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DR. ATIF SHAHZAD
PGR ORTHOPEDIC DEPARTMENT
SHL
A benign tumor is a mass of cells that lacks
the ability to invade neighboring tissue
or metastasize.
They mostly occur wi...
Mostly classified according to the normal cell
or tissue of origin.
Lesions that do not have normal tissue
counterparts ar...
Bone-forming tumors:
Osteoid osteoma
Bone island
Cartilage lesions:
Chondroma
Osteochondroma
Fibrous lesions:
Nonossifying...
Clinically, present in various ways.
The more common benign lesions are
frequently asymptomatic and are detected as
incide...
Radiographic analysis plays an important role
in diagnosing bone tumors.
Exact location and extent of the tumor.
It can de...
FIBROUS TUMORS
• Nonossifying fibroma (fibrous cortical defects) is
a common developmental abnormality due to
proliferation of fibrous ti...
• A well-defined lobulated
solitary lesion located
eccentrically in the
metaphysis.
• Multilocular appearance
or ridges in...
• Spindle-shaped cells
distributed in a
whorled pattern.
• There is fibroblastic
proliferation with high
cellularity.
• Gi...
Chondromyxoid Fibroma
Fibrous Dysplasia
Infection
Radiological findings
Biopsy & Histopathology
Mostly asymptomatic and regress
spontaneously in adulthood.
Most pathological fractures can be treated
conservatively.
Cur...
• A benign disorder characterized by tumor-like
proliferation of fibro-osseus tissue.
• A developmental abnormality of bon...
• Three clinical presentations exist:
Monostotic fibrous dysplasia 70%
Polyostotic fibrous dysplasia 25%
McCune-Albright s...
Pain with complete pathologic fracture or micro-fracture
Swelling with pathologic fracture.
Commonly presents as a long le...
• Appearance is characteristic,
witch is lucent purely lytic
having a granular, ground-
glass appearance.
May also contain...
Variably cellular fibrous
tissue containing irregularly
shaped trabeculae of woven
bone
Woven bone is immature
bone that h...
Serum alkaline phosphatase
Plain X-Rays
Bone Scan
CT Scan
MRI
Occasionally, biopsy is necessary to establish
the diagnosis.
Monostotic lesions:
Unicameral bone cyst
Aneurysmal bone cyst
Nonossifying fibroma
Giant cell tumor
Infection
Polyostotic ...
Clinical findings
Radiological findings
Biopsy
• Therapy determined by patient's age, activity
of lesion, extent of fracture risk, and mechanical
deformity
• Conservativ...
• Surgical treatment :
Indicated when significant deformity or
pathological fracture occurs or significant
pain exists.
• ...
• Because recurrence rates
are high after curettage
and bone grafting,
cortical bone grafts are
preferred over cancellous
...
Pathologic fracture
Progressive deformity in weight-bearing bones.
Painful stress fractures in femoral neck
Although dyspl...
Malignant degeneration is rare,0.5% to 1%.
When malignant degeneration occurs, it is usually
in fibrous dysplasia that has...
• Osteofibrous dysplasia (ossifying fibroma of long
bones, also known as Campanacci disease) is a
rare lesion usually affe...
• RADIOLOGY:
• The radiographs show
eccentric intracortical
osteolysis with expansion of
the cortex.
HISTOLOGY:
• Loose fi...
The natural course is unpredictable.
Some lesions regress spontaneously during
childhood; most progress during childhood, ...
FATTY TUMORS
Intraosseous lipoma is a relatively rare lesion, in
contrast to its soft-tissue counterpart.
The true incidence is unknown...
• The radiographic appearance varies, usually
appear as well-defined lucencies possibly
with a thin rim of reactive bone.
...
Surgery is indicated only for the rare
symptomatic lesion. In these cases, simple
curettage usually is curative.
VASCULAR
TUMOR
Hemangioma is a common benign bone lesion.
It is estimated that 10% of the population has
asymptomatic lesions of the vert...
RADIOLOGY:
Appearance in the spine
usually is characteristic,
with thickened, vertically
oriented trabeculae giving
the cl...
• Usually is not necessary; however, multiple options
exist for symptomatic lesions.
• Nerve root or cord decompression wi...
