This document provides an overview of common benign bone lesions. It begins with an introduction to bone tumors and their classification as benign or malignant. Several common benign bone tumors are then described in detail, including their clinical features, radiological appearance, diagnosis, treatment, and prognosis. Examples discussed include osteoid osteoma, osteoblastoma, bone islands, chondromas, osteochondromas, chondromyxoid fibroma, chondroblastoma, non-ossifying fibroma, fibrous dysplasia, unicameral bone cyst, aneurysmal bone cyst, and hemangioma. For each lesion, the key presenting symptoms, diagnostic imaging findings, treatment approaches such as surgery or observation, and recurrence risks

1. Benign Bone Lesions-I
PRESENTER: DR.SABIR KUMAR KHADKA
JR-II
DEPARTMENT OF ORTHOPAEDICS

2. REFERENCES
• CAMPBELL’S OPERATIVE ORTHOPAEDICS, 13TH
EDITION
• APLEY & SOLOMON’S SYSTEM OF
ORTHOPAEDICS AND TRAUMA, 10TH EDITION

3. OBJECTIVES
• INTRODUCTION
• CLASSIFICATION
• COMMON PRESENTATION
• COMMON BENIGN BONE TUMORS
-CLINICAL FEATURES
-RADIOLOGICAL FEATURES
-DIAGNOSIS
-TREATMENT MODALITY
-PROGNOSIS

4. INTRODUCTION
• Neoplasia literally means the process of "new
growth"
• British oncologist Willis defined “ a neoplasm is an
abnormal mass of tissue, the growth of which
exceeds & is uncoordinated with that of the normal
tissues& persists in the same excessive manner
after cessation of the stimuli which evoked the
change”

5. Benign Bone Tumors
• Bone tumors are diverse in their gross and
morphologic features and grade
• Most bone tumors are 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

6. Benign vs. Malignant

7. Classification

8. Classification

9. Presentation
• Clinically, bone tumors present in various ways
• The more common benign lesions are
frequently asymptomatic and are detected as
incidental findings.
• Pain
• Swelling
• Pathological fracture

10. Staging

13. Common Benign Bone Tumors
• Most bone tumors are classified according to
the normal cell or tissue of origin.
- Bone forming tumors
- cartilaginous lesions
- Fibrous lesions
- Cystic lesions
- vascular and Others

14. Osteoid osteoma
• Osteoid osteoma is a benign neoplasm most
often seen in young men 2nd and 3rd decade.
• M:F:: 3:1
• Pain is presenting symptom.
• Size less than 1.5cm
• Predilection for the lower extremity, with half
the cases involving the femur or tibia.

16. • X-ray : Small (<1.5 cm) central radiolucent nidus
with surrounding bony sclerosis. CT is best for
locating nidus.
• Microscopy : Fibrovascular tissue with immature
bony trabeculae that are rimmed by prominent
osteoblasts.
• Treatment :
Medical
Surgical
Percutaneous Radiofrequency ablation

17. OSTEOBLASTOMA
• Benign bone tumor of osteoblast producing
osteoid and woven bone.
• Commonly seen in teenagers and children.
• Prediliction for spine in posterior arch but can
occur anywhere.
• Usually presents with pain at site of tumor.

19. • On X ray: lytic lesion ,typically 2-5 cm in size,
usually central but can be eccentric or
periosteal.
• Histologically: large osteoblast producing
osteoid and woven bone.
• Treatment: extended intralesional curettage
with radiofrequency ablation for small volume
lesion.

20. Bone Island
• Bone islands, also called enostoses, are benign
lesions of cancellous bone.
• Usually are asymptomatic and are discovered
incidentally.
• Almost any bone can be involved, but the pelvis
and the femur are the most common sites.
• Regardless, most remain quiescent.

21. X-ray and MRI of BONE ISLAND

22. • X-ray : Small, round or oval areas of homogeneous
increased density within the cancellous bone.
Radiating spicules on the periphery of the bone
islands merge with the native bone.
• No treatment is required, if pain occur and size
increases then biopsy indicated to rule out
sclerosing osteosarcoma, blastic metastasis, or
sclerotic myeloma.

