| | Clinical features | Most common locations | Plain radiographic features |
| Bone-forming lesions |
| Osteoid osteoma | - 10 to 20 years
- M > F
- Nocturnal pain promptly relieved by NSAIDs; limp; scoliosis
| - Cortex of the metaphysis or diaphysis (less common) of the proximal femur
- Proximal tibia
- Distal femur
- Spine
- Proximal humerus
- Phalanges
| - Small round intracortical lucency (nidus) with sclerotic margin;
- Special imaging studies (bone scan, CT, or MRI) often needed for spine
|
| Osteoblastoma | - Any age (usually 10 to 20 years)
- M > F
- Chronic pain; less responsive to NSAIDs than osteoid osteoma; spine lesions may cause neurologic symptoms
| - Posterior elements of the spine or sacrum
- Metaphysis of the proximal femur or tibia (less common)
| - Variable (often requires CT or MRI for diagnosis)
|
| Cartilage-forming tumors |
| Osteochondroma (exostosis), including hereditary multiple exostosis (HME) | - 10 to 20 years
- M > F
- Pain; functional problems; deformity; pathologic fracture; palpable near the ends of long bones
- Risk of malignant transformation to chondrosarcoma in adults (in HME)
| - Metaphysis of the distal femur
- Proximal tibia
- Proximal humerus
| - Bony spur arising from the surface of the cortex; the cortex of the spur is continuous with the cortex of underlying bone
|
| Solitary enchondroma | - 10 to 20 years
- M = F
- Widening of bone; deformity
| - Diaphysis of the long bones of the hand
- Proximal humerus
- Proximal femur
| - Oval, well-circumscribed central (medullary), lucent lesion with or without matrix calcifications or expansion of the cortex
|
| Enchondromatosis (Ollier syndrome, including Maffucci syndrome*) | - <10 years
- Intracranial enchondromas may cause headache and cranial nerve deficit
- Risk of malignant transformation to chondrosarcoma and increased risk of nonsarcomatous neoplasms
| - Metaphysis or diaphysis of any bone
| - Oval, well-circumscribed central (medullary), lucent lesions with or without matrix calcifications or expansion of the cortex
|
| Periosteal (juxtacortical) chondroma | - Children and adults
- Localized pain; palpable nontender hard mass that is fixed to bone
| - Metaphysis or diaphysis of the:
- Proximal humerus
- Femur
- Other long bones, including, small bones of the hands and feet
| - Small, scalloped radiolucent lesion on outer surface of the cortex; may have intralesional calcification
- Minimal periosteal reaction
|
| Chondroblastoma | | - Epiphysis (or apophysis) of the:
- Proximal humerus
- Distal femur
- Proximal tibia
- Calcaneus
| - Small, well-defined lesions with sclerotic border
- May cross the growth plate
|
| Chondromyxoid fibroma | | - Metaphysis of the:
- Proximal tibia
- Distal femur
- Calcaneus
| - Eccentric, medullary, radiolucent, lobulated lesion in the metaphysis with sclerotic border
|
| Fibrous lesions |
| Fibrous dypslasia, including polyostotic fibrous dysplasia (McCune-Albright syndrome) | - Teens to 20s
- M > F
- Café-au-lait macules; endocrine abnormalities (in McCune-Albright)
- Pathologic fracture (may be recurrent)
| - Metaphysis or diaphysis of the:
- Proximal or distal femur
- Ribs
- Tibia
- Fibula
- Mandible
- Skull
- Pelvis
- Proximal humerus
- Radius
- Ulna
| - Lytic lesion in metaphysis or diaphysis with ground-glass appearance
- Thinning/scalloped cortical bone
- Expansion of bone and possible bowing
|
| Osteofibrous dysplasia (ossifying fibroma) | - 0 to 5 years
- Swelling, anterolateral bowing of lower leg; pathologic fracture
| - Diaphysis of the tibia or fibula
| - Lytic thinning of diaphyseal cortical bone with interspersed sclerosis
- Sharply circumscribed margin
|
| Nonossifying fibroma (metaphyseal fibrous defect) | - Teenagers
- Usually incidental finding
- Pathologic fracture (in large lesions)
| - Metaphysis of the:
- Distal femur
- Distal or proximal tibia
| - Well-defined small, eccentric, expansile lytic lesions in metaphysis
- Sclerotic scalloped borders
|
| Cystic tumors |
| Simple bone cyst (unicameral bone cyst) | - 0 to 20 years
- M = F
- Localized pain; limp; failure to use extremity; pathologic fracture
| - Proximal humerus
- Femur
- Tibia
| - Well-marginated cystic lesion of metaphysis or metadiaphysis without reactive sclerosis
- "Falling leaf" sign
|
| Aneurysmal bone cyst | - Adolescents
- F > M
- Localized pain or swelling; limp; growth arrest (if lesion crosses the growth plate); neurologic symptoms (for spine lesions); pathologic fracture
| - Posterior elements of the spine
- Metaphysis of the:
- Distal femur
- Proximal tibia
- Proximal humerus
- Pelvis
- Fibula
- Ribs
- Clavicle
- Cervical spine
| - Aggressive, expansile, lytic metaphyseal lesions with an "eggshell" sclerotic rim
- Lesions may have a "soap bubble" appearance secondary to reinforcement of remaining trabeculae
|
| Miscellaneous benign bone tumors |
| Langerhans cell histiocytosis | - Any age (most common 5 to 10 years)
- M > F
- Painful swelling of affected site; pathologic fracture; proptosis; thirst; refractory otitis media
| - Skull
- Ribs
- Pelvis
- Long bones
- Mandible
- Vertebrae
| - Well-defined lytic lesion with or without sclerotic margins
- Variable periosteal reaction
- Flattening of vertebral body
- "Floating" teeth (with mandibular involvement)
|
| Giant cell tumor | - Young adults (peak incidence in 20s to 30s)
- F > M
- Pain; swelling; limitation of joint movement; pathologic fracture
| - Epiphysis of the:
- Distal femur
- Proximal tibia
- Distal radius
- Sacrum
| - Expansile, eccentric, lytic lesion in epiphysis and adjacent metaphysis; may extend to subchondral plate
- Absence of matrix calcification and periosteal reaction
|