NON NEOPLASTIC
LESIONS
Paget’s disease of bone is a localized disorder of
bone remodeling, characterized by enhanced
resorption of bone by giant ...
Paget disease may affect 4% of people of
Anglo-Saxon descent who are older than age
55 years, but it is rare in most other...
• Radiographic findings
depend on the stage of
the disease.
• In the lytic phase, bone
resorption can take on
a “blade of ...
MRI is helpful in this
circumstance because
the marrow signal in
patients with Paget
disease usually
remains normal.
Histo...
Medical Management :
Consists of nonsteroidal anti inflammatory
drugs, calcitonin, or bisphosphonates.
Serum alkaline phos...
Approximately 1% of patients with Paget
disease develop a secondary bone sarcoma,
usually an osteosarcoma.
This risk is pr...
A bony lesion that arises in settings of
excess osteoclastic activity, as hyperparathyroidism.
Primary hyperparathyroidism...
BLOOD CHEMISTRY:
The diagnosis should be established by
◦ Serum calcium,
◦ Phosphorus,
◦ Alkaline phosphatase,
◦ Parathyro...
• Intense osteoclastic
and osteoblastic
activity associated with
peritrabecular fibrosis.
• Diffuse subperiosteal
resorpti...
More extreme focal bone
resorption may resembles a
primary bone tumor or
metastatic lesion.
Borders are sharp on plain
rad...
Patients with hyperparathyroidism usually are
treated by an endocrinologist. Orthopaedic
management consists of treating a...
Bone infarct refers to ischemic death of the cellular
elements of the bone and marrow.
Idiopathic or secondary to other co...
The diagnosis usually by plain radiographs.
Bone infarcts usually are well-defined
metaphyseal lesions with irregular bord...
TREATMENT:
Bone infarcts usually are asymptomatic, and no
treatment is required. If a patient presents with
pain, another ...
THANK
YOU
Benign tumors and tumor like lesions
Benign tumors and tumor like lesions
Benign tumors and tumor like lesions
Benign tumors and tumor like lesions
Benign tumors and tumor like lesions
Benign tumors and tumor like lesions
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Benign tumors and tumor like lesions

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Concise description on benign tumors

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Benign tumors and tumor like lesions

  1. 1. DR. ATIF SHAHZAD PGR ORTHOPEDIC DEPARTMENT SHL
  2. 2. A benign tumor is a mass of cells that lacks the ability to invade neighboring tissue or metastasize. They mostly occur within the first three decades of life. The precise incidence is not known because many benign lesions are not biopsied. They outnumber malignant tumors by at least several hundredfold. Timely, accurate diagnosis allows appropriate treatment so that the patients can not only survive, but also maintain optimal function of the affected body parts.
  3. 3. Mostly classified according to the normal cell or tissue of origin. Lesions that do not have normal tissue counterparts are grouped according to their distinct clinicopathologic features. Overall, matrix-producing and fibrous tumors are the most common. Among the benign tumors, osteochondroma and fibrous cortical defect are most frequent.
  4. 4. Bone-forming tumors: Osteoid osteoma Bone island Cartilage lesions: Chondroma Osteochondroma Fibrous lesions: Nonossifying fibroma Cortical desmoid Benign fibrous histiocytoma Fibrous dysplasia Osteofibrous dysplasia Desmoplastic fibroma Cystic lesions: Unicameral bone cyst Aneurysmal bone cyst Intraosseous ganglion cyst Epidermoid cyst Fatty tumors: Lipoma Vascular tumors: Hemangioma Other Nonneoplastic lesions: Paget disease “Brown tumor” hyperparathyroidism Bone infarct Osteomyelitis Stress fracture
  5. 5. Clinically, present in various ways. The more common benign lesions are frequently asymptomatic and are detected as incidental findings. Many tumors, however, produce pain or noticed as a slow-growing mass. Sometimes, the first hint of a tumor's presence is a sudden pathologic fracture.
  6. 6. Radiographic analysis plays an important role in diagnosing bone tumors. Exact location and extent of the tumor. It can detect features that help limit the differential diagnosis and give clues to the aggressiveness of the tumor. Ultimately, in most instances, biopsy and histological study are necessary.
