Benign Bony Lesions Research Articles

Repeat Exchange Autologous Cranioplasty for Recurrent Benign Osteoma: Meta-analysis and Literature Review.

Osteomas are benign bony lesions that can occur throughout the craniofacial skeleton. Surgical excision can be an effective treatment, as recurrence is relatively uncommon. Outside of incomplete resection, causes of recurrence are poorly documented, especially in the pediatric population. Exchange cranioplasty is an autologous reconstructive surgical option for patients of all ages, and it can be effective in the treatment of large calvarial osteomas. Recurrent lesions of the cranioplasty site have not been well described in the literature, with only 3 documented reports. In this study, we present a unique case of a recurrent osteoma at the site of a prior exchange cranioplasty. The authors also provide a systematic review of the literature for recurrent osteomas and highlight causes and conclusions for these lesions. Utilizing the PRISMA guidelines, a systematic review of articles published across databases was performed to identify accounts of recurrent osteomas at prior cranioplasty sites. Our systematic review illustrates that recurrent osteomas overlying different cranioplasty biomaterials is a rare entity and is due to incomplete resection of the galea and periosteum during the index procedure. Biomaterial selection for the pediatric population requires careful consideration before reconstruction. Though limited by 3 articles previously published and without a direct link to recurrence, long-term studies are needed to further guide biomaterial selection in the pediatric population to evaluate potential recurrences.

An Iliac Blade Osteochondroma- a Rare Case Presentation and Review of Literature

Most common benign tumors in orthopedic outdoor clinics seem to be osteochondroma/exostosis which are around 20-50% of all benign bony lesions. Flat bones like iliac blade, scapula, ribs and clavicle which develop from intra-membranous ossification are rarely involved. A28 year old female from rural area presented to orthopedic outdoor clinic with pain and swelling around the inguinal region on right side for past 18 months and diagnosis was made after incisional biopsy. Iliac blade is a rare site for presentation and the patient had no neurovascular compression or mass effect on surrounding structures. Osteochondromas of flat bones are rarely encountered, therefore, proper diagnosis should be made and other differential diagnoses should be considered during evaluation of mass around the pelvic girdle.

Injection of a Bone Substitute in the Treatment of Unicameral Bone Cysts.

Simple bone cysts are benign bony lesions. Treatment strategies are varied for this particular pathology. It remains controversial as to what the ideal treatment strategy is. Recently, bony substitute injections have emerged as a potential option for treatment. This paper aimed to describe our institution's experience in using bony substitute injections to treat unicameral bone cysts. A retrospective review of consecutive patients over an 84-month period at a tertiary paediatric hospital was performed. Information regarding patients' presentation, diagnosis, and management was recorded and summarised. A total of 15 patients were included in our study, with a mean follow-up of 118 weeks. 86.7% of patients demonstrated clinical resolution (absence of pain at the latest follow-up) and 80% of patients demonstrated radiographic resolution. Only one patient sustained a subtrochanteric fracture post-index operation, whilst two others demonstrated redevelopment of cystic architecture on follow-up. This study demonstrates that bone substitute injection is potentially a minimally invasive and seemingly successful technique in the treatment of unicameral bone cysts and other simple bone lesions. Further randomised and comparative studies are required to confirm and validate our findings.

Ossifying fibroma and its differential diagnosis

Bony lesions of the sinuses can cause disfigurement or functional issues in orbit. Benign bony lesions of the para-nasal sinuses are collectively called as the fibro-osseous lesions. Osteoma, fibrous dysplasia, and ossifying fibroma (OF) are common among them. OF is a rare benign bony tumor occurring in the second to fourth decade. We present this case as juvenile OF is very rare and to discuss the differentials of the bony sinus pathologies.

Recent advances on diagnosis and treatment of osteoid osteoma

Osteoid osteoma (OO) is a benign bony lesion with a characteristic radiologic feature of x-ray focus (nidus). The most common symptom indicating diagnosis is strong nocturnal pain that eases with nonsteroidal anti-inflammatory drugs (NSAID). Computed tomography (CT) is a method of choice for diagnosing and localizing the tumor. Osteoid osteoma can regress spontaneously, thus conservative treatment is one of the methods of choice. In the past open resection surgery had been a standard management of osteoid osteoma until radiofrequency ablation (RFA) was discovered in the early 1990s. Nowadays, there are a few minimally invasive treatment techniques that are used. CT-guided radiofrequency ablation is considered a gold standard technique these days. Many cases occur with late diagnosis, and delayed treatment despite of characteristic symptoms. Therefore, it is crucial to be familiar with the clinical features of osteoid osteoma, proper diagnostic patterns, and treatment schemes.

