Benign
tumours
Many of the benign
tumours appear to have been present from birth and to grow with the child. They
may be multiple, suggesting a problem in development, and if they are truly
benign they stop growing when the child stops growing.
Osteochondromas
are outgrowths of the bone, which may look much smaller on X-ray than they feel
on clinical examination. This is because the outgrowth of bone has a large
cartilage cap over it. Growths within the bones such as enchondromas may weaken
the bone so that it fractures. The benign tumour is then diagnosed on X-ray with
a pathological fracture running across it (Fig. 25.1).
Where
possible, benign tumours should be left alone. There are, however, three
indications for surgical intervention in a benign tumour (Table
25.2).
1. If there is doubt about diagnosis and a biopsy is needed to determine
whether the tumour is, indeed, benign or malignant. In this case surgery should
be planned as if the tumour is malignant, and an approach made which allows
either complete excision of the tumour or an incision which will not interfere
with further surgery later, if a massive implant or amputation is required.
2. If the bone is so weakened that a pathological fracture has occurred
or is likely to occur. In this case the contents of the tumour can be curetted
out and the cavity filled with chips of bone harvested from elsewhere in the
patient.
3.
If the bony protuberance is so
prominent that it creates a cosmetic deformity or interferes with muscles or
joints, so that the limb cannot function normally.