Benign Bone/Soft Tissue

Tumors
Dr Afsar Khan Afridi
Assistant Professor Orthopedic Surgery
MBBS(KMC), FCPS(Ortho)
 Introduction
• Primary Musculoskeletal tumors arise
from tissue of mesenchymal origin (i-e.
bone, muscle, connective tissue,
adipose.)
• Secondary/Metastatic bone tumors
arise from a host of other tissues.
Bone Tumors

• Secondary (metastasis) tumors are the most common malignancy of

bone.
• Primary bone tumors are divided into benign and malignant.
• Benign primary bone tumors are much more common than malignant
primary bone tumors.
 BONE TUMORS: CLASSIFICATION
Tissue type Benign Malignant

Osseous Osteosarcoma
Osteoid osteoma Radiation Sarcoma
Osteoblastoma
Cartilaginous Enchondroma Chondrosarcoma
Exostosis Clear cell Chondrosarcoma
Periosteal chondroma
Chondroblastoma
Chondromyxoid fibroma
Fibrous Nonossifying fibroma Fibrosarcoma
Desmoplastic fibroma Malignant Histiocytic Fibroma
Fibrous dysplasia
Ossifying fibroma
Reticuloendothelial Eosinophilic granuloma Ewing’s sarcoma
Hands-Schuller-Christian disease
Letterer-Siwe disease
Vascular Aneurysmal bone cyst Angiosarcoma
Hemangioma of bone
Unknown Origin Simple bone cyst
Giant-cell tumor of bone Malignant Giant cell tumour
Marrow Tumour Plasmocytoma
Multiple myeloma
 Tumors of Soft Tissue
Tissue type Benign

Osseous Myositis ossificans

Cartilaginous Chondroma
Synovial Chondromatosis
Fibrous Fibroma
Fibromatosis
Synovial Pigmented villonodular synovitis
Ganglion cyst
Vascular Hemangioma

Fatty Lipoma
Angiolipoma
Neural Neurolemmoma
Neurofibroma
Muscular Leiomyoma
Rhabdomyoma
Unknown origin Giant-cell tumor of tendon sheath
RADIOGRAPHIC ASSESMENT
Enneking’s 4 Questions

1.Where is the lesion?

2.What is the lesion doing to the bone?

1. Geographic
2. Moth eaten
3. Permeative

3.What is the bone doing?

Periosteal reaction?
Smooth, Onion skin,Sunburst reaction,Codmans triangle.

4.What is in the lesion?

calcifications, Ground glass, soap bubble

Add 2 more questions

5.Patients age?
6.Multiplicity?
SURGICAL STAGING SYSTEM FOR BENIGN
BONE TUMORS
 ENCHONDROMA/JUXTA CORTICAL CHONDROMA
Age: Adults
Male=Female
Intramedullary or juxtacortical
Site: small tubular bones of hand and feet, proximal humerus, distal femur and proximal tibia, may occur
any where
• Multiple lesions – Olliers disease
• Multiple lesions with haemangiomas – Maffucci syndrome
X ray: central radiolucent lesion with well defined bony margins, may
have stippled calcification
Treatment : asymptomatic solitary benign enchondroma – periodic follow up
If symptomatic – curettage and bone grafting
If malignant transformation – wide margin excision
Risk of malignant transformation
• Solitary Enchondroma -- < 1%
• Olliers disease -- 10%
• Maffucci syndrome – 25%
Osteocartilagenois Exostosis
(Osteochondroma)

Site ; long bones metaphysis

Age : adolescence
X-ray: sessile
pedunculated
Evidence of malignant transformation.

1. Cartilaginous cap thickness > 2cm

2. Sudden increase radioisotope uptake on bone scan
3. On CT Scan/MRI presence of soft tissue mass or displacement of
neurovascular bundle .
Treatment:
 Asymptomatic-- Observation
 Symptomatic-- Resection
 Recurrence : 5%
 Risk of Sarcomatous change
Solitary Exostosis 1%
Multiple Hereditary Exostosis 10%
MULTIPLE OSTEOCHONDROMATOSIS
(MULTIPLE HEREDITARY EXOSTOSES)
• Rare

• Inherited as an autosomal dominant trait, usually associated with short stature and
other bone deformities .

• Presents with disfigurement or with pain induced by pressure on surrounding

soft-tissue structures.

• Radiologically, grossly and microscopically similar to solitary

osteochondromas.

• Incidence of malignant transformation, compared with that in

solitary osteochondromas is much higher (about 10 percent).

OSTEOID OSTEOMA
Benign osseous tumor.
Age: 2nd or 3rd decade
Site: most common in femur and tibia.

• Diaphysis of long bones,

• Foot (Talus, navicular, calcaneum)
• Posterior elements of vertebrae (scoliosis)

Clinically: localized pain, increase at night, decrease with Aspirin.

XRAYS: Intense bone reaction to a small oval nidus (5-15mm).

Treatment: May resolve spontaneously

NSAIDs
Radiofrequency ablation
Enbloc excision
Unicameral/Simple Bone Cyst

• Age: First two decades

• Sex: Male: Female =2:1
• Site: Proximal humerus or proximal femur
• Symptoms—Asymptomatic, Pathological Fx – Cyst healing
• X-ray :Centrally located lytic lesion with well developed margins; fallen fragment sign
• Treatment: - Small asymptomatic – observe, Aspiration & Injection -
-Large symptomatic – curettage & bone graft
- Proximal femur – curettage, bone graft & internal fixation
Aneurysmal Bone Cyst
• Growing ends of long bones (proximal humerus, proximal femur, proximal tibia and posterior
elements of vertebra
• Age 1st and 2nd decade
• Blood filled cysts
• X-rays= Expansile, eccentric, lytic lesion located in metaphysis
• CT Scan/MRI – multiloculated, double density fluid levels
• Treatment
Extended curettage & grafting
Giant Cell Tumor
• Age– 20 to 40
• Slight female predominance
• Site-- Distal femur, proximal tibia, distal radius
• Symptoms-- Pain and pathological fracture
• X rays– eccentric located in epiphysis, purely radiolucent, no rim of reactive
bone, abuts subchondral bone, may extend to soft tissues
• 3% benign pulmonary mets
• Treatment– Extended Curretage with BG/Bone cement
Resection
Radiation for spinal and sacral tumors
Lipoma
• Age– any age, more common in adults, rare in children
• Male= Female
• Site– any, more common subcutaneous
• Symptoms– painless mass
• Diagnosis– clinically, ultrasound and MRI (isointense to subcutaneous
tissue
• Treatment– Observation, Marginal Excision
THANKYOU