  7. 7. FIBROUS TUMORS
  8. 8. • Nonossifying fibroma (fibrous cortical defects) is a common developmental abnormality due to proliferation of fibrous tissue. • 35 % of Children • Mostly asymptomatic and an incidental finding with or without a fracture. • Approximately 5% of all investigated benign bone tumors. • Primarily in first 2 decades . Boys > Girls. • Generally, these latent lesions occur in the metaphyseal region of long bones ; • 40% in distal femur, • 40% in proximal tibia, • 10% in fibula.
  9. 9. • A well-defined lobulated solitary lesion located eccentrically in the metaphysis. • Multilocular appearance or ridges in the bony wall, sclerotic borders, erosion of the cortex. • There is no periosteal reaction. • May occur as a multifocal lesion. • The radiographic appearance is always typical, and no additional imaging and biopsy is warranted
  10. 10. • Spindle-shaped cells distributed in a whorled pattern. • There is fibroblastic proliferation with high cellularity. • Giant cells and foam cells are almost always apparent. • Usually no bone formation
  11. 11. Chondromyxoid Fibroma Fibrous Dysplasia Infection
  12. 12. Radiological findings Biopsy & Histopathology
  13. 13. Mostly asymptomatic and regress spontaneously in adulthood. Most pathological fractures can be treated conservatively. Curettage and bone grafting for lesions that significantly cause weakening the bone. Large symptomatic lesions, subjected to repeated trauma require treatment with Internal fixation & bone grafting. Recurrence after treatment is rare.
  14. 14. • A benign disorder characterized by tumor-like proliferation of fibro-osseus tissue. • A developmental abnormality of bone. • The hallmark is replacement of normal bone and marrow by fibrous tissue and small, woven spicules of bone. • Occur in the epiphysis, metaphysis, or diaphysis. • Latent, active and aggressive features. • Occurs in younger age . • M:F =1:1and 15% of all benign bone tumors. • Mutations of the Gs alpha gene leading to over activity of adenylyl cyclase have been identified in patients.
  15. 15. • Three clinical presentations exist: Monostotic fibrous dysplasia 70% Polyostotic fibrous dysplasia 25% McCune-Albright syndrome 2-5% • McCune-Albright syndrome refers to polyostotic fibrous dysplasia, cutaneous pigmentation, and endocrine abnormalities.
  16. 16. Pain with complete pathologic fracture or micro-fracture Swelling with pathologic fracture. Commonly presents as a long lesion in a long bone. The ipsilateral proximal femur is invariably affected, especially proximal femur-varus deformity (Shepherd's crook deformity) affects hip motion, especially abduction, may result in limp. Limb length discrepancy. Associated abnormalities, such as sexual precocity, abnormal skin pigmentation, intramuscular myxoma, and thyroid disease, may be present.
  17. 17. • Appearance is characteristic, witch is lucent purely lytic having a granular, ground- glass appearance. May also contain cystic parts, calcifications and ossifications. Thinning of the cortex and endosteal scalloping. Bone expansion and bone deformity (shepherd's crook• deformity ) involving one end to the other. Tiny trabeculae are noted within the lesion.
  18. 18. Variably cellular fibrous tissue containing irregularly shaped trabeculae of woven bone Woven bone is immature bone that has not undergone remodelling into lamellar bone. Fibroblasts, with few mitoses. Bone appears to arise directly from fibrous tissue, not from osteoblasts; termed "Chinese characters" because of unusual shape.
  19. 19. Serum alkaline phosphatase Plain X-Rays Bone Scan CT Scan MRI Occasionally, biopsy is necessary to establish the diagnosis.
  20. 20. Monostotic lesions: Unicameral bone cyst Aneurysmal bone cyst Nonossifying fibroma Giant cell tumor Infection Polyostotic lesions: Multiple enchondromatosis (Ollier's disease) Paget's disease Brown tumor of hyperparathyroidism
  21. 21. Clinical findings Radiological findings Biopsy
  22. 22. • Therapy determined by patient's age, activity of lesion, extent of fracture risk, and mechanical deformity • Conservative therapy: Bracing and modification of activity. Treatment with bisphosphonates is beneficial for patients with extensive disease.