23. CHONDROMA
• Chondromas are benign lesions of hyaline cartilage.
They are common, and all age groups are affected.
• The phalanges of the hand are the most common
location.
• Enchondroma and periosteal or juxtacortical
chondroma
• Ollier’s disease
• Maffucci syndrome

25. • Radiography
– Plain Radiography
• Solitary, metaphyseal lesion
• Intralesional calcification – irregular, termed -
“stippled,” “punctate,” or “popcorn”
• Erosion and expansion of the overlying cortex
– CT
• Evaluates endosteal erosion – presence =
chondrosarcoma

26. • Treatment
– Solitary enchondromas – observation with serial
radiographs
– Lesion enlarges or becomes symptomatic –
extended curettage
– Low recurrence rates .
– Multiple enchondromatosis – individual lesions –
not treated, deformities – corrective osteotomy

27. OSTEOCHONDROMA
• Common benign bone tumors
• The lesions consist of a bony mass, often in the
form of a stalk, produced by progressive
endochondral ossification of a growing
cartilaginous cap.
• Common sites- distal femur, the proximal tibia,
and proximal humerus
• Osteochondromas are of two types: pedunculated
and broad based or sessile.

28. OSTEOCHONDROMA

29. Osteochondroma

30. • Solitary Osteochondroma
• Multiple Hereditary Exostoses
• Malignant transformation may occur
• Treatment : osteochondromas may
spontaneously regress. They are usually treated
by simple excision for cosmetic reasons or
when symptoms of pain, limitation of motion,
or impingement on adjacent structures such as
nerves and blood vessels become clinically
manifest.

31. CHONDROMYXOID FIBROMA
• Benign cartilaginous tumor comprising lobules
of fibromyxoid and chondroid tissue.
• Common sites: long bone metaphyses,
particularly proximal tibia and pelvis.
• Most frequent: teenagers and young adults.
• Presents with insidious mild to moderate pain.

33. • On X ray: appearsas small, metaphyseal,
eccentric lytic lesion.
• Lie parallel to long axis of bone, can cause
fusiform swelling.
• Histologically:stellate cells on myxoid
background.
• Treatment: intralesional curettage with a low
risk of recurrence.

34. CHONDROBLASTOMA
• Benign tumor of childhood
• Mostly epiphyses, usually at end of long bones
• Typically presents with pain and ocassionally
cause joint effusion and stiffness.
• On X ray: round or oval lesion ranging from 1
to 7 cm on x ray.

36. • Histologically: appears as “wet-sawdust” with
areas of chondroid matrix,calcification and
haemorrhage.
• Presence of chicken- wire calcification is
pathognomic.
• Treatment: simple curettage with or without
bonegraft.
• Recurrence: 10% of cases.

37. NON OSSIFYING FIBROMA
• This, the commonest benign lesion of bone, is
a developmental defect in which a nest of
fibrous tissue appears within the bone and
persists for some years before ossifying.
• It is asymptomatic and is almost always
encountered in children as an incidental
finding on x-ray. Generally, these lesions occur
in the metaphyseal region of long bones.

39. • X-ray: oval or lobulated eccentric radiolucent
lesion in metaphysis surrounded by thin
margin of dense bone.
• Histologically, the defect is filled with spindle-
shaped cells distributed in a whorled or
storiform pattern.
• Most nonossifying fibromas are asymptomatic
and regress spontaneously in adulthood.

40. FIBROUS DYSPLASIA
• Fibrous dysplasia is a developmental anomaly of
bone formation. The hallmark is replacement of
normal bone and marrow by fibrous tissue and
small, woven spicules of bone.
• Fibrous dysplasia can occur in the epiphysis,
metaphysis, or diaphysis.
• Mazabraud syndrome
• McCune-Albright syndrome

41. • The disease usually manifests during the first
three decades of life (approximately 70% of
cases).
• The radiographic appearance is characteristic,
with the lucent area having a granular,
ground-glass appearance with a well-defined
sclerotic rim

42. • Characteristic deformity in proximal femoral
fibrous dysplasia is the shepherds crook
deformity.
• Histology: Demonstrates mixture of benign
proliferating fibroblastic cells within islands of
woven bone which characteristically appear in
a chinese letter formation.

