Benign bone tumors

Last updated: July 29, 2023

Summarytoggle arrow icon

Benign bone lesions are a heterogeneous group of slow-growing neoplasms that arise from cartilage or bone. They appear on x-ray as localized lesions with sharp margins and without soft tissue involvement. Surgical removal or curettage may be required to manage pain and/or prevent pathological fractures.

Overview of benign bone tumorstoggle arrow icon

Benign bone tumors are usually asymptomatic and do not require treatment until they become symptomatic (pain, swelling, etc). Surgery is indicated for symptomatic lesions and may involve curettage, bone grafting, or resection.

Predominantly osseous tumors

Overview of predominantly osseous tumors
Type Description Epidemiology Location Characteristics
Osteoid osteoma
  • Small, predominantly cortical tumor (< 2 cm)
Giant-cell tumor (osteoclastoma)
  • Well-defined solitary tumor, usually with a diameter < 1 cm that arises from osteoblasts
  • Usually asymptomatic
  • A nasal sinus osteoma may result in obstruction of the ostium, with subsequent congestion and pressure headaches.
  • Associated with Gardner syndrome
Torus palatinus
  • Usually asymptomatic and requires no treatment
  • If it interferes with speech or eating, surgery is an option.

Tumors with cartilaginous components

Overview of tumors with cartilaginous components
Description Epidemiology Location Characteristics
(Distal) enchondroma
Synovial chondromatosis
  • Pain, effusion, knee locking
  • Radiographically visible loose bodies
  • Malignant degeneration to synovial chondrosarcoma in extremely rare cases
Osteochondroma (cartilaginous exostosis)

Fibrous lesions

Overview of fibromas
Description Epidemiology Location Characteristics
Nonossifying fibroma
  • Fibrous growth in areas that normally ossify
  • Usually an incidental finding
  • X-ray
    • Marginal sclerosis
    • Lobulated structures with translucent components
Ossifying fibroma
Fibrous dysplasia
  • Normal skeletal tissue is replaced by fibrous tissue
  • Often asymptomatic; may cause bone pain
  • X-ray
    • Long bones: well-defined, lobulated lytic lesions with a thin cortex and a radiolucent, ground-glass appearance
    • Facial bones: radiodense lesions with a leonine appearance

Cysts and hemangiomas

Overview cysts and hemangiomas
Type Description Epidemiology Location Characteristics
Unicameral bone cyst
  • Solitary, generally single-chambered bone cysts
Aneurysmal bone cyst
  • Mostly septated, blood-filled cysts
  • May affect any bone
  • Most common localizations: spine and metaphysis of the long bones
  • Predominantly affects the lower extremities
Intraosseous hemangioma
Langerhans cell histiocytosis
  • Most commonly in the skull

Giant-cell tumor of bone (osteoclastoma)toggle arrow icon

Osteochondroma (cartilaginous exostosis)toggle arrow icon

Enchondromatoggle arrow icon

  • Description: benign tumor arising from hyaline cartilage
  • Epidemiology
    • Most common type of hand tumor
    • Peak incidence: 20–50 years (but may occur at any age)
  • Clinical features
    • Usually found in medulla of the long bones of the hands and feet (most often the metacarpals of the hand and phalanges of the fingers)
    • Often painless
    • Widening of the bone
    • Pathological (spontaneous) fractures
  • Subtypes and variants: enchondromatosis [3]
    • Definition: A predominantly hereditary condition that manifests with multiple enchondromas.
    • Epidemiology: peak incidence between 10 and 20 years
    • Clinical features: often leads to skeletal deformities and stunted growth
    • Prognosis: increased risk of malignant degeneration to chondrosarcoma
  • Treatment
    • Asymptomatic tumors do not require treatment and close monitoring suffices.
    • Symptomatic tumors may require surgical curettage and subsequent bone grafting to prevent pathological fractures.

