essential currettage usually
erradicates it
Multiple lesions suggests more complex
form of disease