“Central Giant Cell Granuloma of Maxilla- A Case Report”

Central giant Cell granuloma (CGCG) formerly called giant cell reparative granuloma is a benign bony lesion and etiology is unclear. It occurs most commonly in mandible and also occur in maxilla. 1%-7% of all benign lesions of jaws are central giant cell granuloma. It affects children and adults. it is usually a slow growing lesion, fast growing lesions also reported. The fast growing CGCG has an aggressive behavior mimicking a malignant lesion through it has the innocent histological appearance. CGCG sometimes resemble a wide variety of conditions that led to a misdiagnosis both on clinical and radiographic examination. Histological examination confirms as CGCG. The case described here involved maxilla which was treated with surgical curettage. The patient has been followed up for 11/2 years with no post operative complications and no recurrence. Keywords: Central giant cell granuloma, maxilla, benign, jaw

A Case of C 3 Aneurysmal Bone Cyst Managed by Staged Surgery

Aneurysmal bone cysts are often mistaken as malignant tumors such as lesions or another benign bony lesion because of their proliferative component. Treatment of spinal aneurysmal bone cyst is challenging because of its proximity to the spinal cord, unique pathology, and complex growth characteristics. The treatment options are curettage and bone grafting, irradiation, embolization, intralesional injection of calcitonin, and steroid. We present a case of cervical aneurysmal bone cysts operated in a staged procedure: arterial embolization followed by surgical resection and stabilization. Keywords: Aneurysmal bone cyst, Arterial embolization, Bone grafting

Periosteal Variety of Sacral Osteoid Osteoma Encroaching into the Spinal Canal – Treatment with a Tubular Retractor System: Case Report

Background: Osteoid osteomas are benign primary bone tumors with a predilection for posterior elements of the spinal column. Complete surgical excision through a traditional open approach is the treatment of choice for patients not responding to non-steroidal anti-inflammatory medications and patients with contraindications for nidus ablation. The study aims to highlight an alternative minimally invasive technique for complete surgical excision of osteoid osteoma encroaching into the spinal canal. Methods: We report a case of 22 years-old obese male suffering from left S1 radiculopathy and night pain. Magnetic resonance imaging and computed tomography (CT)-scan of the lumbosacral region revealed a benign bony lesion of size 13 mm × 11 mm × 8 mm encroaching from S1 lamina into the spinal canal and compressing left S1 root. Peri-lesional bony sclerosis and soft tissue edema were absent. In view of obesity and a small size of the lesion, it was decided to remove the lesion with a tubular retractor system under general anesthesia. Complete resection of the lesion was carried out sparing the L5-S1 facet, with a minimally invasive approach. Results: Patient had complete symptomatic improvement after the surgery. Histopathology showed interconnected trabeculae of woven bone matrix rimmed by osteoclasts consistent with the diagnosis of osteoid osteoma. Post-operative CT scan showed that the nidus was removed completely and important structures such as facet, pedicle, and midline posterior ligament complex were preserved. The patient resumed his daily activities and remained symptoms-free at the end of 6 months of follow-up. Conclusion: Minimally invasive surgery using a tubular retractor system can be safe and effective alternative to traditional open surgery for excision of osteoid osteoma from the posterior elements. Faster recovery, minimal tissue damage, and early return to work are added advantages for an obese patient undergoing minimally invasive total surgical excision. Keywords: Benign bone tumors, Sacral spine, Osteoid osteoma, Periosteal osteoid osteoma, Minimally invasive spine surgery, Tubular retractor system

Pediatric Mandibular Central Giant Cell Granuloma: Neoadjuvant Immunotherapy to Minimize Surgical Resection

Central giant cell granuloma (CGCG) is a relatively uncommon benign bony lesion accounting for approximately 7% of all non-neoplastic lesions of the jaw. The clinical behavior of CGCG can vary from a slow-growing, painless lesion to fast-growing and locally destructive. When such a lesion involves the mandible, this can be quite debilitating for the patient, inhibiting oral intake and requiring an extensive resection and bone graft reconstruction. The authors present a case of effectively decreasing the surgical morbidity associated with a large and rapidly growing CGCG of the mandible in a pediatric patient. Neoadjuvant immunotherapy with denosumab (human monoclonal antibody) facilitated treatment of the tumor without the need for a large resection which would have otherwise necessitated a vascularized bony mandibular reconstruction. Consideration of neoadjuvant medical management of CGCG as the primary treatment is advocated.

