Behandlungskonzepte bei benignen Knochentumoren und tumorsimulierenden Knochenläsionen

Abstract

The indications for surgical treatment of benign bone tumors and tumor-like lesions depend on the biological activity, clinical symptoms and anatomic location of the the lesion. Clinically silent lesions ("leave me alone Lesions") lacking any scintigraphic enhancement and without danger of pathologic fracture or malign transformation only need surveillance and do not require surgery.However, tumors becoming symptomatic, displaying progression after termination of skeletal growth or radiographic signs of malignancy should be scheduled for surgical intervention. For most benign tumors intralesional curettage and subsequent bone grafting is the treatment of choice, maintaining structural integrity and functional stability of the bone and adjacent joint. In case of uncertain histopathological diagnosis an open biopsy should be performed followed by definitive either marginal or en-bloc resection, preferably at a single procedure. Depending on the tumor-specific risk of recurrence, adjuvant measures as phenol instillation or cryotherapy using liquid nitrogen may additionally be applied. As for the unicameral juvenile bone cyst or osteoid osteoma alternative minimal invasive techniques like corticoid injection and CT-guided percutaneous eradication of the nidus have been successfully introduced into clinical practice. Depending on the activity of the tumor recurrent lesions are recommended to be treated by marginal or enbloc resection. The radical and aggressive mode of surgical therapy has to be balanced with the treatment-related morbidity, i.e. complication rate, possibilities for reconstructive stabilizations and resultant functional deficits,making the decision a responsible challenge to the orthopedic surgeon.

Indications for prophylactic osteosynthesis associated with curettage in benign and low-grade malignant primitive bone tumors of the distal femur in adult patients: a case series

“…For most of the benign tumors, intralesional curettage and subsequent bone filling represents the treatment of choice, maintaining structural integrity and functional stability of the bone and adjacent joint. Depending on the tumor-specific risk of recurrence, adjuvant measures such as phenol instillation or cryotherapy with liquid nitrogen may additionally be applied due to their chemical and physical effects improving the local effect of curettage [ 1 , 5 – 7 ].…”

External fixation reconstruction of the residual problems of benign bone tumours

“…complications, the need for reconstructive stabilization and potential functional deficit. The decision is a challenge for the orthopaedic surgeon [ 3 ]. Conventional methods of correcting deformity and limb-length inequality, such as shortening, single or multiple osteotomies or epiphysiodesis are limited in their scope and often unpredictable or unsatisfactory.…”

Klinische Symptomatik, differenzialdiagnostische Schwierigkeiten und Therapieoptionen bei tumorartigen Läsionen der Orbita

“…Die früher angewendete Bezeichnung "reparatives Riesenzellgranulom" wird aufgrund der destruierenden Charakteristik nicht mehr verwendet [16,30]. Klinisch ist die Unterscheidung zwischen dem zentralen Riesenzellgranulom, das vor allem im Gesichtsschädel auftritt, und dem peripheren Riesenzellgranulom wichtig [16,27]. Das zentrale Riesenzellgranulom kommt seltener vor als ein peripheres Riesenzellgranulom und ist vorwiegend im Unterkiefer (72%) lokalisiert [19,24,31].…”

“…Das zentrale Riesenzellgranulom kommt seltener vor als ein peripheres Riesenzellgranulom und ist vorwiegend im Unterkiefer (72%) lokalisiert [19,24,31]. Als zugrunde liegende Ätiologie der Erkrankung wird ein entzündlicher Prozess auf dem Boden einer Blutung oder einer Traumatisierung angenommen [27]. Die Erkrankung betrifft doppelt soviel Frauen wie Männer, in über 60 % der Fälle beginnt die Krankheit vor dem 30.…”