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  • Many benign bone tumors are painless and are incidental findings on radiographs. They may also present with pain from the tumor or from a pathologic fracture.
  • Osteoid osteoma is a relatively common benign tumor. It frequently causes pain that is worse at night and is exquisitely responsive to NSAIDs.
  • Nonossifying fibromas are common fibrous lesions. They are often incidental findings but can also cause chronic pain.
  • Osteochondromas tend to present as a bony, nonpainful mass. Radiographically they appear as sessile or pedunculated lesions of the long bones.
  • Patients with enchondromas may present with a mass or pathologic fracture, but most are asymptomatic. The hands are most commonly involved.
  • Solitary bone cysts in the lower extremity are prone to fracture and require excision.
  • Aneurysmal bone cysts commonly involve the long bones. They are associated with rapidly progressive pain and swelling and can cause significant morbidity.

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A number of histologically benign tumors of bone present in childhood. Many of these tumors are painless and are found incidentally on routine radiographs. Alternatively, they may present with pain from either the tumor itself or from a pathologic fracture.

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Osteoid osteoma is a very common benign tumor of bone and accounts for 2% to 3% of all bone tumors and 10% to 20% of benign bone tumors.1 It is two to three times more frequent in men and is most common between 5 and 20 years of age. Osteoid osteoma most commonly involves the long bones of the lower extremities but may occur in any bone including the spine and the short bones of the hands.

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Pain is the most common presentation of osteoid osteoma and point tenderness at the site is usual. Patients initially have mild intermittent bone pain that becomes continuous and severe. The pain tends to be worse at night. The pain of osteoid osteoma is mediated by the proliferation of nerve endings in the tumor and a high level of prostaglandins in the nidus. This accounts for the exquisite responsiveness of the pain to nonsteroidal anti-inflammatory drugs (NSAIDs).2 Patients may have point tenderness, a swollen limb, and/or a tender palpable mass. Alternatively, patients may present with a painless limp. Osteoid osteomas in the joints may mimic arthropathy while those in the spine may present with stiff scoliosis, torticollis, hyperlordosis, or kyphoscoliosis. Osteoid osteomas that are close to the growth plates may lead to growth disturbance and limb length discrepancies or angular deviations. If the diagnosis of osteoid osteoma is delayed, patients may present with chronic pain or limping as well as atrophy of the affected limb.

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Clinical history and standard radiographs are usually sufficient to diagnose osteoid osteoma. The typical radiographic appearance of a cortical osteoid osteoma is of a small (<1 cm) radiolucent round or oval area of osteolysis (nidus), surrounded by a regular ring of bony sclerosis (Fig. 106–1). The entire entity rarely exceeds 1.5 cm. In some cases, the center of the nidus may have an irregular nucleus of bone density giving a cockade appearance. The bone ...

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