Updated: 8/11/2018

Benign Bone Tumors

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  • A 12-year-old boy develops mild pain in his right leg. The pain is worse at night and improves with aspirin. A radiograph of the right leg is shown demonstrating a small mass with a radiolucent nidus surrounded by reactive bone. The patient is subsequently diagnosed with an osteoid osteoma. 
Osteoma
  • Definition
    • benign bone tumor (osteogenic) derived from osteoblasts
  • Presentation
    • location
      • skull
      • mandible
    • symptoms
      • painless mass
    • associated conditions
      • Gardner syndrome
  • Associated findings
    • histology
      • proliferating osteoblasts with active intramembranous ossification
    • radiography
      • radiodense and smooth bony mass 
Osteoid Osteoma
  • Definition
    • benign bone tumor (osteogenic) derived from osteoblasts
    • small (< 2 cm)
  • Presentation
    • location
      • proximal femur (most common)
      • tibial diaphysis
      • vertebrae
    • symptoms
      • focal pain that resolves with NSAIDs
      • if arising in the spine, may cause painful scoliosis
  • Associated findings
    • histology
      • nidus of osteoid and immature osteoblasts surrounded by a rim of reactive bone formation
    • radiography
      • radiolucent nidus (< 2 cm) surrounded by reactive bone 
Osteoblastoma
  • Definition
    • benign but locally aggressive bone tumor (osteogenic) derived from osteoblasts
    • larger than an osteoid osteoma (> 2 cm)
  • Presentation
    • location
      • vertebrae (most common)
      • long bone diaphyses
    • symptoms
      • focal pain that is not relieved by NSAIDs
      • if arising in the spine, may cause neurologic symptoms
  • Associated findings
    • histology
      • nidus of osteoid and immature osteoblasts surrounded by a rim of reactive bone formation 
    • radiography
      • radiolucent nidus (> 2 cm) surrounded by reactive bone 
        • large lesions may extend into soft tissues
Giant Cell Tumor (Osteoclastoma)
  • Definition
    • benign but locally aggressive tumor derived from stromal cells with accompanying giant cells
      • stromal cells resemble interstitial fibroblasts and are neoplastic cells
      • giant cells are derived from monocyte/macrophage lineage and have similar characteristics to osteoclasts
  • Presentation
    • location
      • metaphyseal regions of long bones
        • distal femur (most common)
        • proximal tibia
        • distal radius
    • symptoms
      • focal pain
        • may be referred to nearby joint
  • Associated findings
    • histology
      • 3 cells types may be seen 
        • stromal cells resembling fibroblasts
          • neoplastic cells
        • monocyte/macrophage cells recruited from peripheral blood
          • precursors to giant cells
        • giant cells
          • multiple nuclei
          • similar to osteoclasts
          • resorb bone
    • radiography 
      • an eccentric lytic metaphyseal lesion that may extend into the distal epiphysis
      • characteristic "double bubble" or "soap bubble" appearance
        • increased activity of osteoclasts results in a cavitary lesion 
Osteochondroma (Exostosis)
  • Definition
    • benign cartilage-derived tumor (chondrogenic) containing bone and a cartilage cap
      • arises as a lateral projection of the growth plate
    • most common cartilage-derived tumor
    • two forms
      • solitary osteochondroma
        • may be caused by Salter-Harris fracture, surgery, or radiation therapy
      • syndromatic osteochondromas
        • multiple hereditary exostosis (MHE)
  • Presentation
    • location
      • metaphyseal regions of long bones
        • distal femur
        • proximal tibia
        • proximal humerus
    • symptoms
      • painless mass
  • Associated findings
    • histology
      • normal bony trabeculae with a thin cartilaginous cap 
    • radiography
      • sessile (broad base) or pedunculated (narrow stalk) lesions found on the surface of bones 
Enchondroma
  • Definition
    • benign cartilage-derived (chondrogenic) tumor
      • arises when chondroblasts and epiphyseal cartilage escape from the physis, enter the metaphysis, and proliferate
    • second most common cartilage-derived tumor
    • two forms 
      • solitary enchondroma
      • syndromatic enchondromas
        • Ollier disease
        • Maffucci syndrome
  • Presentation
    • location
      • medullary cavity in the metaphyseal or diaphyseal regions
        • hand (most common)
        • feet
        • distal femur
    • symptoms
      • most often asymptomatic
      • pathologic fracture
  • Associated findings
    • histology
      • bland mature hyaline cartilage
    • radiography
      • well-defined lucent medullary lesion 
 

