Benign bone tumors

Challenges

Some of the challenges these benign bone tumors pose include

1. Interference of growth of the bone of origin (eg. unicameral bone cysts, osteochondroma)

2. Interference of neighbouring bones (eg. osteochondroma)

3. A tendency to fracture (eg. unicameral bone cysts)

4. Pain (especially inflammatory pain unrelated to a tendency to fracture eg. osteoid osteoma or osteoblastoma)

5. A diagnostic tendency to be mistaken for malignant tumours (eg. osteoid osteomas being mistaken for Ewing's sarcoma)

6. Destruction of the bone in aggressive lesions (e.g. Giant cell tumors)

7. Malignant transformation (eg. osteochondroma, enchondroma and even giant cell tumor)

Figure. Depending on where the tumor appears on the long bone we can make the diagnosis in up to 90% of cases with a plain x-ray

It is often more difficult to offer a cogent argument for or against a treatment modality then the case with malignant disease - because it is benign there is a tendency to feel that intervention is unnecessary. While often true, some of the risks, especially of fractures and a tendency for intractable pain make observation sometimes difficult.

Finally, while these benign bone tumours are very common they usually happen in children. Some of them do not have tumours ultra-structural features and may be better referred to as 'tumor-like' lesions as they are probably developmental in origin. These tumor-like lesions include the entities fibrous dysplasia and unicameral bone-cysts and often present with the problem of fracture risk.

Enclosed here are a number of benign conditions we have managed over the years that give but a sampling of the typical approaches that become necessary in their management.