Benign Primary Bone Tumor Research Articles

Challenges of denosumab in giant cell tumor of bone, and other giant cell-rich tumors of bone.

Purpose of reviewGiant cell tumor of bone (GCTB) is an uncommon benign primary bone tumor, consisting of receptor activator of nuclear factor kappa-B (RANK) expressing reactive osteoclast-like giant cells and neoplastic spindle-shaped cells. Denosumab was approved by FDA in 2013 and by EMA in 2014 to treat adults and skeletally mature adolescents with unresectable GCTB or when resection is likely to result in severe morbidity. However, there is much discussion regarding the optimal applied treatment strategy.Recent findingsNeoadjuvant treatment of GCTB with denosumab can effectively downstage tumors to facilitate less morbid surgery or completely avoid the need for resection, but there is concern about local recurrence postsurgery. Definitive treatment of unresectable GTCB improves symptoms and halts tumor progression. The optimal treatment duration is unclear and long-term treatment is associated with adverse events like osteonecrosis of the jaw (ONJ) and atypical femoral fractures. Denosumab maintenance dose interval is currently being investigated.SummaryFor the related but heterogenous group of giant cell rich tumors of bone, like aneurysmal bone cysts (ABC) and central giant cell granuloma (CGCG), denosumab is a new treatment modality under investigation. Given the effectiveness in GCTB, this could be a promising treatment option for selected patients with advanced disease.

Osteochondroma of femoral neck: a rare cause of sciatic nerve compression

<p>Osteochondroma is most common primary benign bone tumor and comprising of more than one-third of primary benign bone tumors. Osteochondromas are usually extra-articular lesions secondary to their common origin from metaphysis of long bones. Osteochondroma of the femoral neck is atypical as they represent an intra-articular lesion. They are mostly asymptomatic depending on their size and location. We are describing a rare cause of sciatic nerve compression in an adult which turned out to be solitary osteochondroma of femoral neck. 18 years old man reported to us with complains of pain in left groin region, mass in buttock region associated with tingling sensations in left lower limb since 8 months. Patient complains of difficulty in sitting on hard surface. Sensation was decreased on plantar and dorsal aspect of left foot. A sessile mass measuring 6 x 4 cm on posterior femoral neck was seen on plain radiographs and CT. Electromyography showed moderate sciatic neuropathy of the peroneal and tibial branches. Surgical en-bloc resection was performed through posterior approach. The final pathological report indicated the tumor was an osteochondroma. Post-operatively symptoms resolved dramatically. At follow up, he had full resolution of neurologic findings. Postoperatively, the patient reported improvement in numbness and tingling in the leg. So we should have awareness and high index of suspicion of rare entities such as proximal femur osteochondroma during diagnosis and treatement of sciatic neuropathy along with other more common etiology. </p>

Long-term Follow-up of the Use of a Synthetic Bone Graft Composite in the Surgical Management of Primary Bone Tumors

The surgical management of benign and benign aggressive bone tumors typically involves intralesional curettage and reconstruction of the resulting defect with cement or bone graft material. At the authors' institution, an injectable synthetic calcium sulfate-calcium phosphate composite is now the standard graft material for these cases. This study reports the long-term follow-up, specifically the stability of bone regeneration, for the use of the synthetic graft material for oncologic reconstruction. Fourteen patients who underwent intralesional curettage of a primary bone tumor followed by cavitary reconstruction with synthetic graft material who had at least 4-year follow-up were identified from an institutional orthopedic oncology database. Clinical outcome data, focusing on long-term clinical and radiographic features of the reconstruction, were extracted from electronic and paper medical records. Seven females and 7 males were included (mean age at surgery, 28.1 years; range, 13-64 years). Follow-up ranged from 50 to 105 months (mean, 68 months). Most surgical reconstructions were done for the lower limb (n=11), and giant cell tumor of bone was the most common tumor treated. The mean amount of synthetic graft material used was 18.6 cm3. Complete radiographic resorption and new bone incorporation was observed within the first year, and bone remodeling was complete in all patients. Bone remodeling remained stable throughout the longer-term follow-up (ie, up to 9 years). The use of an injectable synthetic calcium sulfate-calcium phosphate composite is a viable option in the reconstruction of cavitary bone defects following intralesional curettage of primary benign bone tumors. This reconstruction technique was safe, with no long-term complications, and led to complete radiographic resorption and new bone incorporation with long-lasting stability. [Orthopedics. 2018; 41(6):e868-e875.].