  23. 23. • Surgical treatment : Indicated when significant deformity or pathological fracture occurs or significant pain exists. • Symptomatic lesions can be treated by closed methods (splinting), curettage and bone grafting, internal fixation, and wide excision . • Actual and impending pathological fractures are best treated with intramedullary fixation when possible.
  24. 24. • Because recurrence rates are high after curettage and bone grafting, cortical bone grafts are preferred over cancellous grafts (or bone graft substitutes) because of their slower resorption. • Deformities are corrected by osteotomy with internal fixation.
  25. 25. Pathologic fracture Progressive deformity in weight-bearing bones. Painful stress fractures in femoral neck Although dysplastic bone heals at normal rate after fracture, resulting callus also dysplastic and disease persists. Transform to sarcoma (most commonly osteosarcoma, fibrosarcoma of bone) Third most common cause of osteosarcoma arising in diseased bone after Paget's and radiation- induced osteosarcoma
  26. 26. Malignant degeneration is rare,0.5% to 1%. When malignant degeneration occurs, it is usually in fibrous dysplasia that has received irradiation. Do not irradiate the bone lesions of fibrous dysplasia.
  27. 27. • Osteofibrous dysplasia (ossifying fibroma of long bones, also known as Campanacci disease) is a rare lesion usually affecting the tibia and fibula. • Patients usually are in the first two decades of life. • The middle third of the tibia is the most frequently affected location. • Usually diaphyseal, it may encroach on the metaphysis. • Pain usually is absent, unless pathological fracture has occurred.
  28. 28. • RADIOLOGY: • The radiographs show eccentric intracortical osteolysis with expansion of the cortex. HISTOLOGY: • Loose fibrous tissue in the center of the lesion and a band of bony trabeculae rimmed by active osteoblasts at the periphery. • The lesion must be distinguished from monostotic fibrous dysplasia
  29. 29. The natural course is unpredictable. Some lesions regress spontaneously during childhood; most progress during childhood, but not after puberty. Recurrence rates are high after curettage or marginal resection in children. Conversely, recurrence rates are low after surgery in skeletally mature patients. Pathological fractures can be treated nonoperatively. Surgical management is aimed at preventing or correcting deformity.
  30. 30. FATTY TUMORS
  31. 31. Intraosseous lipoma is a relatively rare lesion, in contrast to its soft-tissue counterpart. The true incidence is unknown because most are asymptomatic and never come to medical attention. Most intraosseous lipomas are discovered as incidental findings.
  32. 32. • The radiographic appearance varies, usually appear as well-defined lucencies possibly with a thin rim of reactive bone. • CT and MRI show well-defined lesions with the same signal characteristics as fat. • Central necrosis or calcification sometimes is evident. • Biopsy rarely is necessary because imaging usually is diagnostic.
  33. 33. Surgery is indicated only for the rare symptomatic lesion. In these cases, simple curettage usually is curative.
  34. 34. VASCULAR TUMOR
  35. 35. Hemangioma is a common benign bone lesion. It is estimated that 10% of the population has asymptomatic lesions of the vertebral bodies. Common in the skull & vertebrae, relatively uncommon in long bones of the extremities. Discovered as incidental findings. Spinal lesions rarely are symptomatic unless there is vertebral collapse or, in rare cases with soft-tissue extension, nerve root or cord compression.
  36. 36. RADIOLOGY: Appearance in the spine usually is characteristic, with thickened, vertically oriented trabeculae giving the classic “jailhouse” appearance. On CT Scan cross section, these thickened trabeculae have a “polka dot” pattern. On MRI, the lesions usually are bright on T1- and T2- weighted images. HISTOLOGY: Rarely needed, reveals a proliferation of normal- appearing blood vessels.
  37. 37. • Usually is not necessary; however, multiple options exist for symptomatic lesions. • Nerve root or cord decompression with spinal stabilization for rare cases of vertebral collapse with neurological compromise. • Most lesions of the long bones can be treated adequately with extended curettage. • Preoperative embolization minimize intraoperative blood loss, which otherwise could be massive. • Selective arterial embolization can be used as definitive treatment in surgically inaccessible locations. • Low-dose radiation is an option for inoperable lesions but carries the risk of malignant degeneration.