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Questions (4)
Lab Values
Blood, Plasma, Serum Reference Range
ALT 8-20 U/L
Amylase, serum 25-125 U/L
AST 8-20 U/L
Bilirubin, serum (adult) Total // Direct 0.1-1.0 mg/dL // 0.0-0.3 mg/dL
Calcium, serum (Ca2+) 8.4-10.2 mg/dL
Cholesterol, serum Rec: < 200 mg/dL
Cortisol, serum 0800 h: 5-23 μg/dL //1600 h:
3-15 μg/dL
2000 h: ≤ 50% of 0800 h
Creatine kinase, serum Male: 25-90 U/L
Female: 10-70 U/L
Creatinine, serum 0.6-1.2 mg/dL
Electrolytes, serum  
Sodium (Na+) 136-145 mEq/L
Chloride (Cl-) 95-105 mEq/L
Potassium (K+) 3.5-5.0 mEq/L
Bicarbonate (HCO3-) 22-28 mEq/L
Magnesium (Mg2+) 1.5-2.0 mEq/L
Estriol, total, serum (in pregnancy)  
24-28 wks // 32-36 wks 30-170 ng/mL // 60-280 ng/mL
28-32 wk // 36-40 wks 40-220 ng/mL // 80-350 ng/mL
Ferritin, serum Male: 15-200 ng/mL
Female: 12-150 ng/mL
Follicle-stimulating hormone, serum/plasma Male: 4-25 mIU/mL
Female: premenopause: 4-30 mIU/mL
midcycle peak: 10-90 mIU/mL
postmenopause: 40-250
pH 7.35-7.45
PCO2 33-45 mmHg
PO2 75-105 mmHg
Glucose, serum Fasting: 70-110 mg/dL
2-h postprandial:<120 mg/dL
Growth hormone - arginine stimulation Fasting: <5 ng/mL
Provocative stimuli: > 7ng/mL
Immunoglobulins, serum  
IgA 76-390 mg/dL
IgE 0-380 IU/mL
IgG 650-1500 mg/dL
IgM 40-345 mg/dL
Iron 50-170 μg/dL
Lactate dehydrogenase, serum 45-90 U/L
Luteinizing hormone, serum/plasma Male: 6-23 mIU/mL
Female: follicular phase: 5-30 mIU/mL
midcycle: 75-150 mIU/mL
postmenopause 30-200 mIU/mL
Osmolality, serum 275-295 mOsmol/kd H2O
Parathyroid hormone, serume, N-terminal 230-630 pg/mL
Phosphatase (alkaline), serum (p-NPP at 30° C) 20-70 U/L
Phosphorus (inorganic), serum 3.0-4.5 mg/dL
Prolactin, serum (hPRL) < 20 ng/mL
Proteins, serum  
Total (recumbent) 6.0-7.8 g/dL
Albumin 3.5-5.5 g/dL
Globulin 2.3-3.5 g/dL
Thyroid-stimulating hormone, serum or plasma .5-5.0 μU/mL
Thyroidal iodine (123I) uptake 8%-30% of administered dose/24h
Thyroxine (T4), serum 5-12 μg/dL
Triglycerides, serum 35-160 mg/dL
Triiodothyronine (T3), serum (RIA) 115-190 ng/dL
Triiodothyronine (T3) resin uptake 25%-35%
Urea nitrogen, serum 7-18 mg/dL
Uric acid, serum 3.0-8.2 mg/dL
Hematologic Reference Range
Bleeding time 2-7 minutes
Erythrocyte count Male: 4.3-5.9 million/mm3
Female: 3.5-5.5 million mm3
Erythrocyte sedimentation rate (Westergren) Male: 0-15 mm/h
Female: 0-20 mm/h
Hematocrit Male: 41%-53%
Female: 36%-46%
Hemoglobin A1c ≤ 6 %
Hemoglobin, blood Male: 13.5-17.5 g/dL
Female: 12.0-16.0 g/dL
Hemoglobin, plasma 1-4 mg/dL
Leukocyte count and differential  
Leukocyte count 4,500-11,000/mm3
Segmented neutrophils 54%-62%
Bands 3%-5%
Eosinophils 1%-3%
Basophils 0%-0.75%
Lymphocytes 25%-33%
Monocytes 3%-7%
Mean corpuscular hemoglobin 25.4-34.6 pg/cell
Mean corpuscular hemoglobin concentration 31%-36% Hb/cell
Mean corpuscular volume 80-100 μm3
Partial thromboplastin time (activated) 25-40 seconds
Platelet count 150,000-400,000/mm3
Prothrombin time 11-15 seconds
Reticulocyte count 0.5%-1.5% of red cells
Thrombin time < 2 seconds deviation from control
Volume  
Plasma Male: 25-43 mL/kg
Female: 28-45 mL/kg
Red cell Male: 20-36 mL/kg
Female: 19-31 mL/kg
Cerebrospinal Fluid Reference Range
Cell count 0-5/mm3
Chloride 118-132 mEq/L
Gamma globulin 3%-12% total proteins
Glucose 40-70 mg/dL
Pressure 70-180 mm H2O
Proteins, total < 40 mg/dL
Sweat Reference Range
Chloride 0-35 mmol/L
Urine  
Calcium 100-300 mg/24 h
Chloride Varies with intake
Creatinine clearance Male: 97-137 mL/min
Female: 88-128 mL/min
Estriol, total (in pregnancy)  
30 wks 6-18 mg/24 h
35 wks 9-28 mg/24 h
40 wks 13-42 mg/24 h
17-Hydroxycorticosteroids Male: 3.0-10.0 mg/24 h
Female: 2.0-8.0 mg/24 h
17-Ketosteroids, total Male: 8-20 mg/24 h
Female: 6-15 mg/24 h
Osmolality 50-1400 mOsmol/kg H2O
Oxalate 8-40 μg/mL
Potassium Varies with diet
Proteins, total < 150 mg/24 h
Sodium Varies with diet
Uric acid Varies with diet
Body Mass Index (BMI) Adult: 19-25 kg/m2
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