Benign bone tumors in childhood and ... - Vinzenz Gruppe

Benign bone tumors in
childhood and adolescence
Benign bone tumors in childhood and adolescence
Stephanie Josepha Friederike
Wilhelmine Antonia von
Hohenzollern-Sigmaringen.
M. Cassiano Neves / Monika Thuesing
Centro Hospitalar Lisboa Central - CHLC
Hospital Pediátrico Dona Estefânia - Lisbon
PORTUGAL 1
Queen of Portugal - 1858/59
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Benign bone tumors in childhood and adolescence
Benign bone tumors in childhood and adolescence
Benign Bone Tumours do not
spread to other parts of the body
______________
Non Cancerous Tumours
Bone
Cartilage
Tissue Origin
Benign Bone Tumour
Osteoma
Osteochondroma
Osteoid Osteoma
Osteoblastoma
Enchondroma
Chondroblastoma
Chondromyxoide Fibroma
Juxtacortical Chondroma
Osteochondroma
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Benign bone tumors in childhood and adolescence
Benign bone tumors in childhood and adolescence
Fibrous
Uncertain
Tissue Origin
Marrow Elements
Hematopoietic
Benign Bone Tumour
Nonossifying Fibroma
Multiple Nonossifying Fibroma
Fibrous Dysplasia
Osteofibrous Dysplasia (Campanacci)
Giant Cell Tumour
Fibrous Histiocytoma
Histiocytosis X
Clinical Presentation
Clinical Presentation
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Benign bone tumors in childhood and adolescence
Benign bone tumors in childhood and adolescence
Clinical Presentation
NO CLINICAL SIGNS (60%)
Clinical Presentation
• NO CLINICAL SIGNS (60%)
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Benign bone tumors in childhood and adolescence
Benign bone tumors in childhood and adolescence
Clinical Presentation
• NO CLINICAL SIGNS (60%)
Clinical Presentation
• Pain
• Deformity
• Local Inflammatory Signs
• Pathological Fracture
• NO CLINICAL SIGNS (60%)
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Unicameral Bone Cyst
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Benign bone tumors in childhood and adolescence
Benign bone tumors in childhood and adolescence
Clinical Presentation
• Pain
• Deformity
• Local Inflammatory Signs
• Pathological Fracture
• NO CLINICAL SIGNS (60%)
Osteochondroma
Clinical Presentation
• Pain
• Deformity
• Local Inflammatory Signs
• Pathological Fracture
• NO CLINICAL SIGNS (60%)
Nonossifying Fibroma
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Benign bone tumors in childhood and adolescence
Benign bone tumors in childhood and adolescence
Clinical Presentation
• Pain
• Deformity
• Local Inflammatory Signs
• Pathological Fracture
• NO CLINICAL SIGNS (60%)
Clinical Presentation
• Pain
• Deformity
• Local Inflammatory Signs
• Pathological Fracture
• NO CLINICAL SIGNS (60%)
Fibrous Dysplasia
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Benign bone tumors in childhood and adolescence
Benign bone tumors in childhood and adolescence
Clinical Presentation
• Pain
• Deformity
• Local Inflammatory Signs
• Pathological Fracture
• NO CLINICAL SIGNS (60%)
Chondroblastoma
Pain characteristics in benign
bone tumours
• Mechanic Vs Continuous
• “Aspirin relief...”
• Joint involvement
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Benign bone tumors in childhood and adolescence
Benign bone tumors in childhood and adolescence
Image
• X-Ray
• CT Scan
• MRI
• Bone Scan
Chondromyxoid
Fibroma
Chondroblastoma
c
c
c
Unicameral Bone Cyst
Aneurysmal Bone Cyst
Giant Cell Tumour
Enchondroma
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Benign bone tumors in childhood and adolescence
Benign bone tumors in childhood and adolescence
Image
• X-Ray
• CT Scan
• MRI
• Bone Scan
AP
Image
• X-Ray
• CT Scan
• MRI
• Bone Scan
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PA
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Benign bone tumors in childhood and adolescence
Benign bone tumors in childhood and adolescence
Differential Diagnosis
• Clinical Picture
• Image
Differential Diagnosis
• Clinical Picture
• Image
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Benign bone tumors in childhood and adolescence
Benign bone tumors in childhood and adolescence
Differential Diagnosis
• Clinical Picture
• Image
Definitive Diagnosis
• Biopsy
Nidus, com matriz laxa, hipercelular
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Benign bone tumors in childhood and adolescence
Benign bone tumors in childhood and adolescence
Treatment options:
Treatment options:
Treatment options:
Treatment options:
12 Y 16 Y
Do they need treatment
Do they need treatment
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Evanescent exostosis. A new case. Revilla Y, Lozano MC, Gonzáles G,
Martinez A..