Pathological study on some common bone tumors in human

The study aimed to find the most common bone tumors , affected ages and to identify gross and microscopical appearances. Thirty bone tumor were obtained ; 28 cases diagnosed as primary bone tumor and 2 cases diagnosed as secondary bonetumors . The primary benign bone tumors (13) while malignant bone tumor (11) and the rest (4) cases were tumor like conditions.The primary bone tumors are diagnosed as follows osteoid osteosarcoma (4),osteoma(2),chondroblastoma(1),osteochondroma(6)chondrasarcoma (2), fibrosrcoma (1) , giant cell tumors (5) , hemangiosarcoma (1) , ewing sarcoma (1) , lymphoma (1). aneurysmal bone cysts (3) and fibrous dysplasia (1) . The secondary bone tumors (2) metastatic bronchial carcinoma case andanother case poorly differentiated prostatic carcimomaConclusion: Osteosarcoma is the most common malignant primary bone tumors and osteochondroma is the most commonbenign primay bone tumor .key word: pathology of some bone tumors in human patients

Chondroblastoma

Chondroblastomas are very rare benign primary bone tumors occurring preferentially in the epiphyses or apophyses of long bones in children and adolescents. In most cases the typical histological and imaging findings lead to acorrect diagnosis that may be substantiated by demonstrating the highly specific point mutation in the H3F3B gene (p.K36M), either by sequencing or immunohistochemistry. Recurrences occur in 5-15% of cases, postsurgical metastatic deposits to the lungs are very rare (<1%). Histologically "malignant" chondroblastomas have been reported as single case reports. The treatment of choice is athorough curettage, also in the case of local relapses.

Primary Tumor and Tumor-Like Lesions of Bones of the Foot: Single-Center Experience of 166 Cases

Primary bone tumors of the foot are rare lesions. The purpose of the present study was to evaluate the clinical manifestations, treatment modalities, and recurrences of various primary bone tumors of the foot from a specialized center for orthopedic oncology. Among 3681 musculoskeletal tumor cases, which were diagnosed and surgically treated in our hospital from 1983 to 2013, 166 primary tumor and tumor-like bone lesions of the foot (4.5%) were retrospectively reviewed regarding age, gender, localization, biopsy-revealed diagnosis, applied treatment modalities, follow-up period, and recurrence, if any. Of the 166 primary bone tumors of the foot, 155 (93.4%) were benign and 11 (6.6%) were malignant. The most common primary benign bone tumor was a unicameral bone cyst (57 of 155; 36.8%), and the most common malignant tumor was chondrosarcoma (7 of 11; 63.6%). The hindfoot was the most common location for both primary benign (104 of 155; 67.1%) and malignant (6 of 11; 54.5%) bone tumors of the foot. The results of our study have confirmed that the radiologic findings can be confusing owing to the structural and histopathologic features of the bones of the foot; thus, histopathologic diagnosis should be considered for foot involvement. Because the characteristics of the compartments in the foot allow for the rapid spread of malignant lesions, aggressive surgical management and wider resection are recommended to prevent recurrence and further spread.

Breast osteoblastoma and recurrence after resection: Demonstration by color Doppler ultrasound.