Chondroblastomatoggle arrow icon

Synovial chondromatosistoggle arrow icon

  • Description: cartilage formation as a result of metaplasia of the synovial tissue
  • Epidemiology: peak incidence between 20 and 40 years
  • Clinical features
  • Diagnostics: x-ray shows radiographically visible (calcified) loose bodies
  • Treatment: removal of loose bodies and synovial tissue
  • Prognosis: extremely low risk of malignant degeneration to synovial chondrosarcoma

Osteoid osteoma and osteoblastomatoggle arrow icon

Osteoid osteoma [4]

Osteoblastoma [6]

Osteomatoggle arrow icon

Osteomas of the skull and mandible in conjunction with hypertrophy of the retinal pigment epithelium, adrenal adenomas, desmoid tumors, and dental abnormalities are characteristic of Gardner syndrome.

Nonossifying fibromatoggle arrow icon

Ossifying fibroma (osteofibrous dysplasia)toggle arrow icon

  • Description: fibrous benign bone tumor
  • Epidemiology: peak incidence between 1 and 5 years
  • Clinical features
    • Most commonly found in tibia and fibula
    • Localized swelling
    • Tibial bowing
  • Diagnostics: X-ray shows intracortical, osteolytic lesions with interspersed sclerosis.
  • Treatment
    • If asymptomatic, monitoring is sufficient.
    • If symptomatic, surgical removal is preferred.

Fibrous dysplasiatoggle arrow icon


Syndromes associated with polyostotic fibrous dysplasia

Unicameral bone cysttoggle arrow icon

Aneurysmal bone cyststoggle arrow icon

Intraosseous hemangiomatoggle arrow icon

Langerhans cell histiocytosistoggle arrow icon

Referencestoggle arrow icon

  1. Osteoclastoma. Updated: February 16, 2017. Accessed: February 16, 2017.
  2. Verdegaal SHM, Bovée JVMG, Pansuriya TC, et al. Incidence, Predictive Factors, and Prognosis of Chondrosarcoma in Patients with Ollier Disease and Maffucci Syndrome: An International Multicenter Study of 161 Patients. Oncologist. 2011; 16 (12): p.1771-1779.doi: 10.1634/theoncologist.2011-0200 . | Open in Read by QxMD
  3. ller L, Wood NH, Khammissa RA, Lemmer J, Raubenheimer EJ. The nature of fibrous dysplasia. Head Face Med. 2009; 5: p.22.doi: 10.1186/1746-160X-5-22 . | Open in Read by QxMD
  4. Primary Intraosseous Haemangioma. Updated: September 1, 2017. Accessed: June 12, 2018.
  5. Howlett D., Farrugia M., Ferner R., Rankin S. Multiple lower limb non-ossifying fibromas in siblings with neurofibromatosis. Eur J Radiol. 1998; 26 (3): p.280-283.doi: 10.1016/s0720-048x(97)01175-3 . | Open in Read by QxMD
  6. Mankin HJ, Trahan CA, Fondren G, Mankin CJ. Non-ossifying fibroma, fibrous cortical defect and Jaffe–Campanacci syndrome: a biologic and clinical review. MUSCULOSKELETAL SURGERY. 2009; 93 (1): p.1-7.doi: 10.1007/s12306-009-0016-4 . | Open in Read by QxMD
  7. Osteoid Osteoma. Updated: June 4, 2018. Accessed: June 12, 2018.
  8. Osteoid Osteoma. Updated: August 1, 2019. Accessed: April 29, 2020.
  9. Lucas DR. Osteoblastoma. Arch Pathol Lab Med. 2010; 134 (10): p.1460-6.doi: 10.1043/2010-0201-CR.1 . | Open in Read by QxMD
  10. Osteochondroma. Updated: December 1, 2018. Accessed: April 29, 2020.
  11. Langerhans Cell Histiocytosis in Children. Updated: September 7, 2017. Accessed: June 12, 2018.
  12. Langerhans Cell Histiocytosis. Updated: October 19, 2016. Accessed: June 12, 2018.
  13. Langerhans Cells. Updated: May 19, 2016. Accessed: June 12, 2018.

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