Experiences with Benign Bone Tumors in Pediatric Practice

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Abstract
We have made an analytic study of 412 bone tumors in children from infancy to fourteen years of age seen at the Children's Mercy Hospital (Kansas City, Mo.) and in our private practice of radiology within a period of fifteen years. These cases have been reviewed with two primary problems in mind: first, a correlation of the roentgenologic and pathologic findings; second, a reclassification of some of the tumors, since during and immediately after this period several new entities came to light. These entities include three new lesions of bone, namely, osteoid osteoma, fibrous dysplasia, and eosinophilic granuloma. Whether these conditions represent true bone tumors will not be discussed here. Attention will be directed rather to their clinical and pathologic aspects. Instances were found in which originally both the radiologic and pathologic diagnoses were at fault. After careful roentgen examination and evaluation of the history in view of the three new entities mentioned, we were able to suggest the histology of the bone lesion in 90 per cent of the cases. Osteoid Osteoma Osteoid osteoma was first described in 1935 by Jaffe (8). It is a small, round or oval nidus-like lesion of bone seldom exceeding a centimeter in its greatest diameter. Case I (Fig. 1): M. R., a 14-year-old white girl complained of pain in the back of the neck for seven months. The pain was at first intermittent but became increasingly severe until it kept her awake at night. Roentgen examination revealed a small (7 mm.) lytic lesion containing a rounded sequestrum in the dorsal spinous process of the fifth cervical vertebra. Though there is little osteosclerosis around it, we believe it is an osteoid osteoma (Fig. 1C). Case II (Fig. 2): W. C., a 14-year-old boy, was admitted to the hospital complaining of pain in the neck of six months duration, aggravated by all movements but particularly by flexion. Laboratory examinations of the blood were negative. X-ray examination revealed an osteolytic lesion of the fifth cervical vertebra confined to the pedicle and to the body of the vertebra. No sclerosis was present except posteriorly. The lesion was biopsied and curetted. The pathologist made a diagnosis of osteogenic sarcoma and suggested radiation therapy, which we declined to give. Further analysis of the lesion proved it to be an osteoid osteoma. The diagnosis of malignant growth is common in this entity. Follow-up in this instance showed alleviation of symptoms and no roentgenologic evidences of recurrenee. Case III (Figs. 3–5): J. H. H., aged 9 years, first experienced pain in the lower leg seven months prior to admission to the hospital. At the time of examination he had been limping for a week. No redness or elevation of temperature was found. There was minimal swelling.

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