Bone Graft Vs Bone Substitutes in Treatment of Cavitary Benign Bone Tumors (A Systematic Review Study)

Abstract Background and Introduction Extended curettage is the commonest mode of treatment of cavitary benign bone tumors. If a tumor is very large and threatening to involve the joint, complete excision with joint reconstruction may be necessary. Cure rates of 90–95% have been achieved using curettage as the sole mode of treatment in benign bony lesions. However this treatment is not devoid of controversy and many authors recommend that bone defect after curettage of benign bone tumors should be filled with bone grafts or bone substitutes. Aim of the Work To compare clinical and radiological outcomes, when possible after using of synthetic bone substitutes and bone grafts in surgical treatment of cavitary benign bone tumors. Materials and Methods This systematic literature review has included 22 studies and consisting of 4 steps which are a systematic search of the literature (PubMed, SCOPUS, Cochrane Library), selection of studies , recording of study characteristics and extraction of data based on clinical outcomes and their comparisons between different surgical groups. Results This systematic review has included 1071 patients of which 742 were treated using different types of bone substitutes, while the remaining 329 were treated using bone grafts (allografts or autografts). Comparing between both groups we have found that the difference in the graft incorporation time between both groups was statistically insignificant which was 6.65 months in group A and 7.01 months in group B with P value = 0.355(NS). The difference in the postoperative fracture rate as well was statistically insignificant; 1.9% in group A and 3.9% in group B with P value = 0.294(NS). However, there was a significant difference in the postoperative infection rate between group A (2.1%) and group B (12.8%) with P value = 0.01(S) and in the recurrence rate as well, which was 10% for group A and 4.3% for group B with P value = 0.002(HS). Conclusion Synthetic bone graft substitutes have evolved in response to the downsides of autograft and allograft. No level I studies regarding their use in the treatment of bone tumors have been performed. This study indicates that all of the bone substitutes are safe and may be as effective as other bone graft options and with no limitation in their source for filling the large defects. Prospective randomized clinical trials in the treatment of bone tumors comparing bone graft substitutes versus other grafts (autograft and allograft) are necessary to properly delineate the real indications for bone grafting and to demonstrate the graft’s efficacy in this regard.

Benign Pediatric Jaw Lesions at Massachusetts General Hospital Over 13 Years

To the best of our knowledge, no study has reported pediatric jaw lesions according to the latest World Health Organization (WHO) classification of head and neck tumors. We reviewed the spectrum of benign pediatric jaw lesions treated at the Massachusetts General Hospital during a 13-year period according to the 2017 WHO classification. We implemented a retrospective cohort study of patients younger than 18years old with benign bony lesions. The primary predictor variable was the histopathologic diagnosis, grouped into odontogenic tumors (OTs), non-OTs, and odontogenic cysts. The primary outcome variables were the incidence of recurrence and the interval to recurrence. Other outcome variables included symptoms, radiographic findings, and treatment modalities. Descriptive statistics were computed. Kaplan-Meier analyses and Cox regressions were performed. The sample included 131 patients (58 males and 73 females; mean age, 12.6±3.7years) with 14 pathologic diagnoses. These were grouped as follows: non-OTs (n=67), OTs (n=36), and odontogenic cysts (n = 28). Odontogenic cysts were predominantly radiolucent, unilocular, and well-circumscribed cysts compared with the OTs and non-OTs (P<.05). Enucleation was the most commonly performed surgical procedure (72.5%). Adjuvant nonoperative procedures included cryotherapy for 10 patients, interferon therapy for 9 patients, and chemotherapy with denosumab for 3 patients to treat aggressive tumors. The overall incidence of recurrence was 0.77/100 person-years. The Cox hazard ratio of non-OTs/OTs was 3.1 (P=.13) and cysts/OTs was 4.3 (P=.075). Neither the incidence of recurrence nor the interval to recurrence among the 3 groups showed significant differences. A high incidence of recurrence was noted for aggressive central giant cell tumors (39.1%) and odontogenic keratocysts (40%) during a median follow-up of 3years. Although pediatric jaw lesions are uncommon, symptoms such as swelling could indicate potential pathologic findings and require panoramic examination. Management of pediatric jaw lesions should consider the biologic behavior of the lesion, maxillofacial development, and growth. Enucleation combined with pharmacologic therapy is a promising strategy for the management of aggressive central giant cell tumors in children.