Osteoblastoma is a rare benign primary bone tumor, which occurs in any part of the skeleton. Extraskeletal osteoblastoma is rather rare. We presented an extremely rare case of extraskeletal osteoblastoma located in the breast. The tumor recurred 7 months later after resection and transformed to aggressive osteoblastoma. The histopathological features, ultrasonic manifestations and ultrasonic differential diagnoses of the primary and recurrent tumors were discussed. The recommended treatment of the tumor is surgical excision. Due to its tendency of recurrence and potential malignant transformation, adequate resection and careful follow up is essential.

Primary arthroplasty in healed osteoarticular allograft in patients with history of primary femoral bone tumors

BackgroundRoughly 25–35% of patients who are treated with osteoarticular allograft for primary bone sarcomas or aggressive benign bone tumors require surgery in the long-term due to degenerative changes of the articular surface of the allograft. There are three established methods of reconstruction for this complication; a total hip arthroplasty (THA) or total knee arthroplasty (TKA) in the retained osteoarticular allograft, a proximal or distal endoprosthesis after removal of the allograft, and an allograft-prosthesis composite (APC). The aims of this study are 1) to determine the rate of complication and failure of THA/TKA in healed femoral allograft; 2) to compare the methods of revision for allograft degeneration; and 3) to compare the use of arthroplasty in healed allograft to that of arthroplasty in native bone. MethodsWe included all patients with primary bone sarcomas and locally aggressive primary benign bone tumors treated between 1984 and 2014 with an osteoarticular allograft followed by any subsequent arthroplasty technique as described above. Complications and reasons for failure are described following the classification of Henderson et al. Failure was defined as any complication leading to removal of the initial treatment construct. Failure rates of these groups were compared to primary arthroplasty in a live host bone (Control Group). ResultsComplications happened in 25 (61.0%) of the patients with a THA/TKA in the retained allograft, of these, 24 (58.5%) experienced failure, the most common being structural failure/type III (14, 58.3%). Thirteen patients (81.3%) with an endoprosthesis after removal of the allograft experienced complications, all of whom failed. The most common failure modes were aseptic loosening/type II (4, 30.8%) and infection/type IV (5, 38.5%). Complications in patients with an APC were experienced by 12 (85.7%) patients, 11 (78.6%) of whom failed. The most common failure mode was infection/type IV (4, 36.4%). Significantly (p < 0.001) fewer failures were observed in the control group compared to patients with an arthroplasty in a healed allograft. ConclusionsWe found no significant difference in the outcome of treating patients with allograft and subsequent degenerative bone disease with a THA/TKA in a retained allograft, an endoprosthesis after removal of the allograft, or a primary APC, although infection is a significantly greater cause of failure in the latter two. Primary arthroplasty in healed allografts is a less extensive surgery than removing the allograft and shows comparable complication and failure rates. Level of evidenceLevel III, Therapeutic Study.

Surgical management of spinal osteoblastomas.

OBJECTIVE Osteoblastoma is a rare primary benign bone tumor with a predilection for the spinal column. Although of benign origin, osteoblastomas tend to behave more aggressively clinically than other benign tumors. Because of the low incidence of osteoblastomas, evidence-based treatment guidelines and high-quality research are lacking, which has resulted in inconsistent treatment. The goal of this study was to determine whether application of the Enneking classification in the management of spinal osteoblastomas influences local recurrence and survival time. METHODS A multicenter database of patients who underwent surgical intervention for spinal osteoblastoma was developed by the AOSpine Knowledge Forum Tumor. Patient data pertaining to demographics, diagnosis, treatment, cross-sectional survival, and local recurrence were collected. Patients in 2 cohorts, based on the Enneking classification of the tumor (Enneking appropriate [EA] and Enneking inappropriate [EI]), were analyzed. If the final pathology margin matched the Enneking-recommended surgical margin, the tumor was classified as EA; if not, it was classified as EI. RESULTS A total of 102 patients diagnosed with a spinal osteoblastoma were identified between November 1991 and June 2012. Twenty-nine patients were omitted from the analysis because of short follow-up time, incomplete survival data, or invalid staging, which left 73 patients for the final analysis. Thirteen (18%) patients suffered a local recurrence, and 6 (8%) patients died during the study period. Local recurrence was strongly associated with mortality (relative risk 9.2; p = 0.008). When adjusted for Enneking appropriateness, this result was not altered significantly. No significant differences were found between the EA and EI groups in regard to local recurrence and mortality. CONCLUSIONS In this evaluation of the largest multicenter cohort of spinal osteoblastomas, local recurrence was found to be strongly associated with mortality. Application of the Enneking classification as a treatment guide for preventing local recurrence was not validated.

