Enchondroma

Enchondromas are most commonly discovered when an xray or MRI is performed to diagnose knee or shoulder pain, most commonly in adults. Enchondromas do not cause symptoms and thus the treatment is simply observation. Sometimes, the reading radiologist raises the concern whether the tumor really represents a "low grade chondrosarcoma". Generally, the diagnosis is clear enough from imaging studies that biopsy is not required.

When an enchondroma occurs in the small bones of the hands or feet, it can weaken the bones and cause pain, so that surgery is needed to remove ("curette") the tumor and fill the bone defect with bone graft to allow it to heal.

Non-Ossifying Fibroma

Non-ossifying fibromas are also most commonly discovered when an X-ray is performed in response to a knee or ankle injury. They are most common in adolescents and teens. The cause is thought to be incomplete bone formation during growth, and thus they are probably not truly tumors. Generally, the diagnosis is clear enough from imaging studies that biopsy is not required.

For most patients, non-ossifying fibromas will heal as they grow into their 20's and thus they typically simply observed. In the rare cases where the lesion is large enough to weaken the bone and threaten fracture, surgery can be performed to remove ("curette") the tumor and fill the bone defect with bone graft to allow it to heal. Eventually, the bone graft is converted to bone by the body.

Osteochondroma

Osteochondromas are regions where bone has grown outward and resulted in a bony bulge. They are most common around the knee but can also be found in other regions. Osteochondromas are not painful but when located near joints, they can cause symptoms by irritating nearby muscles and tendons.

Most commonly, they are discovered when children enter adolescence, which is when they grow most quickly and become more active. Osteochondromas do not always need surgery, only if the symptoms are significant. Generally, the diagnosis is clear enough from imaging studies that biopsy is not required.

Bone Cyst

Bone cysts in children are most common found near the shoulder and hip. The child will have a segment of bone filled with cyst fluid, rather than bone. The cause is unknown. Generally, the diagnosis is clear enough from imaging studies that biopsy is not required.

The cyst itself is not painful but since the bone is weakened, the child will present with sudden pain when a hairline or complete fracture results after a minor fall. In these cases, the fracture is first allowed to heal then the cyst is surgically filled with bone graft. This is a minor procedure which helps prevent future fractures. Eventually, the bone graft is converted by the body to bone.

Fibrous Dysplasia

Fibrous dysplasia is not a tumor, but rather a segment of bone which does not develop normally. It probably is present at birth but is most commonly discovered when an imaging study is performed for an unrelated reason. Generally, the diagnosis is clear enough from imaging studies that biopsy is not required.

The affected region of bone is slightly weaker than normal. If fibrous dysplasia occurs in high stress regions of the skeleton such as the hip, the patient may present with pain. In these cases, surgery is sometimes recommended to reinforce the bone and reduce pain. The most common type of procedure in these cases is placement of a metal rod within the bone to strengthen it. In the absence of symptoms, surgery is not required.

Giant Cell Tumor

Giant cell tumor mostly affects young adults and presents with pain. It most common around the knee. It can grow quickly and is always treated with surgery. In some cases, the mass may be big enough that biopsy is recommended before surgery.

As the tumor has a tendency to come back after surgery, more aggressive techniques of removal are needed. In addition to manual "curettage", these will include use of a high-speed burr followed by application of an alcohol solution into the bone cavity to destroy any removing tumor cells. The hole is filled with bone "cement" (plastic polymer), and if large enough, metal plates & screws may be needed. Patients are typically followed for 5 years after surgery with regular X-rays.

Osteoid osteoma

Osteoid osteoma is a small painful bone tumor. It can occur anywhere in the body but is most common around the hip and the leg. The cause is unknown. Typically patients will have pain during the day but also pain that wakes them at night. In many cases, they will have discovered that use of aspirin or ibuprofen provides rapid but temporary relief of the symptoms. Generally, the diagnosis is clear enough from imaging studies that biopsy is not required.

The treatment for osteoid osteoma is a non-surgical procedure called "radiofrequency ablation" where the small, affected portion of bone is electrically heated to "ablate" the tumor. This is associated with permanent resolution of the symptoms more than 80% of the time.