Campbell's Operative Orthopaedics 12th 6_Part473

CHAPTER 26  BENIGN/AGGRESSIVE TUMORS OF BONE 905

AB

CD

FIGURE 26-17 A and B, Anteroposterior and lateral radiographs demonstrate an ill-defined lesion in the femur of a 7-year-old girl
who complained of right thigh pain. A needle biopsy was performed that established the diagnosis of histiocytosis. Shortly after biopsy,
symptoms abated and patient was treated with observation. C and D, Lateral radiographs 4 years later demonstrate resolution of the
tumor with gradual remodeling of bone.

TABLE 26-1  Summary of Tumor Characteristics

TUMOR AGE DEMOGRAPHICS SITE PRESENTATION IMAGING HISTOLOGY TREATMENT COMMENTS
Giant cell tumor (YEARS) Distal femur Pain Multinucleated giant Extended 3% incidence of
20–40 Slight female Proximal Pathological Eccentrically located
predominance in epiphysis cells in sea of curettage benign pulmonary
tibia fracture mononuclear cells Resection if metastases
Chondroblastoma 10–25 Male : female 2 : 1 Distal radius (10%–30%) Purely radiolucent Nuclei of
(no matrix mononuclear cells residual bone 1% incidence of
Distal femur Pain formation) identical to nuclei stock inadequate benign pulmonary
Proximal Symptoms can of giant cells Consider radiation metastases
Usually no rim of for spinal/sacral
tibia mimic chronic reactive bone Sheets of tumors
Proximal synovitis chondroblasts Resection of
Abuts subchondral (polygonal cells pulmonary
humerus bone with distinct metastases
cytoplasmic
May exhibit cortical outlines) “chicken Extended
destruction with wire” calcification curettage
soft tissue
extension Multinucleated giant Resection of
cells pulmonary
Metaphyseal in metastases
skeletally Secondary
immature patients aneurysmal bone
cyst in 20%
Well-circumscribed
lesion in epiphysis
or apophysis

May cross an open
physis

Frequently with
rim of bone,
30%–50%
with matrix
calcification