Osteoid osteoma – radiofrequency ablation treatment guided by computed tomography: a case series

The osteoid osteoma is a benign primary bone tumor that affects mainly males in the second and third decades of life. Radiographic findings show a radiolucent nidus surrounded by reactive sclerotic bone, particularly in the long bones of the lower extremity. Clinically, it presents persistent pain, which is worse at night and improves with salicylates. It can be a self-limiting injury, with an average duration of three years, but because of pain intensity and intolerance to prolonged use of nonsteroidal anti-inflammatories, surgical treatment is an option. The diagnosis is suspected according to the history and radiographic findings, and the confirmation is made by histological analysis. The traditional surgical treatment is the complete excision of the nidus, but some disadvantages have been described, such as difficulties in localizing the lesion and risk of fracture during the procedure, hospital stay for pain control, and unfavorable esthetic outcome. The authors report a series of cases treated with thermal radiofrequency ablation guided by computed tomography in this service. It is a safe and an effective percutaneous method that aims to cure, minimizing the trauma and morbidity when compared with the conventional block-resection method.

Osteoma osteoide – Tratamento com radioablação guiada por tomografia computadorizada: uma série de casos

The osteoid osteoma is a benign primary bone tumor that affects mainly males in the second and third decades of life. Radiographic findings show a radiolucent nidus surrounded by reactive sclerotic bone, particularly in the long bones of the lower extremity. Clinically, it presents persistent pain, which is worse at night and improves with salicylates. It can be a self‐limiting injury, with an average duration of three years, but because of pain intensity and intolerance to prolonged use of nonsteroidal anti‐inflammatories, surgical treatment is an option. The diagnosis is suspected according to the history and radiographic findings, and the confirmation is made by histological analysis. The traditional surgical treatment is the complete excision of the nidus, but some disadvantages have been described, such as difficulties in localizing the lesion and risk of fracture during the procedure, hospital stay for pain control, and unfavorable aesthetic outcome. The authors report a series of cases treated with thermal radiofrequency ablation guided by computed tomography in this service. It is a safe and an effective percutaneous method that aims to cure, minimizing the trauma and morbidity when compared with the conventional block‐resection method.

Benign Tumors of the Spine

Clinically based systematic review. To determine the role of (A) medical treatment and (B) interventional radiology as either adjuvant or stand-alone treatment in primary benign bone tumors of the spine. A multidisciplinary panel of spine surgeons, radiation oncologists, and medical oncologists elaborated specific focused questions regarding aneurysmal bone cyst, giant cell tumor, and osteoid osteoma. Denosumab, bisphosphonate, interferon, bone marrow aspirate, doxycycline, thermal ablation, and selective arterial embolization were identified as areas of interest for the article. A systematic review was performed through MEDLINE and EMBASE. Recommendations based on the literature review and clinical expertise were issued using the GRADE system. The overall quality of the literature is very low with few multicenter prospective studies. For giant cell tumor, combination with Denosumab identified 14 pertinent articles with four multicenter prospective studies. Nine studies were found on bisphosphonates and six for selective arterial embolization. The search on aneurysmal bone cyst and selective arterial embolization revealed 12 articles. Combination with Denosumab, Doxycycline, and bone marrow aspirate identified four, two, and three relevant articles respectively. Eleven focused articles were selected on the role of thermal ablation in osteoid osteoma. Alternative and adjuvant therapy for primary benign bone tumors have emerged. Their ability to complement or replace surgery is now being scrutinized and they may impact significantly the algorithm of treatment of these tumors. Most of the data are still emerging and further research is desirable. Close collaboration between the different specialists managing these pathologies is crucial. N/A.

