Fritzsche H, Schaser K-D, Hofbauer C
UniversitätsCentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum "Carl-Gustav-Carus" der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
Orthopade. 2017 Jun;46(6):484-497. doi: 10.1007/s00132-017-3429-z.
Benign bone lesions are much more common than malignant lesions. Some benign bone tumors have a characteristic and typical radiographic appearance, while others are more challenging. Therapy of benign bone tumors differs greatly. While the majority of benign bone tumors do not require surgical therapy, other specific lesions, e. g. aneurysmal bone cysts or giant cell tumors (GCT) of the bone require surgery due to their locally aggressive behavior.
The major challenge for the radiologist and/or pathologist is the differentiation between a benign and low-grade malignant lesion (e. g. enchondroma versus low-grade chondrosarcoma) for which all available clinical and radiographic information is mandatory. Therefore, surgical therapy is rather more often performed than necessary due to uncertainty in many cases.
Novel systemic therapies are available for fibrous dysplasia and GCT of the bone: Fibrous dysplasia can be treated with bisphosphonates, and GCT responds to denosumab. In fact, denosumab has been approved for the treatment of irresectable GCT. Osteoid osteoma is fairly easy to recognize and also to treat given the characteristic clinical presentation and rapid and effective response to local therapy (possible as percutaneous thermo-/laser ablation). In summary, several therapeutic options exist for benign bone tumors, and the choice depends upon the tendency/risk of local recurrence, the rate of surgical complications, options for defect reconstruction, postoperative functional deficits, and specific patient characteristics.
良性骨病变比恶性病变更为常见。一些良性骨肿瘤具有特征性和典型的影像学表现，而其他一些则更具挑战性。良性骨肿瘤的治疗差异很大。虽然大多数良性骨肿瘤不需要手术治疗，但其他特定病变，如骨动脉瘤样骨囊肿或骨巨细胞瘤（GCT），由于其局部侵袭性行为而需要手术治疗。
放射科医生和/或病理学家面临的主要挑战是区分良性和低度恶性病变（如内生软骨瘤与低度软骨肉瘤），为此必须获取所有可用的临床和影像学信息。因此，由于许多情况下存在不确定性，手术治疗的实施往往比必要的更为频繁。
对于骨纤维异常增殖症和骨巨细胞瘤有新的全身治疗方法：骨纤维异常增殖症可用双膦酸盐治疗，骨巨细胞瘤对地诺单抗有反应。事实上，地诺单抗已被批准用于治疗不可切除的骨巨细胞瘤。骨样骨瘤相当容易识别，鉴于其特征性临床表现以及对局部治疗的快速有效反应（可采用经皮热消融/激光消融），治疗也相对容易。总之，良性骨肿瘤有多种治疗选择，选择取决于局部复发的倾向/风险、手术并发症发生率、缺损重建选择、术后功能缺陷以及特定的患者特征。