  38. 38. NON NEOPLASTIC LESIONS
  39. 39. Paget’s disease of bone is a localized disorder of bone remodeling, characterized by enhanced resorption of bone by giant multinucleated osteoclasts followed by formation of disorganised woven bone by osteoblasts. The resultant bone is expanded, weak and vascular, causing bone pain brittleness and deformity. Paget’s disease is a disorder of uncertain origin. This disease can occur any where but is most common in the pelvis, skull, the hip and the bones of the legs.
  40. 40. Paget disease may affect 4% of people of Anglo-Saxon descent who are older than age 55 years, but it is rare in most other populations. It is a disorder of unregulated bone turnover. Excessive osteoclastic resorption is followed by increased osteoblastic activity. An early lytic phase is followed by excessive bone production with cortical and trabecular thickening.
  41. 41. • Radiographic findings depend on the stage of the disease. • In the lytic phase, bone resorption can take on a “blade of grass” or “flame” appearance beginning at the end of the bone and extending toward the diaphysis. • Later the radiographs show bony sclerosis, thickened cortices, and thickened trabeculae . • Bone scans usually are “hot”.
  42. 42. MRI is helpful in this circumstance because the marrow signal in patients with Paget disease usually remains normal. Histology usually reveals a characteristic “mosaic” pattern with widened lamellae, irregular cement lines, and fibrovascular connective tissue.
  43. 43. Medical Management : Consists of nonsteroidal anti inflammatory drugs, calcitonin, or bisphosphonates. Serum alkaline phosphatase levels and urine pyridinium cross-links can be used to monitor the activity of the disease. Surgical Management : Consists of correcting deformity and treating pathological fractures. During periods of active disease, intraoperative bleeding from affected bones can be massive.
  44. 44. Approximately 1% of patients with Paget disease develop a secondary bone sarcoma, usually an osteosarcoma. This risk is probably higher for patients with polyostotic disease.
  45. 45. A bony lesion that arises in settings of excess osteoclastic activity, as hyperparathyroidism. Primary hyperparathyroidism usually is caused by an adenoma of the parathyroid glands. Secondary hyperparathyroidism can occur in patients with chronic renal failure. When the disease is discovered early, the skeletal change usually is limited to diffuse demineralization. May occur in any bone, most frequently centrally in the diaphysis. Only rarely does the change become markedly focal and produce a “brown tumor” which resembles a giant cell tumor and is difficult to distinguish from it.
  46. 46. BLOOD CHEMISTRY: The diagnosis should be established by ◦ Serum calcium, ◦ Phosphorus, ◦ Alkaline phosphatase, ◦ Parathyroid hormone levels MICROSCOPY: Some microscopic features in hyperparathyroidism, (1) the giant cells are a little smaller, often occurring in a nodular arrangement, especially around areas of hemorrhage; (2) the stromal cells are more spindle-shaped and delicate
  47. 47. • Intense osteoclastic and osteoblastic activity associated with peritrabecular fibrosis. • Diffuse subperiosteal resorption or generalized demineralization.
  48. 48. More extreme focal bone resorption may resembles a primary bone tumor or metastatic lesion. Borders are sharp on plain radiographs, though non- sclerotic. May be confused with giant cell tumor when located in the epi-metaphysis.
  49. 49. Patients with hyperparathyroidism usually are treated by an endocrinologist. Orthopaedic management consists of treating actual or impending pathological fractures
  50. 50. Bone infarct refers to ischemic death of the cellular elements of the bone and marrow. Idiopathic or secondary to other conditions like steroid use, alcoholism, sickle cell anemia. Bone infarct refers to lesions occurring in the metaphysis and diaphysis of bone. They also can occur in patients with no other apparent underlying disorder.
  51. 51. The diagnosis usually by plain radiographs. Bone infarcts usually are well-defined metaphyseal lesions with irregular borders. The periphery of the lesion is calcified, in contrast to chondroid lesions, which are usually calcified throughout. Biopsy (usually unnecessary) shows mineralization of necrotic marrow elements. Bone scan CT Scan MRI
  52. 52. TREATMENT: Bone infarcts usually are asymptomatic, and no treatment is required. If a patient presents with pain, another etiology should be sought. Rarely, malignancy, such as a malignant fibrous histiocytoma, can occur at the site of a bone infarct.
  53. 53. THANK YOU

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