Pediatric aneurysmal bone cyst in the ischial region

Aneurysmal bone cyst (ABC) is an expanding osteolytic lesion. ABC represents 1% of all primary benign bone tumors, whereby 4-12% occur in the pelvis. The etiology of this disease remains vague. Aneurysmal bone cyst can exist either as primary bone lesion (70%) or as secondary lesion arising from another bone disorder (30%). Moreover, pelvic ABCs are characterized by their large size and high vascularity. We present a rare pediatric case with ABC involving the ischial region. A 5-year-old girl presented with left pelvic pain and limping for the past 6 months. Initial imaging showed an expansile lesion in the left ischium, and computed tomography guided biopsy showed giant cells in histopathology study with no evidence of metastasis. The patient underwent intraoperative frozen section followed by extensive intra-lesional bone excision. Bone curettage was pursued along with bone grafting. The case was successfully managed without postoperative complications after the 6-month follow-up period.

SCLEROTIC OSTEODYSPLASIAS

Sclerotic osteodysplasias represent a group of relatively rare diseases; a common feature of them is the diffuse or local bone sclerosis. The reasons for their development are congenital abnormalities of endochondral and intramembranous bone formation either the hereditary nature or arising from spontaneous mutations. The main diagnostic problems arise when the differential diagnostic sclerotic dysplasias from various symptomatic osteopathies entailing bone sclerosis is needed. The aim of this research is the information about the group of rare congenital disorders characterized by diffuse and local osteosclerosis, and analysis of the literature on the diagnosis and differential diagnosis from other diseases and states, accompanied by compaction of bone tissue. A search of publications in English and Russian in electronic databases PUBMED, PUBMED CENTRAL, GOOGLE SHOLAR and eLIBRARY is performed. Keyword: sclerotic osteodisplasias, hyperostosis, osteopetrosis, osteopoikilosis, pyknodisostosis, melorheostosis, osteopathia striata, progressive diaphiseal dysplasia, diaphiseal sclerosis, enostosis and their Russian analogs for the period from 1953 to 2015. This clinical and radiological signs of osteopetrosis, osteopathia striata. osteopoikilosis, enostosis, piknodisostosis, progressive diaphyseal dysplasia, generalized hyperostosis cortical generalisata, melorheostosis and other forms of sclerotic osteodysplasias are presented. The main attention is paid to clinical and radiological diagnosis and differential diagnosis from osteoblastic metastases, primary benign and malignant bone tumors, chronic osteomyelitis and other diseases accompanied by local or diffuse osteosclerosis.

Surgical Treatment of a C3-osteoblastoma with Cord Compression and Encompassing the Vertebral Artery via Combined Approach

Background Osteoblastoma is a rare and benign osteoid-producing primary bone tumor that affects mainly the long bones. 36% of these tumors are observed around the spine and the vast majority arises around the posterior. Case Presentation: This report describes a case of C3 osteoblastoma occurring in a 22-years old male. He represented with cervical pain and quadriparesia. Cervical CT and MRI demonstrated an osteolytic mass that invade anterior and posterior elemant of C3 and cause severe cord compression. Because of the close proximity of the osteoblastoma to the vertebral artery canal and cord total resection of tumor was a challenging decision. To prevention of vertebral artery injury, laminectomy and partial resection of tumor was done with posterior approach and bilateral vertebral arteries preserved and then fussed with lateral mass screw. For best reconstruction and stability, total C3 corpectomy and anterior fusion with allograft and plate was done via anterior cervical approach. Conclusions Osteoblastoma in cervical spine with involvement of anterior and posterior part of vertebrae is a rare pathology and can encase vertebral artery. This case has favorable prognosis after 2 sessions surgery and adequate rehabilitation.

