Benign Bone and Soft Tissue Tumours
Most tumours found in bone and soft tissue are benign. Some only need monitoring; those causing pain, fracture risk or growth are treated surgically.
The word “tumour” is often worrying, but most lumps found in bone and soft tissue are benign. Benign tumours do not spread to other parts of the body. Some cause no symptoms and are found by chance on an X-ray taken for another reason. Others can cause pain, weaken the bone or press on surrounding tissue.
Common benign bone tumours
- Osteochondroma: A bony projection with a cartilage cap growing from the surface of a bone, usually noticed during growth.
- Enchondroma: Cartilage tissue inside the bone, especially in the hand bones.
- Simple and aneurysmal bone cysts: Fluid-filled cavities in the bone that can weaken it and cause fractures.
- Osteoid osteoma: A small tumour causing pain that is worse at night and eased by painkillers.
- Fibrous dysplasia and non-ossifying fibroma
- Giant cell tumour: Benign but with a tendency to spread locally and recur.
Common benign soft tissue tumours
- Lipoma: Soft, mobile lumps made of fat
- Ganglion cyst: A cyst arising from a joint or tendon sheath
- Giant cell tumour of the tendon sheath: Especially in the hand and fingers
- Schwannoma and neurofibroma: Tumours arising from nerve sheaths
- Haemangioma: Lumps of blood vessel origin
Symptoms
- A lump or swelling that can be felt
- Pain that is worse at night or not relieved by rest
- Limited joint movement
- A fracture after minor trauma (pathological fracture)
- Numbness or tingling if a nerve is compressed
Diagnosis
After examination, X-rays are valuable in predicting the type of most bone tumours. MRI and CT show the extent of the tumour and its relationship to surrounding tissue. When imaging cannot give a firm diagnosis, a biopsy is done. The biopsy must be planned so that it does not complicate any later surgery.
Treatment
- Monitoring: Many tumours that cause no symptoms and look typical on imaging are simply followed at intervals.
- Curettage and grafting: Tumour tissue inside the bone is scraped out and the cavity filled with bone graft or bone cement, with plates and screws for support if needed.
- Excision: Bony projections and soft tissue tumours are removed surgically.
- Image-guided procedures: Some tumours, such as osteoid osteoma, can be treated with radiofrequency ablation.
Bone lesions found by chance
Finding a bone lesion on an X-ray or MRI taken for another reason is common and often worrying. Most of these lesions are benign and cause no symptoms. Well-defined borders, an intact outer shell of bone and no spread into surrounding tissue suggest a benign lesion. A specialist assessment avoids unnecessary worry and tests, and follow-up imaging is planned at intervals if needed.
Risk of pathological fracture
Bone cysts and some benign tumours can thin the bone from the inside. In weight-bearing bones such as the thigh bone, this thinning can lead to a fracture even during everyday activities. The size of the lesion, how much of the bone it occupies and the thickness of the outer shell are considered in assessing fracture risk. For high-risk lesions, protective surgery may be recommended before a fracture happens.
Osteochondroma and multiple lesions
Osteochondromas are usually single, but some children inherit a condition with lesions in several bones (multiple hereditary exostoses). In these children, bony projections can limit joint movement and cause leg length differences or bone deformities, so regular follow-up during growth is recommended. In adulthood, osteochondromas that keep growing or become painful are assessed for the rare possibility of malignant change.
Warning signs in soft tissue lumps
Although most soft tissue lumps are benign, some features need further assessment: larger than 5 centimetres, deep inside or under a muscle, growing quickly and painful. For lumps with any of these features, MRI assessment is recommended before planning surgery. Removing a lump with a simple procedure without imaging can, in rare cases, make treatment of a malignant tumour harder.
After surgery
After curettage and grafting, weight bearing may be reduced for a while or a protective brace used while the bone heals. Follow-up X-rays check that the graft becomes bone and that the tumour has not returned. Recovery after removal of soft tissue tumours is usually quick. The removed tissue is sent for pathology, which confirms the final diagnosis.
Frequently asked questions
Can a benign tumour become malignant?
For most benign tumours this risk is very low. For some types a change can rarely occur, so regular follow-up is recommended.
Does every tumour need surgery?
No. Many tumours that cause no symptoms and carry no fracture risk are only monitored.
My lump is growing quickly. What should I do?
Lumps that grow quickly, lie deep, are larger than 5 centimetres or are painful should be assessed without delay.
Should a lipoma be removed?
Small lipomas that cause no problems can simply be monitored. Growing, bothersome, deep or large lipomas can be assessed and removed surgically.
Can a bone cyst affect my child's growth?
Some cysts near the growth plate can rarely affect growth, which is why bone cysts in children are followed regularly.
Can the tumour come back after removal?
Some benign tumours, especially giant cell tumour and aneurysmal bone cyst, tend to recur. Regular check-ups after surgery are therefore important.
If the tumour is benign, why is a biopsy done?
Imaging does not always allow a firm diagnosis. A biopsy confirms the type of tumour so the right treatment can be planned.
Is bone cement permanent?
In suitable cases, bone cement can stay in place for many years and support the bone.
The information on this page is general and does not replace an examination. An examination is needed to decide which treatment suits you.