43. Fibrous dysplasia

44. • Malignant transformation 0.5 to 5 percent.
• Small lesion require no treatment.
• Surgical treatment is indicated when
significant deformity or pathological fracture
occurs or when significant pain exists.
• Deformities corrected by osteotomy with
internal fixation.

45. Other Fibrous tumor
• CORTICAL DESMOID:A cortical desmoid is an
irregularity in the posteromedial aspect of the
distal femoral metaphysis and usually is seen in
boys 10 to 15 years old. It may be a reaction to
muscle stress exerted by the adductor magnus.
• Radiographs and MRI reveal erosion of the cortex
with a sclerotic base.
• A biopsy is not warranted. Treatment usually
consists of observation.

47. BENIGN FIBROUS HISTIOCYTOMA
• Rare tumor, occurs most frequently in the soft
tissues and is less common in bone.
• Benign fibrous histiocytoma may occur in the
diaphysis or epiphysis of long bones or in the
pelvis. Common at 3rd or 4th decade.
• Radiographically, is a well-defined, lytic,
expanding lesion with little periosteal reaction.
• Because of its tendency for local recurrence,
extended curettage or wide resection is
recommended.

48. CYSTIC LESIONS
UNICAMERAL BONE CYST:
• Common – Childhood, 85% - first 2 decades
• M:F = 2 : 1
• Common sites – children - proximal humerus and
femur, adults - Ilium and calcaneous
• Clinical features - often asymptomatic, pain,
swelling, stiffness – joint, pathological fracture
• Active during bone growth and may regress
spontaneously at maturity.
• Two thirds of patients present with pathological
fractures, which can stimulate the cyst to heal.

49. Pathogenesis
• A focal defect in metaphyseal remodelling
blocks interstitial fluid drainage.
• This leads to increased pressure which leads
to focal bone necrosis and accumulation of
fluid.
• Lining ofunicameral bone cyst is composed of
fibroblast.

50. X-ray

51. • X-ray : centrally located, purely lytic lesion with a
well-marginated outline.
• Treatment :
- Small, asymptomatic lesions in the upper
extremities can be treated with observation
-Larger lesions, symptomatic lesions, and lesions in
the lower extremities)- curettage (with or without
bone grafting or internal fixation)
- Aspiration and injection (corticosteroids, bone
marrow aspirate, demineralized bone matrix, or
other materials)

52. ANEURYSMAL BONE CYST
• Locally destructive, blood-filled reactive lesions of bone
• Slight female predominance
• Common sites – proximal humerus, distal femur, proximal
tibia, and spine
• Clinical features
– mild to moderate pain
– rapid growth – mimics malignancy
– spinal lesions – neurological deficits or radicular pain

54. • Plain Radiography
– Expansile, eccentrically located lytic lesion -
metaphyses, elevated periosteum +/- periosteal
reaction, lined by thin shell of cortical bone
• Bone scan
– diffuse or peripheral tracer uptake with central area
of decreased uptake

55. Treatment
Extended curettage and grafting with a bone graft
substitute under tourniquet control
Marginal resection – rarely
Spine or pelvis lesions – preoperative embolization
Arterial embolization – difficult locations
Low-dose irradiation - effective method, not used
routinely – risked malignant transformation

56. Vascular lesion
• HEMANGIOMA:
-Hemangioma is a common benign bone
lesion.
- Hemangiomas also are common in vertebral
bodies and the skull.
The radiographic appearance in the spine
usually is characteristic, with thickened,
vertically oriented trabeculae giving the classic
“jailhouse” appearance.

57. Hemangioma

58. Treatment
 Usually not necessary
 Nerve root or cord decompression with spinal stabilization -
vertebral collapse with neurological compromise
 Long bones lesions - extended curettage
 Selective arterial embolization - surgically inaccessible locations
 Low-dose radiation
 Preoperative embolization - minimizes intraoperative blood loss

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