A narrative literature review on the diagnostic and therapeutic intervention approaches of polyostotic fibrous dysplasia in bones: A bangladeshi case report

Background: Fibrous dysplasia (FD) is a less common benign bony fibro-osseous lesion, which is divided into two main kinds: monostotic FD and polyostotic FD (PFD). The natural history or aetiopathogenesis of FD is poorly understood, and treatments are still controversial. Methods: A review of the literature was performed to analyse and discuss the diagnosis and management of FD through a case report and literature review. Results: The current case of a PFD patient, which is usually presented in late childhood or early adulthood, is sometimes associated with endocrine disorders such as McCune–Albright syndrome (MCA). Computed tomography-guided biopsy from the lytic bone area is a useful technique for the evaluation and diagnosis of disease, though the accuracy of the histopathology findings has been not conclusive. Exclusion of other lytic bone lesion disease is the mainstay of diagnosis. All medical and surgical treatments are valid; no one has been proven to be better. The present case is reported because it illustrates specific points of differential diagnosis, such as multiple myeloma, hyperparathyroidism, primary bone malignancy, secondary metastasis in bones, sarcoidosis or granulomatous disease of bone. Conclusions: In the current case, surgical repair of the bone is not possible due to extensive involvement in different sites of the bones, and there is no mechanical compression in any neurological structures, hence medical management was chosen. There is no gold standard in medical or surgical treatment, and each treatment should be individualised. Only medical management shows good results in such cases.

Central Giant Cell Granuloma

Central giant cell granuloma (central giant cell granuloma) is an uncommon benign bony lesion that occurs in the mandible and maxilla and accounts for approximately 7% of all benign tumours of the jaws [1]. The World Health Organization (WHO) has defined central giant cell granuloma as an intraosseous lesion consisting of cellular fibrous tissue that contains multiple foci of haemorrhage, aggregations of multinucleated giant cells and occasional trabeculae of woven bone [2]. Central giant cell granuloma occurs predominantly in children or young adults, with approximately 75%of cases presenting before 30 years of age although presentation can occur at any age [3]. Females are affected more frequently than males, with a ratio of 2:1

Percutaneous cryoablation of benign bony tumours of the mandible.

Treatment of bony tumours of the oral and maxillofacial area usually involve resection. However, access to certain areas may be difficult because of the size or site of the tumour. A poor view of the lesion during operation is another limiting factor, which can lead to incomplete resection in difficult cases. Percutaneous cryoablation is a common procedure for treating benign and malignant bony lesions outside the oral and maxillofacial area, but has to our knowledge never been used as a stand-alone treatment as we describe here. In 2016, three patients with benign bony tumours of the mandible (one a keratocyst, one an angiofibroma, and one a giant cell granuloma) were treated with one session of percutaneous cryoablation. Outcomes were monitored with computed tomography or magnetic resonance imaging at one year. No patient had a procedure-related complication, and there were no other complications. Radiological controls showed complete recovery. Percutaneous cryoablation seems to be an interesting and valuable alternative to resection for bony lesions with its limited access and high operative morbidity.

A Conservative Surgical Approach Towards Central Giant Cell Granuloma: A Case Report

Central giant cell granuloma (CGCG) is an infrequent benign bony lesion of unpredictably aggressive behavior. The precise lesion character is debatable and remains inconclusive. However, three main theories were proposed: a sensitive lesion, a kind of neoplasm, or a developmental anomaly. This is a case presentation of a 16-year-old boy with a dental history of extraction of the lower right first molar, presented to hospital with two months history of swelling in the aforementioned area after the procedure. First biopsy of the swelling was performed outside the Kingdom of Bahrain. As per histopathological findings, the swelling was described as pyogenic granuloma. Second biopsy with necessary workup was conducted in the Kingdom of Bahrain and was confirmed as central giant cell granuloma through histopathological analysis; it was removed surgically.

The unusual demographic presentation of an osteoid osteoma

Demographics are an important tool for narrowing down the differential diagnosis for many medical presentations, and though usually steadfast, there are exceptions in using demographics as a guideline for diagnosis. Neoplastic bony lesions are particularly reliable in their presentation within a specific age range. However, if these cases are not fully evaluated and demarcated from one another, it may lead to overevaluation and treatment or underevaluation and treatment of benign neoplastic bony lesions. In this report, we present the case of a 30-year-old male with an osteoid osteoma presenting out of the typical age range. We also include the subsequent treatment of the benign tumor with radiofrequency ablation after the initial failure in medical management. The age range of the presentation of osteoid osteomas is commonly reported in the literature as 5–25 years, and the treatment can be medical or surgical. Here, we discuss the treatment options, demographic presentation, and course of osteoid osteomas. The following core competencies are addressed in this article: Patient care, Medical knowledge.

