The Natural History of Benign Bone Tumors of the Extremities in Asymptomatic Children

Abstract

Background: Benign bone tumors are common incidental findings in the pediatric population during radiographic evaluation. Counseling these patients requires reassurance and raises questions about the natural history of these tumors over time. The purpose of this study was to estimate the prevalence and observe the behavior of benign childhood bone tumors in an asymptomatic population. Methods: A historical, longitudinal radiographic collection of healthy children was reviewed, which included comprehensive left-sided radiographs of the extremities at yearly intervals. In this study, 262 subjects with 25,555 radiographs were screened for benign bone tumors at a median age of 8 years (range, 0 to 18 years). All potential tumors were reviewed by a multidisciplinary panel, which confirmed the radiographic diagnosis of each lesion, the age at which the lesion first appeared, and the age at which it had resolved. Prevalence rates were calculated using the number of distinct subjects available for each radiographic location and age. Results: Thirty-five tumors were identified in 33 subjects, including 19 nonossifying fibromas, 8 enostoses, 6 osteochondromas, and 2 enchondromas. The prevalence rate for all tumors combined increased with age and was 18.9% overall. The overall prevalence rates for specific tumor types were 7.5% for nonossifying fibromas, 5.2% for enostoses, 4.5% for osteochondromas, and 1.8% for enchondromas. Nonossifying fibromas demonstrated a bimodal distribution of prevalence, with a peak at 5 years (10.8%) and another after skeletal maturity (13.3%). The median age at the first appearance for all tumors combined was 9 years (range, 2 to 15 years), but varied by tumor type. Nonossifying fibromas often resolved (7 [37%] of 19), with further resolution possible beyond the last available radiograph. Enostoses, osteochondromas, and enchondromas persisted until the last available radiographs in all subjects. Conclusions: The prevalence of benign childhood bone tumors of the extremities was 18.9% in a historical asymptomatic population. Longitudinal radiographs allowed observation of the timing of the first appearance and the potential for resolution for each tumor type. These findings provide unique evidence to answer many commonly encountered questions when counseling patients and their families on benign bone tumors. Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Prevalence of benign bone lesions of the lower extremity in the pediatric spinal disorders: a whole-body imaging study

“…In our study, the low prevalence of NOF/FCD, osteochondroma and bone islands, compared to historic and more recent studies, may be due to sole reporting on lower extremities, as well as the fact that we have female-weighted and a younger cohort, compared to the age range in which some benign bone tumors are common. However, unlike the other literature studies with unknown symptomatology, the prevalence rates in our study are consistent with the previously shown asymptomatic pediatric population [27].…”

“…Lastly, in their longitudinal radiographic natural history study, Collier et al . [27] reported the prevalence of benign childhood bone tumors of the extremities as 18.9%. In the study without FCD/NOF distinction, prevalence rates for specific tumor types were 7.5% for FCD/NOF, 5.2% for enostoses, 4.5% for osteochondromas and 1.8% for enchondromas.…”

“…For NOF/FCD, the prevalence has historically been reported to be 30–40% in children [6,8] and 54% of boys and 22% of girls were reported to have NOF at 4 years of age [7,19]. More recently, bimodal distribution with a peak at 5 years (10.8%) and after skeletal maturity (13.3%) has been reported [27]. Osteochondroma was reported to account for 35% of benign and 8% of all bone tumors [16], and the reported median age at diagnosis was 15 years with a two-thirds male predominance [28].…”

Orthopaedic Manifestations of Neurofibromatosis Type I

“…These lesions tend to be found in early childhood and will resolve in early adulthood. 15 As such, these lesions often do not require any surgical intervention. However, if the lesion involves >50% of the bone, there is a high risk of fracture, and these lesions would benefit from curettage and bone grafting.…”

Minor Shoulder Injury Reveals Spontaneous Regression of Proximal Humerus Osteochondroma

“…Nevertheless, the literature is scarce regarding the natural history of solitary osteochondroma [4]. Recent studies evaluating long-term outcomes of conservative management of these lesions suggest that spontaneous regression of solitary osteochondromas may not be as rare as previously thought [4][5][6].…”