Tan Emily, T Mehlman Charles, Baker Michael
*Department of Orthopaedic Surgery, Grandview Hospital & Medical Center, Ohio University Heritage College of Osteopathic Medicine, Dayton, OH †Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
J Pediatr Orthop. 2017 Jun;37(4):e282-e285. doi: 10.1097/BPO.0000000000000918.
Benign bone tumors are common in children and are usually diagnosed incidentally or after pathologic fractures. However, case reports of children with lytic lesions with previously normal radiographs are rare. This series presents several such cases.
This was a retrospective case series of 8 benign osteolytic lesions in 8 pediatric patients (5 female and 3 males). All have previous radiographs of the effected extremity showing no pathology. All participants were at a single institution.
Eight cases were identified with 2 aneurysmal bone cysts and 6 nonossifying fibromas. Average age at discovery was 10.75 years old. The range of time between normal and pathologic radiographs was from 2.5 to 7.25 years. Both cases of aneurysmal bone cysts were histologically confirmed and treated with curettage and grafting with one recurrence. One of 6 nonossifying fibromas was treated surgically with the remainder treated with casting for pathologic fractures or observation for incidentally identified lesions.
Benign osteolytic lesions such as aneurysmal bone cysts and nonossifying fibromas can arise in a short time period. The average time between normal and pathologic radiographs was 4.6 years. Prelesion radiographs were obtained to evaluate traumas and leg length discrepancies.
Radiographs taken before diagnosis in children with osseous lesions are rare, but likely under recognized. Further studies of such instances in larger databases may provide a noninvasive means to reach diagnostic or etiologic conclusions.
良性骨肿瘤在儿童中很常见，通常是偶然发现或在病理性骨折后被诊断出来。然而，之前X线片正常的儿童出现溶骨性病变的病例报告很少。本系列介绍了几例此类病例。
这是一项回顾性病例系列研究，涉及8例儿科患者（5名女性和3名男性）的8处良性溶骨性病变。所有患者之前患侧肢体的X线片均未显示病变。所有参与者均来自同一机构。
共确诊8例，其中2例为骨囊肿，6例为非骨化性纤维瘤。发现时的平均年龄为10.75岁。正常X线片与病理性X线片之间的时间间隔为2.5至7.25年。2例骨囊肿均经组织学确诊，采用刮除术和植骨治疗，1例复发。6例非骨化性纤维瘤中，1例接受手术治疗，其余病例因病理性骨折采用石膏固定或对偶然发现的病变进行观察。
骨囊肿和非骨化性纤维瘤等良性溶骨性病变可在短时间内出现。正常X线片与病理性X线片之间的平均时间为4.6年。拍摄病变前的X线片以评估创伤和腿长差异。
骨病变儿童在诊断前拍摄X线片的情况很少见，但可能未得到充分认识。在更大的数据库中对这类病例进行进一步研究可能会提供一种无创手段来得出诊断或病因结论。