Radiofrequency ablation of a difficult accessible osteoblastoma of the first sacral vertebrae: Fluoroscopic-guided electrode placement using a challenging posterior transpedicular approach

Background Context Osteoblastoma is a benign primary bone tumour >1,5 cm in size, histologically related to osteoid osteoma, and the potential for progressive growth. Between 7-17% of osteoblastomas involve the sacrum with clinically presentation of localized pain and neurological deficits. Resection is often impeded by close localization to vulnarable structures with a high risk of procedural complications. Purpose To present a patient with a sacral osteoblastoma located at the difficult accessible anterior aspect of the S1 vertebral body using a technical demanding transpedicular approach for radiofrequency ablation (RFA). Study design Case report Methods A 16 years old male patient presented with an eighteen months history of severe sacral back pain pretreated with nonsteroidal anti-inflammatory drugs. Native computed tomography revealed an osteoblastoma, 2 x 2 cm in diameter, of the S1 vertebral body, that was histologically confirmed. A challenging surgical anterior approach by laparotomy was precluded because of the increased risk of injury to vascular and intestinal structures. RFA and subsequent alcohol injection was performed by a transpedicular approach of the S1 vertebral body under fluoroscopic guidance combined with flat panel CT for probe position. Result A significant pain reduction could be achieved when the patient leaved the hospital after 6 hours. At follow-up examination 3 months after RFA full daily activity was resumed and pain completely disappeared. Conclusion The use of a biplane x-ray system with flatpanel-CT for RFA allows spatial orientation for the anatomically very complex transpedicular access to the anterior aspect of the S1 vertebral body that can surgically only be reached with an increased risk of procedural morbidity. Key words Osteoblastoma, S1 vertebral body, radiofrequency ablation, transpedicular access, biplane x-ray system with flatpanel-CT, alcohol injection

Giant cell tumor of bone arising in long bones possibly originates from the metaphyseal region.

Giant cell tumor of bone (GCTB) is a primary benign bone tumor with a locally aggressive character. Definitive descriptions of the site of origin for this type of tumor are not available. The aim of the present study was to evaluate the site of origin of GCTB of long bones with regards to epiphyseal lines by means of radiographic examination. For that purpose, plain X-ray scans of 71 GCTBs arising in long bones were retrospectively reviewed. The tumor locations were the distal femur in 31 cases, proximal femur in 11 cases, proximal tibia in 13 cases, distal radius in 6 cases, proximal humerus in 5 cases and proximal fibula in 5 cases. The vertical center (VC) of the tumor was determined with X-ray anteroposterior view, and the correlation between the VC and the epiphyseal line, and between the distance from the epiphyseal line to the VC and tumor area or volume were analyzed using a regression model equation based on scatter plot diagrams. The VC of the tumor was located in the metaphyseal region in 57 cases, in the epiphyseal line in 11 cases and in the epiphyseal region in 3 cases. In cases of GCTB located in the distal femur or proximal tibia, significant correlations between the distance from the VC to the epiphyseal line and tumor area or volume were identified. The site of origin of GCTB was estimated to be located in the metaphyseal region. GCTB often occurs in mature patients, which renders it challenging to estimate the true site of origin of this lesion, since the metaphyseal line has disappeared in mature patients. The results of the present study suggest that GCTB possibly originates in the metaphyseal region.

