Benign Bone Lesions  

Posted bythespinebookadminPosted inTopics, Tumor

Classification (Enneking) 

  1. Latent 
    1. HOOG 
  2. Active 
    1. HOOOGA 
  3. Aggressive 
    1. GO (GCT, Osteoblastoma) 

Lesions 

Osteoid Osteoma 

  • LATENT 
  • Age: 20 
  • Location: pedicle, apex of scoliosis (on concavity) 
  • Size <2cm (>2cm is osteoblastoma) 
  • Presentation 
    • Pain +/- radiculopathy 
    • Worse at night 
    • Better with NSAIDs 
  • Imaging 
    • Early: sclerotic lesion in pedicle 
    • Later: Central nidus with Surrounding sclerosis 
    • Mx: 
      • Non Operative: observation + NSAIDS 
      • Operative 
        • Ind: failed non-op 
        • Excision +/- Fusion if unstable (did you remove facet/ pedicle?) 
      • RFA 
        • Unclear results 
        • Don’t do if close to cord (what are you, an idiot?) 

Osteoblastoma 

  • ACTIVE or AGGRESSIVE 
  • Same as Osteoid Osteoma except >2cm 
  • Imaging 
    • Lytic or Blastic 
    • Destructive Expansile lesion with Cortical Rim 
  • Mx: Wide Excision (intralesional excision recurrent of 20% at 9 years) 

Osteochondroma 

  • LATENT 
  • Most common primary bone tumour 
  • Chondrogenic from aberrant cartilage from perichondral ring 
  • Age: 10-30 
  • Location: Cervical/ Upper thoracic, POSTERIOR 
  • Imaging: 
    • Sessile vs Pedunculated 

Aneurysmal Bone Cyst (ABC) 

  • ACTIVE 
  • Age: <20 
  • Location: POSTERIOR 
  • Presentation: back pain, muscle spasm (can lead to scoliosis and rigidity) 
  • Associated with other tumours 
  • Imaging 
    • Expansile with neocortex 
    • Bubbly! 
    • MRI with Gad: Septations, multiple fluid lines 
    • Can affect contiguous levels 
  • Mx: 
    • Fracture: Non-op until fracture headling 
    • Non Fracture ABC: aggressive currettage +/- adjuvant (phenol, argon, liquid nitrogen) 
    • **Preoperative embolization 

Hemangioma 

  • LATENT 
    •  
  • Age 10-30 
  • Common 
  • Location: BODY 
    • Posterior involvement indicative of aggressive lesion 
  • Presentation: pain, neurologic, path fracture 
  • Imaging: 
    • XR: corduroy vertebrae 
    • CT: Polka-dot appearance 
    • MRI: Inc signal on both T1 and T2 
  • Mx:  
    • Non operative: 
      • Observe/ pain control 
      • Radiation – symptomatic lesions (successful up to 80%) 
      • Embolization – progressive neuro deficit 
      • Intralesional injection (ethanol) (15mL) 
    • Operative 
      • Kyphoplasty vs Vertebroplasty 

Eosinophilic Granuloma 

  • Age: <10 
  • Location: Body 
  • Presentation: pain, ridigity, neuro symptoms, systemic symptoms, progressive kyphosis 
  • Biopsy 
  • Ix: 
    • Punched out lytic 
    • XR/ CT – Vertebrae plana – collapse of vertebral body on lateral 
    • MRI: T2 flair (this gets rid of liquids) 
    • Bone Scan – cold 
  • Mx:  
    • Non Operative – most common 
    • Operative 
      • Curretage +/- Bone Graft 
        • Failed non-op 
        • Instability 

Giant Cell Tumour 

  • Location: Sacrum (eccentric) 
  • Ix: 
    • Looks like ABC (more in thebody) vs osteoblastoma vs Mets 
    • lytics 
    • +/- cortical breach 
    • +/- soft tissue mass  
  • Mx:  
    • Wide excision (10-50% recurrence) 
    • Preoperative embolization (Dr. Lewis says no) 
    • Adjuvant 
    • New drug – denosumab 

All dull T1 Bright T2 except Hemangioma (bright on both) (And Chordoma, but Chordoma is a Primary MALIGNANT) 

Management 

Intralesional 

  • Benign 1 and 2 

Marginal 

  • Benign 3 or recurrent 2 
  • Selected 1&2 sarcoma with adjuvant 

Wide 

  • Recurrent 
  • 1&2 Sarcomas