Benign tumors Classification nBone tissue (osteoma, osteoid osteoma, n osteoblastoma) nCartilage tissue (chondroma, osteochondroma, chondroblastoma, chondromyxoid fibroma) nFibrous tissue (fibroma, fibrous histiocytoma) nVascular tissue (hemangioma, glomus tumor, n hemangiopericytoma nAdipous tissue (lipoma) nGiant cell tumor – osteoclastoma nBenign soft tissue tumors n Benign bone tumors nosteoid osteoma nosteoblastoma nchondroblastoma nchondromyxoid fibroma nosteoclastoma nfibroma nosteochondroma nchondroma Surgical staging system (Enneking) nGrade 1 – latent ( G0, T0, M0) nGrade 2 – active (G0, T0,M0) nGrade 3 – aggressive (G0, T1-2, M0-1) Grade 1 - latent nNo symptoms nScintigraphy- minimal finding nangiography – negative nCT – sharp edges n Grade 2 - active nSlight symptoms nScintigraphy – positive nAngiography – mild neovascular reaction nCT – mild expansion n Grade 3 - aggressive nPain, advanced symptoms nScintigraphy – positive nAngiography – advanced neovascular reaction nCT – extracompartmental expansion Osteoid osteoma n5 – 25 years nfemur, tibia, spine nsolitary npain nnidus – osteoid tissue ndiff.dg.: osteoblastoma, osteomyelitis n Surgery, RFA msotw9_temp0 msotw9_temp0 msotw9_temp0 Osteoblastoma n10-20 let nSpine, long bones nPain, neurological symptoms nGreater nidus, calcifications, expansion into soft tissue ndiff.dg.: osteoid osteom, osteosarcpma nResection, curretage n n n msotw9_temp0 msotw9_temp0 msotw9_temp0 Chondroblastoma n5-25 years nEpiphysis, metaphysis nsolitary nPain, synovitis ndiff.dg. Osteoclastoma,. chondrosarcoma nCurretage + bone grafting n msotw9_temp0 Chondromyxoid fibroma nmetadiaphysis nyoung adults nsolitary npain ndiff.dg. chondroblastoma, osteoclastoma, chondrosarcoma nresection, curretage msotw9_temp0 Giant cell tumor - osteoclastoma n15-50 years nEpimetaphysis, femur, tibia n solitary nPain, swelling, fracture nBenigne type nMalignant type ndiff. dg.: aneurysmatical bone cyst, HPT nCurretage, fenolisation, bone cement nResection + bone graft, n +endoprosthesis n Osteochondroma nUp to 20 years nmetaphysis nswelling nExostosis disease – autosomal dominant nUSG- 10 mm chondral layer – nMalignisation – chondral lesion over 20 mm, or progression ndiff.dg.: parostal OSA, Chondrosa nTh- following nTh- ablation msotw9_temp0 msotw9_temp0 msotw9_temp0 Chondroma n10-50 years nShort bones ncentral, periostal, juxtacortical nswelling nEnchondromatosis (Ollier), + hemangioma (Mafucci) nMalignisation ndiff.dg.: Chondrosarcoma nTh.- following n curretage, resection n msotw9_temp0 Nonossifiying fibroma nIn young adults nMetaphysis of long bones nsolitary nasymptomatic or aggressive expandig ndiff.dg. : eosinofilic granuloma, giant cell tumor nFollowing, curretage + grafting n msotw9_temp0 Lipoma nRarely in bone nExtraskeletal localisation nAsymptomatic nCentral or periostal nFollowing, curretage msotw9_temp0 Benign soft tissue tumors n nLipoma nFibrolipoma nDesmoid nSynovial chondromatosis nHaemangioma nOthers Lipoma n lipom angio lipom CT Desmoid n desmoid MR Desmoid MR po op Synovial chondromatosis n chondromat chondromat Haemangioma n haemangio MR řez haemangion MR Tumor like lesions nJuvenile bone cyst nAneurysmatical bone cyst nFibrous bone dysplasia nEosinofilic granuloma nmyositis ossificans nIntraoseous gangliona nhyperparathyroidism ndesmoid nothers Juvenile bone cyst nIn children nhumerus, femur nNo symptoms, pathological fracture nX-ray- cystis lesion ndiff. dg: aneurysmatical bone cysts, eosinofilic granuloma nSpontaneous healing nCurretage + bone grafts nLocal coticoids nAutologous bone marrow nHealing after a fracture msotw9_temp0 Aneurysmatical bone cyst n5-30 years nEvery bone nPain, swelling nContent – haemoragic fluid nDiff. dg. osteosarcoma nResection, curretage + fenolisation + bone cement nEmbolisation, radiotherapy n msotw9_temp0 msotw9_temp0 Fibrous dysplasia Jaffe-Lichtenstein disease nYoung adults nSkull, femur, tibia, pelvis nMonoostotic, polyostotic type (Albright syndrom) nMild pain, deformity nX-ray shepherd´s stock, scintigraphy positive nDiff. dg.: bone cyst, nonossifying fibroma, OSA nmalignisation (1%) nFollowing, curretage n n n msotw9_temp0 Eosinofilic granuloma nUp to do 20 years nSkull, ribs, femur nSolitary or polyostotic nhistiocytosis X (Letterer-Siwe, Hand-Schűller-Christian) nMild pain, swelling nDiff. Dg. : Ewing sarcoma, osteomyelitis nSelf limiting process nFollowing, curretage n n msotw9_temp0 Myositis ossificans nAny age ntrauma, idiopathic, head injury nSoft tissue along bones nSwelling, limited movement nX- ray finding, zonal features ndiff. dg.: OSA nFollowing, resection n msotw9_temp0 Myositis ossificans pseudomaligna n myos myositis os Intraoseous ganglion n20-60 years nNo symptoms, mild pain nDiff. dg: chondroblastoma, enchondroma nFollowing, curretage msotw9_temp0 Paget´s disease of bone nHigher age nCoarse trabeculae nOsteolytic, mixed , osteoblastic phase nMonoostotic, polyostotic form nPain, deformity, fracture, O.A. nMalignisation (OSA, chondrosarcoma …) nFollowing, bisphosphonates, calcitonin, surgery msotw9_temp0