Osteoblastoma of the thoracic spine presenting with back pain

A 22-year-old man presented with complaint of persistent back pain. His medical history and physical examination were unremarkable. Magnetic resonance imaging (MRI) revealed an expansile, circumscribed lesion (2×1.5×1.3 cm) located in the right inferior articular process and pedicle of the 10th thoracic vertebra (Fig. 1). It extended anteroinferiorly into the right neural foramen and lateral recess, causing compression of the spinal nerve at the T10–T11 levels (Fig. 2). It was mildly hypointense to muscles on T1-and T2weighted images. Surrounding intense soft tissue and bone marrow edema was also seen. The lesion was isodense to bone, without adjacent cortical erosion or sclerosis on computed tomography images. Enhancement of the lesion and the adjacent reactive edema were seen on post-contrast MRIs. Imaging findings were compatible with osteoblastoma. Surgical resection of the tumor was performed, and histologic examination revealed the diagnosis of osteoblastoma. No neurologic deficits were observed after surgery. Followup MRI at 3 months showed postoperative changes, but no residual tumor. There has been a significant reduction in the patient’s back pain. Osteoblastoma is a rare, benign primary bone tumor that is mostly located in the spine (40%), especially the posterior elements. Surrounding reactive bone marrow and soft tissue edema and enhancement can be seen [1].

Chondromyxoid Fibroma of Pelvis, Surgical Management of 8 Cases.

Chondromyxoid fibroma is a rare benign primary bone tumor of cartilaginous origin, which most commonly involves the metaphyseal bone of proximal tibia and distal femur. The purpose of the study is to report our experience with diagnosis and surgical management of Chondromyxoid fibroma in the pelvic region. Eight consecutive patients with a final diagnosis of pelvic Chondromyxoid fibroma were treated from 2001 to 2010. We considered the presentations and outcome for surgical complications and local recurrence after extended curettage and allogenic corticocancellous bone grafting. Three patients were female and five were male. The median follow up period was 72 (30-126) months. The mean age of cases was 31.9 (20-41) years. Five patients had left side involvement and in the remaining three, the right side was involved. Four involved periacetabulum, two involved the ilium and the remaining two cases were ischiopubic. The mean Musculoskeletal Tumor Society Score was 94.1%. The major complications were recurrence in one case and herniation after pubic rami resection in another case. Chondromyxoid fibroma should be distinguished from chondrosarcoma. Management recommendation includes extensive curettage and corticocancellous bone grafting. We also advocate use of fibular strut allograft for reconstruction of pubic rami after its resection to prevent hernia in cases with pubic rami involvement.

A novel surgical approach for the treatment of tumors in the lesser trochanter.

The proximal femur is a common location for the development of primary benign bone tumors. However, there is currently no surgical technique designed specifically for treating tumors located in the lesser trochanter. In the present study, a novel procedure was developed for directly exposing the lesser trochanter for surgical intervention. This technique may be particularly suited to treating tumors that extend toward the lateral and anterior forward of the lesser trochanter. The new approach involved passing through the femoral triangle, separating the femoral nerve and femoral vessels (artery and vein) and resecting the tumor between the iliopsoas and pectineal muscles. The procedure was performed on six patients with various types of tumor, including one case with osteoid osteoma, one case with non-osteogenic fibroma, one case with osteoma, one case with liposarcoma and two cases of osteochondroma. The preliminary results indicated that the surgical durations were short (60-100 min), blood loss was minimal (30-200 ml) and that pain relief was achieved following surgery. Only one patient continued to experience mild pain, scoring 18 mm on a visual analog scale. The other patients were fully relieved of pain. Sensory dysfunction was experienced by one patient following surgery, with persistent numbness and paresthesias in the distribution of the femoral nerve. No cases of deep vein thrombosis, femur head necrosis, hip joint degeneration disease or local recurrence were identified in any patients during the follow-up period. In order to clarify the virtual tissue, such vessels, nerves and the available space in our approach area, we collected 20 cadaveric specimens and performed anatomical examinations in and around the formal triangle. The spaces between the femoral artery and femoral nerve were measured and analyzed, with the results demonstrating that a definite space existed. Therefore, the novel approach presented in the study may be useful in the resection of benign tumors and the preoperative palliative resection of malignant tumors. The technique may be particularly suited to tumors extending toward the lateral and anterior of the lesser trochanter.