Benign Bone Tumours

Non-ossifying Fibroma, radiograph of a non-ossifying fibroma
Radiograph of a non-ossifying fibroma. Image by Herget et Al., Wikimedia Commons, CC BY 4.0.

Overview

  • Far more common than malignant tumours, often incidental
  • Age, location in the bone and radiographic appearance narrow the differential
  • Well defined, sclerotic margin and no soft tissue mass suggest benign
  • Enneking stages latent, active and aggressive
  • Observe latent lesions
  • Discuss atypical lesions with a sarcoma service before biopsy

Western Health Orthopaedic Registrar presentation – Benign Bone Lesions by Dr Jack Pang

Western Health Orthopaedic Registrar presentation – Benign Bone Tumours By Dr Daniel Sydenham

Classification

Enneking benign staging

StageDescriptionTreatment
1LatentObservation
2ActiveIntralesional curettage
3Aggressive, cortical breachExtended curettage with adjuvant or en bloc excision

Pathology

  • Osteoid osteoma is under 1.5 cm with NSAID-responsive night pain, treated by radiofrequency ablation
  • Osteoblastoma exceeds 2 cm, favours posterior spinal elements and can be locally aggressive
  • Enchondroma versus chondrosarcoma relies on pain, scalloping beyond two thirds, cortical breach and size
  • Ollier disease and Maffucci syndrome carry increased malignant risk
  • Osteochondroma is the commonest benign bone tumour, with continuous cortex and medulla
  • An adult cartilage cap over about 2 cm suggests secondary chondrosarcoma
  • Multiple hereditary exostoses relate to EXT1 and EXT2
  • Chondroblastoma is epiphyseal in immature patients, with chicken-wire calcification
  • NOF resolves spontaneously, with multiple lesions in Jaffe-Campanacci syndrome
  • Fibrous dysplasia has GNAS mutation, ground glass and shepherd’s crook deformity
  • UBC shows the diagnostic fallen fragment sign
  • ABC has fluid-fluid levels and USP6 rearrangement, so exclude telangiectatic osteosarcoma
  • GCTB is epimetaphyseal after maturity, H3F3A mutated and RANKL driven
  • LCH gives vertebra plana, with CD1a positivity and Birbeck granules

Management

  • Biopsy uncertain lesions following sarcoma principles
  • Phenol, liquid nitrogen, argon beam or burr adjuvants reduce recurrence
  • Denosumab for unresectable GCTB
  • Fibrous dysplasia needs internal fixation, as graft is resorbed

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.