Benign bone tumors and cystic lesions are common in childhood. Some represent fibrous dysplasia. Others are benign bone cysts (unicameral) or benign bone tumors (osteoid osteoma). Subacute osteomyelitis (Brodie abscess) and eosinophilic granulomas are lesions not associated with abnormal bone or cartilage growth. Some of these lesions can produce pain, limp, and pathologic fractures. Others can be incidental findings on radiographs. The prognosis is usually excellent. A brief differential diagnosis of bone tumors and their management is listed in Table 204-1. Malignant bone tumors are discussed in Section 21.
Table 204-1 Benign Bone Tumors and Cysts DISEASE CHARACTERISTICS RADIOGRAPHIC FINDINGS TREATMENT PROGNOSIS Osteochondroma (osteocartilaginous exostosis) Common; distal metaphysis of femur, proximal humerus, proximal tibia; painless, hard, nontender mass Bony outgrowth, sessile or pedunculated Excision, if symptomatic Excellent; malignant transformation rare
Multiple hereditary Osteochondroma of long bones; As above As above Recurrences exostoses bone growth disturbances
Osteoid osteoma Pain relieved by aspirin; femur and Dense sclerosis surrounds small As above Excellent tibia; found predominantly in boys radiolucent nidus, <1cm
Osteoblastoma (giant As above, but more destructive Osteolytic component; size As above Excellent osteoid osteoma)
Table 204-1 Benign Bone Tumors and Cysts—cont’d DISEASE CHARACTERISTICS RADIOGRAPHIC FINDINGS TREATMENT PROGNOSIS Nonossifying fibroma Silent; rare pathologic fracture; late childhood, adolescence Incidental radiographic finding; thin sclerotic border, radiolucent lesion None or curettage with fractures Excellent; heals spontaneously
Aneurysmal bone cyst As above; contains blood, fibrous Expands beyond metaphyseal Curettage, bone Excellent tissue cartilage graft
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