Central giant cell granuloma: a case report

Introduction: Central giant cell granuloma (CGCG) is an uncommon benign bony lesion that occurs in the mandible and maxilla. Observation: A 30-year-old woman was evaluated for a radiolucent lesion of the mandible, which was discovered by chance. This image was associated with a painless swelling covered by normal mucosa. No symptoms were associated. After surgical excision, histological examination of the surgical specimen concluded a CGCG. Surgical follow-up was simple, and the first radiological test performed 3 months after confirming the onset of bone healing. Comments: The clinical behavior of CGCG ranges from a slow-growing asymptomatic swelling to an aggressive lesion with pain, local osteolysis, root resorption and tooth displacement. Therapeutic options have greatly varied in recent years. Nonsurgical treatments with alpha-interferon, calcitonin, and corticosteroids have been described and their benefits may be worthy of consideration. Conclusion: A surgical approach is considered as the traditional treatment and is still the most accepted one. However, in some publications, authors disagree on the type of surgery that should be performed.

All-endoscopic management of benign bone lesions; a case series of 26 cases with minimum of 2 years follow-up.

Purpose: Assessment of the functional and oncologic outcomes regarding endoscopic curettage of different benign bone tumor types within variable anatomic locations.Patients and methods: During the period between February 2012 and December 2016, 26 patients with symptomatic intra-osseous benign bony lesions were included. The age ranged from 3 up to 49 years (mean 20), of 14 females and 12 males. The follow-up duration ranged from 26 up to 58 months (mean 41). Functional scoring was done according to the Revised Musculoskeletal Tumour Society Rating Scale. Anatomic locations of the lesions included: 6 cases in the proximal tibia, 6 cases in the distal femur, 4 cases in the calcaneus, 3 cases in the proximal humerus, 3 cases in the distal tibia, 2 cases in the talus, 1 case in the proximal femur, and 1 case in the distal fibula. The procedure used 4 mm 30° scope for endoscopy, and high speed burrs 3.5–5 mm for extended curettage. Autogenous bone grafting was done in 5 cases, and adjuvant material (polymethylmethacrylate) was needed in 7 cases.Results: After exclusion of one case that was lost in the follow-up, the remaining 25 cases showed full functional recovery at a period of 8–12 weeks, and improved mean functional scores from 20.2 to 28.6/30 post-operatively, with p value <0.001 which was considered as a statistically significant result. The oncologic outcome showed 24 cases with adequate healing, while 1 case developed recurrence (aneurysmal bone cyst in the proximal tibia) for which, an open revision surgery was performed. Intra-operative fracture occurred in another case with aneurysmal bone cyst of the proximal femur, which was fixed by flexible nails with complete healing.Conclusion: Endoscopic curettage of different types of intra-osseous benign bony lesions proved to be an effective treatment modality with promising oncologic outcome, improved functional scores, and fast functional recovery.

Arthroscopic excision of an intra-articular osteoid osteoma in the elbow joint

An osteoid osteoma is a rare, small, benign and painful tumour occurring in the extra-articular portion of long bones seen most commonly in the lower extremities. This is a case...

Diagnosing and discriminating between primary and secondary aneurysmal bone cysts.

Aneurysmal bone cysts (ABCs) are benign bony lesions frequently accompanied by multiple cystic lesions and aggressive bone destruction. They are relatively rare lesions, representing only 1% of bone tumors. The pathogenesis of ABCs has yet to be elucidated. In the present study, a series of 22 cases of primary and secondary ABC from patients treated in Department of Orthopedic Surgery, Kagoshima University Hospital (Kagoshima, Japan) from 2001–2015 were retrospectively analyzed. The average age at the time of diagnosis of primary ABC was 17.9 years. Intralesional curettage and artificial bone grafting were performed in the majority of the patients with primary ABC. The local recurrence rate following curettage for primary ABC was 18%, and the cause of local recurrence was considered to be insufficient curettage. Although no adjuvant therapy was administered during the surgeries, it may assist the prevention of local recurrence in certain cases. The cases of secondary ABC were preceded by benign bone tumors, including fibrous dysplasia, giant cell tumors, chondroblastoma and non-ossifying fibroma. The features of the secondary ABC typically reflected those of the preceding bone tumor. In the majority of cases, distinguishing the primary ABC from the secondary ABC was possible based on characteristic features, including age of the patient at diagnosis and the tumor location. In cases that exhibit ambiguous features, including a soft tissue mass or a thick septal enhancement on the preoperative magnetic resonance images, a biopsy must be obtained in order to exclude other types of aggressive bone tumors, including giant cell tumor, osteosarcoma and telangiectatic osteosarcoma.