Benign Osteolytic Lesions in Children With Previously Normal Radiographs

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.