Benign Bone Tumours

WHO Classification of bone tumours

Xray Appearance
(Lodwick classification)

• Geographical

• Moth eaten

• Permeative
Geographical - 3 types

1. With Sclerotic margins

2. No Sclerosis

3. Ill Defined margins

• Simple bone cyst • GCT • Chondrosarcoma
• Enchondroma • Enchondroma • Osteosarcoma
• Chondroblastoma • Chondroblastoma • GCT
• Myeloma • Metastasis
• GCT
• Metastasis • Infection
• Fibrous dysplasia
• Chondrosarcoma • Lymphoma
 Moth eaten
Multiple scattered holes that vary in
size and shape to arise separately

• Myeloma
• Metastasis
• Infection
• Osteosarcoma
• Chondrosarcoma
• Lymphoma
 Permeative
• Poorly demarcated from normal
• numerous elongated holes/slots in cortex
• Run parallel to long axis of bone

• Ewing’s Sarcoma
• Infection
• Myeloma
• Osteosarcoma
Location of tumor
Along the axis:

Epiphyseal
Metaphyseal
Diaphyseal

Along the axis of bone:

Centric
Eccentric
Periosteal
Age

Location

Site

Destruction pattern

Margins

Cortex

Periosteal reaction

Characteristic features
 Simple bone cyst
Age <20
Location Metaphyseal/ Diaphyseal
Centrally placed
Site Proximal humerus
Destruction pattern Lytic
Margins Well defined
Cortex Thinned
Periosteal reaction Absent
Characteristic feature • Fallen leaf sign
• Pathological fracture may occur
Simple bone cyst

Pathogenesis:
Focal defect in metaphyseal remodelling
blocks drainage of interstitial fluid

Treatment – Curettage with Bone grafting

Pathological fracture – heals spontaneously

 Aneurysmal bone cyst
Age <20
Location Metaphyseal/ Diaphyseal
Eccentric
Site Proximal humerus
Distal femur
Proximal tibia
Spine (posterior elements
Destruction pattern Lytic and Expansile
Margins Well defined
Cortex Thinned or Eggshell like
Periosteal reaction Absent
Characteristic feature • Blood filled
• Multiloculated cavities and fluid
levels
• Soap bubble appearance
 Aneurysmal bone cyst

Pathogenesis: Reactive lesion (AV malformation in metaphysis)

Microscopy: Hemorrhagic tissue and multinucleate giant cells

Treatment – Extended Curettage with Bone grafting

 Aneurysmal bone cyst
Age 20 to 40s
Location Epiphyseal in mature
Diaphyseal in immature
Eccentric
Site Distal femur
Proximal tibia
Distal radius
Spine (rare)
Destruction pattern Lytic
Margins Well defined
Cortex Expanded, breached/ Intact
Periosteal reaction Absent
Characteristic feature • Does not enter joint but abuts
joint cartilage
 Aneurysmal bone cyst

Microscopy:
Multinucleated giant cells (40 – 60
nuclei/cell) in a sea of mononuclear
stromal cells

Treatment:
Extended Curettage with Bone grafting
(High rate of recurrence)

En-bloc resection if bone is expendable

 Osteochondroma (Diaphyseal Aclasia)
Age 20s
Location Metaphyseal
Grows away from joint
Site Distal femur
Proximal tibia
Proximal humerus
Margins Well defined
Cortex Intact
Periosteal reaction Absent
Characteristic feature • Pedunculated or sessile
• Cartilage cap
• Cortex is continuous with parent
bone
Painful
• Bursitis
• Neurovascular complications
• Fracture
• Malignant transformation to Chondrosarcoma
Malignant transformation
• Cartilage thickness >2 cm (MRI)
• Rapid increase in size
• Growth after skeletal maturity
Treatment

Extra- periosteal resection

Indications:
• Cosmetic
• Painful
• Malignant transformation
• Joint ROM affected
• NV compromise
Osteoid Osteoma
Age 20 to 30s
Location Diaphysis
Site Femur
Tibia
Margins Well defined
Cortex Intact (Thickened and sclerosed)
Periosteal reaction Present
Characteristic feature • Night pain
• Lytic lesion with Radiolucent nidus
Treatment
• Analgesics
• Radiofrequency ablation
• Surgery
Enchondroma

• Metaphyseal
• Small bones of hand and
feet
• Hyaline cartilage present
• Malignant potential –
5%
• Treatment – curettage
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