Benign Bone and Soft Tissue Tumors
Benign bone tumors can occur in any bone in the body. Soft tissue tumors show up in connective tissue. Benign means the tumor is not spreading to other parts of the body. Orthopedic oncology involves diagnosing, treating and removing bone and soft tissue cancers. From removal to bone reconstruction procedures, the end goal is to help patients restore mobility and function as much as possible.
Age-appropriate care is important to ensure every patient, from infant to teen, receives the right care as their body grows and develops. The orthopedic oncology experts at Nationwide Children's treat benign tumors of the bones and soft tissue, while considering each patient's short- and long-term outcomes.
Whether your child has received a diagnosis, is currently in treatment, or you are looking for a second opinion, the Ortho-Oncology team at Nationwide Children's can help. From surgery to therapy to ongoing follow-up, your team is with you every step of the way.
Nationwide Children's Hospital is ranked by U.S. News & World Report for Orthopedics.
Tumors with Cartilage Component
- Chondroblastoma: Typically occurs in the epiphysis (ends) of long bones, more common in adolescents. It starts with pain and swelling.
- Chondromyxoid fibroma: Rare tumor that arises from cartilage-like tissue, most commonly in the lower extremities. It can cause pain and swelling.
- Enchondroma: Arises from cartilage within bone, often found incidentally on imaging. Usually no symptoms (asymptomatic) unless there's a fracture caused by underlying disease process that has weakened the bone (pathological fracture).
Tumors with Fibrous Component
- BPOP (Bizarre parosteal osteochondromatous proliferation): Rare benign tumor composed of fibrous tissue and metaplastic bone, often arising from the surface of bone. It may cause pain and deformity.
- Fibrous dysplasia: Characterized by abnormal growth of fibrous tissue within bone, leading to weakened bone and deformities. It may be present with pain, fractures or deformities.
- Non-ossifying fibroma: Common benign fibrous lesion found in children, typically with no symptoms and often discovered incidentally.
Tumors with Osteoid Component
- ABC (Aneurysmal bone cyst): Expansile cystic lesion filled with blood, typically occurring in the long bones or spine. It may cause pain and swelling.
- Cystic Lesions-Unicameral bone cyst: Fluid-filled cyst usually found in the long bones of children. It may cause pain and increased risk of fractures.
- Hereditary multiple osteochondromas: Inherited condition characterized by multiple osteochondromas throughout the skeleton.
- Osteochondroma: Most common benign bone tumor, typically arises near growth plates. It presents as a bony outgrowth with a cartilage cap.
- Osteoblastoma: Rare bone tumor that produces osteoid tissue, usually presents with pain that worsens at night and is relieved by NSAIDs.
- Osteoid osteoma: Small benign tumor that causes localized pain, often relieved by aspirin or NSAIDs.
Tenosynovial Giant Cell Tumor
Tenosynovial giant cell tumor: A giant cell tumor typically occurs in the epiphysis of long bones, more common in adolescents and young adults. It presents with pain, swelling, and possible pathological fractures. Each of these tumors requires careful evaluation and management, considering factors such as location, symptoms, growth potential, and risk of recurrence. Treatment may involve observation, surgical excision, or other interventions depending on the specific characteristics of the tumor and the patient's clinical presentation.
How Are Benign Bone and Soft Tissue Tumors or Lesions in Children Treated?
- Arthroplasty, or joint replacement surgery, may be offered for benign tumors that involve joint destruction or severe deformity. It can be considered for conditions like giant cell tumor or aggressive chondroblastoma that compromise joint function and cause significant pain. When joint replacement is needed, we also offer comprehensive arthroplasty care. Unlike centers that perform the procedure on adults only, we have significant experience reconstructing joints in children and young adults, preserving or restoring their range of motion.
- Chemotherapy
- Curettage and bone grafting: A common procedure for benign bone tumors like enchondroma, chondroblastoma, and giant cell tumor. It involves scraping out the tumor and filling the cavity with bone graft to promote healing.
- Embolization: Pre-operative procedure to reduce blood flow to highly vascular tumors like aneurysmal bone cysts, making subsequent surgical resection safer and more manageable. The choice of surgical procedure depends on various factors, including tumor type, location, size, patient's age and functional requirements, and the extent of bone and soft tissue involvement. It's essential for the surgical team to carefully assess each case and tailor the approach accordingly to achieve the best possible outcome for the patient.
- Limb salvage surgery aims to remove the tumor while preserving the limb's function and appearance. It involves techniques such as wide resection of the tumor followed by reconstruction using metal implants, bone grafts, or biological reconstruction techniques like allografts or vascularized fibula grafts. Limb salvage surgery is commonly considered for most benign bone tumors to maintain functionality and cosmesis.
- Non-invasive limb lengthening or expandable prosthetics: These implants are controlled by a magnet to lengthen the limb instead of lengthening surgically to keep up with patient's growth. Patients are typically seen in the office every two months and lengthen at least a few millimeters each time. This is a painless approach. Devices can lengthen 6 to 9 centimeters to keep up with patient's skeletal growth.
- Osteotomy: Surgical cutting of bone to correct deformities caused by benign tumors like fibrous dysplasia or osteochondroma.
- Radiation Therapy
- Resection: Surgical removal of the tumor without limb preservation, typically considered for aggressive or recurrent tumors where limb salvage is not feasible.
- Rotationplasty is often considered for cases where a significant portion of the bone needs to be removed. It involves removing a segment of bone, rotating the remaining portion (usually the foot and ankle), and reattaching it to the upper leg. This procedure can be considered for tumors near the knee joint, such as osteosarcoma, where limb salvage is challenging. Nationwide Children's performs more rotationplasty procedures than almost any other hospital. This unique operation converts what would be an above-knee amputation to the functional outcome of a below-knee amputation. This procedure can also offer activity options not available with most prosthetic knees or above-knee amputations, such as the ability to play sports that involve heavy jumping, rotating, running or pivoting.
- Targeted muscle reinnervation (TMR) is a surgical technique used to improve prosthetic control and reduce phantom limb pain in amputees. While not typically used directly for benign tumors, it can be part of the treatment plan for cases where limb amputation is necessary, such as in advanced osteosarcoma or aggressive giant cell tumor. TMR attaches those cut nerves into the muscle around the amputation. The procedure can eliminate or prevent phantom nerve pain. It also gives children the option to eventually make use of a bio-prosthetic. A bio-prosthetic is a device that connects the nerves to the prosthetic so that people can control it using their own thoughts and nerve signals, much like a normal limb. Our team pioneered TMR in children with great success after performing dozens of successful TMR procedures in adults, and now teaches the approach to surgeons from around the world. As the world’s first center performing targeted muscle reinnervation (TMR) in children, we are leading the way toward a future with less post-amputation pain and the potential for bio-prosthetics.
Why Choose Nationwide Children's?
The Orthopedic Oncology Program at Nationwide Children's focuses on innovative limb salvage strategies and ways to protect quality of life both now and in the future for our patients. We are supported by a robust range of related programs to help maximize health outcomes, from oncology and child life to adaptive therapies and rehabilitation resources.
Leading the Way to New Treatments and Outcomes Through Clinical Research
Clinical care and research work together. This helps scientists and doctors to find new treatments and therapies. Clinical studies (also called clinical trials) will continue to become more common in daily care at Nationwide Children's. Clinical studies help doctors learn more about conditions and treatment.
This means you might hear about a clinical study that your child might be able to join. This does not mean that your child has to join a study. You always have the choice about whether or not to join a study.