European Journal of Radology. 29 (1999) 26 270-272.
Benign bone tumors in childhood and adolescence
Benign bone tumors in childhood and adolescence
Treatment options:
Treatment options:
11 Y 13 Y
Treatment Indications:
Treatment Indications:
• Locally agressive
• Risk of fracture
• Pain control
• Bone deformity
A randomized clinical trial comparing intralesional bone marrow and steroid
injections for simple bone cysts. Wright JG, Yandow S, Donaldson S, Marley L
J Bone Joint Surg Am. 2008 Apr;90(4):722-30
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Benign bone tumors in childhood and adolescence
Benign bone tumors in childhood and adolescence
Treatment options:
Treatment options:
Treatment options:
Treatment options:
Common begnin tumours that may require some treatment
Common begnin tumours that may require some treatment
• Fibrous dysplasia
• Metaphyseal fibrous defect
• Osteochondroma
• Unicameral bone cyst
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Benign bone tumors in childhood and adolescence
Benign bone tumors in childhood and adolescence
Treatment options:
Treatment options:
Treatment options:
Treatment options:
Simple bone cysts. A review of 59 cases with special reference to their
treatment. Mylle J; Burssens A; Fabry G
Arch Orthop Trauma Surg. 1992; 111(6):297-300
Contrast examination as a prognostic factor in the treatment of solitary bone cyst by cortisone injection.
Capanna R; Albisinni U; Caroli GC; Campanacci M Skeletal Radiol. 1984; 12(2):97-102
• In a retrospective study, 21 simple bone cysts (SBC) treated by curettage (with or
without bone grafting) are compared to 20 SBC treated by intralesional injections of
methylprednisolone
• Curettage led to 43% favourable results and 29% recurrences
• Cortisone injections led to 90% favourable results and 5% recurrences
A randomized clinical trial comparing intralesional bone marrow and steroid injections for simple bone
cysts. Wright JG, Yandow S, Donaldson S, Marley L
J Bone Joint Surg Am. 2008 Apr;90(4):722-30
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Benign bone tumors in childhood and adolescence
Benign bone tumors in childhood and adolescence
Treatment options:
Treatment options:
Treatment options:
Treatment options:
A randomized clinical trial comparing intralesional bone marrow and steroid
injections for simple bone cysts. Wright JG, Yandow S, Donaldson S, Marley L
J Bone Joint Surg Am. 2008 Apr;90(4):722-30
• Intralesional injections of bone marrow VS methylprednisolone acetate
• 90 patients / randomly allocated / 77 were followed for two years
• Sixteen (42%) of the thirty-eight cysts treated with methylprednisolone
acetate healed
• Nine (23%) of the thirty-nine cysts treated with bone marrow healed
(p = 0.01)
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Benign bone tumors in childhood and adolescence
Benign bone tumors in childhood and adolescence
Treatment options:
Treatment options:
Treatment options:
Treatment options:
Common benign tumours that will require treatment
Common benign tumours that will require treatment
• Aneurysmal bone cyst
• Chondroblastoma
• Chondromyxoid fibroma
• Giant cell tumor
•Osteoblastoma
• Osteoid osteoma
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Benign bone tumors in childhood and adolescence
Benign bone tumors in childhood and adolescence
Treatment options:
Treatment options:
Treatment options:
Treatment options:
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Benign bone tumors in childhood and adolescence
Benign bone tumors in childhood and adolescence
Treatment options:
Treatment options:
Treatment options:
Treatment options:
Pre op Maping
Guide Wire
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Benign bone tumors in childhood and adolescence
Benign bone tumors in childhood and adolescence
Treatment options:
Treatment options:
Treatment options:
Treatment options:
Trocar Excision
Post-Op
9 months Post-Op
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Benign bone tumors in childhood and adolescence
Benign bone tumors in childhood and adolescence
Treatment options:
Treatment options:
Conclusion:
Begnin bone tumours do not spread to other parts of the
body but some can be locally aggressive
The clinical picture together with image are the key factors
in the diagnosis although definitive diagnosis only by
biopsy
Percutaneous treatment of osteoid osteoma by laser thermocoagulation under
computed tomography guidance in pediatric patients.
Aschero A, Gorincour G, Paris M, Bollini G. Petit P. Eur Radiol. 2008 Oct 7.
Treatment should be addressed individually
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